Background and objectives: Despite a generally good prognosis, testicular cancer can be a
life-altering event. We explored perceived positive and negative life changes after testicular cancer in
...terms of frequency, demographic and disease-related predictors, and associations with depression
and anxiety. Materials and methods: All testicular cancer survivors receiving follow-up care at two specialized
outpatient treatment facilities were approached at follow-up visits or via mail. We assessed
a total of N = 164 patients (66% participation rate, mean time since diagnosis: 11.6 years, SD = 7.4)
by the Posttraumatic Growth Inventory (PTGI, modified version assessing positive and negative
changes for each of 21 items), Patient-Health-Questionnaire-9 (PHQ-9), and Generalized-Anxiety-
Disorder-Scale-7 (GAD-7). We conducted controlled multivariate regression analyses. Results: Most
survivors (87%) reported at least one positive change (mean number: 7.2, SD = 5.0, possible range:
0–21). The most frequent perceived positive changes were greater appreciation of life (62%), changed
priorities in life (62%), and ability rely on others (51%). At least one negative change was perceived
by 33% (mean number of changes: 1.1, SD = 2.5). Negative changes were most frequent for decreases
in self-reliance (14%), personal strength (11%), and ability to express emotions (9%). A higher socioeconomic
status was associated with more positive changes ( = 0.25, 95% CI 0.08 to 0.42); no other
association with demographic and disease-related predictors emerged. While positive life changes
were not associated with depression ( = 0.05, 95% CI 0.17 to 0.07) and anxiety ( = 0.00, 95%
CI 0.13 to 0.13), more negative life changes were significantly associated with higher depression
( = 0.15, 95% CI 0.03 to 0.27) and anxiety ( = 0.23, 95% CI 0.11 to 0.36). There was no significant
interaction of positive and negative changes on depression or anxiety. Conclusions: Although positive
life changes after testicular cancer are common, a significant number of survivors perceive negative
changes in life domains that have been primarily investigated in terms of personal growth. Early
identification of and psychosocial support for patients who perceive predominantly negative changes
may contribute to prevention of prolonged symptoms of anxiety and depression.
Despite prophylaxis with 5-HT(3) antagonists and dexamethasone, nausea/emesis are common chemotherapy- induced toxicities. The aim of this trial was to evaluate the efficacy of adding the NK1 ...antagonist aprepitant in patients refractory to standard prophylaxis.
Patients with significant nausea/vomiting despite prophylaxis with 5-HT(3) antagonists and dexamethasone were eligible. Aprepitant was added to the same antiemetic regimen used during previous cycles.
34 patients received 92 cycles of chemotherapy with aprepitant which was applied orally at 125 mg on day 1 and 80 mg on days 2 and 3. All patients were refractory to standard antiemetic prophylaxis during cisplatin-based (n = 12) or other chemotherapy (n = 22). With the addition of aprepitant, all patients reported subjective improvement. The number of patients with nausea for >4 days decreased from 24 (71%) to 4 (12%) (p < 0.001), and the number of those with emesis for >2 days decreased from 26 (77%) to 0 (0%) (p < 0.001). In 12 patients receiving aprepitant for >2 cycles (3-8) the efficacy was maintained. No toxicity possibly related to aprepitant was observed.
Aprepitant demonstrated significant activity in patients with nausea/vomiting refractory to prophylaxis with 5-HT(3) antagonists and dexamethasone.
Objectives: We developed the first German evidence- and
consensus-based clinical guideline on diagnosis, treatment,
and follow-up of germ cell tumours (GCT) of the testes in
adult patients. We ...present the guideline content in 2 separate publications. The present second part summarizes the
recommendations for the treatment of advanced disease
stages and for the management of follow-up and late effects.
Materials and Methods: An interdisciplinary panel of 42 experts including 1 patient representative developed the
guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review
questions, which were based on systematic literature searches (last search in March 2018), were provided. Thirty-one experts, who were entitled to vote, rated the final clinical recommendations and statements. Results: Here we present
the treatment recommendations separately for patients
with metastatic seminoma and non-seminomatous GCT
(stages IIA/B and IIC/III), for restaging and treatment of residual masses, and for relapsed and refractory disease stages. The recommendations also cover extragonadal and sex
cord/stromal tumours, the management of follow-up and
toxicity, quality-of-life aspects, palliative care, and supportive therapy. Conclusion: Physicians and other medical service providers who are involved in the diagnostics, treatment, and follow-up of GCT (all stages, outpatient and inpatient care as well as rehabilitation) are the users of the present
guideline. The guideline also comprises quality indicators for
measuring the implementation of the guideline recommendations in routine clinical care; these data will be presented
in a future publication
Abstract
Introduction: This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment,
and follow-up on germ cell tumours (GCTs) of the testis in
adult patients. We ...present the guideline content in two
publications. Part I covers the topic’s background, methods, epidemiology, classification systems, diagnostics,
prognosis, and treatment recommendations for the localized stages. Methods: An interdisciplinary panel of 42 experts including 1 patient representative developed the
guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review
questions, which were based on systematic literature
searches (last search was in March 2018) were provided.
Thirty-one experts entitled to vote, rated the final clinical
recommendations and statements. Results: We provide
161 clinical recommendations and statements. We present
information on the quality of cancer care and epidemiology
and give recommendations for staging and classification as
well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I,
we separately present the treatment recommendations for
germ cell neoplasia in situ, and the organ-confined stages
(clinical stage I) of both seminoma and nonseminoma. Conclusion: Although GCT is a rare tumour entity with excellent
survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional
expertise and can be reassured by established online-based
second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary
approach as well as the referral of selected patients to centres with proven experience can help achieve favourable
clinical outcomes.
This article discusses the relevance of gender issues for social science education and gives an interim report on developments in the field. We explore the significance of gender differences in ...political attitudes and preferences for certain topics of instruction, consider differences in the learning needs of male and female students, and analyse the curricular challenges involved in incorporating the gender perspective in the classroom. Deficits in the curricular coverage of gender issues reflect the fact that the didactics of social science is still hesitant in its response to the findings of women's and gender studies, and has yet to integrate gender issues as a core element of social science education.
Disenclosure is a term that refers to the structural erosion of society. The social structure of modernity is undergoing a change of which we can predict neither the direction nor the outcome. ...Generally disenclosure can be understood as the phenomenon whereby certain historical conditions change & thereby affect the structure of society. Therefore, the current change opens up the possibility for a restructurization along with all the risks & chances that are inherent in this development. 14 References. Adapted from the source document.
