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Analysis of circulating cell-free DNA (ccfDNA) is a suitable tool for detecting somatic mutations for the purpose of making decisions on treatment, monitoring treatment response, and predicting survival. High-throughput techniques for ccfDNA extraction are essential to implementing ccfDNA testing in the clinical setting. We set out to compare two automated techniques with regard to hands-on time, ccfDNA output and integrity, and circulating mitochondrial DNA (mtDNA). CcfDNA was isolated using the EZ1&2 ccfDNA field test kit (EZ2 kit, QIAGEN) and the Maxwell RSC ccfDNA plasma kit (Maxwell kit, Promega). DNA was extracted from plasma of 30 breast cancer patients enrolled in the iMODE-B (#325_19B; 12.10.2020) study. Real-time PCR, fluorescence-based detection and automated electrophoresis were used to assess ccfDNA concentrations. The ccfDNA yield was significantly higher when extracted with the EZ2 kit. The EZ2 kit enabled the isolation of a higher proportion of short fragments and a lower proportion of long fragments, resulting in lower DNA integrity. Significantly lower mtDNA quantities were detected in the Maxwell eluate than in the EZ2 eluate. Thus, decisions on which extraction method to use should proceed on the basis of the required input for downstream applications, the anticipated fragment size and minimum hands-on time.

Nahrungserganzungsmittel gewinnen immer mehr an Beliebtheit. Sowohl Patienten als auch gesunde Personen nehmen diese ein, um unter anderem eine Verbesserung der Lebensqualitat zu erreichen. Ob dies wirklich sinnhaftig ist, wird im Beitrag genauer untersucht. Ebenso wird eine genaue Ubersicht uber die Vitamine und die wichtigsten Spurenelemente gegeben. Mikronahrstoffe liefern dem Korper zwar keine Energie, mussen aber dennoch zugefuhrt werden. Am sinnvollsten ist es, alle notwendigen Vitamine und Spurenelemente uber die Nahrung aufzunehmen. Fur gesunde Personen mit einer ausgewogenen Ernahrung ist keine Supplementierung von Mikronahrstoffen notig. Allerdings ist bei Mangelzustanden, bei onkologischen Patienten, eine externe Zufuhr notwendig. Bei Krebspatienten sollte beispielsweise eine ausreichende Zufuhr an Vitamin C und D sichergestellt werden, falls notig auch uber Nahrungserganzungsmittel. Die aktuelle Datenlage zeigt, dass eine ubermasige Zufuhr aber teilweise sogar ins Gegenteil umschlagen kann. So wurde beispielsweise gezeigt, dass eine ubermasige Zufuhr von Vitamin B12 das Risiko fur ein Bronchialkarzinom erhohen kann. Ebenfalls kann aktuell aus onkologischer Sicht keine Empfehlung zur Supplementierung von Selen gegeben werden. Ein genauer Uberblick uber die aktuelle Datenlage wird im Artikel gegeben.

Complementary medicine services are nowadays usually quite heterogeneous, and little information is available on standards for running an integrative medicine consultancy service. This study aimed to assess patients' satisfaction with a standardized treatment service on integrative medicine.Using a cross-sectional design, 75 breast cancer patients from the integrative medicine consultancy service at the University Breast Center for Franconia were evaluated between January 2016 and March 2017. At primary consultation, patients answered a standardized questionnaire on their medical history and treatment goals regarding integrative medicine. In a subsequent interview, patients evaluated their satisfaction with the treatment service and individual treatment goals.72% of the patients (n = 54) reported high satisfaction with the overall approach of the treatment service. 76% of the patients (n = 57) were very satisfied or satisfied with their individual treatment plans. The most frequently reported goals were to slow tumor progression (n = 64, 85.3%), reducing the side effects of conventional cancer treatments (n = 60, 80%), and a desire to participate actively in the treatment of breast cancer (n = 64, 85.3%).Using a standardized procedure in integrative medicine allows a high quality level to be offered to patients. Overall, breast cancer patients report very high satisfaction with the integrative medicine consultancy service and state long-term treatment goals. Hence, long-term treatment with integrative medicine methods should be taken into consideration.

Purpose: The growing popularity and acceptance of integrative medicine is evident both among patients and among the oncologists treating them. As little data are available regarding health-care professionals’ knowledge, attitudes, and practices relating to the topic, a nationwide online survey was designed. Methods: Over a period of 11 weeks (from July 15 to September 30, 2014) a self-administered, 17-item online survey was sent to all 676 members of the Research Group on Gynecological Oncology (Arbeitsgemeinschaft Gynäkologische Onkologie) in the German Cancer Society. The questionnaire items addressed the use of integrative therapy methods, fields of indications for them, advice services provided, level of specific qualifications, and other topics. Results: Of the 104 respondents (15.4%) using integrative medicine, 93% reported that integrative therapy was offered to breast cancer patients. The second most frequent type of tumor in connection with which integrative therapy methods were recommended was ovarian cancer, at 80% of the participants using integrative medicine. Exercise, nutritional therapy, dietary supplements, herbal medicines, and acupuncture were the methods the patients were most commonly advised to use. Conclusion: There is considerable interest in integrative medicine among gynecological oncologists, but integrative therapy approaches are at present poorly implemented in routine clinical work. Furthermore there is a lack of specific training. Whether future efforts should focus on extending counseling services on integrative medicine approaches in gynecologic oncology or not, have to be discussed. Evidence-based training on integrative medicine should be implemented in order to safely guide patients in their wish to do something by themselves.

Die Anwendung von integrativer Medizin erfreut sich bei Anwendern und Arzten zunehmender Beliebtheit. Aktuell nutzen 38–60 % aller Krebspatienten in den westlichen Industrielandern komplementare und alternative Medizin (CAM) im Krankheitsverlauf zur Therapieunterstutzung. Beim Mammakarzinom sind es stadiumabhangig sogar bis zu 90 %. Definition, Historie, Zahlen und Fakten zur integrativen Medizin werden prasentiert und Systeme und Hauptmethoden dargestellt. Die aktuelle Literatur und Publikationen werden ausgewertet und Expertenforen analysiert. Die integrative Medizin ist als ein ganzheitliches Konzept zu verstehen, bei dem die wissenschaftliche evidenzbegrundete Medizin mit der komplementaren, zumeist erfahrungsbegrundeten Medizin vereint wird. Komplementare Methoden, deren Erkenntnisgewinne haufig durch Erfahrungen und andere Wissensgewinnmethoden begrundet sind, werden in Erganzung zur konventionellen Medizin eingesetzt. Sinnvolle und geeignete komplementare Methoden mussen unbedingt von den umstrittenen alternativen Methoden und Ausenseitermethoden abgegrenzt werden. Je nach Indikation und Behandlungskonzept konnen mit integrativer Medizin gute Erfolge erzielt werden. Wenn bestimmte Grenzen, insbesondere wenn es um die Sicherheit der Patientin geht, eingehalten werden, zweifelhafte Methoden kritisch hinterfragt werden und geeignete Methoden den ublichen medizinischen Regeln folgend angewandt werden, bieten sich im Rahmen der integrativen Medizin erganzende Moglichkeiten, den Genesungsprozess bzw. Gesundheitszustand der Patientinnen zu verbessern sowie den Menschen mit seiner Erkrankung ganzheitlich und individuell zu behandeln.

Background Physical exercise and nutritional treatment are promising measures to prevent muscle wasting that is frequently observed in advanced-stage cancer patients. However, conventional exercise is not always suitable for these patients due to physical weakness and therapeutic side effects. In this pilot study, we examined the effect of a combined approach of the novel training method whole-body electromyostimulation (WB-EMS) and individualized nutritional support on body composition with primary focus on skeletal muscle mass in advanced cancer patients under oncological treatment. Methods In a non-randomized controlled trial design patients (56.5% male; 59.9 ± 12.7 years) with advanced solid tumors (UICC III/IV, N = 131) undergoing anti-cancer therapy were allocated to a usual care control group (n = 35) receiving individualized nutritional support or to an intervention group (n = 96) that additionally performed a supervised physical exercise program in form of 20 min WB-EMS sessions (bipolar, 85 Hz) 2×/week for 12 weeks. The primary outcome of skeletal muscle mass and secondary outcomes of body composition, body weight and hand grip strength were measured at baseline, in weeks 4, 8 and 12 by bioelectrical impedance analysis and hand dynamometer. Effects of WB-EMS were estimated by linear mixed models. Secondary outcomes of physical function, hematological and blood chemistry parameters, quality of life and fatigue were assessed at baseline and week 12. Changes were analyzed by t-tests, Wilcoxon signed-rank or Mann-Whitney-U-tests. Results Twenty-four patients of the control and 58 of the WB-EMS group completed the 12-week trial. Patients of the WB-EMS group had a significantly higher skeletal muscle mass (0.53 kg [0.08, 0.98]; p = 0.022) and body weight (1.02 kg [0.05, 1.98]; p = 0.039) compared to controls at the end of intervention. WB-EMS also significantly improved physical function and performance status (p

In the original version of this article contained an error in figure 1. It was provided in German.

Prediction of the prognosis for metastatic breast cancer patients depends on molecular subtypes similar to those found in patients with primary breast cancer. Several studies have shown that estrogen receptor (ER) and progesterone receptor (PR) status determine the course of the disease and the prognosis. As Ki-67 helps to differentiate molecular subtypes in patients with primary breast cancer, the aim of this study was to assess the prognostic relevance of Ki-67 in the primary tumor in relation to its prognostic relevance for patients with metastatic breast cancer. A total of 467 patients with invasive breast cancer were identified in the database of a single breast cancer center, in whom Ki-67 had been assessed in tumor material from the breast at the time of the primary diagnosis and who had developed a metastasis at any time during the subsequent course. For these patients, tumor and patient characteristics were used to determine prognostic factors relative to overall survival after the diagnosis of distant metastases. Ki-67 was added to this model to investigate whether this might improve the prediction of overall survival. In the multivariate Cox model, age at diagnosis, body mass index, nodal status, tumor size, ER and PR status, and time from diagnosis to metastasis were identified as relevant prognostic factors. Adding Ki-67 to the model improved the prediction of overall survival. There was also a significant and relevant interaction with the PR status. In patients with a low-proliferation primary tumor, a high level of PR expression would indicate an extraordinarily good prognosis (HR 0.39; 95 % CI, 0.23-0.66). In patients with higher-proliferation primary tumors, PR status was not capable of differentiating prognostic groups. Ki-67 is useful in addition to known prognostic factors for breast cancer. It is able to indicate a group of women with a poorer prognosis, specifically in the group of patients with PR-positive breast cancer.

Die Nachsorge nach Mammakarzinom ist − wie die Diagnostik und Therapie − ein komplexer Vorgang. Zwar werden Forderungen nach einer intensivierten Nachsorge mit mehr diagnostischen Masnahmen (z. B. Rontgen, CT, MRT, PET und Tumormarker) gestellt, doch dafur bestehen weder Datenlage noch Empfehlung. Es sollte also keine intensivierte Nachsorge, sondern eine Verbesserung der Nachsorge durchgefuhrt werden. Schlagworte in diesem Zusammenhang sind Intensivierung des Gesprachs, Compliance mit adjuvanten Therapien, Teilnahme an den empfohlenen Untersuchungen in den empfohlenen Intervallen und Beratung zur Lebensfuhrung.