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Die psychoonkologische Versorgung von Tumorpatienten ist in der onkologischen Medizin zunehmend etabliert, nicht zuletzt durch die Implementierung der S3-Leitlinie. Daruber hinaus gibt es bei der psychoonkologischen Versorgung von Patienten mit akuten Leukamien einige spezifische Besonderheiten zu berucksichtigen. In diesem Artikel werden Aspekte aufgezeigt, die Arzte und Psychoonkologen bei der Unterstutzung der Patienten beachten sollten.

Development of quality of life in patients undergoing allogeneic stem cell transplantation with regard to anxiety, depression and resilience

Undertreatment of the older patients with AML can explain, in part, their inferior outcome when compared with that in younger patients. In analogy to the benefit of patients under the age of 60 years from high-dose AraC there are dosage related therapeutic effects in the patients over 60 years in particular for daunorubicin in the induction treatment, and for maintenance versus no maintenance in the post-remission treatment. Utilizing these effects can partly overcome the mostly unfavorable disease biology in older age AML, whereas the role of risk factors involved is not completely understood and the concept of dose–response needs to be requestioned. We recommend an adequate dosage of 60mg/(m 2 day) daunorubicin for 3 days in a combination with standard dose AraC and 6-thioguanine given for induction and consolidation and followed by a prolonged monthly maintenance chemotherapy. Further improvements in supportive care may help delivering additional anti-leukemic cytotoxicity. As a novel approach, reduced toxicity preparative regimens may open up allogeneic transplantation for older patients with AML. Other new options like MDR modulators, antibody targeted therapies and tyrosine kinase inhibitors are under clinical investigation. A questionnaire study in patients with AML showed that according to patients' self-assessment intensive and prolonged treatment did not result in decreasing quality of life. This finding did not vary by age under or above 60 years. Given the actual median age in this disease being more than 60 years the adequate management of older age AML remains as the major challenge.

Undertreatment of older patients with acute myeloid leukemia (AML) can explain, in part, their inferior outcome when compared to that of younger patients. In agreement with the benefit seen by patients under age 60 from high-dose cytosine arabinoside (Ara-C), there are dose effects in the over 60s, in particular for daunorubicin, in induction treatment and for the duration of postremission treatment. The use of these effects can partly overcome the mostly unfavorable disease biology in older age AML, as expressed by the absence of favorable and the over-representation of adverse chromosomal abnormalities as well as the expression of drug resistance. We recommend an adequate dosage of 60 mg/m2 daunorubicin on 3 days in combination with standard dose Ara-C and 6-thioguanine given for induction and consolidation, and followed by a prolonged monthly maintenance chemotherapy for at least 1 year's duration. Further improvements in supportive care may help to deliver additional antileukemic cytotoxicity. As a novel approach, nonmyeloablative preparative regimens may open up the possibility of allogeneic transplantation for older patients with AML. Other new options like multidrug resistance modulators, antibody targeted therapies and molecular targeting are under clinical investigation. A questionnaire study in patients with AML showed that, according to patients' self-assessment, intensive and prolonged treatment did not result in a diminished quality of life. This finding did not vary by age, under or over 60 years. As the median age in this disease is more than 60 years, the adequate management of AML in older patients remains the major challenge.

Background The impact on quality of life of allogeneic stem cell transplantation or conventional chemotherapy in patients with acute myeloid leukemia remains unclear, mainly because of a lack of studies with long-term follow-up. The German AML-Intergroup, therefore, initiated a survey on quality of life of patients with a relapse-free survival of at least 5 years after first-line treatment. Design and Methods The EORTC Quality of Life Core Questionnaire (QLQ-C30), supplemented by information on self-assessed concomitant diseases, late treatment effects, and demographics was used. The questionnaire was returned by 419 of 818 patients (51.2%) identified by six study groups. The patients’ median age at diagnosis was 42 years, and the median follow-up period was 8 years. One hundred and seventy patients were treated with stem cell transplantation (121 allogenic, 49 autologous) in first complete remission; the other 249 patients were treated with conventional chemotherapy. Results The ECOG activity index revealed normal activity in 45% vs. 60% of the patients in the allogeneic stem cell transplantation vs. conventional chemotherapy groups, respectively and disabled person status in 60% vs. 35%. All QLQ-C30 functions, except physical functioning and pain, were poorer in allogeneic stem cell transplantation patients. Problems in leisure-time activities, social life, and financial management, sexual limitations and adverse effects were significantly more frequent in patients after allogeneic stem cell transplantation than after conventional chemotherapy. Multivariate logistic regression models on global health status revealed concomitant disease, age >45 years, and allogeneic stem cell transplantation as significant risk factors. Conclusions These results indicate that, compared to conventional chemotherapy, allogeneic stem cell transplantation has a significantly worse long-term impact on quality of life. This needs to be considered when treatment options are discussed.

The paper provides an overview on the 11th scientific conference of the European Society for Psycho-Oncology (ESPO), which took place in June 2001, at Heidelberg, Germany. The main topics discussed during the conference were: (1) the state of the art of research on the effects of psychological interventions in cancer patients; (2) psychosocial aspects in the new field of cancer genetics; (3) recent developments in Quality of Life research; (4) Psycho-Oncology from an European perspective; and (5) children and cancer. The conference gave an impressive picture of the many achievements Psycho-Oncology in Europe has accomplished during the last years, in the clinical and scientific domain. With recent biomedical innovations Psycho-Oncology is facing new challenges. Despite these achievements limitations have become apparent. Identifying these limitations, future aims can be outlined. Among these, there is the need for methodological refinement, as well as for proof of clinical relevance of research results, in order to narrow the gap between research and practice.

Quality of life (QL) was evaluated in 101 patients with AML undergoing intensive and prolonged treatment at 12 sequential time points by using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C 30 questionnaire and the profile of mood states scale (POMS). For those patients having completed the course of inpatient treatment (n=37), QL improved from the beginning of chemotherapy to the end of inpatient treatment. Patients who subsequently went off protocol did not differ significantly in their self-assessed QL when compared with patients who completed therapy. Fatigue was more closely related to QL than nausea/emesis or appetite loss, but did not correlate with hemoglobin levels.

Intensification of treatment for acute myeloid leukemia (AML) in adult patients resulted in a substantial improvement in long-term prognosis. Therefore, the assessment of quality of life (QL) of patients undergoing treatment is of growing interest. This study was designed to evaluate QL in patients with AML treated according to the protocol of the German AML-Cooperative Group (Munster, Germany). The EORTC QLQ-C 30 questionnaire was used to analyze QL throughout therapy, evaluating defined specific parameters at 12 different time-points. Sixty-one patients were recruited within the first 30 months of the study. Those 28 patients who have completed the course of inpatient treatment (n=28) are evaluated for changes in the conceptually distinct QL domains: Physical Functioning (P

Abstract 2088 Introduction: Quality of life (QoL) plays a very important role for the assessment of oncological treatment outcome. For the assessment of therapy strategies both survival time and quality of survival regarding physical and emotional conditions are of interest. The present cross sectional study evaluated the impact of resilience, life satisfaction, anxiety and depression on the global health status of patients having received an allogeneic stem cell transplantation (HSCT). Design and Methods: 80 eligible patients from 26 German cancer centres fulfilling the following criteria were contacted: 1. Treatment within the AMLCG 99 trial for acute myeloid leukemia (AML). Patients were randomized to receive either standard-dose Cytarabine containing TAD or high-dose Cytarabine containing HAM-HAM induction therapy, followed by TAD consolidation and HSCT when having no low-risk cytogenetics and an available family donor or high-risk cytogenetics and an unrelated donor. 2. HSCT in first complete remission at least 6 months before the questionnaire. 3. Outpatient setting at the time of the questionnaire. The multi-part questionnaire included general informations about age, gender, marital and employment status as well as validated scaled questionnaire parts. These include the QLQ-C30, the Resilience Scale RS-25, the Hospital Anxiety and Depression Scale (HADS) and a questionnaire about general and health-related life satisfaction (FLZ). To ensure standardized analyses of the data, scales were summarized based on well-established scoring principles or rather linear transformed, so that scores ranged from 0 to 100. Global health status was defined as the primary objective of quality of life assessment. Results: Overall, 41 of 80 patients (51%) completed the questionnaire and were evaluable. Thus 41 patients (18 male, 23 females) aged between 23 and 66 (median 49) years at the time of data collection were included in the analysis. 66% were treated with de novo AML, 24% with secondary AML from MDS and 5% of the evaluable patients had MDS and t-AML, respectively. Median time between HSCT and questionnaire was 3.1 years (range, 8 months to 7 years). 26 patients (63%) received an HSCT from a related donor and 15 (37%) from an unrelated donor. Patients' self-assessed high quality of life was associated with an improved resilience (r=0.538, p Conclusion: The results suggest that quality of life after HSCT for AML correlates with patients' subjective assessment of emotional and physical conditions. For an effective evaluation of the quality of life assessment and the interaction with clinical parameters in AML patients, specific QoL instruments should be applied and different comparable studies should be combined in order to obtain more reliable results. Disclosures: No relevant conflicts of interest to declare.