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Background The taxanes docetaxel and cabazitaxel prolong overall survival for men with metastatic castration-resistant prostate cancer (mCRPC), with cabazitaxel approved in the postdocetaxel setting only. Recent data suggest they have similar efficacy but a different safety profile in the first-line mCRPC setting. Objective To assess patient preference between docetaxel and cabazitaxel among men who received one or more doses of each taxane and did not experience progression after the first taxane. Design, setting, and participants Chemotherapy-naive patients with mCRPC were randomized 1:1 to receive docetaxel (75 mg/m2 every 3 wk × 4 cycles) followed by cabazitaxel (25 mg/m2 every 3 wk × 4 cycles) or the reverse sequence. Randomization was stratified by prior abiraterone or enzalutamide use. Outcome measurements and statistical analysis The primary endpoint was patient preference, assessed via a dedicated questionnaire after the second taxane. Secondary endpoints included reasons for patient preference, prostate-specific antigen response, radiological progression-free survival, and overall survival. This clinical trial is registered at ClinicalTrials.gov as NCT02044354. Results and limitations Of 195 men randomized, 152 met the prespecified modified intent-to-treat criteria for analysis. Overall, 66 patients (43%) preferred cabazitaxel, 40 (27%) preferred docetaxel, and 46 (30%) had no preference (p = 0.004, adjusted for treatment period effect). More patients preferred treatment period 1 (43%, 95% confidence interval [CI] 36–52%) versus period 2 (27%, 95% CI 20–34%). Patient preference for cabazitaxel was mainly related to less fatigue (72%), better quality of life (64%), and other adverse events (hair loss, pain, nail disorders, edema). Adverse events were consistent with the known safety profile of each drug. Conclusions A significantly higher proportion of chemotherapy-naive men with mCRPC who received both taxanes preferred cabazitaxel over docetaxel. Less fatigue and better quality of life were the two main reasons driving patient choice. Patient summary Men with metastatic castration-resistant prostate cancer preferred cabazitaxel over docetaxel for chemotherapy, mainly because of less fatigue and better quality of life.

Functional somatic symptoms (FSS) are physical symptoms that cannot be sufficiently explained by organic pathology, and may include headaches, nausea and fatigue (1). FSS are common among children, reportedly accounting for 10 to 15% of all pediatric visits (2-4). Persistent FSS are associated with reduced quality of life and children with persistent FSS often experience impairment in daily activities, function poorly at school, show reduced engagement in peer activities, and perceive their own health as negative (5-8). The origins of FSS are presumably multifactorial where complex interactions between biological, psychosocial and environmental factors are involved (1). It has been argued that shared environmental factors, such as family context, have a stronger influence on the development and course of FSS than biological factors (9). Recent insights suggest that early life experiences related to somatic symptoms may influence proneness to FSS throughout life (10-12) and it has been found that FSS run within families (13-16). Social learning theory provides a framework to understand how proneness to FSS is transmitted across generations. From an early age onwards, children learn to interpret physical sensations, give meaning to them, and respond to them by observing and communicating with their caregivers (17). As such, parental cognitive, emotional and behavioral responses to their own and their child’s symptoms, i.e. parental symptom perception and related behavior, may influence the way their offspring copes with their own somatic symptoms in the future. Even further, it may contribute to how proneness to FSS is transmitted from one generation to the next. Patterns of health care use within families may provide insight into the intergenerational transmission of symptom and illness related behaviors and can serve as a proxy for processes of intergenerational transmission of FSS. This transmission can occur along two paths. First, parents who seek excess health care for their own symptoms, may model this way of managing symptoms to their children. Second, parents may reinforce their children’s symptoms by frequently taking them to health care providers. Indeed, it has been shown that children whose parents suffer from FSS make more use of health care services (22). Others found that mother’s previous health care use was a stronger predictor of child’s health care use than child’s concurrent pain (23). This illustrates that parental health care use for own somatic symptoms influences the way parents utilize health care for symptoms of their offspring, potentially transmitting symptom and illness behavior that may contribute to the occurrence of FSS. Although the literature reveals associations between health care seeking behavior and FSS, the majority of previous studies only examined FSS and health care use by either the parent or child. As a result, it remains largely unclear how health care use in parents as well as the child interact to influence FSS in the child. In addition, the existing literature lacks studies with large sample sizes and prospective designs that follow parents and children for several years, which can yield stronger evidence on trajectories of symptoms and health care use over time. Moreover, many studies rely on self-reported health care use, rendering the studies prone to biases (e.g. recall bias) and therefore at risk of being less accurate (24). Studying family patterns of health care use and their effects on the development of childhood FSS could contribute to a better understanding of early risk factors of FSS. This can inform about targets viable for prevention. For example, a psychoeducation program could be designed to educate parents of high utilizing families about the potential effect of excessive health care use on their child’s symptoms. It might also aid to create a signaling tool for health care professionals to identify vulnerable families. Overall, prevention and early stage intervention could potentially decrease the development of FSS early in life as well as improve the quality of life of young patients already suffering from FSS.

The ARISE project, which stands for “Health Care Online Survey Europe,” aims to identify aspects of healthcare that may influence the symptom course of individuals with or at risk for persistent somatic symptoms (PSS) and to improve our understanding healthcare professionals’ perspectives on healthcare across Europe for individuals with PSS. The ARISE project is led by the Department of Psychosomatic Medicine and Psychotherapy of the University Medical Centre Hamburg-Eppendorf, Germany (Prof. Bernd Löwe), and involves collaboration with USUMA GmbH (Dr. Jürgen Schunter, Martin Liebau, Georg Grewer), University Medical Center Groningen (Prof. Judith Rosmalen), Wrocław Medical University (Prof. Joanna Rymaszewska), and University of Florence (Prof. Fiammetta Cosci). Theoretical Background: Persistent somatic symptoms (PSS) are ongoing physical complaints that can persist for several months, causing distress to individuals, regardless of their cause [1]. PSS are prevalent in primary and specialized healthcare settings [2-3], and effective management is challenging for healthcare practitioners. The uncertainty around treatment options can lead to repeated investigations and hospitalizations, resulting in high socio-economic costs and potential harmful overuse of health care [4-5]. Furthermore, how healthcare practitioners respond to and manage patients with PSS may significantly influence the development and perpetuation of the illness, [6]. Additionally, many European countries lack guidelines for the diagnosis and management of PSS, resulting in significant variations in treatment options across the continent [7]. Therefore, it is crucial to investigate the potential impact of healthcare aspects, including their structure and organization, on the course of PSS across Europe. This study aims to quantify the views and perceptions of healthcare professionals from four European countries on healthcare and treatment-related factors associated with symptom persistence, deterioration, and improvement in patients with PSS. The study will also explore practitioners' needs for developing pan-European recommendations for PSS management. Capturing the views of healthcare professionals is vital because they have direct insights into the healthcare system and can identify the most relevant healthcare aspects associated with the course of PSS. By doing so, this study can help improve the understanding of PSS management and facilitate the development of PSS care guidelines across Europe.

The ARISE project, which stands for “Health Care Online Survey Europe,” aims to identify aspects of healthcare that may influence the symptom course of individuals with or at risk for persistent somatic symptoms (PSS) and to improve our understanding of patients’ perspectives on healthcare across Europe for individuals with PSS. The ARISE project is led by the Department of Psychosomatic Medicine and Psychotherapy of the University Medical Centre Hamburg-Eppendorf, Germany (Prof. Bernd Löwe), and involves collaboration with USUMA GmbH (Dr. Jürgen Schunter, Martin Liebau, Georg Grewer), University Medical Center Groningen (Prof. Judith Rosmalen), Wrocław Medical University (Prof. Joanna Rymaszewska), and University of Florence (Prof. Fiammetta Cosci). Theoretical Background: Persistent somatic symptoms (PSS) are subjectively distressing somatic complaints, which, regardless of their cause, are present most days for at least several months [1]. PSS are frequent across primary and specialized healthcare settings [2-3], constitute a major health problem across Europe and are associated with significant individual and societal burdens, as they impair patients` quality of life and functioning and are costly for society [4-5]. While effective treatments exist, their availability may be limited in some European countries, and PSS may frequently remain under-recognized and undertreated. Whereas studies from Germany indicate a duration of untreated illness between six [6] and 23 [7] years, comparative studies across Europe are lacking. Furthermore, many European countries lack guidelines for the diagnosis and management of PSS, re-sulting in significant variations in treatment options across the continent [8]. This heterogeneity in care has led to practitioners' uncertainty in providing effective management for affected patients, contrib-uting to repeated investigations and frequent hospitalizations, leading to high socio-economic costs, unnecessary and potentially harmful overuse of health care [9-10] and a high risk for chronic disease courses [7]. Thefore, most appropriate treatments for patients are uncertain. Hence, there is a great need to investigate the potential influence of healthcare aspects, their structure and organization on the course of PSS across Europe. Therefore, this study aims to identify relevant healthcare aspects across Europe that may be associated with the course of PSS based on patients' perspectives.

This is a conversation analytic study of existing recorded GP-patient consultations. Conversation analysis (CA) is a micro-analytic approach which considers how speakers use both spoken language and non-verbal behaviour. This can include asking questions, providing explanations, or making evaluations. This study aims to analyse clinical consultations regarding PPS in a natural setting. The approach used is recordings of participants' visits to the GP who are experiencing PPS. The consultations are studied using conversation analysis, which is a well-established way of analysing in vivo communication and language used in a qualitative way. By understanding the linguistic characteristics and communication during medical consultations regarding PPS, this study aims to lay the groundwork for understanding the communication process regarding PPS and medically complex issues in primary care. The aim is to target the current gaps of knowledge in research regarding medical consultations of FDs and PPS. Further studies are planned to develop interventions in order to reduce stigma during medical consultations and increase the patient-clinican’s therapeutic alliance.

Functional Somatic symptoms (FSS) refers to bodily symptoms which cannot be attributed to a well-defined physical disease. FSS commonly occur in childhood and adolescence [1, 2]. At these early ages, FSS are generally mild and self-limiting, and commonly present as abdominal pain, headaches, sore muscles or fatigue. Nonetheless, some youths develop persistent symptoms, which affects approximately 4-10% in the general population, and can impair their everyday functioning [1-5]. Different lines of research have focused on developmental explanatory models which aim to understand the complex aetiology, with its dynamic interplay between mechanisms and risk factors, underlying FSS in adulthood [6], and already in childhood and adolescence [2, 7]. However, scientific literature is scarce regarding early risk factors, and how these could pose an individual at increased risk for the development of severe FSS. Factors specific to the child, as well as familial, or parental, risk factors need to be considered when looking at a younger age group [1, 2, 8]. Child personality-specific factors associated with the development or maintenance of unspecific somatic symptoms in children and adolescents include being insecure, and co-occurs with anxiety and depression already during childhood and adolescence [3, 9-14]. Together, these findings might suggest that personality styles characterized by impairment in temperament, self- or emotion-regulation, and heightened stress reactivity could play a role as a predisposing, precipitating and/or perpetuating factor for FSS later on [1, 8, 15-21]. Even in infancy, regulatory problems, e.g., a deviant behavioral pattern (i.e. hypersensitivity) of tactile reactivity seem to predict severe FSS during early childhood [16, 22]. In combination with other child-specific factors, such as disturbed temperament or emotion regulation, as well as early impairments in the child’s ability to communicate with its environment, these early impairments in sensory reactivity could pose an increased risk for FSS also later in life, beyond the stages of early childhood. The familial setting, including parent-specific factors, has received special focus in the investigation on risk factors of the development and maintenance of FSS at younger ages in both clinical and research settings [8]. For instance, a history of parental psychiatric illness [16, 22-25], as well as certain parenting behaviors and patterns of parental interaction with their child (e.g. (emotional) over-involvement in their child's symptoms or overprotective parenting) [1, 26-29] appear to increase the child's somatic symptom levels. Furthermore, adversities in the family environment, such as poor family functioning, high levels of conflict or family disruption (i.e. parental divorce), have been identified to potentially increase symptom severity and associated impairment [1, 14, 30-34].

Challenging persistent somatic symptom (PSS) related stigma among healthcare professionals is increasingly a priority in research and clinical practice. Valid, reliable and responsive measurement of stigma is needed to understand its prevalence and severity, but also to design effective interventions against stigma and evaluate their effectiveness. We have recently developed a new instrument to measure stigma among healthcare professionals in the UK, the Persistent Somatic Symptom Scale for Healthcare Professionals (PSSS-HCP). The aim of this study is to develop a Dutch version of the PSSS-HCP and evaluate its measurement properties.

Functional disorders (FD) and persistent somatic symptoms (PSS) are complex conditions that require the involvement of multiple healthcare professionals. However, fragmentation of care through specialised working and reduced collaboration between different disciplines has resulted in poor care experiences for both patients and professionals. Collaborative care networks (CCNs) provide a potential solution to the problem of fragmentation of care in the management of PSS/FD. Little is known about CCNs in this context, including how to implement a new CCN or changing an existing one. Within the process of implementation of change (whether this is a new CCN or a change to an existing CCN), it is important to identify barriers to implementation of change and thus relevant strategies for this towards creating an effective implementation plan (Wensing et al. 2020). Through the use of the Research World Café method, we aim to identify realistic strategies to overcome barriers towards implementing CCNs for PSS/FD. Reference Wensing, M., Grol, R., and Grimshaw, J., 2020. Improving patient care. Hoboken, NJ: Wiley Blackwell.

There is a widespread belief that collaborative care networks (CCN) have the potential to significantly improve outcomes in the care of functional disorders (FD) and persistent somatic symptoms (PSS). However, evidence of the effectiveness of CCNs is lacking. The first steps are being taken - defining CCNs, outlining the characteristics that have been considered, as well as identifying quality indicators. The next step is to study how the quality of CCNs for FD can be improved, using the results from the first steps. We argue that the best way to do this is with an active network, and with the involvement of the network members themselves as this not only has the possibility of directly improving a service, it also gives a more realistic view of what works, as well as giving an immediate process of trial and error. Therefore, in this study we will use participatory action research (PAR) to incorporate and enact the learning we have made bringing this together with the experience of an active network and its members. In this case, we will be working with ALK Netwerk Salland, a network of healthcare professionals across the Salland region in the east of the Netherlands, who work with persons suffering with FD and PSS (in dutch: aanhoudende lichaamlijke klachten - ALK).

Functional Disorder (FD) is an umbrella term used to describe a group of conditions diagnosed based on the presence of persistent symptom patterns that cannot be better explained by physical or psychiatric conditions (1). The most commonly known FDs are Fibromyalgia (FM), Chronic Fatigue Syndrome (CFS) and Irritable Bowel Syndrome (IBS). A significant overlap can be observed between these conditions, which was categorized in the alternative unifying diagnostic construct of bodily distress syndrome (BDS) (2, 3). FDs can be associated with significant impairment of everyday functioning, increased patient disability (4) and serious impacts on quality of life (5). Evidence suggests that several factors contribute to the development of FDs including biological, psychological, social, and healthcare related factors (6). A diagnosis of FDs is usually made based on the presenting symptom pattern and medical history, but many patients who qualify for a diagnosis do not receive one (7). Evidence suggests that the likelihood of receiving an FD diagnosis might be higher for women (8) and could be associated with the attitudes of physicians towards FDs (9). Diagnostic labels can be detrimental to patient’s health status. On the one hand, they can provide validation of experiences and can lead to support from patient’s surrounding social environment (10). On the other hand, diagnostic labels can be related to negative impacts such as stereotyping, stigma (11, 12) and discrimination (13) In this study, we aim to examine the factors associated with receiving a diagnostic label of FD by a physician in participants who fulfil the diagnostic criteria for these conditions. The scientific questions for the planned project have been developed within the framework of the European Training Network “Encompassing Training in fUnctional Disorders across Europe (ETUDE)” funded under the EU Horizon2020 programme, grant agreement No 956673.