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Sekundäre Prävention bei Patienten mit oberflächlichem Urothelkarzinom

Secondary prevention in patients with superficial urothelial carcinoma

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Zusammenfassung

Hintergrund

Das Urothelkarzinom ist bei Männern die vierthäufigste und bei Frauen die siebthäufigste maligne Erkrankung in Deutschland. 95 % aller Tumoren der Harnblase sind Urothelkarzinome. Zirka 80 % dieser Karzinome sind bei Erstdiagnose nicht invasiv. Der Befall ist oft multizentrisch. Zirka 10–15 % dieser Tumoren entwickeln im weiteren Verlauf ein muskelinvasives Wachstum. Wir analysierten, welche Maßnahmen Patienten selber unternehmen, in der Hoffnung, damit ihr Rezidivrisiko senken zu können.

Material und Methoden

Im Zeitraum zwischen Januar 2012 und Dezember 2013 befragten wir insgesamt 97 Patienten mit einem superfiziellen pTa-Urothelkarzinom im Rahmen der Tumornachsorge in unserer uroonkologischen Sprechstunde, inwieweit die Diagnose Urothelkarzinom ihre Lebensumstände und Ernährungs- und Trinkgewohnheiten verändert hat. Ob Nachsorgen regelmäßig durchgeführt werden und wurden, sie psychische Betreuung angenommen haben und ob sie selbstständig Prophylaxemaßnahmen ergriffen haben, sowie ihre Rauchgewohnheiten, sofern vorhanden, geändert haben.

Ergebnisse

Unter den 97 Befragten waren 79 Männer und 18 Frauen, darunter 56 Raucher und 41 Nichtraucher. Der Altersmedian lag bei 71 (36–96) Jahren. Für 22 (22,7 %) Patienten führte die Diagnose zu keinen Veränderungen ihrer Lebensumstände. Bei 33 Patienten war die Veränderung gering (44 %), bei 20 mittelgradig (26,7 %), bei 14 (18,6 %) stark und bei 8 (10,7 %) sehr stark. 25 (25,8 %) Patienten änderten ihre Ernährungsgewohnheiten. 49 Patienten änderten ihre Trinkgewohnheiten, davon gaben 48 Patienten an, mehr zu trinken (> 2,0 l/Tag), 1 Patient reduzierte seine Trinkmenge. Nach Diagnosestellung hörten 40 (71,4 %) Patienten auf zu rauchen, 7 (12,5 %) reduzierten den Konsum. 6 (10,7 %) rauchten unverändert weiter. 44 (45,4 %) Patienten gaben an, ihr Sportverhalten geändert zu haben, davon trieben 11 (25 %) mehr Sport, und 8 (18,1 %) weniger. Nur 3 (3,1 %) Patienten nahmen psychoonkologische Betreuung im Verlauf in Anspruch. 39 (40,2 %) Patienten griffen zu supportiven/komplementärmedizinischen Maßnahmen, um ihre Erkrankung potentiell günstig zu beeinflussen (Misteltherapie, Vitaminpräparate), 22 (22,7 %) Patienten ließen sich durch Ärzte zusätzlich beraten. Allerdings glaubten 45,4 % aller Patienten nicht an den Erfolg der von ihnen getroffenen Maßnahmen.

Schlussfolgerung

Für 77,3 % aller Patienten stellte die Diagnose Urothelkarzinom eine Veränderung ihrer Lebensumstände dar und sie waren bereit, diverse Maßnahmen, wie Aufgabe des Rauchens, Änderung von Trink- und Essgewohnheiten, Sport und Prophylaxemaßnahmen durchzuführen. Allerdings glaubt nahezu die Hälfte der Patienten (45,4 %) selbst nicht an einen durchschlagenden Erfolg der von Ihnen getroffenen Maßnahmen.

Abstract

Background

Urothelial cancer is the 4th most common cancer in men and the 7th most common malignancy in women in Germany. 95 % of all tumors of the urinary bladder are urothelial carcinomas. At the time of diagnosis approximately 80 % of these carcinomas are not invasive. The affection is often multicentric. Approximately 10–15 % of the tumors develop into muscle-invasive growth. In this prospective study, we analyzed measures patients independently took to reduce their risk of bladder cancer recurrence.

Materials and methods

During the period January 2012 to December 2013, we surveyed a total of 97 patients with superficial transitional cell carcinoma (pTa). The question was how far the diagnosis of urothelial cancer has changed their lives, eating and drinking habits or whether follow-up consultations had been carried out regularly. Furthermore, we recorded whether they accepted psychological care or had autonomously adopted prophylactic measures, as well as changed their smoking habits, if they had smoked.

Results

Of the 97 patients questioned, there were 79 men and 18 women (56 smokers and 41 nonsmokers). The median age was 71 years (range 36–96 years). For 22 patients (22.7 %), the diagnosis resulted in no changes. In 33 patients the changes were small (44 %), moderate in 20 (26.7 %), in 14 (18.6 %) strong and very strong in 8 (10.7 %). A total of 25 patients (25.8 %) changed their eating habits. In all, 49 patients changed their drinking habits; 48 patients claimed to drink more (> 2.0 L/day). One patient reduced his drinking amount. Regarding smoking, 40 patients (71.4 %) had stopped and 7 (12.5 %) reduced consumption, while 6 patients (10.7 %) had not changed their smoking habits. Overall, 44 patients (45.4 %) changed their physical activity: 11 (25 %) exercised more, 8 (18.1 %) less. Only 3 patients (3.1 %) used psycho-oncological care and 39 (40.2 %) patients used supportive/complementary medicine measures of favorablly influence their disease (mistletoe therapy, vitamin supplements). In addition, 22 patients (22.7 %) sought advice from their physician. However, 45.4 % of all patients did not believe in the success of their measures taken.

Conclusion

Of all patients diagnosed with urothelial carcinoma, 77.3 % reported a change in their living habits and they were willing to take specific steps, such as giving up smoking, being more physically active, changing drinking and eating habits in order to positively influence their disease. However, almost half of the patients (45.4 %) did not believe in a resounding success of their measures taken.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T.J. Schnöller, F. Zengerling, C. Hirning und F. Jentzmik geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland

    T.J. Schnöller, F. Zengerling, C. Hirning & F. Jentzmik

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  1. T.J. Schnöller
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Correspondence to T.J. Schnöller.

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Schnöller, T., Zengerling, F., Hirning, C. et al. Sekundäre Prävention bei Patienten mit oberflächlichem Urothelkarzinom. Urologe 54, 992–997 (2015). https://doi.org/10.1007/s00120-015-3839-7

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