Sebaceous gland carcinomas are rare malignant cutaneous adnexal tumors with sebocytic differentiation. The typical predilection area is the head and neck region, where sebaceous gland carcinomas are the most common malignant adnexal tumors of the skin. According to their localization a distinction is made between periocular and extraocular sebaceous gland carcinomas. Muir-Torre syndrome (MTS) should always be ruled out if it is suspected. In terms of prognosis, sebaceous gland carcinomas are potentially aggressive tumors with a clear tendency to recur and metastasize. Only small extraocular sebaceous gland carcinomas that have been completely resected have a very good prognosis. Sebaceous gland carcinomas most frequently metastasize lymphogenously to regional or distant lymph nodes; organ metastasis occurs less frequently. Periocular sebaceous gland carcinomas have a higher metastasis rate (up to 15%) than extraocular sebaceous gland carcinomas (up to 2%). Complete micrographically controlled surgery (MCS) of the primary tumor is the therapy of first choice, regardless of periocular or extraocular localization. Adjuvant or therapeutic radiotherapy may be considered. There is currently no established standard therapy for advanced, inoperable or metastatic sebaceous gland carcinomas. Local procedures and system therapies such as chemotherapy or immunotherapy can be considered. The procedure should be determined individually in an interdisciplinary tumor board. Close follow-up care is recommended for these potentially aggressive carcinomas.
Talgdrüsenkarzinome sind seltene maligne kutane Adnextumoren mit sebozytärer Differenzierung. Der typische Prädilektionsbereich ist die Kopf‐Hals‐Region; hier sind die Talgdrüsenkarzinome die häufigsten malignen Adnextumoren der Haut. Nach ihrer Lokalisation unterscheidet man periokuläre und extraokuläre Talgdrüsenkarzinome. Ein Muir‐Torre‐Syndrom (MTS) sollte bei entsprechendem Verdacht unbedingt ausgeschlossen werden. Im Hinblick auf die Prognose handelt es sich bei Talgdrüsenkarzinomen um potenziell aggressive Tumoren, die eine deutliche Rezidiv‐ und Metastasierungsneigung aufweisen. Nur kleine extraokuläre Talgdrüsenkarzinome, die sicher vollständig reseziert wurden, weisen eine sehr gute Prognose auf. Talgdrüsenkarzinome metastasieren am häufigsten lymphogen in regionäre oder entfernte Lymphknoten, seltener kommt es zur Organmetastasierung. Periokuläre Talgdrüsenkarzinome haben eine höhere Metastasierungsrate (bis zu 15%) als extraokuläre Talgdrüsenkarzinome (bis zu 2%). Die vollständige mikroskopisch kontrollierte Chirurgie (MKC) des Primärtumors ist unabhängig von periokulärer oder extraokulärer Lokalisation die Therapie der ersten Wahl. Eine adjuvante oder therapeutische Radiatio kann in Betracht gezogen werden. Für fortgeschrittene, inoperable oder metastasierte Talgdrüsenkarzinome gibt es aktuell keine etablierte Standardtherapie. Es kommen lokale Verfahren sowie Systemtherapien wie Chemotherapie oder Immuntherapie in Betracht. Das Vorgehen sollte in einem interdisziplinären Tumorboard individuell festgelegt werden. Eine engmaschige Nachsorge ist bei diesen potenziell aggressiven Karzinomen empfehlenswert.

BACKGROUND: Gynecological cancers are long-term, challenging, and stressful diseases. In Türkiye, the majority of patients with gynecological cancer use complementary and alternative medicine (CAM). Considering the stress that gynecological cancer patients are exposed to, patients need to know how to cope with stress.
OBJECTIVE: This study aimed to determine the use of CAM and coping with stress by patients with gynecological cancer and the relationships between them and the factors that predict the approaches to coping with stress in women with gynecological cancer in Türkiye.
METHODS: This is a descriptive and cross-sectional study. The study was conducted with 204 patients between April and August 2022. The data of the study were collected by face-to-face interview and filled out by the patients using the Descriptive Information Form and the Stress Coping Styles Scale (SCSS). Number, percentage, mean, χ2, one-way ANOVA, t test, and the Spearman correlation analysis were used in the data analysis. To analyze the multivariate independent associations between variables, a multivariate ordinal logistic regression model was used, with the SCSS domains as dependent variables. A 95% confidence interval was calculated, and all statistical tests had an alpha level of 0.05.
RESULTS: The mean age of the patients was 58.38 ± 12.64 years (32-80). The prevalence of CAM use by patients was 39.2%, and the most common types of CAM were herbal products (43.8%) and supplication (42.5%). The reasons for using CAM were relaxation (symptomatic)-feeling healthy (63.8%) and treating cancer (36.2%). No statistically significant difference was found between the use of CAM and their approaches to coping with stress (p > 0.05). As a result of multivariate ordinal logistic regression analysis, education level under high school, having ovary, cervix, and endometrium cancer, being in the first stage of cancer, receiving chemotherapy, receiving surgical treatment, having another cancer patient in the social environment and increased interest in a partner after the diagnosis of cancer was associated with an effective coping with stress (p < 0.05, adjusted R2 = 0.27, 0.79, and 0.32, respectively). Not working, experiencing an abortion, having another cancer patient in their social environment, being in the third stage of cancer, having an extended family, and living in a rural area of residence were associated with ineffective coping with stress (p < 0.05, adjusted R2 = 0.20 and 0.24, respectively).
CONCLUSIONS: The prevalence of CAM use by patients was low. While determining the approaches of the patients to cope with stress, their education level, place of residence, family type, diagnosis of cancer, stage of cancer, treatment, partner support, and stressful life events should be considered. As nurses, we need to be more knowledgeable about the use of CAM to provide correct guidance to our patients for access to accurate and effective information. We need to determine our patients\' stressors and how our patients cope with stress.
Gynäkologische Krebserkrankungen sind langfristige, herausfordernde und belastende Krankheiten. In der Türkei nehmen die meisten Patientinnen mit gynäkologischen Krebserkrankungen Komplementär- und Alternativmedizin in Anspruch. Angesichts der großen Belastungen, denen Patientinnen mit gynäkologischen Krebserkrankungen ausgesetzt sind, müssen sie wissen, wie sie mit Stress umgehen können.Mit dieser Studie sollen die Inanspruchnahme von Komplementär- und Alternativmedizin und die Stressbewältigung von Patientinnen mit gynäkologischer Krebserkrankung ermittelt werden und es sollen die Zusammenhänge zwischen diesen beiden Aspekten und den prädiktiven Faktoren für die Ansätze zur Stressbewältigung bei Frauen mit gynäkologischer Krebserkrankung untersucht werden.Es handelt sich um eine deskriptive Querschnittsstudie. Die Studie wurde mit 204 Patientinnen zwischen April und August 2022 durchgeführt. Die Erhebung der Studiendaten erfolgte durch persönliche Befragung und mithilfe des deskriptiven Informationsformulars sowie der Stress Coping Styles-Skala, die die Patientinnen ausfüllten. Für die Datenanalyse wurden Anzahl, Prozentanteil, Mittelwert, Chi-Quadrat-Test, einfaktorielle ANOVA, t Test und die Spearman-Korrelationsanalyse verwendet. Zur Analyse der multivariaten unabhängigen Zusammenhänge zwischen den Variablen wurde ein multivariates ordinales logistisches Regressionsmodell verwendet mit den SCSS (Stress Coping Styles-Skala)-Domänen als abhängigen Variablen. Es wurde ein 95%-Konfidenzintervall berechnet, und das Signifikanzniveau betrug für alle statistischen Tests α = 0.05.Das Durchschnittsalter der Patientinnen betrug 58.38 ± 12.64 Jahre (32–80 Jahre). Die Prävalenz der Inanspruchnahme von Komplementär- und Alternativmedizin (CAM) durch die Patientinnen lag bei 39.2%, und die häufigsten CAM-Arten waren pflanzliche Produkte (43.8%) und Bittgebete (42.5%). Die Gründe für die Inanspruchnahme von Komplementär- und Alternativmedizin waren Entspannung (symptomatisch), das Gefühl von Gesundheit (63.8%) und die Behandlung der Krebserkrankung (36.2%). Es fand sich kein statistisch signifikanter Unterschied zwischen der Inanspruchnahme von Komplementär- und Alternativmedizin und ihren Ansätzen zur Stressbewältigung (p > 0.05). Die multivariate ordinale logistische Regressionsanalyse zeigte, dass ein Bildungsniveau unterhalb der Oberstufe sowie Ovarial-, Zervix- und Endometriumkarzinom, Krebs im Anfangsstadium, Chemotherapie, operative Behandlung, eine andere Krebspatientin im sozialen Umfeld und ein gesteigertes Interesse an einem Partner nach der Krebsdiagnose mit effektiver Stressbewältigung assoziiert waren (p < 0.05, adjustiertes R2 = 0.27, 0.79 bzw. 0.32). Fehlende Berufstätigkeit, Fehlgeburt/Schwangerschaftsabbruch, eine andere Krebspatientin im sozialen Umfeld, eine Krebserkrankung im dritten Stadium, eine Großfamilie zu haben und in einer ländlichen Gegend zu leben waren mit ineffektiver Stressbewältigung verbunden (p < 0.05, adjustiertes R2 = 0.20 bzw. 0.24).Die Prävalenz der Inanspruchnahme von Komplementär- und Alternativmedizin durch die Patientinnen war gering. Bei der Ermittlung der Ansätze der Patientinnen zur Stressbewältigung sollten ihr Bildungsniveau, ihr Wohnort, ihr Familientyp, die Krebsdiagnose, das Krebsstadium, die Behandlung, die Unterstützung durch den Partner und belastende Lebensereignisse berücksichtigt werden. Als Pflegekräfte müssen wir mehr über die Inanspruchnahme von Komplementär- und Alternativmedizin wissen, um unsere Patientinnen in Hinblick auf den Zugang zu genauen und wirksamen Informationen die richtige Orientierungshilfe zu geben. Wir müssen die Stressfaktoren unserer Patientinnen ermitteln und herausfinden, wie unsere Patientinnen mit Stress umgehen.

SCC (squamous cell carinomas) are among the most common eye neoplasms in horses. In recent studies Haflinger horses with a homozygous genotype for a missense variant in the DDB2 gene (damage specific DNA binding protein 2) had a significant increased risk of developing ocular SCC. The aims of this study were to determine the frequency of the SCC-associated risk allele in the DDB2 gene in Swiss and Austrian Haflinger populations and to validate the previously described phenotypic correlation. For this purpose, Haflingers presented at various horse clinics in Switzerland (n = 21, including 11 SCC cases), privately kept Haflingers (n = 52, including 1 SCC case), and Haflingers from a stud farm in the Austrian Tyrol (n = 53) were recruited. The individual DDB2 genotype of the animals was determined using a polymerase chain ceaction (PCR) test using hair follicle or whole blood samples. Of the 12 horses suffering from SCC, nine had ocular SCC and three had non-ocular SCC. Six of the nine Haflingers with ocular SCC and one of the three Haflingers with non-ocular SCC were homozygous for the DDB2 variant. Of the 113 clinically normal animals, 7/113 were homozygous (6 %) and 42/113 were heterozygous (37 %), which corresponds to an allele frequency of 24,8 % in the control cohort. The risk of ocular SCC occurring in Haflingers is significantly increased with the homozygous DDB2 genotype. However, not all animals with SCC carry this gene variant and not all DDB2 homozygous animals develop SCC, which can be explained by the multifactorial genesis of the disease. Due to the high frequency of the undesirable allele, we recommend taking the individual DDB2 genotype of breeding animals into account in order to avoid homozygous offspring with a greatly increased SCC risk by excluding high-risk matings.
SCC (Plattenepithelkarzinom) zählen bei Pferden zu den häufigsten Neoplasien am Auge. Kürzlich konnte gezeigt werden, dass Haflinger mit homozygotem Genotyp für eine missense Variante im DDB2-Gen (damage specific DNA binding protein 2) ein deutlich erhöhtes Risiko für das Auftreten von okulären SCC aufweisen. Die Ziele dieser Studie bestanden darin, die Häufigkeit des SCC-assoziierten Risikoallels im DDB2-Gen in schweizerischen und österreichischen Haflingerpopulationen zu bestimmen, sowie die zuvor beschriebene Phänotypkorrelation zu validieren. Dazu wurden an verschiedenen Pferdekliniken der Schweiz vorgestellte Haflinger (n = 21, darunter 11 SCC-Fälle), privat gehaltene Haflinger (n = 52, darunter 1 SCC-Fall), sowie Haflinger eines Gestüts im österreichischen Tirol (n = 53) rekrutiert. Der individuelle DDB2-Genotyp der Tiere wurde per PCR-Test anhand von Haarwurzel- oder Vollblutproben bestimmt. Unter den insgesamt 12 SCC-erkrankten Pferden fanden sich neun mit okulären und drei mit nicht-okulären SCC. Sechs der neun Haflinger mit okulärem SCC und einer der drei Haflinger mit nicht-okulärem SCC waren homozygot für die DDB2-Variante. Von den 113 klinisch unauffälligen Tieren waren 7/113 homozygot (6 %) und 42/113 heterozygot (37 %), was einer Allelfrequenz von 24,8 % in der Kontrollkohorte entspricht. Das Risiko für das Auftreten des okulären SCC beim Haflinger ist mit dem homozygoten DDB2-Genotyp deutlich erhöht. Allerdings tragen nicht alle SCC-erkrankten Tiere diese Genvariante und nicht alle DDB2-homozygoten Tiere entwickeln ein SCC, was sich mit der multifaktoriellen Genese der Erkrankung erklären lässt. Aufgrund der hohen Frequenz des unerwünschten Allels empfehlen wir, den individuellen DDB2-Genotyp von Zuchttieren zu beachten, um so reinerbige Nachzucht mit stark erhöhtem SCC-Risiko durch den Ausschluss von Risikoanpaarungen zu vermeiden.
Les carcinomes épidermoïdes (CE) sont parmi les néoplasmes oculaires les plus fréquents chez les chevaux. Des études récentes ont montré que les chevaux Haflinger présentant un génotype homozygote pour un variant faux-sens dans le gène DDB2 (damage specific DNA binding protein 2) avaient un risque significativement plus élevé de développer un CE oculaire. Les objectifs de cette étude étaient de déterminer la fréquence de l’allèle à risque associé au CE dans le gène DDB2 dans les populations suisses et autrichiennes de Haflinger et de valider la corrélation phénotypique décrite précédemment. Pour ce faire, des Haflingers présentés dans différentes cliniques équines en Suisse (n = 21, dont 11 cas de CE), des Haflingers privés (n = 52, dont 1 cas de CE) et des Haflingers d’un haras du Tyrol autrichien (n = 53) ont été recrutés. Le génotype DDB2 individuel des animaux a été déterminé à l’aide d’un test de réaction en chaîne par polymérase (PCR) utilisant des échantillons de follicules pileux ou de sang total. Sur les 12 chevaux souffrant de CE, neuf avaient un CE oculaire et trois un CE non oculaire. Six des neuf Haflingers atteints de CE oculaire et un des trois Haflingers atteints de CE non oculaire étaient homozygotes pour la variante DDB2. Sur les 113 animaux cliniquement normaux, 7/113 étaient homozygotes (6 %) et 42/113 étaient hétérozygotes (37 %), ce qui correspond à une fréquence d’allèle de 24,8 % dans la cohorte de contrôle. Le risque de CE oculaire chez les Haflingers augmente de manière significative avec le génotype DDB2 homozygote. Cependant, tous les animaux atteints de CE ne sont pas porteurs de cette variante génétique et tous les animaux homozygotes DDB2 ne développent pas de CE, ce qui peut s’expliquer par la genèse multifactorielle de la maladie. En raison de la fréquence élevée de l’allèle indésirable, nous recommandons de tenir compte du génotype DDB2 individuel des animaux reproducteurs afin d’éviter une progéniture homozygote présentant un risque fortement accru de CE en excluant les accouplements à haut risque.
Gli SCC (carcinomi a cellule squamose) sono tra le neoplasie oculari più comuni nei cavalli. Recenti studi hanno dimostrato che i cavalli Haflinger con un genotipo omozigote per una variante missenso nel gene DDB2 (damage specific DNA binding protein 2) presentano un significativo aumento del rischio di sviluppare SCC oculari. Gli obiettivi di questo studio erano di determinare la frequenza dell’allele di rischio associato agli SCC nel gene DDB2 nelle popolazioni di cavalli Haflinger svizzere e austriache e convalidare la correlazione fenotipica precedentemente descritta. A tale scopo, sono stati inclusi nello studio cavalli Haflinger presentati in varie cliniche veterinarie in Svizzera (n = 21, di cui 11 casi di SCC), cavalli Haflinger tenuti privatamente (n = 52, di cui 1 caso di SCC) e cavalli Haflinger provenienti da un allevamento in Tirolo, Austria (n = 53). Il genotipo individuale del gene DDB2 degli animali è stato determinato mediante un test PCR utilizzando campioni di radici dei peli o sangue intero. Dei 12 cavalli affetti da SCC, nove avevano SCC oculari e tre avevano SCC non oculari. Sei dei nove Haflinger con SCC oculari e uno dei tre Haflinger con SCC non oculari erano omozigoti per la variante DDB2. Dei 113 animali clinicamente normali, 7/113 erano omozigoti (6 %) e 42/113 erano eterozigoti (37 %), corrispondenti a una frequenza dell’allele del 24,8 % nella coorte di controllo. Il rischio di sviluppare SCC oculari nei cavalli Haflinger è significativamente aumentato con il genotipo omozigote per il gene DDB2. Tuttavia, non tutti gli animali affetti da SCC portano questa variante genetica e non tutti gli animali DDB2 omozigoti sviluppano un SCC, il che può essere spiegato dalla natura multifattoriale della malattia. A causa dell’alta frequenza dell’allele indesiderato, raccomandiamo di tenere conto del genotipo individuale del gene DDB2 negli animali da riproduzione al fine di evitare una discendenza omozigote con un elevato rischio di SCC, quindi escludendo gli accoppiamenti ad alto rischio.

This case series describes the clinical course of ocular and non-ocular squamous cell carinoma (SCC) in the Haflinger horse and is intended to raise awareness of the high recurrence rate and tendency to metastasize. Eight Haflingers with histologically confirmed SCC were included, five ocular and three non-ocular, who were presented at the Institut Suisse de Médecine Équine (ISME) Bern between July 2015 and January 2022. The ocular SCC cases were all presented because of an apparent mass, which in most cases was post-treatment recurrence. The occurrence of recurrences was observed between 3 weeks and 16 years after initial therapy. Four of five Haflingers with ocular SCC had an enucleation, three of which were clinically normal at the time of the completion of this study, one case was euthanized due to confirmed metastases and one due to lameness. The result of enucleations for therapy of ocular SCC was good if no metastases occurred. Of the three non-ocular SCC cases, only one case, a penile SCC, had an apparent mass. Therapy was initiated in this case, while the other two cases were euthanized shortly after diagnosis due to the poor prognosis of SCC in the appropriate locations (maxillary sinus, mandible). Metastases occurred three and two years after removal of the primary tumor in ocular SCC in the scapula, liver and lungs and in non-ocular SCC from the penis to the nostrils. Since a postmortem pathological examination was not carried out on all Haflingers, further metastases cannot be ruled out. Haflingers with SCC should be monitored by a veterinarian over the long term, as recurrences and/or metastases can still occur years later.
Diese Fallserie beschreibt den klinischen Verlauf des okulären und nicht-okulären Plattenepithelkarzinoms (SCC) beim Haflinger und soll für die hohe Rezidivrate und Metastasierungstendenz sensibilisieren. Eingeschlossen wurden acht Haflinger mit histologisch bestätigtem SCC, davon fünf okuläre und drei nicht-okuläre, die zwischen Juli 2015 und Januar 2022 an der Pferdeklinik Institut Suisse de Médecine Équine (ISME) Bern vorgestellt wurden. Die okulären SCC wurden alle aufgrund einer augenscheinlichen Masse vorgestellt, bei der es sich in den meisten Fällen um ein Rezidiv nach bereits erfolgter Behandlung handelte. Das Auftreten von Rezidiven wurde zwischen 3 Wochen und 16 Jahren nach initialer Therapie beobachtet. Bei vier von fünf Haflingern mit okulärem SCC wurde eine Enukleation des Augapfels vorgenommen, davon sind drei zum Zeitpunkt des Abschlusses dieser Studie klinisch unauffällig, ein Fall wurde aufgrund bestätigter Metastasen und einer aufgrund von Lahmheit euthanasiert. Das Resultat der Enukleationen zur Therapie der okulären SCC war gut, solange keine Metastasen auftraten. Von den drei nicht-okulären SCC-Fällen wies nur ein Fall, ein SCC am Penis, eine augenscheinliche Masse auf. In diesem Fall wurde eine Therapie eingeleitet, während die beiden anderen Fälle aufgrund der schlechten Prognose von SCC in den entsprechenden Lokalisationen (Sinus maxillaris, Mandibula) kurz nach der Diagnosestellung euthanasiert wurden. Metastasen traten drei bzw. zwei Jahre nach Entfernung des Primärtumors bei einem okulären SCC in Scapula, Leber und Lunge und bei einem nicht-okulären SCC vom Penis in den Bereich der Nüstern auf. Da nicht bei allen Haflingern eine postmortale pathologische Untersuchung durchgeführt wurde, können weitere Metastasen nicht ausgeschlossen werden. Haflinger mit SCC sollten unbedingt langfristig tierärztlich überwacht werden, da auch nach Jahren noch Rezidive und/oder Metastasen auftreten können.
Cette série de cas décrit l’évolution clinique des carcinomes épidermoïdes (CE) oculaires et non oculaires chez le cheval Haflinger et vise à faire prendre conscience du taux de récidive élevé et de la tendance à la formation de métastases. Huit Haflinger avec un CE confirmé histologiquement, cinq oculaires et trois non-oculaires, qui ont été présentés à l’Institut Suisse de Médecine Équine (ISME) Berne entre juillet 2015 et janvier 2022, ont été inclus. Les cas de CE oculaires ont tous été présentés en raison d’une masse apparente, qui dans la plupart des cas était une récidive post-traitement. La survenue des récidives a été observée entre 3 semaines et 16 ans après le traitement initial. Quatre des cinq Haflinger atteints de CE oculaire ont subi une énucléation, dont trois étaient cliniquement normaux au moment de l’achèvement de l’étude, un cas ayant été euthanasié en raison de métastases confirmées et un autre en raison d’une boiterie. Le résultat des énucléations pour la thérapie du CE oculaire était bon s’il n’y avait pas de métastases. Sur les trois cas de CE non oculaires, seul un cas, un CE pénien, présentait une masse apparente. Le traitement a été initié dans ce cas, tandis que les deux autres cas ont été euthanasiés peu de temps après le diagnostic en raison du mauvais pronostic des CE dans les localisations constatées (sinus maxillaire, mandibule). Des métastases sont apparues trois et deux ans après l’ablation de la tumeur primaire dans le cas du CE oculaire, au niveau de l’omoplate, du foie et des poumons et, dans un cas de CE non oculaire, celui du pénis, aux narines. Étant donné que tous les Haflinger n’ont pas fait l’objet d’un examen pathologique post-mortem, on ne peut exclure la possibilité d’autres métastases. Les Haflinger atteints de CE doivent être suivis à long terme par un vétérinaire, car des récidives et/ou des métastases peuvent encore survenir des années plus tard.
Questa serie di casi descrive l’andamento clinico dei carcinomi a cellule squamose (SCC) oculari e non oculari nel cavallo di razza Avelignese e ha lo scopo di sensibilizzare riguardo all’alta frequenza di recidive e alla propensione alla metastatizzazione. Sono stati inclusi otto Avelignesi con SCC confermati istologicamente, di cui cinque oculari e tre non oculari, che sono stati presentati presso l’Istitut Suisse de Médecine Équine (ISME) di Berna tra luglio 2015 e gennaio 2022. I casi di SCC oculare sono stati tutti presentati a causa di una massa apparente, che nella maggior parte dei casi era una recidiva post-trattamento. La comparsa delle recidive è stata osservata tra 3 settimane e 16 anni dopo la terapia iniziale. Quattro dei cinque Avelignesi affetti da SCC oculare sono stati sottoposti ad enucleazione, tre dei quali erano clinicamente normali al momento della conclusione di questo studio, un caso è stato eutanasizzato a causa di metastasi confermate e uno a causa di zoppia. Il risultato dell’enucleazione come terapia per il SCC oculare è stato positivo se vi erano metastasi. Dei tre casi di SCC non oculare, solo un caso, un SCC penieno, presentava una massa apparente. La terapia è stata avviata in questo caso, mentre gli altri due casi sono stati eutanasizzati poco dopo la diagnosi a causa della scarsa prognosi del SCC dovuta alla loro localizzazione (seno mascellare e mandibola). Le metastasi sono comparse due e tre anni dopo l’asportazione del tumore primario nel SCC oculare nella scapola, nel fegato e nei polmoni, e nel SCC non oculare nel pene e nell’area delle narici. Poiché non è stata effettuata un’analisi patologica post mortem su tutti gli Avelignesi, ulteriori metastasi non possono essere escluse. Gli Avelignesi affetti da SCC dovrebbero essere monitorati a lungo termine da un veterinario, poiché le recidive e/o le metastasi possono ancora verificarsi dopo anni.

High-quality studies are necessary and feasible in personalised medicine in order to evaluate the benefits across the entire treatment chain of biomarker tests and resulting treatments in regard to patient-relevant endpoints. With the introduction of genome sequencing in oncology, a considerable number of new treatment concepts with mostly low-quality evidence can be expected. High quality requirements, interdisciplinary cooperation structures, knowledge-generating care and the connection of patient care at the expense of the statutory health insurance funds, with research at the expense of the manufacturers or public funding, are necessary.

Background: Several reviews are available on the effects of specific nursing tasks in oncology care. However, a synthesis across cancer entities and stages is lacking. Aim: To synthesise the results of reviews assessing the scope and effectiveness of tasks of nurses specifically qualified in cancer care. Methods: We conducted an Umbrella Review based on systematic searches in six databases and a search for grey literature following a priori-defined inclusion criteria. Further steps: standardised data extraction and quality assessment, determination of the degree of overlap, and structured narrative summary on outcome measures of health-related quality of life, symptom burden, utilisation of care services/resources, and patient satisfaction. All reviews were categorised according to the EONS Cancer Nursing Education Framework and the Omaha System Intervention Scheme. Results: After screening 2,657 references, 11 reviews (10 high quality) for a total of 148 studies were included. Specially qualified nurses and advanced practice nurses take on a variety of tasks in the disease process, especially related to education, counselling, and case management. Effects on outcome measures are mixed, with increased indications of reduced symptom burden. Conclusion: Specially qualified nurses with expanded roles have the potential to contribute to improved oncology care. This emphasises the importance of appropriate task profiles and qualification programs. More well-reported studies based on theoretical framework models are needed.

BACKGROUND: The Federal Standardized Medication Plan (BMP) offers the possibility of providing patients with specific information on drug therapy. Cancer patients who are treated with oral anticancer drugs have a great need for information as they take the drugs independently in their home environment. Providing specific instructions for oral anticancer drugs may enhance the patient role and improve medication safety.
METHODS: In a four-step process (needs assessment, compilation of the text modules, pilot and main phase), an oncologic addendum for the BMP was developed and subjected to an acceptance test. Also, a needs assessment was conducted with oncologists, pharmacists and patients to identify important information to be included in the oncologic addendum. Subsequently, the acceptability of the BMP including the addendum (\'Onko-BMP\') was tested among health care providers and patients in two study phases (pilot and main phase). Updates made to the Onko-BMP were documented at each follow-up visit. At the end of the observation period, discrepancies between a brown bag review and the latest Onko-BMP were identified to evaluate its completeness. In addition, acceptance of the Onko-BMP was analyzed using qualitative methods. At the end of the pilot phase the patients were interviewed and completed a questionnaire at the end of the main phase. Focus interviews and a focus group were conducted with the health care providers.
RESULTS: A total of 347 health care providers and cancer patients participated in the needs assessment, including 167 oncologists, 130 pharmacists, and 50 patients. Suggestions for additional information to be included in the oncologic addendum mainly included instructions for how to take the medication, therapy-limiting side effects as well as potentially relevant interactions with over-the-counter drugs. Ten patients participated in the pilot phase and 60 patients in the main phase of the project. The use of the Onko-BMP was positively evaluated by all participants. The majority of the 178 updates in the main phase were made by the patients themselves. Most frequently, missing items were added (62). After comparison with the brown bag at the end of the observation period, 175 discrepancies for a total of 270 products, including food supplements (mean 6.3 ± 3.9), and 245 drugs (mean 5.7 ± 3.1) taken by the patients were detected, 49 of which were due to missing drugs on the Onko-BMP, mainly on-demand medication (30). 82 documented discrepancies were for prescription drugs. In the qualitative surveys, health care providers indicated that there is a high need for the Onko-BMP. In particular, its use could strengthen the patient\'s role in therapy. The frequently missing or poor technical requirements for working with the BMP were perceived as limiting its widespread use. Assignment of clear responsibilities and remuneration of all professionals involved were identified as important influential factors for an efficient use of the Onko-BMP. Patients considered the added value of the Onko-BMP primarily to be in their being able to inform their treating physicians and pharmacists about their medication.
CONCLUSIONS: The developed Onko-BMP gained a high level of acceptance among patients and health care providers. It can improve education about oral anticancer drugs and thereby strengthen the patient role. However, in order to ensure widespread use of the tool, the necessary conditions should be created on the part of the health care providers. In particular, the IT infrastructure for its use in daily routine needs to be improved in order to exploit its full potential and ensure its successful large-scale implemention.

BACKGROUND: Cancer patients are facing a variety of treatment and other disease-related decisions. This study aims to provide insights into preferred and perceived participation roles in decision-making among patients with diverse tumors using the German Cancer Information Service (CIS).
METHODS: Patients\' decision-making preferences and experiences were assessed as a part of a cross-sectional survey among CIS users. An adapted version of the Control Preferences Scale (CPS) was used to assess preferred and perceived participation roles in eight different areas of medical decision-making (e.g., choice of medication, termination of treatment). Logistic regression analyses were applied to explore preference matching and to analyze associations between participation roles and sociodemographic variables. Moreover, we examined preferences and perceptions of participation roles across different decision situations.
RESULTS: In the final sample (N = 1566, 64.9% female, mean age = 61.6), almost half of the patients (47.1%) preferred to take a collaborative role in decisions on treatment methods, whereas 36.3% preferred an active role and 15.9% a passive role. Collaborative role preferences frequently (40.7%) coincided with experiencing a passive role and predicted a reduced chance of a match between preferences and experiences (OR = 0.57, p = .001). A higher level of education was associated with a lower chance of preferring and perceiving a passive role (OR = 0.85, p < .01). Compared with men, women had increased odds of preferring (OR = 1.45, p < .05) and of actually taking (OR = 2.04, p < .001) a passive role in medical encounters. Preferred participation roles regarding treatment methods were highly correlated with preferences in all other decision areas (r > .50, p < .001) except decisions about family involvement.
CONCLUSIONS: The study reveals well-known deficits in the fulfilment of patients\' collaborative role preferences across different areas of medical decision-making in a sample of CIS users characterized by high information-seeking behavior. Participation roles were not only influenced by the patients\' level of education but also by their gender. The gender effect may be more pronounced than previous studies suggest. These effects should be considered in the development of interventions to promote shared decision-making. Additionally, study results indicate that preferences for participation in decisions about treatment methods, as assessed by the CPS, can be generalized to other areas of medical decision-making.

BACKGROUND: In addition to physical, psychological and social effects, economic effects and the associated financial burden of a cancer diagnosis may also gain in importance during prolonged disease progression. Counselling by social services is an important factor in coping with this burden.
METHODS: People employed in social work in oncology were invited to participate in a survey. The survey comprises 16 items on the perception of financial burdens, changes in the relevance of the topic, risk factors and current counselling practice.
RESULTS: 81% of the respondents reported that the financial burden arising from a cancer diagnosis is a relevant topic of consultation for at least half of the patients. For 55%, this topic has become more important in recent years, which is due to higher survival rates, an increased number of younger patients, and poorer social security and working conditions.
CONCLUSIONS: Despite comprehensive insurance coverage, the financial burden of cancer patients has also gained in importance in Germany and must be increasingly taken into account in everyday social service counselling. Due to numerous risk factors and complex reasons, further measures are required to enable the early identification of risk constellations and to improve the situation of those affected.

How do nurses experience and interpret the screening of hospitalised cancer patients by means of the distress thermometer? - A qualitative study Abstract. Background: People with cancer experience distress and may need professional support. In 2012, the University Hospital Zurich introduced its distress thermometer (DT) screening, whereby all inpatients were to be screened to gauge their support need. However, after five years, the screening rate was 40 % and the referral rate to psycho oncology was 7.9 %, surprisingly low. Aim: The aim of this qualitative study was to describe how nurses experience the screening and how they interpret the screening and referral rate. Methods: The evaluation of three focus group interviews with 14 nurses followed the principles of qualitative content analysis according to Mayring. Results: The analysis revealed four main categories. The first category \"Trying to perform useful screening in a complex daily routine\" comprises three subcategories: \"Using the benefits of screening for comprehensive care\", \"The best way to recognize the individuality of the counterpart\" and \"Failing due to structural and personal barriers\". Three further main categories addressing nurses\' personal attitudes complete the screening experience: \"Experiencing fewer difficulties due to competence and experience\", \"Being careful due to hesitations\", and \"Reflecting one\'s responsibility\". Conclusions: Nurses want to use the DT. However, they need more practical and scientific support to usefully integrate screening into their everyday life.
Zusammenfassung. Hintergrund: Krebserkrankte Menschen können psychosozial so belastet sein, dass sie Unterstützung benötigen. Seit 2012 sollen Pflegefachpersonen (PFP) im Universitätsspital Zürich alle eintretende Krebspatienten mit Hilfe des Belastungsthermometers (BT) screenen, um den Unterstützungsbedarf zu erkennen. Nach fünf Jahren war die Screeningrate mit 40 % sowie die Rate der psychoonkologischen Konsile mit 7,9 % wider Erwarten niedrig. Ziel: Das Ziel dieser qualitativen Studie bestand darin, zu beschreiben, wie PFP das Screening mit dem BT erlebten und wie sie die geringe Screening- bzw. Überweisungsrate interpretierten. Dies sollte ein besseres Verständnis der Einflussfaktoren ermöglichen. Methode: Die Auswertung von drei Fokusgruppeninterviews mit 14 PFP erfolgte mithilfe der qualitativen Inhaltsanalyse nach Mayring. Ergebnisse: Die Analyse ergab vier Hauptkategorien. „Der Versuch, das nützliche Screening im komplexen Alltag anzuwenden “ steht im Mittelpunkt. Die drei Unterkategorien lauten: „Das hilfreiche Screening für eine ganzheitliche Pflege nutzen“, „Der beste Weg, die Individualität des Gegenübers zu erfassen“ und „An strukturellen und menschlichen Hindernissen scheitern“. Drei weitere Hauptkategorien zur persönlichen Haltung der PFP ergänzen das Screeningerleben: „Weniger Schwierigkeiten durch Kompetenz und Erfahrung erleben“, „Aufgrund von Hemmschwellen vorsichtig sein“ und „Die eigene Zuständigkeit hinterfragen“. Schlussfolgerungen: Die PFP möchten das BT nutzen. Sie benötigen jedoch praktische und wissenschaftliche Unterstützung, um es gewinnbringend in den Alltag zu integrieren.