Versorgungsforschung in der Psychoonkologie

Zusammenfassung

Hintergrund

Die Psychoonkologie wird heute als konzeptionell wichtiger Bestandteil der medizinischen Versorgung in allen Bereichen wie der Primärversorgung im Akutkrankenhaus, der ambulanten oder stationären Rehabilitation sowie der ambulanten Versorgung angesehen. Trotz einiger Fortschritte in der psychoonkologischen Versorgung in Deutschland sind noch zahlreiche Lücken insbesondere im ambulanten Bereich sowie Verbesserungsbedarf in allen Versorgungsbereichen festzustellen. Daher sind die Themen der psychoonkologischen Versorgungsforschung sehr vielfältig. Dieser Übersichtsbeitrag konzentriert sich auf die in der S3-Leitlinie genannten zentralen Aufgabengebiete der Psychoonkologie und benennt die sich daraus ableitenden Bereiche psychoonkologischer Versorgungforschung.

Methoden und Ergebnisse

Die Aufgabenbereiche der Versorgungsforschung im Bereich Psychoonkologie werden anhand von 4 Themen zusammengefasst: (1) Belastungsscreening und Psychodiagnostik, (2) psychoonkologische Interventionen, (3) Inanspruchnahme psychoonkologischer Versorgung und Versorgungsbarrieren sowie (4) Qualitätssicherung. Der jeweilige Kenntnistand wird auf der Basis einer selektiven Literaturrecherche dargestellt und zukünftige Aufgaben werden kurz skizziert.

Schlussfolgerungen

Die psychoonkologische Versorgungsforschung kann mit dazu beitragen, Lücken in der psychosozialen Versorgung aufzudecken und Lösungen für eine verbesserte Patientenversorgung aufzuzeigen.

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Aktueller Stellenwert der zytoreduktiven Tumornephrektomie bei Patienten mit synchron metastasiertem Nierenzellkarzinom

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Virtual quad zygoma implant placement using cone beam computed tomography: sufficiency of malar bone volume, intraosseous implant length, and relationship to the sinus according to the degree of alveolar bone atrophy

Publication date: Available online 18 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Bertos Quílez, R. Guijarro-Martínez, S. Aboul-Hosn Centenero, F. Hernández-Alfaro
The objective of this study was to investigate the malar bone volume and length that a zygomatic implant can engage, and the relationship to the sinus according to the degree of alveolar bone atrophy. A three-dimensional evaluation was performed using cone beam computed tomography scans from 23 patients with a totally edentulous maxilla; quad zygoma implants were virtually placed. The predictor variable was the amount of malar bone volume and length that a zygomatic implant can engage. The primary outcome variable was the relationship to the sinus according to the degree of alveolar bone atrophy. Other variables were the residual alveolar bone height to the floor of the sinus and the nasal cavity. The mean volume of malar bone engaged in this sample of 92 zygomatic implants was 0.19±0.06cm³. The implant had an extrasinus path in 60.9% of cases, a parasinus path in 25%, and an intrasinus path in 14.1%. The results suggest that the average volume of malar bone engaged by a zygomatic implant is constant regardless of implant position and the degree of alveolar bone atrophy. As alveolar atrophy increases, the trajectory of the implant becomes more parasinus and intrasinus. The examiners were able to find enough bone to adequately distribute the implants in all cases.



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The difference between registered natural head position and estimated natural head position in three dimensions

Publication date: Available online 18 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Zhu, A. Keeling, T.C. Hsung, Y. Yang, B. Khambay
This study determined the intra-rater and inter-rater reliability of re-orientating three-dimensional (3D) facial images into the estimated natural head position. Three-dimensional facial images of 15 pre-surgical class III orthognathic patients were obtained and automatically re-orientated into natural head position (RNHP) using a 3D stereophotogrammetry system and in-house software. Six clinicians were asked to estimate the NHP of these patients (ENHP); they re-estimated five randomly selected 3D images after a 2-week interval. The differences in yaw, roll, pitch, and chin position between RNHP and ENHP were measured. For intra-rater reliability, the intra-class correlation coefficient (ICC) values ranged from 0.55 to 0.77, representing moderate reliability for roll, yaw, pitch, and chin position, while for inter-rater reliability, the ICC values ranged from 0.38 to 0.58, indicating poor to moderate reliability. The median difference between ENHP and RNHP was small for roll and yaw, but larger for pitch. There was a tendency for the clinicians to estimate NHP with the chin tipped more posteriorly (6.3±5.2mm) compared to RNHP, reducing the severity of the skeletal deformity in the anterior–posterior direction.



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Marginal or segmental mandibulectomy: treatment modality selection for oral cancer: a systematic review and meta-analysis

Publication date: Available online 18 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L. Gou, W. Yang, X. Qiao, L. Ye, K. Yan, L. Li, C. Li
Surgery is the most well established mode of initial definitive treatment for the majority of oral cancers. The most important decision in terms of tumour ablation in oral cancers when the jaws are potentially involved is the management of the mandible. The aim of this study was to explore the differences in survival rate and disease control between patients undergoing marginal mandibulectomy and patients undergoing segmental mandibulectomy using a systematic review and meta-analysis approach. A total of 15 cohort studies, including 1672 participants, were identified. Meta-analysis provided weak evidence in favour of segmental mandibulectomy for local control. Segmental mandibulectomy gave 73% better disease-free survival than marginal mandibulectomy when the marrow was invaded (P=0.04). The overall survival rate was evaluated, and no statistically significant difference was found between the two different mandibulectomy approaches, although the results showed a trend in favour of segmental mandibulectomy which could increase the overall survival by 23%. Based on these findings regarding the survival rate and efficacy of disease control, this study indicates that a marginal mandibulectomy may be recommended for cases with no invasion or superficial invasion of the mandibular cortex, and a segmental mandibulectomy may be a more reasonable choice for patients with extensive mandibular cortex invasion or medullary invasion.



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A two-year follow-up of surgical and non-surgical treatments in patients with masticatory muscle tendon-aponeurosis hyperplasia

Publication date: Available online 18 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Hayashi, T. Sato, Y. Fukushima, A. Takano, I. Sakamoto, T. Yoda
This study re-examined the usefulness of surgery for the management of masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) through a comparison of the outcomes between patients who underwent surgery and those who did not. The duration of follow-up was 2 years. Twenty-eight patients who attended the study hospital and were given a diagnosis of MMTAH were included. Nineteen patients underwent surgery (surgical group) and nine patients were instructed to open their mouths wide once a day and did not undergo surgery (non-surgical group). Maximum mouth opening, impairment of daily activities, satisfaction, and the status of mouth opening training were evaluated after surgery. The mean increase in mouth opening after 2 years was 20.2mm in the surgical group and 2.4mm in the non-surgical group. Adequate mouth opening training led to satisfactory results 2 years postoperative, and sustained mouth opening training for 6 months after surgery was a key factor for obtaining good outcomes. The general condition and personality of individual patients should be evaluated carefully before surgery to estimate whether or not they can endure the pain associated with postoperative mouth opening training. The results of this study suggest that the surgical procedure is useful for the management of MMTAH.



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Dentoskeletal parameters related to visual perception of facial asymmetry in patients with skeletal class III malocclusion after orthognathic surgery

Publication date: Available online 17 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C.-W. Lin, Y.-C. Wang, Y.-H. Chen, E.W.-C. Ko
The purpose of the study is to explore the critical parameters determining the visual perception of postoperative facial symmetry. This study retrospectively included 24 patients with skeletal class III malocclusion and double-jaw orthognathic surgery (OgS). The patients were classified according to the outcome of subjective visual perception scores (SVPS) based on the postoperative frontal images by 10 orthodontists: symmetrical surgical outcome (S group, n=12) and facial asymmetry after surgery (A group, n=12). The 3D dentofacial measurements from cone beam computed tomography, were compared between the S and A groups. The relationship of all variables in all patients with the SVPS was explored by Spearman correlation coefficient. Significant differences were observed in the midline parameters in the mandible, the B point, gnathion and menton, and the mandibular border axis as well as in the discrepancy of the chin morphology between the two groups (P<0.05). The findings demonstrated that the midline parameter deviation, shape of the mandibular border, and the contour of menton morphology play the major role in the visual perceptions of postoperative asymmetry.



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