Untersuchung von Therapieentscheidungen in Bezug auf aktuelle Leitlinien bei postmenopausalen Patientinnen mit Mammakarzinom : Erhebung anhand der Versorgungssituation am Marburger Universitätsklinikum

The Mamma carcinoma is with more than 57.000 newly diagnosed cases the most frequent cancer of women in Germany. The average age at which cancer is contracted is 61 years and the risk to come down with breast cancer increases with age. After diagnose there are guidelines for the therapy decision. This thesis summarizes the available guidelines including the S3 guideline, recommendations of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and recommendations of the conference of St. Gallen organized according to the different therapy principles and the validity period in table form. In terms of the prognosis of the future age structure of the population the attending patient collective grows older and older. A rising number of malign diseases as well as comorbidity can be expected. These comorbidity define the prognosis on older patients significantly. The treatment strategy should not only match with the carcinoma but also on the patient himself in order to avoid an under as well as overtreatment. Although 60% of all tumour patients are older, they were initially excluded from the clinical trials. Within the retrospective paper, on the base of files of a chosen patient collective from the university hospital of Marburg, the treatment decisions from September 2003 till June 2007 will be examined according to the existing guidelines of postmenopausal women 50 years and older with being diagnosed for the first time with a primary or primary metastasizing Mamma carcinoma at the time of diagnosis. The conformable and non-conformable treated patients according to the guidelines were compared with patient data as well as tumour characteristics, in order to find out criteria which justify a divergence to the therapeutic recommendation of the guidelines. The average age of the patient collective was 69,66 years. Most of the carcinoma were with 59,9% T1-Tumore. The larger part is nodal negative (56,9%) and with the first diagnosis there were no distant metastasis (86,4%). Concerning tumour progression and metastasis with increasing age a trend towards advanced radiation was able to be noted down. The part of T1-tumours decreases from 72,9% (50th -64th year of life) till 44,9% (75th -84th years of life) and the metastasizing tumour decreases from 3,1% to 7,7%. According to the other examined tumour characteristics no other differences in the age structure were found. With a good general condition of the patients there a explicit differences within the age groups. The part of patients with an ECOG of 0-1 decreases significantly with age. As there are 93-100% patients with a ECOG of 0-1 in group 1-2 applies this only to 50-69% of the patients in group 3-4. Similar results can be found with the ASA-Score and CIRS. 96,4% of the cases were a operative therapy of the breast recommended (31,6% mastectomy, 70,9% BET) and 24% of the patients were a chemotherapy recommended. The chemotherapy was recommended to patients between 50 and 74 years of age, beyond that age range it was rarer. Regardless of age 45,7% of the patients collective were recommended Tamoxifen, 41,3% were recommended a aromatase inhibitor (also in combination) and 2,4% were recommended an antibody therapy with Trastuzumab. 14, 19% of the patients were, after being introduced to the Tumourboard Conference recommended, a from this individual time of diagnosis existing guidelines dissenting therapy. The group without the guidelines conformable therapy recommendation showed in comparison to the group with the guidelines conformable therapy only tendencies to older age, a worse general condition and serious comorbidity status. There was no individual criteria of the routinely collected data found, which could be brought together with the existing guidelines or justifies them. So there is still the question whether the conformable guideline therapy the best possible treatment was and if a divergence is seen as a individual improper-treatment. This problem is from the retro perspective point of view not easily collected. Therefore geriatric assessments had to be developed, which are realizable throughout the clinical practice and which can be established in the standardized procedure. From this point of view a objective risk evaluation would be possible. Otherwise a prospective case control study would ethical not be justifiable. It is from great importance that for the aim of the optimal therapy for the aging population and as a prerequisite for basic formulations of evidence-based treatment recommendations future therapeutic studies of older patients especially with comorbidities will be included.