Objective: Due to the increasing success and survival rates in the primary treatment of malignancies derived from the CNS as well as the hematopoietic system, endocrine late effects of cancer and its therapy are of growing importance. Despite evaluation of these late effects in patients treated for cancer in childhood, the impact on adults remains largely unclear. Methods: 1035 adult patients primarily diagnosed with a CNS malignancy, a Hodgkin (HL) or non-Hodgkin lymphoma (NHL) between 1998 and 2008 were recruited via the regional epidemiological cancer registry covering w2.8 million inhabitants in the federal state of Schleswig-Holstein, Northern Germany. The prevalence of endocrine disorders and current psychosocial impairment was assessed employing several questionnaires (SF-36v1, WHO-5). Results: Fully completed questionnaires of 558 patients were available for subsequent analysis showing markedly reduced overall performance and psychological status when compared to German reference data. Thyroid disorders were reported in 16.3% of patients with 10.4% suffering from hypo-and 5.9% from hyperthyroidism. Overall, 17.6% stated to be affected by diabetes mellitus with an increased rate of 21.1% among NHL patients and 11.5% of participants were affected by osteoporosis. Conclusion: Compared to German population based studies on the prevalence of diabetes mellitus, osteoporosis and thyroid disorders the frequency of all these endocrine problems was significantly increased in CNS, HL, and NHL cancer survivors. These data confirm that not only children and adolescents but also adult cancer patients are at risk for therapy associated endocrine late effects.

Introduction: Bisphosphonates are well known above all for their use in the treatment of osteoporosis. They also play an important role as accompanying therapy for advanced tumour diseases with extensive spread into the skeletal system. Their adjuvant use in the treatment of breast cancer without bony metastases is currently a subject of controversial discussion. The objective of the present evaluation is to describe the use of bisphosphonates in the therapy for breast cancer. We will show how frequently bisphosphonates are used, which bisphosphonates are preferred and what specific features patients under bisphosphonate therapy exhibit. Methods and Materials: The pseudonymous data set from the biobank of the German PATH foundation was used for the evaluation. From the total collective, 2492 patients were selected after consideration of the inclusion and exclusion criteria. The selected patient collective was divided into two?groups (with and without bisphosphonate therapy) and the two groups compared with one another with the help of descriptive statistics. Results: 17.5?% of the 2492 patients had prescriptions for a bisphosphonate as part of their therapy. The most frequently administered bisphosphonate was zoledronate. Pathological (induced by tumour therapy) osteoporosis was the most frequently stated indication among the bisphosphonate patients, followed by consumption starting prior to the breast cancer therapy and treatment of bony metastases. Patients under bisphosphonate and antihormonal therapy frequently received an aromatase inhibitor as the active principle in the antihormonal therapy whereas patients under antihormonal therapy but without bisphosphonates more frequently received tamoxifen as active principle. Ten of the 2492 patients reported receiving bisphosphonate therapy as prophylaxis for bony metastases without a documented and approved indication. Use of bisphosphonates in the course of the GAIN, ICE, SUCCESS or, respectively, NATAN trials was reported by 29 of the 2492 patients. Conclusions: In the PATH collective, bisphosphonates were employed above all for the treatment of (tumour therapy-induced) osteoporosis and bony metastases. Off-label use and participation in clinical trials played only a minor role in this patient ...

PurposeThe aim of this cross-sectional health care study (use of bisphosphonates in primary tumors of the mammae, EBisMa) is to determine how often bisphosphonate medication is used in patients with non-metastatic primary breast cancer treatment, but who do not suffer from osteoporosis. Furthermore, we describe patients’ characteristics and the most frequently used type of bisphosphonate in adjuvant therapy.Materials and MethodsThe study population included primary breast cancer patients of four breast centers in northern Germany. Data on bisphosphonate therapy were collected by use of patient questionnaires; clinical data were extracted from the registers. Patients with and without prescribed bisphosphonate adjuvant treatment were tested for statistically significant differences regarding their characteristics.ResultsFour hundred seventy-four of 663 contacted patients participated in the study. Thirty-nine out of 474 patients (9.6%) were on adjuvant bisphosphonate therapy. Zoledronic acid was the most frequently reported bisphosphonate used for prevention of bone metastases. Compared to patients who did not report bisphosphonate medication, women who did report bisphosphonate therapy had a significantly higher advanced tumor stage (p < 0.001). Both the T2-T4 stage and N+ stage remained significant predictors in multivariate-adjusted regression models.ConclusionBisphosphonates are rarely used in the adjuvant treatment of primary breast cancer. Patients with advanced tumor stage were more likely to use bisphosphonates in the adjuvant treatment of primary breast cancer. Further research is needed to identify patients who may benefit most from adjuvant bisphosphonate treatment.

Zusammenfassung ! Einleitung: Die Bisphosphonate sind vor allem für ihren Einsatz bei der Behandlung einer Osteoporose bekannt. In der Therapie des Mammakarzinoms spielen sie als begleitende Therapie bei fortgeschrittenen, auf das Skelett ausgedehnten Tumorerkrankungen eine wichtige Rolle. Kontrovers diskutiert wird zurzeit der adjuvante Einsatz bei primären Brustkrebserkrankungen ohne ossäre Metastasen. Das Ziel dieser Auswertung ist es, den Einsatz der Bisphosphonate in der Therapie des Mammakarzinoms zu beschreiben. Es soll gezeigt werden, wie oft die Bisphosphonate eingesetzt werden, welche Bisphosphonate bevorzugt eingesetzt werden und welche besonderen Merkmale Patientinnen mit einer Bisphosphonattherapie aufweisen. Methoden und Materialien: Für die Auswertung wurde der pseudonymisierte Datensatz aus der Biobank der deutschen Stiftung PATH verwendet. Aus dem Gesamtkollektiv wurden unter Berücksichtigung der Ein-und Ausschlusskriterien 2492 Patientinnen ausgewählt. Das ausgewählte Patientenkollektiv wurde in 2 Gruppen (mit und ohne Bisphosphonattherapie) aufgeteilt und mithilfe der deskriptiven Statistik miteinander verglichen. Ergebnisse: 17,5 % der 2492 Patientinnen wurde im Rahmen der Therapie ein Bisphosphonat verordnet. Das am häufigsten eingesetzte Bisphosphonat war Zoledronat. Die pathologische (tumortherapieinduzierte) Osteoporose war die am häufigsten genannte Indikation unter den Bisphosphonat-Patientinnen, gefolgt von der Einnahme bereits vor der Brustkrebstherapie und der Behandlung von Knochenmetastasen. Patientinnen mit Bisphosphonat-und Antihormontherapie erhielten häufiger einen Aromatasehemmer als Wirkstoff der Antihormontherapie, während Patientinnen mit einer Antihormontherapie, aber ohne Bisphosphonattherapie häufiger Tamoxifen als Wirkstoff erhielten.