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Was wissen Patienten mit einem Prostatakarzinom über das Rauchen?

Ergebnisse einer bizentrischen Fragebogenstudie (KRAUT-Studie)

What do prostate cancer patients know about smoking?

Results of a bicentric questionnaire study (KRAUT study)

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Zusammenfassung

Hintergrund

Gemäß einer rezenten Metaanalyse weisen Patienten mit Prostatakarzinom (PCA) ganz unterschiedlicher Tumorstadien und Therapien eine um 24 % höhere PCA-spezifische Mortalität auf, sofern sie Zigarettenraucher sind. Der Einfluss des Zigarettenrauchens auf die Prognose scheint dosisabhängig zu sein. Es ist aktuell vollkommen unklar, inwieweit diese Erkenntnisse den Patienten erreichen und in welcher Qualität diesbezügliche ärztliche Aufklärungsgespräche erfolgen.

Fragestellungen

Es wurden drei Hypothesen formuliert: (1) der Kenntnisstand der PCA-Patienten über den Zusammenhang zwischen Tumorprognose und Zigarettenkonsum ist gering, (2) es erfolgte nur in seltenen Fällen eine klare ärztliche Empfehlung zum Raucherstopp, (3) es bestand ein direkter Zusammenhang zwischen dem Tumorstadium des PCA und dem Ausmaß des Zigarettenkonsums.

Material und Methoden

Es wurde ein Fragebogen mit 23 Items entwickelt und vor dem Studienstart an 25 uroonkologischen Patienten durch strukturierte Interviews validiert. Im Zeitraum September 2013 bis Dezember 2014 wurden dann an zwei Kliniken insgesamt 124 PCA-Patienten (Altersmedian 65 Jahre) in diese Fragebogenstudie eingeschlossen.

Ergebnisse

Die Studiengruppe bestand zu 43 % (n = 54), 39 % (n = 48) bzw. 18 % (n = 22) aus Nichtrauchern, Ex-Rauchern und aktive Rauchern. Aktive und ehemalige Raucher unterschieden sich nur insignifikant in der Zahl der Packyears (24,8 vs. 23,7 Jahre; p = 0,995). 56 % der Patienten hielten es für möglich, dass Zigarettenkonsum die PCA-spezifische Prognose beeinflusst. Da das aber auch signifikant jene Patienten waren, die im Rauchen fälschlicherweise eine Ursache der PCA-Entstehung vermuteten (p < 0,001), basieren die Patientenkenntnisse über die PCA-Prognose mutmaßlich nicht auf einem suffizienten Wissenserwerb. Zwei der 22 aktiven Raucher (9,1 %), 5 der 48 Ex-Raucher (10,4 %) und 2 der 54 Nichtraucher (3,7 %) hatten anamnestisch ein Aufklärungsgespräch mit einem Urologen über den Zusammenhang zwischen Zigarettenkonsum und PCA-Prognose erhalten (weitere 9,1 %, 4,2 % bzw. 3,7 % bekamen diese Information ausschließlich durch andere fachärztliche Kollegen). Lediglich einem der 22 aktiven Rauchern (4,5 %) wurde von hausärztlicher Seite Hilfsmittel zum Raucherstopp angeboten; von Urologen wurde in keinem Fall Unterstützung angeboten. Es bestand keine Assoziation zwischen der Raucheranamnese bzw. den Packyears und dem Tumorstadium des PCA.

Schlussfolgerungen

Die ärztliche Aufklärung über den Zusammenhang des Zigarettenrauchens mit der PCA-spezifischen Prognose kommt aktuell zu kurz. Die den neuen Erkenntnissen folgende Beratung der Patienten sollten die Urologen forcieren und somit ihren Stellenwert als primärer Partner zur Festlegung des PCA-Therapiemanagements festigen.

Abstract

Background

According to the results of a recent meta-analysis, cancer-specific mortality of prostate cancer (PCA) patients is enhanced by 24 % in case of a positive smoking history with a dose-dependent impact of smoking. Until now it is unknown whether this information actually reaches the patients and how extensively an informational discussion about this topic is pursued by physicians.

Objective

Three study hypotheses were defined: (1) the knowledge of PCA patients about the potential relationship between tumor progression and cigarette consumption is low, (2) only in rare cases has a clear statement been provided by treating physicians including the explicit advice to stop smoking, and (3) there was a direct association between tumor stage and the extent of cigarette consumption.

Materials and methods

A questionnaire comprising 23 items was developed and validated with 25 uro-oncological patients prior to study start. Between September 2013 and December 2014 a total of 124 PCA patients (median age 65 years) from two urology departments were included in this questionnaire-based survey.

Results

The study population comprised 43 % (n = 54), 39 % (n = 48), and 18 % (n = 22) nonsmokers, former smokers and active smokers, respectively. Active and former smokers differed insignificantly in the number of pack–years only (24.8 vs. 23.7 years, p = 0.995). Of the patients, 56 % regarded an influence of cigarette consumption on the PCA-specific prognosis as possible. However, because a significant (p < 0.001) number of patients wrongly suspected smoking to be causative for PCA development, their knowledge about PCA prognosis is supposedly not based on adequate knowledge. Two of 22 active smokers (9.1 %), 5 of 48 former smokers (10.4 %), and 2 of 54 nonsmokers (3.7 %) had an informational discussion with their urologist about the association of cigarette consumption and PCA-related prognosis (a further 9.1, 4.2 and 3.7 %, respectively, received this information solely from other medical specialties). Only 1 of 22 active smokers (4.5 %) was offered medical aids for smoking cessation by the general practitioner; none of the patients received such support by an urologist. There was no association between a positive smoking history or number of pack–years and PCA tumor stage.

Conclusions

Education of PCA patients about the relationship between cigarette consumption and cancer-related prognosis is currently inadequate. Following the latest findings on this topic, urologists should pursue informational discussions with their patients, thereby strengthening their position as the primary contact person for decision making in PCA management.

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Authors and Affiliations

  1. Urologische Klinik, St. Elisabeth-Klinikum Straubing, St. Elisabeth-Str. 23, 94315, Straubing, Deutschland

    M. May, C. Gilfrich, O. Maurer & T. Karl

  2. Urologische Klinik, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland

    P. Spachmann, M. K. Dombrowski, H. M. Fritsche & M. Burger

  3. Urologische Klinik, RoMed Klinikum Rosenheim, Rosenheim, Deutschland

    M. Wöhr

  4. Urologische Klinik, Ludwig-Maximilians-Universität München, München, Deutschland

    S. Brookman-May

  5. Urologische Klinik, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland

    M. Schostak

  6. Urologische Klinik, Ruppiner Kliniken Neuruppin, Neuruppin, Deutschland

    S. Lebentrau

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Correspondence to M. May.

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Interessenkonflikt

S. Brookman-May arbeitet als Director Regional Therapeutic Area Expert Oncology (EMEA) im Bereich Research and Development des Pharmaunternehmens Janssen-Cilag GmbH, was jedoch zu keiner Beeinflussung der Studie führte. M. May, C. Gilfrich, P. Spachmann, O. Maurer, M.K. Dombrowski, H.M. Fritsche, M. Wöhr, T. Karl, M. Schostak, M. Burger und S. Lebentrau geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. May und C. Gilfrich waren zu gleichen Teilen an der Erstellung dieses Artikels beteiligt.

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May, M., Gilfrich, C., Spachmann, P. et al. Was wissen Patienten mit einem Prostatakarzinom über das Rauchen?. Urologe 55, 1078–1085 (2016). https://doi.org/10.1007/s00120-016-0165-7

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  • DOI: https://doi.org/10.1007/s00120-016-0165-7

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