title: Palliative treatment of colorectal cancer with secondary metastasis resection in Germany - impact of the multidisciplinary treatment approach on prognosis and cost: the Northern Bavaria IVOPAK I Project.
abstract: OBJECTIVE
  The aim of this study was to evaluate the quality of care and interdisciplinary cooperation in the palliative treatment of colorectal cancer (CRC), including the associated costs.
  
  
  METHODS
  103 patients were enrolled from 13 institutions to reflect the existing clinical treatment reality and costs of palliative CRC treatment. We present the clinical outcome of the patients and compare the results obtained in the 3 centers with double-figure recruitment numbers (centers A, B, and C).
  
  
  RESULTS
  First-line treatment with 5-fluorouracil monotherapy was applied in exceptional cases. The regular treatment method comprised either an irinotecan- (30%) or an oxaliplatin-based regimen (32%). Biological agents were added to the treatment of 33 patients (32%). The median overall survival (OS) of the total patient collective was 25 months. The OS differed significantly in 2 out of the 3 centers, ranging between 27 and 11 months. Secondary metastasis resections were performed in 26% of the total patient collective. The center with the most favorable outcome results also had the lowest costs for palliative treatment and care, including the lowest drug costs.
  
  
  CONCLUSIONS
  A combined chemotherapy treatment was the rule. Concerning biological agents, a significant lack of their application in first-line treatment and the quality of interdisciplinary cooperation have to be addressed.
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pneumology and Endocrinology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Wein
authors.forename: Martin
authors.initials: M
authors.lastname: Emmert
authors.forename: Susanne
authors.initials: S
authors.lastname: Merkel
authors.forename: Hanns-Detlev
authors.initials: HD
authors.lastname: Harich
authors.forename: Juergen
authors.initials: J
authors.lastname: Siebler
authors.forename: Roland
authors.initials: R
authors.lastname: Thiemann
authors.forename: Christof
authors.initials: C
authors.lastname: Lamberti
authors.forename: Bernhard
authors.initials: B
authors.lastname: Göttler
authors.forename: Stefan
authors.initials: S
authors.lastname: Fries
authors.forename: Alexander
authors.initials: A
authors.lastname: Kiani
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schlag
authors.forename: Marcus
authors.initials: M
authors.lastname: Grüner
authors.forename: Simone
authors.initials: S
authors.lastname: Steinbild
authors.forename: Sonja
authors.initials: S
authors.lastname: Eberl
authors.forename: Katharina
authors.initials: K
authors.lastname: Pohl-Dernick
authors.forename: Frank
authors.initials: F
authors.lastname: Dörje
authors.forename: Thomas
authors.initials: T
authors.lastname: Horbach
authors.forename: Oliver
authors.initials: O
authors.lastname: Schöffski
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics; D011379:Prognosis