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Existenzielle und psychische Belastungen als Folge einer Krebserkrankung im Bereich Rehabilitation und Nachsorge
Abstract
Krebserkrankungen und deren begleitende Behandlungen können bei Betroffenen zu kognitiven Beeinträchtigungen und zu emotionaler Überforderung mit unterschiedlicher Intensität und abhängig von der jeweiligen Krankheitsphase führen. Dieses Kapitel bearbeitet spezifische psychische Belastungen im Kontext einer Krebserkrankung, wie Angst, Progredienzangst, Depressivität und Verzweiflung, sowie die wichtige Rolle der psychoonkologischen Versorgung und Interventionen und der sozialen Unterstützung als Ressource. Weiters wird ein kurzer Ausblick von unterschiedlichen Aspekten in der Nachsorge und psychoonkologischer Betreuung von KrebspatientInnen dargestellt.
... Many cancer patients suffer from distress, fatigue, anxiety, depression or posttraumatic stress [1][2][3]. Emotional distress is recognised as 'The 6th Vital Sign' in cancer care [4] and has led to the implementation of screening instruments and evidence-based psycho-oncological interventions worldwide [5]. Psycho-oncological care includes a multidisciplinary approach, entailing psychological, social, behavioural, and ethical aspects [6,7]. ...
Background
Guideline-compliant provision of psycho-oncological (PO) care is still challenging in Germany. Hence, a new care programme, called integrated cross-sectoral psycho-oncology (isPO), was implemented to improve the integration of needs-oriented PO care. Quality of care (QoC) was externally evaluated from the patient’s perspective. We aim to gain insight into patients’ experiences with isPO and how their assessment affects relevant patient-reported outcomes (anxiety and depression, health status, and work ability).
Methods
An explanatory, sequential mixed-methods design was applied. Patients were surveyed twice during their 1-year care trajectory: after 3 (T1) and 12 (T2) months. Data sets were matched using pseudonyms. Care documentation data, including sociodemographic characteristics and the primary outcome variable (anxiety and depression), were matched. In the survey, patients rated their satisfaction with respective isPO service providers and the programme in general (QoC). Health status (EORTC-QLQ-C30) and work ability (WAS) were measured. Descriptive analyses and t-tests for dependent samples were conducted to assess changes in outcome variables over time. Linear regression analyses were conducted to assess whether care satisfaction predicted outcome variables. Patients who completed their isPO care trajectory were asked to participate in semi-structured telephone interviews to share their experiences. Purposeful sampling was applied. All 23 interviews were audiotaped, transcribed, and analysed via content-structuring method.
Results
Patients reported medium-to-high satisfaction with their isPO care. All patient-related outcomes significantly improved over time and QoC measures predicted those outcomes. Needs orientation (e.g., care intensity or mode of delivery) was perceived as essential for high QoC, and outpatient care with fixed contact persons as highly important for care continuity. Furthermore, patients identified programme optimisation needs, such as period of care or extension of care to relatives.
Conclusions
Patients assessed the isPO programme’s QoC positively. They identified facilitators for QoC and optimisation needs. Therefore, data on QoC can function as an indicator for a programme’s feasibility and maturity within care reality. As patients’ care satisfaction positively influences important patient-related outcomes, it may be routinely considered for quality management. Based on patients’ perspectives, isPO seems to be recommendable for routine psycho-oncological care in Germany, if ongoing programme optimisation within structured quality management is guaranteed.
Trial registration
The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30.10.2018.
Objective:
Fear of recurrence (FoR) is among the most important concerns for cancer survivors. Studies on potentially influencing variables, like time since diagnosis, cancer type, and sex, have yielded heterogeneous results. Also social support has rarely been examined as an influencing factor. This study aims to increase knowledge on these factors.
Method:
Analyses are based on cross-sectional data of long-term survivors of breast, colorectal, and prostate cancer (5-16 years postdiagnosis), recruited by 6 German population-based cancer registries. Six thousand fifty-seven women and men were included in the analyses. FoR was assessed using the short form of the Fear of Progression Questionnaire (FoP-Q-SF). The associations of cancer type, age, sex, time since diagnosis, and social support with moderate/high FoR were identified via multiple logistic regression analyses.
Results:
The majority of long-term cancer survivors reported experiencing FoR, mostly in low intensity. Female survivors, survivors ≤54 or 55-59 years of age, 5 to 7 years postdiagnosis, with a lower education, with recurrence/metastases, or being socially isolated were at greater risk to experience moderate/high FoR. Cancer type and stage at diagnosis did not reach statistical significance.
Conclusion:
Our results indicate a potential vulnerability for women to experience FoR in moderate/high severity. Also younger and socially isolated survivors were at greater risk to suffer from moderate/high levels of FoR and should thus be monitored for high levels of FoR and be offered the support needed to manage their fears. (PsycINFO Database Record
Context: Fear of cancer recurrence (FOCR) is one of the most important psychological problems among cancer patients. In extensive review of related literature there were no articles on FOCR among Iranian cancer patients.
Aim: The aim of present study was to investigation FOCR and its predictive factors among Iranian cancer patients.
Materials and Methods: In this descriptive-correlational study 129 cancer patients participated. For data collection, the demographic checklist and short form of fear of progression questionnaire was used. Logistic regression was used to determine predictive factors of FOCR.
Result: Mean score of FOCR among participants was 44.8 and about 50% of them had high level of FOCR. The most important worries of participants were about their family and the future of their children and their lesser worries were about the physical symptoms and fear of physical damage because of cancer treatments. Also, women, breast cancer patient, and patients with lower level of education have more FOCR.
Discussion: There is immediate need for supportive care program designed for Iranian cancer patients aimed at decreasing their FOCR. Especially, breast cancer patients and the patient with low educational level need more attention.
Fear of progression (or fear of recurrence) is an appropriate, rational response to the real threat of cancer and cancer treatments. However, elevated levels of fear of progression can become dysfunctional, affecting well-being, quality of life, and social functioning. Research has shown that fear of progression is one of the most frequent distress symptoms of patients with cancer and with other chronic diseases. As a clear consensus concerning clinically relevant states of fear of progression is currently lacking, it is difficult to provide a valid estimate of the rate of cancer patients who clearly suffer from fear of progression. However, recent systematic reviews suggest that probably 50 % of cancer patients experience moderate to severe fear of progression. Furthermore, many patients express unmet needs in dealing with the fear of cancer spreading. These results underline the necessity to provide effective psychological treatments for clinical levels of fear of progression. A few psychosocial interventions for treating fear of progression have been developed so far. Our own, targeted intervention study showed that dysfunctional fear of progression can be effectively treated with a brief group therapy.
Optimism and social support serve as protective factors against distress in medically ill patients. Very few studies have specifically explored the ways in which these variables interact to impact quality of life (QOL), particularly among patients with advanced cancer. The present study examined the role of optimism as a moderator of the relationship between social support and anxiety, depression, hopelessness, and QOL among patients with advanced cancer.
Participants (N = 168) completed self-report assessments of psychosocial, spiritual, and physical well-being, including social support, optimism, hopelessness, depressive and anxious symptoms, and QOL. Hierarchical multiple regression analyses were conducted to determine the extent to which social support and optimism were associated with depressive and anxious symptomatology, hopelessness and QOL, and the potential role of optimism as a moderator of the relationship between social support and these variables.
Higher levels of optimism were significantly associated with fewer anxious and depressive symptoms, less hopelessness, and better QOL. Higher levels of perceived social support were also significantly associated with better QOL. Additionally, optimism moderated the relationship between social support and anxiety, such that there was a strong negative association between social support and anxiety for participants with low optimism.
This study highlights the importance of optimism and social support in the QOL of patients with advanced cancer. As such, interventions that attend to patients' expectations for positive experiences and the expansion of social support should be the focus of future clinical and research endeavors. Copyright © 2013 John Wiley & Sons, Ltd.
We aimed to systematically summarize the empirical evidence on the 4-week-, 12-month-, and lifetime prevalence of adjustment disorders, acute and posttraumatic stress disorders as well as somatoform disorders in cancer patients. We evaluated 64 English or German language original papers and systematic reviews that assessed the prevalence of affective and anxiety disorders using structured clinical interviews published between 1995 and 2010. Adjusted prevalence rates were calculated using a random-intercept model. We found the following pooled adjusted 4-week prevalence rates: For adjustment disorder 12.5% (95% CI 9.9-15.7), for posttraumatic stress disorder 2.6% (95% CI 1.7-4.0), for acute stress disorder 4.8% (95% CI 2.2-10.0) and for somatoform disorders 3.1% (95% CI 1.6-5.8). Our findings show the need for further research on representative studies that take into account the range of psychosocial stressors and supportive care needs.
© Georg Thieme Verlag KG Stuttgart · New York.
We aimed to systematically summarize the empirical evidence on the 4-week-, 12-month-, and lifetime prevalence of affective and anxiety disorders in cancer patients. We evaluated 89 English or German language original papers and systematic reviews that assessed the prevalence of affective and anxiety disorders using structured clinical interviews published between 1995 and 2010. Adjusted prevalence rates were calculated using a random-intercept model. The pooled adjusted 4-week prevalence of affective disorders was 11.1% (95% CI 8.1-15.1), and 10.8% (95% CI 6.8-16.7) based on German studies. The pooled adjusted 4-week prevalence of anxiety disorders was 10.2% (95% CI 6.9-14.8), and 13.5% (95% CI 7.1-24.3) based on German studies. The findings show the need for further research on representative studies that take into account the range of psychosocial stressors and supportive care needs in addition to the prevalence of mental disorders.
© Georg Thieme Verlag KG Stuttgart · New York.
To what extent is professional psychosocial care of cancer patients in acute hospitals necessary? In a previous meta-analysis, prevalence of psychological sequelae was found to be the same as in the general population. New studies with advanced methodology have been published since; therefore, an updated meta-analysis was needed.
We systematically reviewed studies assessing the prevalence of mental health conditions in acute care hospitals with comprehensive structured clinical interviews.
Of 46 retrieved manuscripts, eight were deemed eligible for this meta-analysis. Within the studies, 1448 cancer patients had been assessed, whereby 456 were diagnosed having a mental health disorder. The prevalence rates ranged from 23% (breast cancer patients in Turkey) to 53% (elderly cancer patients in Uganda). The combined prevalence estimate is 32% (95% confidence interval 27% to 37%).
One-third of the cancer patients in acute care hospitals is suffering from mental health disorders and need appropriate treatment.
We identified five patterns of coping in a sample of 603 cancer patients: “seeking or using social support,” “focusing on the positive,” “distancing,” “cognitive escape-avoidance,” and “behavioral escape-avoidance.” Relationships of these coping patterns to sociodemographic characteristics, medical factors, stress appraisals, psychotherapeutic experience, and emotional distress were tested using correlational and regression techniques. Type of cancer, time since diagnosis, and whether a person was currently in treatment had few or no relationships to coping. The specific cancer-related problem (e.g., pain, fear of future) was also not associated with how individuals coped. Perceptions of its stressfulness, however, were related to significantly more coping through social support and more of both forms of escape-avoidance. Coping through social support, focusing on the positive, and distancing was associated with less emotional distress, whereas using cognitive and behavioral escape-avoidance was associated with more emotional distress. Implications of the results for understanding coping processes and intervention with cancer patients are discussed.
Key words: coping, cancer, adjustment to illness, stress
The purpose of this study was to assess the psychological distress of cancer patients in a disease-specific manner as well as the demographic and medical variables that have an impact on the distress. Psychological distress was assessed with the Questionnaire on Stress in Cancer Patients revised version, which has been developed and psychometrically evaluated in Germany. It consists of items about 23 cancer-specific stress situations, which have to be answered in terms of relevance and amount of distress. A heterogeneous sample of 1721 cancer in- and outpatients was assessed. For the total group, the most important distress is the fear of disease progression. We consider between 23.4% (ca. of the upper gastrointestinal tract) and 40.9% (breast cancer patients) as highly distressed. The most distressed diagnostic subgroups are patients with soft tissue tumours and breast cancer patients. There are no global (general) stress factors, as the relevant demographic and medical 'risk factors' varied between the diagnostic subgroups. Cancer-specific distress questionnaires give a more precise insight into patients' experience than general or psychiatric questionnaires. They are not only used in large screening studies but also in routine medicine, particularly when the objective is to identify patients to whom psycho-oncological support is to be given.
Adjustment disorder (AD) refers to a condition in which an individual reacts to an identifiable stressor with disproportionate symptoms and behaviors. Now included in the DSM-5 in the category of trauma and stress-related disorders, it is the most commonly diagnosed psychiatric disorder in cancer patients, but also the most problematic in terms of its conceptualization and evidence base. There has been debate about the specificity of the diagnostic criteria, and concern that it constitutes the medicalization of distress that then may be treated unnecessarily with psychopharmacological interventions. However, evidence suggests that categorization of distress as AD may allow it to be appropriately targeted by interventions aimed at prevention or treatment. This chapter focuses on the validity and utility of the concept of and diagnostic criteria for AD and will review the available evidence base regarding treatment of this disorder in cancer patients.
Purpose:
To provide the 4-week prevalence estimates of mental disorders in cancer populations.
Patients and methods:
We enrolled adult patients with cancer from in- and outpatient care facilities, using a proportional stratified random sample based on the nationwide cancer incidence in Germany. Patients who scored 9 or above on the Patient Health Questionnaire (PHQ-9) were administered to the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for cancer patients (CIDI-O). A random sample of those with a PHQ-9 score that was less than 9 were selected for a CIDI-O.
Results:
A total of 5,889 patients were identified, which led to 4,020 participants (a 68.3% response rate); of those, 2,141 patients were interviewed. The 4-week total prevalence for any mental disorder was 31.8% (95% CI, 29.8% to 33.8%); this included any anxiety disorder (11.5%; 95% CI, 10.2% to 12.9%), any adjustment disorder (11.1%; 95% CI, 9.7% to 12.4%), any mood disorder (6.5%; 95% CI, 5.5% to 7.5%), any somatoform/conversion disorder (5.3%; 95% CI, 4.3% to 6.2%), nicotine dependence (4.5%; 95% CI, 3.6% to 5.4%), alcohol abuse/dependence (0.3%; 95% CI, 0.1% to 0.6%), any mental disorder resulting from general medical condition (2.3%; 95% CI, 1.7% to 2.9%), and any eating disorder (0%). The highest prevalence for any mental disorder was found in patients with breast cancer (41.6%; 95% CI, 36.8% to 46.4%), followed by patients with head and neck cancer (40.8%; 95% CI, 28.5% to 53.0%). The lowest prevalence was found in patients with pancreatic cancer (20.3%; 95% CI, 8.9% to 31.6%) and stomach/esophagus cancers (21.2%; 95% CI, 12.8% to 29.6%).
Conclusion:
Our findings provide evidence for the strong need for psycho-oncological interventions.
Die Psychoonkologie als interdisziplinäres Fachgebiet umfasst ein breites Spektrum an Aufgabenstellungen, die darauf abzielen,
Krebspatienten und Angehörige beim Umgang mit den Krankheits- und Behandlungsfolgen zu unterstützen, psychische Belastungen zu
reduzieren und ein höchstes Maß an Selbständigkeit und Lebensqualität zu erhalten. Psychoonkologische Versorgung
beinhaltet die Identifikation psychosozialer Belastungen und Unterstützungsbedürfnisse bei Patienten und Angehörigen, die
zeitnahe Zuweisung bzw. das Ermöglichen des Zugangs zu psychosozialen Unterstützungsangeboten sowie die psychosoziale Unterstü
tzung im Rahmen der Diagnostik, Therapie, Rehabilitation und Nachsorge sowie der palliativen Versorgung.
Purpose
Fear of cancer recurrence (FCR) is among the most commonly reported problems and one of the most prevalent areas of unmet needs for cancer survivors and their carers. This review aims to provide a comprehensive overview of current scientific knowledge on FCR and to formulate recommendations for future research.
Methods
A systematic review was undertaken to identify quantitative studies associated with FCR. Relevant studies were identified via Medline, CINAHL, PsycINFO and AMED databases from 1996 through December 2011. Data from 130 eligible papers were extracted and summarized following a systematic scheme.
Results
Multiple FCR assessment methods were identified. Survivors reported low to moderate level of FCR but considered it as one of the top greatest concerns and the most frequently endorsed unmet need. FCR remains stable over the survivorship trajectory. Younger age, presence and severity of physical symptoms, psychological distress and lower quality of life were associated with higher FCR. Health behaviours, psychological reactions and functional impairments were identified as FCR consequences. Carers reported higher FCR than the patients. Limited data on interventions were available.
Conclusions
FCR research has expanded somewhat haphazardly over the last 20 years. Adopted consensual definition and used well-validated measures will be necessary. Longitudinal research examining the longer-term development and impact of FCR is clearly needed. The proposal and evaluation of theoretical models of FCR is a priority.
Implications for Cancer Survivors
Identifying the key features of FCR will stimulate the research and the development of targeted interventions for cancer survivors and their carers.
Psychosoziale Belastungen und psychische Störungen bei Krebspatienten werden vom onkologischen Behandlungsteam häufig nicht oder nicht in ausreichendem Maße erkannt, sodass ein Teil der Patienten wie auch Angehörige keine Unterstützungsangebote erhalten, obwohl sie davon profitieren könnten. Aus diesem Grund wird die Bedeutung einer psychosozialen Diagnostik in Form eines kontinuierlichen Screenings im Rahmen der onkologischen Behandlung in nationalen wie internationalen Leitlinien nachdrücklich empfohlen. Gegenwärtig liegt eine Reihe von validen Kurz-Screeningverfahren vor, die für die onkologische Versorgung geeignet sind und über die psychischen Belastungen hinaus auch krankheitsspezifische Aspekte berücksichtigen. Neben der Implementierung eines Screenings stellt in der Praxis allerdings die zeitnahe Bereitstellung psychosozialer und psychoonkologischer Unterstützungs- und Nachsorgeangebote, die dem spezifischen Bedarf eines Patienten entsprechen, eine häufige Barriere dar. Ursachen sind das Fehlen personeller, zeitlicher und finanzieller Ressourcen sowie eine ungenügende Koordination verschiedener Gesundheitsleistungen, die eine patientenzentrierte Versorgung von Krebspatienten vielfach erschweren.
PURPOSEThis study aimed to evaluate the effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer. METHODS
Literature databases were searched to identify randomized controlled trials that compared a psycho-oncologic intervention delivered face-to face with a control condition. The main outcome measures were emotional distress, anxiety, depression, and quality of life. Outcomes were evaluated for three time periods: post-treatment, ≤ 6 months, and more than 6 months. We applied standard meta-analytic techniques to analyze both published and unpublished data from the retrieved studies. Sensitivity analyses and meta-regression were used to explore reasons for heterogeneity.ResultsWe retrieved 198 studies (covering 22,238 patients) that report 218 treatment-control comparisons. Significant small-to-medium effects were observed for individual and group psychotherapy and psychoeducation. These effects were sustained, in part, in the medium term (≤ 6 months) and long term (> 6 months). Short-term effects were evident for relaxation training. Studies that preselected participants according to increased distress produced large effects at post-treatment. A moderator effect was found for the moderator variable "duration of the intervention," with longer interventions producing more sustained effects. Indicators of study quality were often not reported. Small-sample bias indicative of possible publication bias was found for some effects, particularly with individual psychotherapy and relaxation training. CONCLUSION
Various types of psycho-oncologic interventions are associated with significant, small-to-medium effects on emotional distress and quality of life. These results should be interpreted with caution, however, because of the low quality of reporting in many of the trials.
Background
Depression has substantial effects on cancer patients' quality of life. Estimates of its prevalence vary widely. We aimed to systematically review published studies to obtain the best estimate of the prevalence of depression in clinically meaningful subgroups of cancer patients.DesignSystematic review that addressed the limitations of previous reviews by (i) including only studies that used diagnostic interviews; (ii) including only studies that met basic quality criteria (random or consecutive sampling, ≥70% response rate, clear definition of depression caseness, sample size ≥100); (iii) grouping studies into clinically meaningful subgroups; (iv) describing the effect on prevalence estimates of different methods of diagnosing depression.ResultsOf 66 relevant studies, only 15 (23%) met quality criteria. The estimated prevalence of depression in the defined subgroups was as follows: 5% to 16% in outpatients, 4% to 14% in inpatients, 4% to 11% in mixed outpatient and inpatient samples and 7% to 49% in palliative care. Studies which used expert interviewers (psychiatrists or clinical psychologists) reported lower prevalence estimates.Conclusions
Of the large number of relevant studies, few met our inclusion criteria, and prevalence estimates are consequently imprecise. We propose that future studies should be designed to meet basic quality criteria and employ expert interviewers.
The idea of this book grew out of the awareness of the need for a better answer to the frequent query: "Where can I learn about the psychological problems of cancer patients and how to treat them?" . . . There were many books and journals that an interested reader could turn to, but no summary of the broad range of issues that one needed to know to be informed was available. We began to conceive of a small book that would serve as an introduction to this emerging area of oncology. Using a developmental model, we sought to understand and to describe the patients' life stage, the disruptions caused by cancer at that stage, and the interventions needed to promote adaptation. . . . In fact, by the mid-1980s, psychooncology had become a respectable subspecialty of oncology and psychiatry with its own body of information.
It was at this point that we began to conceive of an edited book with the major contributors from our own group that, by then, was nearing a decade of experience. We decided to provide a far broader book where both oncologic and mental health professionals, or students in either field, could find information about the range of psychiatric and psychological issues in oncology. The handbook that resulted attempts to put in context the cultural, psychological, and medical aspects that contribute to adaptation, the special problems posed by childhood or older age, by treatment modality, and special problems, such as pain and central nervous system complications. In addition, it reviews the problems of families, home care, staff, ethical, and research problems, and offers treatment principles to be used in providing psychotherapy and behavioral and pharmacologic interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reported prevalence of emotional distress in cancer patients varies widely across studies. The present study determined prevalence of anxiety and depression (separated for presence of symptoms versus clinical levels) in a large, representative sample of cancer patients after diagnosis.
During the years 2004-2009, 10,153 consecutive patients were routinely screened with the Psychosocial Screen for Cancer questionnaire at two major cancer centers.
Patients' mean age was 59years and 45% were men. Across cancer types, 19.0% of patients showed clinical levels of anxiety and another 22.6% had subclinical symptoms. Further, 12.9% of patients reported clinical symptoms of depression and an additional 16.5% described subclinical symptoms. Analyses by cancer type revealed significant differences such that patients with lung, gynecological, or hematological cancer reported the highest levels of distress at the time point of cancer diagnosis. As expected, women showed higher rates of anxiety and depression, and for some cancer types the prevalence was two to three times higher than that seen for men. In some cancer types emotional distress was inversely related to age. Patients younger than 50 and women across all cancer types revealed either subclinical or clinical levels of anxiety in over 50% of cases.
Findings describe levels of emotional distress after diagnosis but cannot inform about trajectories of anxiety and depression over time.
Given that levels of anxiety and depression varied widely by cancer type, gender, and age, these results inform which cancer patients are most likely in need of psychosocial support.
Fear of cancer recurrence (FCR) is a significant psychological problem for cancer survivors. Some survivors experience FCR, which is both persistent and highly distressing. The aim of this systematic review was to identify the key factors associated with fear of recurrence among cancer patients.
A comprehensive literature search using keywords was performed with three databases, followed by an organic search to identify additional relevant articles. Included studies had a quantitative methodology presenting empirical findings focussed on adult cancer patients. A methodological quality assessment was performed for each study, and the strength of evidence was defined by the consistency of results.
Forty-three studies met the inclusion criteria and are presented in this review. The most consistent predictor of elevated FCR was younger age. There was strong evidence for an association between physical symptoms and fear of cancer recurrence. Additional factors moderately associated with increased FCR included treatment type, low optimism, family stressors and fewer significant others. Inconsistent evidence was found for socio-demographic factors.
Fear of cancer recurrence is a complex issue influenced by a multitude of factors, including demographic, clinical and psychological factors. However, some studies have reported contradictory evidence, and FCR has been measured using a range of scales, which can hamper comparison across studies. Further research is needed to clarify inconsistencies in the current published research. Copyright
Cancer survivorship is an emerging area of scientific and clinical interest. Several decades ago, most people diagnosed with cancer did not live long beyond their initial diagnosis. Today the number of cancer survivors exceeds ten million, and this group may experience unique healthcare issues related to their cancer treatment. Chemotherapy, surgery, and radiation therapy each have their own late and long-term complications. It is imperative for clinicians who are caring for cancer survivors to be aware of long-term complications of therapy and to treat these appropriately. When cancer therapy has successfully added years of life, it is equally as important that medical care assures the best quality of life during those years.
This article has no abstract; the first 100 words appear below.
In this issue of the Journal, Burstein and colleagues give us surprising new information about women who begin to use alternative medicine after receiving a diagnosis of breast cancer.¹ The investigators studied 480 patients with newly diagnosed early-stage breast cancer and found that 28 percent of them began to use alternative medical therapies as an adjunct to conventional therapy. There is much confusion about the definition of alternative medicine,² but the main point is that the women chose to use several (an average of 2.5) different forms of alternative medicine, including psychological and healing therapies,³ in addition to the conventional . . .
Jimmie C. Holland, M.D.
Memorial Sloan-Kettering Cancer Center, New York, NY 10021
Fear of an increasing disease progression (fear of progression) is among the main psychological stresses in patients with cancer, diabetes mellitus (type 1 and type 2) and chronic arthritis. The questions the study seeks to answer are: (1) Which are the main fears of these patients?, (2) How and in which circumstances in life do they occur?, (3) Which are the triggers of the fear? To answer these questions, a sample of 65 patients were researched through interviews. The results indicate that the predominant fears of cancer patients are the fear of dying and the unpredictability of the progression of the disease. Patients with chronic arthritis most frequently fear being physically dependent on someone else. The most common anxiety of diabetes patients are long-term complications. For all three groups of patients job-related fears cause a high amount of distress. These results contribute to the development of a standardised fear of progression questionnaire.
We aimed to describe the levels of anxiety and depression in patients during the 3 month period following the end of chemotherapy treatment and to identify factors that predict psychological morbidity.
We performed a prospective study in women with ovarian cancer to determine the changes in psychological status in the 3 months following completion of chemotherapy. Sixty-three consecutive patients were assessed at the completion of chemotherapy (Time 1) and 57 at 3 months follow-up (Time 2). Relevant disease and patient characteristics were recorded and patients were assessed at Time 1 for anxiety, depression and their perception of emotional support, an index of their psychosocial environment. Anxiety and depression were re-assessed at Time 2.
The results indicate significant initial psychological morbidity, with clinical caseness for anxiety (38%) and depression (33%) being common. Follow-up at Time 2 shows that patients undergo a significant reduction in cases (19%) and symptoms of depression but an increase in cases of anxiety (47%). The principal factors associated with symptoms of anxiety at Time 2 were poor perceived social support, increased intrusive thoughts and, to a lesser extent, younger age. Medical parameters, such as the stage of disease, response of the cancer to treatment, Ca125 (a tumour glycoprotein) and Karnofsky Performance status (a measure of how well the patients is) were not associated with worse psychological outcome.
These data show for the first time that social support and intrusive thoughts, rather than physical parameters, are the principal determinants of psychological morbidity in patients with ovarian cancer.
Screeningverfahren in der Psychoonkologie: Testinstrumente zur Identifikation betreuungsbedürftiger Krebspatienten. Eine Empfehlung der PSO für die psychoonkologische Behandlungspraxis
- P Herschbach
- J Weis
Progredienzangst: Manual zur Behandlung von Zukunftsängsten bei chronisch Kranken
- S Waadt
- G Duran
- P Berg
- P Herschbach
- U Koch-Gromus