[Psychological comorbidity in patients with cancer]

Assessment and Evaluation of Psychosocial Distress in Outpatients with Cancer at a University Hospital in Germany

INTRODUCTION

Cancer patients (pts) suffer from a significant amount of psychosocial distress related to tumor disease itself or straining treatments. Despite recommendations on how to screen for and to deal with psychosocial distress in cancer pts, data about implementation of psycho-oncological interventions (poi) in outpatient settings of cancer pts are scarce. The aim of this study was to identify outpatients with cancer in need of poi and to evaluate different assessment instruments.

METHODS

N = 200 outpatients with hemat-/oncological malignancies were interviewed between October 2015 and December 2017 at the University Hospital Mannheim using the Basic Documentation for Psycho-Oncology (PO-Bado) and the Hornheider Screening Instrument (HSI) - both clinician-administered assessment tools - followed by descriptive, univariate, and agreement analysis.

RESULTS

N = 61 cancer pts (31%) were identified to be in need for poi considering the results of both questionnaires. The number of identified pts in need of poi was lower when analyzing the results of the PO-Bado (n = 42, 21%) and the HSI (n = 39, 20%) separately. The degree of agreement between the results of PO-Bado and HSI was low (kappa = 0.3655). Several factors like gender, age and diagnosis were identified to have significant impact on the need for poi (p ≤ 0.05).

CONCLUSION

Our study underlines that different screening instruments for psychosocial distress may identify disparate populations of cancer pts. The study data also revealed significant characteristics that might be associated with elevated levels of psychosocial distress and a clear indication for poi. However, further analyses on larger populations of cancer pts are needed to provide information how to transfer positive screening to poi in clinical routine.

[Validation of the Düsseldorfer screening tool: a trait-based approach to assess psychological distress of cancer patients]

BACKGROUND

Psycho-oncological screening is a useful tool to ascertain whether patients need special support. Currently, patients are asked mainly about their acute problems. Stable internal and external risk factors and preventive patient characteristics are largely disregarded. The newly developed Düsseldorf Screening Tool (DST) captures distress through stable traits, social support, and the patient's coping style. The aim of this study was to validate the DST using the Distress-Thermometer (DT) and Basic Documentation for Psycho-Oncology (PO-Bado).

METHODS

A total of 126 patients with head and neck squamous cell carcinoma were investigated. To determine the cut-off value, receiver operating curves (ROC) curves were calculated. As a measure of quality, area under the curve (AUC) values are given. Sensitivity and specificity were established for each gold standard questionnaire.

RESULTS

Compared to the DT and PO-Bado, the discrimination ability of the DST is good, with AUC values of 0.62 to 0.80. With a DT cut-off value of 5, a sensitivity of 84.2% with a specificity of 37.0% can be stated. Compared to PO-Bado, a sensitivity value of 92.9% with a specificity of 43.6% can be reported.

CONCLUSION

The results show that a trait-based approach to identify patients' level of psychological distress can purposefully and safely assess cancer patients' stress level. A new approach to screening in psycho-oncology has thus emerged.

The Effect of Religious Belief on Depression and Hopelessness in Advanced Cancer Patients

This study was conducted to determine the effect of religious belief on depression and hopelessness in advanced cancer patients. The sample size of this cross-sectional study was determined as 267 as a result of the power analysis. The study was carried out between February 2018 and December 2018. "The Patient Information Form", "The Religious Attitude Scale", "The Beck Depression Inventory (BDI)", and "The Beck Hopelessness Scale (BHS)" were used to collect the data. It was determined that the total mean score of the cancer patients participating in the study for Religious Attitude Scale was 4.51 ± 0.44 (high level), their total mean score for depression inventory was 19.06 ± 9.38 (moderate level), and their total mean score for hopelessness scale was 10.23 ± 1.94 (moderate level). In the study, the difference between the religious beliefs and depression and hopelessness levels of the cancer patients was statistically significant (p < 0.05). In the study, it was determined that depression and hopelessness levels of cancer patients were moderate and their religious beliefs were high. It is recommended for healthcare professionals to add spirituality to healthcare in order to provide the spiritual relief of cancer patients.

Palliative Chemotherapy: The Perspectives and Experiences of South African Nurses

OBJECTIVE

The objective of this study was to describe the perspectives and experiences of South African nurses caring for patients receiving palliative chemotherapy.

METHODS

A qualitative descriptive design was used and purposive sampling allowed us to select 11 nurses practising in a private ambulatory cancer care center in Port Elizabeth. In-depth interviews, guided by three broad themes were conducted and analyzed using qualitative content analyses. Data saturation determined the sample size.

RESULTS

Two themes emerged from the data - the patients cling to hope and the positive influence of palliative chemotherapy. The participants believed that patients consenting to palliative chemotherapy were clinging to false hope. They were also of the opinion that family members pressurize patients to consent to treatment. The participants experienced palliative chemotherapy positively, especially when an improvement in the patients' quality of life or pain relief was evident. Fatigue was highlighted as the major side effect, but it did not temper the participants' positive attitudes toward the treatment.

CONCLUSIONS

Although the participants believed that patients cling to hope and consent to palliative chemotherapy because they hope to be cured, they experienced the treatment as positive. For them, the improvement in pain and quality of life outweighed the side effects the patients experienced. The positive attitude patients upheld while receiving this treatment encouraged them. Nurses should gain more knowledge about the meaning, people living with advanced cancer, attach to hope to prevent them from interpreting patients' hope as denial and false.

Psychosocial experiences in the context of life-threatening illness: The cardiac rehabilitation patient

Objective:

One of the most prevalent life-threatening illnesses is heart disease. The initial trauma of being diagnosed with a life-threatening illness or having a cardiac event can begin a psychosocial chain reaction that results in a transformation of the lives of these patients. The goal of our study was to investigate the lived experiences of psychosocial healing in rehabilitation of cardiac patients using a qualitative written interview.

Method:

A purposive sample of 14 cardiac event survivors was recruited. Participants were interviewed after informed consent and screening. We used a qualitative analysis and model-revision approach similar to the procedure outlined by Charmaz (2006).

Results:

Participants consistently mentioned that a heightened awareness of mortality was a motivating factor that led to participants focusing more on their family and relationships, having an enhanced outlook on life, and making healthy lifestyle changes.

Significance of results:

If clinicians are able to employ a measure to better understand the nature of a patient's progression from cardiac event to successful recovery, interventions such as cardiac rehabilitation can be implemented earlier and more effectively during the course of the illness and recovery phases of treatment. Theoretically, this early detection of a patient's progression could reduce the time spent recovering from a cardiac event, and it would allow treatments for these conditions to better alleviate the psychosocial concerns faced by patients.

Randomised controlled trial of a tailored information pack for patients undergoing surgery and treatment for rectal cancer

PURPOSE

To evaluate the effects of a tailored information package for rectal cancer patients on satisfaction with information, anxiety and depression and readjustment.

METHOD

The study used a randomised control trial method. Seventy six patients undergoing surgery and treatment for rectal cancer were randomly assigned to an intervention (n = 43) or control group (n = 33). The intervention group received an information pack tailored according to their treatment plan and preferred information. The control group received the information currently given to these patients. Satisfaction with information was measured using the Patient Satisfaction with Cancer Treatment Education (PSCaTE) scale, anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) and readjustment was measured using the Reintegration to Normal Living Index, at three time points.

RESULTS

There was a statistically significant difference between the intervention and control group on pre and post intervention scores with patients in the intervention group expressing a higher level of satisfaction with information than those in the control group at Times 2 and 3 (p = 0.00 for both). The intervention group also had a significantly lower anxiety score than the control group at Time 3 (p = 0.03). There was no difference between depression and readjustment scores in the two groups.

CONCLUSION

The results support the hypothesis that a tailored information pack for patients with rectal cancer will positively affect satisfaction with information. These results will enhance the knowledge base surrounding the provision of tailored information to specific patient groups.

Patients' perspectives on palliative chemotherapy of colorectal and non--colorectal cancer: a prospective study in a chemotherapy- experienced population

BACKGROUND

A better understanding of patients' views on the benefit and burden obtained from palliative chemotherapy would facilitate shared decision making. We evaluated palliative cancer patients' reported outcomes (PROs) for toxicity and investigated the survival threshold for which they would repeat chemotherapy (CTx).

METHODS

Patients who had received a minimum of three months of palliative CTx for advanced colorectal (CRC) or non-colorectal (non-CRC: upper gastrointestinal, lung and head-and-neck) cancer were assessed by questionnaire. Patients were questioned about PROs for toxicity, subjective burden from side effects, and were asked for the survival threshold necessary for them to repeat CTx. Expected survival (sum of indicated survival threshold and median survival time with best supportive care) was compared to the patients' actual survival.

RESULTS

One hundred and thirty-four patients (CRC: 58; non-CRC: 76) were surveyed. The most frequent PRO- grade 3/4 toxicities were acne (12.8%), fatigue (9.0%), and diarrhea (8.5%). The symptom causing the highest subjective burden was fatigue and was worse than expected in 29.9% of the patients. The median survival threshold for which patients would repeat CTx was significantly longer in CRC than in non-CRC patients (p=0.01). Median expected survival was significantly longer than actual median survival (CRC: 44.0 months [22.0-65.9] compared with 30.0 months of actual survival [20.9-39.1]; non-CRC: 22.0 months [15.3-28.6] compared with 19.0 months of actual survival [15.1-22.9], p=0.03).

CONCLUSION

Fatigue deserves more attention when toxicity of treatment and symptoms of disease are explained to patients. Patients' survival expectations from palliative chemotherapy are higher than previously described, exceed the median survival time known from phase III trials, and are significantly longer than their actual survival.

[The role of psycho-oncology in orthopedic tumor centers]

INTRODUCTION

Psychosocial screening has not been implemented into diagnosis-related guidelines for the treatment of orthopedic tumor patients. The aim of the study was to evaluate the significance of psycho-oncology in orthopedic institutions specialized in musculoskeletal tumors as well as the opinion and clinical experience of the treating physicians.

METHODS

In total 60 orthopedic institutions were recruited. Data were assessed and analyzed by a newly developed, standardized questionnaire. To detect specific, demographic differences results were additionally analyzed according to gender, age and professional experience.

RESULTS

A total of 118 physicians from 47 institutions participated. Significant differences between professional experience groups were obtained regarding the wish for psychosocial treatment in cases of own illness (p=0.032) and the difficulty of addressing patient feelings (p=0.05).

CONCLUSIONS

The majority of orthopedic physicians deemed psycho-oncology important. To ensure a holistic approach to the treatment of orthopedic tumor patients, psycho-oncological aspects should be implemented in diagnosis-related guidelines.