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Predictors of psychiatric comorbidity in cancer patients at the time of their discharge from the hospital. Soc Psychiatry Psychiatr Epidemiol 2022; 57:553-561. [PMID: 34304277 PMCID: PMC8934323 DOI: 10.1007/s00127-021-02138-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/09/2021] [Indexed: 11/13/2022]
Abstract
PURPOSE A cancer diagnosis can have a substantial impact on one's mental health. The present study investigated the prevalence and predictors of psychiatric comorbidities in cancer patients at the time of their discharge from the hospital. METHODS Psychiatric comorbidities were assessed shortly before hospital discharge and half a year after hospitalization using a structured clinical interview (SCID), based on the diagnostic and statistical manual of mental disorders (DSM-IV). Frequencies at both time points were estimated using percentages and corresponding 95% confidence intervals. Predictors of mental disorders were identified using binary logistic regression models. RESULTS At time of hospital discharge, 39 out of 334 patients (12%) were diagnosed with a psychiatric comorbidity, and 15 (7%) were diagnosed half a year later. Among the diagnoses, adjustment disorders (3%) were most frequent at the time of hospital release, while major depression (3%) was the most frequent 6 months later. Having a mental disorder was associated with unemployment (odds ratio (OR) 3.4, confidence interval (CI) 1.1-10.9, p = 0.04). There was no evidence that school education (OR 2.0, CI 0.4-9.0, p = 0.38), higher education (OR 0.7, CI 0.2-2.4, p = 0.60), income (OR 1.0, CI 1.0-1.0, p = 0.06), tumor stage (OR 1.1, CI 0.4-3.2, p = 0.85), type of disease (OR 0.6, CI 0.2-2.1, p = 0.47), pain (OR 1.0, CI 1.0-1.0, p = 0.15), fatigue (OR 1.0, CI 1.0-1.0, p = 0.77), or physical functioning (OR 1.0, CI 1.0-1.0, p = 0.54) were related to the presence of a psychiatric comorbidity. CONCLUSIONS Unemployment was associated with at least a threefold increased risk of mental disorder, which highlights the need for special attention to be given to this subgroup of cancer patients.
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Singer S, Kojima E, Deppisch L, Taylor K, Wickert M, Riedel P, Alt J, Heß G, Hechtner M, Bayer O. What is the best time for psychosocial counselling from the perspective of cancer patients and their relatives? A multi‐centre qualitative study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Susanne Singer
- Division of Epidemiology and Health Services Research Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre of Johannes Gutenberg University Mainz Germany
- University Cancer Centre Mainz (UCT) Mainz Germany
| | - Erika Kojima
- Division of Epidemiology and Health Services Research Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre of Johannes Gutenberg University Mainz Germany
- University Cancer Centre Mainz (UCT) Mainz Germany
| | - Larissa Deppisch
- Division of Epidemiology and Health Services Research Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre of Johannes Gutenberg University Mainz Germany
- University Cancer Centre Mainz (UCT) Mainz Germany
| | - Katherine Taylor
- Division of Epidemiology and Health Services Research Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre of Johannes Gutenberg University Mainz Germany
- University Cancer Centre Mainz (UCT) Mainz Germany
| | | | | | - Jürgen Alt
- University Cancer Centre Mainz (UCT) Mainz Germany
| | - Georg Heß
- University Cancer Centre Mainz (UCT) Mainz Germany
| | - Marlene Hechtner
- Division of Epidemiology and Health Services Research Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre of Johannes Gutenberg University Mainz Germany
- University Cancer Centre Mainz (UCT) Mainz Germany
| | - Oliver Bayer
- Division of Epidemiology and Health Services Research Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre of Johannes Gutenberg University Mainz Germany
- University Cancer Centre Mainz (UCT) Mainz Germany
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Prevalence of Depression and Cancer - A systematic review. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2021; 68:74-86. [PMID: 34494936 DOI: 10.13109/zptm.2021.67.oa11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective: While comorbidity of different forms of cancer and clinical depression is reported for many single studies, representative and global overviews are scarce. Methods: A systematic review was carried out (mainly based on Medline, Embase, Cochrane, PsychLit, and Psyndex) to identify studies in adult cancer patients from 2007 to 2019. Studies with noncancer populations and cancer survivors were excluded. Assessment methods of depression were chart-based diagnoses, interview-based and self-report questionnaires. Quality and plausibility were checked using the adapted Downs & Black checklist. Results: For all 210 included studies the prevalence rate of clinical depression varied from 7.9 % to 32.4 %, with a mean of 21.2 % depression for different (mixed) cancer entities. The different methods of assessment have led to under- (especially charts-based diagnoses) as well as overreporting for some forms of cancer. In general, the different assessment forms show an acceptable variation in prevalence. Conclusions: The risk for a cancer patient to suffer a clinical depression during the first year after diagnoses is 15 % to 20 %, meaning every fifth or sixth patients. Different cancer entities, stage of cancer and treatments as well as different cultural and medical backgrounds show only slight variation in prevalence rates.
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Hadas S, Huhn M, Rentrop M, Wollenberg B, Combs S, Pigorsch S, Pickhard A, Buchberger AMS. The role of psycho-oncologic screenings in the detection and evaluation of depression in head and neck cancer aftercare patients. Eur Arch Otorhinolaryngol 2021; 279:2143-2156. [PMID: 34406478 PMCID: PMC8930863 DOI: 10.1007/s00405-021-07017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/23/2021] [Indexed: 11/24/2022]
Abstract
Purpose Cancer and morbidity during a therapeutic regimen can result in somatic and psychiatric impairment. We have evaluated the need of appropriate psychological screening by analyzing a large collective of head and neck cancer (HNC) patients with particularly burdensome symptoms. Methods HNC-aftercare patients were asked about somatic and psychological symptoms by means of standardized questionnaires of the European Organization for Research and Treatment of Cancer (EORTC Q30 and QLQ-H&N35). Patients with poor well-being values on the World Health Organization-5-Well-Being Index were screened for depression by using the Mini International Neuropsychiatric Interview, and adequate treatment was initiated, if necessary. Results Our sample consisted of 453 HNC-aftercare patients (average age 64.5 years; 72.0% male; 28.0% female). 25.1% showed abnormalities based on their WHO-5 questionnaire. A current major depressive episode was observed in 8.5% of the total study group. Patients with lip and oral cavity tumors showed the highest depression prevalence (18.9%). Time since initial HNC diagnosis showed no clear trend with regard to the number of depression cases. 50.0% of patients with a current major depressive episode consented to receiving assistance and/or therapy. Within the total study population, the most burdensome symptoms were found to be “dry mouth” (48.3%), “trouble doing strenuous activities” (46.0%), “trouble taking a long walk” (38.5%), and “worry” (35.5%). Aftercare patients with a depression diagnosis tended to have heavier symptom burdens than people without major depression. Conclusions Despite the various cancer-related burdensome factors, prevalence levels of depression among the HNC-aftercare patients and the general population were similar. Nevertheless, since the number of diagnosed depression cases is high, the need for psychological treatment should be considered within the tumor collective. Furthermore, screening for depression should be implemented in clinical routines by using the appropriate standardized questionnaires. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-07017-8.
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Affiliation(s)
- Stefan Hadas
- Hals-Nasen-Ohren Klinik und Poliklinik, Klinikum Rechts der Isar, Technischen Universität München, Ismaningerstr. 22, 81675, München, Deutschland.,Klinik für Strahlentherapie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Maximilian Huhn
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum Rechts der Isar, Technischen Universität München, Ismaningerstr. 22, 81675, München, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Sozialstiftung Bamberg, Klinikum Bamberg, Buger Straße 80, 96049, Bamberg, Deutschland
| | - Michael Rentrop
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum Rechts der Isar, Technischen Universität München, Ismaningerstr. 22, 81675, München, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Kbo-Inn-Salzach-Klinikum, Gabersee-Str 7, 83512, Wasserburg Am Inn, Deutschland
| | - Barbara Wollenberg
- Hals-Nasen-Ohren Klinik und Poliklinik, Klinikum Rechts der Isar, Technischen Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - Stephanie Combs
- Klinik für Strahlentherapie und Radioonkologie, Klinikum Rechts der Isar, Technischen Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - Steffi Pigorsch
- Klinik für Strahlentherapie und Radioonkologie, Klinikum Rechts der Isar, Technischen Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - Anja Pickhard
- Hals-Nasen-Ohren Klinik und Poliklinik, Klinikum Rechts der Isar, Technischen Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - Anna Maria Stefanie Buchberger
- Hals-Nasen-Ohren Klinik und Poliklinik, Klinikum Rechts der Isar, Technischen Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
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Dreismann L, Goretzki A, Ginger V, Zimmermann T. What if… I Asked Cancer Patients About Psychological Distress? Barriers in Psycho-Oncological Screening From the Perspective of Nurses-A Qualitative Analysis. Front Psychiatry 2021; 12:786691. [PMID: 35153856 PMCID: PMC8825354 DOI: 10.3389/fpsyt.2021.786691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Screening questionnaires to assess psychological distress in cancer patients are well-established, but in practice there are difficulties in implementation screening up to referral to psycho-oncology. Interdisciplinary collaboration between psycho-oncology, physicians, and nursing is very important to this process. However, there are barriers and obstacles on all sides. OBJECTIVE The aim of this study is to capture in particular the barriers from the perspective of oncology nursing. MATERIALS AND METHODS Semi-structured interviews with nursing experts (n = 15; n = 10 female; 24-62 years) from different oncology departments of three university hospitals in Germanys were conducted and qualitative content analysis was carried out by two raters. RESULTS The Screening routine is variably well-integrated into daily clinical practice. Structural barriers such as time pressure and a lack of focus on mental distress in nursing are present. Barriers on the side of nurses are primarily a lack of knowledge and communication insecurities when dealing with patients. CONCLUSIONS There is a need for training and implementation of a disciplinary screening approach. The structural and organizational barriers, which are a challenge for the successful screening process due to unfavorable interdisciplinary team communication and clinical daily structure, should be addressed in further studies. Implications for Practice: In order to establish an interdisciplinary screening process and to overcome the barriers, trainings to deal with knowledge deficits and insecurities seem to be useful.
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Affiliation(s)
- Lara Dreismann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Alina Goretzki
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Viktoria Ginger
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
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Baba N, Schrage T, Hartmann A, Baba K, Wuensch A, Schultze-Seemann W, Weis J, Joos A. Mental distress and need for psychosocial support in prostate cancer patients: An observational cross-sectional study. Int J Psychiatry Med 2021; 56:51-63. [PMID: 32597270 DOI: 10.1177/0091217420938896] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Prostate cancer is the most common cancer in German men and associated with various physical and psychosocial problems. This study investigated the association between mental distress and the subjective need for psychosocial support comparing subgroups of patients with different treatments and disease stages. METHOD We performed an observational, cross-sectional study including patients with four medical conditions: Active Surveillance, radical prostatectomy, biochemical relapse, metastasized disease. Mental distress (NCCN Distress-Thermometer), symptoms of depression and anxiety (PHQ-9, GAD-7), psychosocial needs and coping resources (self-designed questionnaire) were assessed. RESULTS N = 130 patients were included. 33.3% showed distress, 16.5% symptoms of moderate depression and 13% symptoms of moderate anxiety. We found no significant differences between the four groups. An association was present between distress and wish for psychosocial support (χ2 = 4.3; p < 0.05; ϕ = 0.19). Almost 90% lived with a partner, which represents a resource. CONCLUSIONS Prostate cancer patients showed low levels of mental distress, depression and anxiety with no difference in terms of disease stage and treatment modality. Therefore, careful psychosocial screening of all patients is essential to identify those in need for support. Distressed patients express a need for psychosocial support more often. Interpersonal relationships, most often wives and children, represent important coping resources.
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Affiliation(s)
- Naomi Baba
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Theresa Schrage
- Comprehensive Cancer Center, Department of Selfhelp Research, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Kenji Baba
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Alexander Wuensch
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.,Psychosocial Counselling for Cancer Outpatients, Comprehensive Cancer Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Joachim Weis
- Comprehensive Cancer Center, Department of Selfhelp Research, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
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Nakata H, Halbach S, Geiser F, Stock S, Kowalski C, Enders A, Pfaff H, Ernstmann N. Health literacy, mental disorders and fear of progression and their association with a need for psycho-oncological care over the course of a breast cancer treatment. PSYCHOL HEALTH MED 2020; 26:818-831. [PMID: 32484756 DOI: 10.1080/13548506.2020.1772987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This studyinvestigates the need for psycho-oncological care over the course of a breast cancer treatment and possible associated factors to develop such a need. The PIAT-Study was a longitudinal postal survey study conducted in Germany (2013 to 2014) with breast cancer patients (BCPs). Patients received a questionnaire at three-time points (T1: few days after surgery, T2: after 10 weeks; T3: after 40 weeks). This study considers information about patients' needs for psycho-oncological care, their breast cancer disease, social support, anxiety, health literacy (HL) and sociodemographic information. Data were analysed with descriptive statistics and logistic regression modelling to estimate the association between a need for psycho-oncological treatment and patient characteristics. N = 927 breast cancer patients reported their psycho-oncological need. 35.2% of patients report at least at one measuring point to be in need for psycho-oncological care. In a multiple logistic regression, noticeable determinants for developing such a need are an inadequateHL(OR = 1.97), fear of progression (FoP) (OR = 2.08) and psychological comorbidities (OR = 8.15) as well as certain age groups. BCPs with a low HL, suffering from a dysfunctional level of FoP or mental disorders are more likely to develop a need for psycho-oncological care.
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Affiliation(s)
- Hannah Nakata
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Franziska Geiser
- Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | | | - Anna Enders
- Department for Health Promotion for Vulnerable Groups, The Federal Centre for Health Education (BZgA), Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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8
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Eichler M, Hechtner M, Wehler B, Buhl R, Stratmann J, Sebastian M, Schmidberger H, Kortsik C, Nestle U, Wirtz H, Wehler T, Blettner M, Singer S. Use of psychosocial services by lung cancer survivors in Germany. Strahlenther Onkol 2019; 195:1018-1027. [DOI: 10.1007/s00066-019-01490-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/22/2019] [Indexed: 01/01/2023]
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9
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Taylor K, Singer S, May M, Durdu G, Petermann-Meyer A. Outcome comparison of integrated psycho-oncological care versus unstructured care-Results of a non-randomised open-label two-arm trial. Eur J Cancer Care (Engl) 2019; 28:e13127. [PMID: 31245886 DOI: 10.1111/ecc.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/29/2019] [Accepted: 06/07/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare patients' experiences with a systematic, integrated psycho-oncological care (IC) model to experiences with "care as usual" (CAU). METHODS To improve patients' knowledge about psychosocial support options and to facilitate use, an IC model was developed by psycho-oncologists and a health insurance company and implemented in one German cancer care facility. Using a parallel, non-randomised design, these patients' experiences were compared to CAU patients. In 2015, both patient groups received questionnaires 6-12 months post-inpatient treatment. Main outcomes were awareness, use and opinion of psycho-oncological care (PC) and anxiety level (Generalized Anxiety Disorder Scale (GAD-7)). RESULTS 228 patients (IC = 90; CAU = 138) participated (response rate 24%). More IC patients felt adequately informed about PC (63% vs. 46%, ORadj : 2.5 (CI: 1.3-4.8); p = 0.008). More IC patients recalled being offered various support options and had had at least one PC discussion (44% vs. 33%, ORadj of IC patient saying "yes" instead of "No, didn't want to" compared to a CAU patient: 0.4 (CI: 0.2-0.8); p = 0.01). More IC patients rated their care as good/excellent (49% vs. 38%, ORadj : 1.8 (CI: 0.7-4.1; p = 0.2)). Anxiety levels were similar (GAD-7 score>=10: IC 34% vs. CAU 28%; p = 0.4). CONCLUSION Structured psycho-oncological care had some positive results on the outcomes, but anxiety levels did not differ.
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Affiliation(s)
- Katherine Taylor
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie May
- Allgemeine Ortskrankenkasse (General Medical Insurance Plan) Rheinland/Hamburg (AOK-RH), Dusseldor, Germany
| | - Gülsemin Durdu
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Section Psychooncology, Euregionales Comprehensive Cancer Center, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andrea Petermann-Meyer
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Section Psychooncology, Euregionales Comprehensive Cancer Center, Medical Faculty, RWTH Aachen University, Aachen, Germany
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10
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Singer S, Amdal CD, Hammerlid E, Tomaszewska IM, Castro Silva J, Mehanna H, Santos M, Inhestern J, Brannan C, Yarom N, Fullerton A, Pinto M, Arraras JI, Kiyota N, Bonomo P, Sherman AC, Baumann I, Galalae R, Fernandez Gonzalez L, Nicolatou-Galitis O, Abdel-Hafeez Z, Raber-Durlacher J, Schmalz C, Zotti P, Boehm A, Hofmeister D, Krejovic Trivic S, Loo S, Chie WC, Bjordal K, Brokstad Herlofson B, Grégoire V, Licitra L. International validation of the revised European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module, the EORTC QLQ-HN43: Phase IV. Head Neck 2019; 41:1725-1737. [PMID: 30636188 DOI: 10.1002/hed.25609] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/25/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We validated the new European Organisation for Research and Treatment of Cancer Quality of Life Head and Neck Module (EORTC QLQ-HN43). METHODS We enrolled 812 patients with head and neck cancer from 18 countries. Group 1 completed the questionnaire before therapy, and 3 and 6 months later. In group 2 (survivors), we determined test-retest reliability using intraclass correlation coefficients (ICC). Internal consistency was assessed using Cronbach's Alpha, the scale structure with confirmatory factor analysis, and discriminant validity with known-group comparisons. RESULTS Cronbach's alpha was >0.70 in 10 of the 12 multi-item scales. All standardized factor loadings exceeded 0.40. The ICC was >0.70 in all but two scales. Differences in scale scores between known-groups were >10 points in 17 of the 19 scales. Sensitivity to change was found to be sufficient in 18 scales. CONCLUSIONS Evidence supports the reliability and validity of the EORTC QLQ-HN43 as a measure of quality of life.
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Affiliation(s)
- Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | | | - Eva Hammerlid
- Department of Otolaryngology and Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden
| | - Iwona M Tomaszewska
- Department of Medical Didactics, Jagiellonian University Medical College, Krakow, Poland
| | - Joaquim Castro Silva
- Department of Otolaryngology, Head and Neck Surgery, Instituto Português de Oncologia Francisco Gentil do Porto, Porto, Portugal
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - Marcos Santos
- Radiation Oncology Department, Brasilia University Hospital, Brasilia, Brazil
| | - Johanna Inhestern
- Clinic of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Christine Brannan
- Lynda Jackson Macmillan Centre, East & North Hertfordshire NHS Trust incorporating Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel-Hashomer, Israel and School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amy Fullerton
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Monica Pinto
- Supportive Care Department, Istituto Nazionale Tumori -IRCCS- Fondazione G. Pascale, Naples, Italy
| | - Juan I Arraras
- Oncology Departments, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital Cancer Center, Kobe, Japan
| | - Pierluigi Bonomo
- Radiation Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Allen C Sherman
- Behavioral Medicine Division, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ingo Baumann
- Department of Otolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany
| | - Razvan Galalae
- Department of Radiation Oncology, EVK Gelsenkirchen, University Duisburg-Essen, Gelsenkirchen, Germany
| | | | - Ourania Nicolatou-Galitis
- Clinic of Hospital Dentistry, Dental Oncology Unit, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Judith Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (location AMC) and Department of Oral Medicine ACTA, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Claudia Schmalz
- Department of Radiation Therapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Paola Zotti
- Department of Psychology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Andreas Boehm
- Department of Otolaryngology Head and Neck Surgery, St. Georg Hospital, Leipzig, Germany
| | - Dirk Hofmeister
- Department of Medical Psychology, University Hospital Leipzig, Leipzig, Germany
| | - Sanja Krejovic Trivic
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Suat Loo
- Department of Oncology, Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom
| | - Wei-Chu Chie
- Department of Family Medicine, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kristin Bjordal
- Department of Research Support Services, Oslo University Hospital, and University of Oslo, Oslo, Norway
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, University of Oslo, and Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Vincent Grégoire
- Radiation Oncology Dept & Center for Molecular Imaging and Experimental Radiotherapy, Université Catholique de Louvain and St-Luc University Hospital, Brussels, Belgium
| | - Lisa Licitra
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, and University of Milan, Milan, Italy
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Psychological Support. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Psychiatric co-morbidity, distress, and use of psycho-social services in adult glioma patients-a prospective study. Acta Neurochir (Wien) 2018; 160:1187-1194. [PMID: 29594548 DOI: 10.1007/s00701-018-3527-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/22/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Distress impacts the daily life of glioma patients. This study explored its course over time and the usage of psychosocial care. METHODS A consecutive sample of glioma patients completed the Hospital Anxiety and Depression Scale to assess distress levels at admission to the hospital (t1), before discharge (t2), after 3 months (t3), and after 6 months (t4). They were interviewed with the Structured Clinical Interview for DSM-IV to ascertain psychiatric disorders at t2. Psycho-oncological care in the hospital was determined with the Hospital Information System, and the use of outpatient treatment was evaluated with the Health Care Usage Questionnaire at t4. We compared the percentages of elevated distress, psychiatric co-morbidity, and care usage between men and women. RESULTS During the study period, 37 patients were enrolled. Nineteen percent of the patients were diagnosed with a psychiatric disorder. The percentages of patients with elevated distress were 56, 59, 39, and 40% at t1, t2, t3, and t4, respectively. Participants who did not survive the 6 months presented with higher levels of distress. In the hospital, 14% of those with elevated distress were visited by a psycho-oncologist. In the outpatient setting, 43% of those with elevated distress visited a neuro-psychiatrist, and 14% went to a psychotherapist. There was no evidence for an effect of gender on psychiatric co-morbidity, distress, or care use. CONCLUSIONS A significant proportion of glioma patients report elevated distress during the hospital stay and thereafter. Only a fraction of them receive mental health care.
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Bussmann S, Vaganian L, Kusch M, Labouvie H, Gerlach AL, Cwik JC. Angst und Emotionsregulation bei Krebspatienten. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0283-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Singer S, Claus S, Briest S, Stolzenburg JU, Papsdorf K, Gockel I, Köhler U, Oestreicher G, Heß G, Schmidt M, Almstedt K. Positive und negative Veränderungen im Leben nach der Krebsdiagnose. ONKOLOGE 2018. [DOI: 10.1007/s00761-018-0369-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Cancer patients' wish for psychological support during outpatient radiation therapy : Findings from a psychooncological monitoring program in clinical routine. Strahlenther Onkol 2018. [PMID: 29532098 PMCID: PMC6008369 DOI: 10.1007/s00066-018-1288-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer patients frequently suffer from physical and psychosocial impairments due to their disease and its treatment. Psychooncology (PO) can help to cope with stress resulting from outpatient radiotherapy (RT) treatment. There are currently few data regarding patients' wishes for PO support. The aim of this study was to investigate the number of patients with a wish for PO, treatment paths, and predictors of the wish for PO among cancer patients at the beginning of RT. METHODS The results of routine psychological stress screening (Hornheide screening instrument; cut-off ≥ 4) of 944 cancer patients between 2015 and 2017 were analyzed in a retrospective cross-sectional study. Predictors for a wish for PO support were identified by stepwise binary logistic regression, in which sociodemographic and treatment data were included in addition to the screening items. RESULTS Around 20% of patients had above-average stress levels and 13% expressed a wish for PO support (participation rate was approximately 55%). Low emotional wellbeing (OR = 11.3) and lack of social support (OR = 9.4) were strong predictors for this treatment wish. Among patients with pancreatic cancer, head and neck tumors, and hematologic disease, there was a substantial difference between the degree of psychological stress and the wish for treatment. Patients with urological (23.5%) and lung tumors (20.9%) most frequently expressed a wish for PO support. CONCLUSION Patient-reported psychosocial problems were better predictors of a wish for PO support than sociodemographic or clinical data. Stress screening should thus be implemented in clinical routine.
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Geue K, Rieckhof S, Buttstaedt M, Singer S. Do cancer patients with high levels of distress benefit more than less distressed patients from outpatient art therapy? Eur J Oncol Nurs 2017; 30:1-7. [PMID: 29031305 DOI: 10.1016/j.ejon.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/30/2017] [Accepted: 07/03/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Several studies have evaluated the effectiveness of art therapy for cancer patients. Our aim was to determine the effects of outpatient art therapy on the quality of life (QoL) of highly vs. less distressed cancer patients. METHODS Participants completed the EORTC QLQ-C30 to measure QoL and the HADS to measure distress level before the intervention (t1), after completing the intervention (t2), and 6-months after t2 (t3). We performed analyses of covariance with repeated measures to test for group differences (highly vs. less distressed). We determined clinically relevant change scores and effect sizes in QoL domains (t1-t2; t1-t3) in patients with low vs. high levels of distress. RESULTS 53 patient's participated at all three measuring points. Less (N = 22) vs. highly distressed patients (N = 31) differed at baseline and follow-up in their global QoL (mean t1:64.0 > 44.6; t2:65.5 > 55.6; t3:66.0 > 51.6; p = 0.01), emotional functioning (t1:65.2 > 37.4; t2:69.3 > 44.6; t3:57.8 > 48.5; p = 0.01), social functioning (t1:65.2 > 41.9; t2:77.3 > 52.7; t3:73.5 > 54.3; p = 0.01), cognitive functioning (t1:76.5 > 57.5; t2:74.4 > 62.4; t3:77.3 > 62.9; p = 0.02). There was no evidence of changes in physical functioning, role functioning, fatigue, pain, or insomnia. Interactions between distress, QoL, and time were not found. Effect sizes for clinical changes in QoL were medium regarding role functioning (Difft1-t3 = -14.4), fatigue (Difft1-t3 = -12.6) in the total group as well as in highly and less distressed patients. CONCLUSION No evidence of outpatient art therapy having an effect on QoL in cancer patients over time was found, in patients with either high or low levels of distress at baseline. Consequently, it remains unclear which patients benefit the most from art therapy.
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Affiliation(s)
- Kristina Geue
- University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany.
| | - Sophia Rieckhof
- University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Marianne Buttstaedt
- University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Susanne Singer
- University Medical Centre Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Epidemiology and Health Services Research, Mainz, Germany
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Singer S, Beckerle J, Kleining B, Reuter K, Schneider E, Kojima E. „Die Strukturen müssen viel flexibler sein“. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0229-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chen Y, Xiao H, Yang Y, Lan X. The effects of life review on psycho-spiritual well-being among patients with life-threatening illness: a systematic review and meta-analysis. J Adv Nurs 2016; 73:1539-1554. [DOI: 10.1111/jan.13208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Ying Chen
- School of Nursing; Fujian Medical University; Fuzhou China
| | - Huimin Xiao
- School of Nursing; Fujian Medical University; Fuzhou China
| | - Yanqing Yang
- School of Nursing; Fujian Medical University; Fuzhou China
| | - Xiuyan Lan
- School of Nursing; Fujian Medical University; Fuzhou China
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Keszte J, Danker H, Dietz A, Meister E, Pabst F, Guntinas-Lichius O, Oeken J, Singer S, Meyer A. Course of psychiatric comorbidity and utilization of mental health care after laryngeal cancer: a prospective cohort study. Eur Arch Otorhinolaryngol 2016; 274:1591-1599. [PMID: 27744529 DOI: 10.1007/s00405-016-4340-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
In a German multi-center prospective cohort study, we wanted to assess the course of psychiatric comorbidity, utilization of mental health care and psychosocial care needs in laryngeal cancer patients during the first year after partial laryngectomy (PRL). Structured interviews with patients were conducted before surgery, 1 week (1 w), 3 months (3 m) and 1 year (12 m) after PRL. Psychiatric comorbidity was assessed using the Structured Clinical Interview for DSM-IV (SCID). Psychosocial care needs and utilization of mental health care were evaluated with standardized face-to-face interviews. In 176 patients, psychiatric disorders were prevalent in 11 % (1 w), 15 % (3 m) and 14 % (12 m), respectively, of which 4 % (12 m) underwent psychiatric treatment or psychotherapy. Two percent had acute, 15 % emerging and 6 % chronic psychiatric comorbidity. Chronically mental ill patients were more frequently younger than 65 years (p = 0.026), female (p = 0.045) and experienced more often a need for psychological counseling (p ≤ 0.001). One year after surgery, 27 % of the comorbid psychiatric patients expressed a need for additional psychological counseling. Alcohol-related disorders were diagnosed in 3 % (1 w), 3 % (3 m) and 8 % (12 m), respectively. Only one of these patients received psychological treatment, while 14 % expressed a need for psychological counseling and 7 % for additional medical consultations. The non-treatment of alcohol-related disorders measured in our sample indicates a major problem since continued alcohol consumption in laryngeal cancer patients is associated with reduced global quality of life, increased functional impairments and reduced overall survival. Screening instruments integrated into acute care are necessary to detect harmful drinking behavior.
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Affiliation(s)
- J Keszte
- Division Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center, Leipzig, Germany.
| | - H Danker
- Division Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center, Leipzig, Germany
| | - A Dietz
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center, Leipzig, Germany
| | - E Meister
- Department of Otorhinolaryngology, Clinical Center Sankt Georg, Leipzig, Germany
| | - F Pabst
- Department of Otorhinolaryngology, Clinical Center Dresden-Friedrichstadt, Dresden, Germany
| | - O Guntinas-Lichius
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital, Jena, Germany
| | - J Oeken
- Department of Otorhinolaryngology, Clinical Center Chemnitz, Chemnitz, Germany
| | - S Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - A Meyer
- Division Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center, Leipzig, Germany
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Keszte J, Danker H, Dietz A, Meister E, Pabst F, Vogel HJ, Meyer A, Singer S. Mental disorders and psychosocial support during the first year after total laryngectomy: a prospective cohort study. Clin Otolaryngol 2015; 38:494-501. [PMID: 24188349 DOI: 10.1111/coa.12194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the frequency of mental disorders and the use of psychosocial services in laryngectomised patients during the first year after surgery. DESIGN Multicentre prospective study including six interviews. Data regarding psychiatric comorbidity 3 months (3 m) and 1 year (12 m) after total laryngectomy (TLE) are reported in this study. SETTING Structured interviews were conducted at nine hospitals and three rehabilitation centres in Germany. PARTICIPANTS One hundred and seventy-one patients were interviewed at both time-points. MAIN OUTCOME MEASURES Structured clinical interview for DSM-IV (SCID). RESULTS Mental disorders were diagnosed in 25% of the patients (3 m) and in 22% of the patients (12 m), respectively. Six per cent of the patients developed a mental disorder during the first year after total laryngectomy. In general, male and female patients suffered from mental disorders with equal frequency (3 m: 23% versus 37%; P = 0.26; 12 m: 22% versus 21%; P = 1.00). Women suffered more often than men from post-traumatic stress disorder (3 m) (P = 0.01) and generalised anxiety disorder (12 m) (P = 0.01).Of the patients who had acquired no voice, 20% suffered from alcohol dependence (P = 0.01) [corrected]. There were no differences between men and women in receiving any kind of counselling (P = 0.79) or psychotherapy/psychiatric treatment (P = 0.47). Of those patients diagnosed with any mental disorder 3 months after total laryngectomy, 7% had received psychotherapy 1 year after total laryngectomy. None of the patients diagnosed with alcohol dependence received psychotherapy or psychiatric treatment. CONCLUSIONS Mental disorders occur in laryngectomees as frequently in men as they do in women. Total laryngectomised patients who were mentally ill did not receive enough psychotherapeutic or psychiatric support. As mental health seems to be related to successful voice restoration, future research should develop and evaluate special psychosocial supportive programmes for patients with laryngeal cancer, especially regarding alcohol dependence treatment.
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Affiliation(s)
- J Keszte
- Department of Medical Psychology and Medical Sociology, Section Psychosocial Oncology, University of Leipzig, Leipzig, Germany
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Singer S, Schwentner L, van Ewijk R, Blettner M, Wöckel A, Kühn T, Felberbaum R, Flock F, Janni W, Kreienberg R. The course of psychiatric co-morbidity in patients with breast cancer - results from the prospective multi-centre BRENDA II study. Psychooncology 2015; 25:590-6. [DOI: 10.1002/pon.3978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Centre, Johannes Gutenberg University Mainz; Mainz Germany
| | - Lukas Schwentner
- Department of Gynaecology and Obstetrics; University of Ulm; Ulm Germany
| | - Reyn van Ewijk
- Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Centre, Johannes Gutenberg University Mainz; Mainz Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Centre, Johannes Gutenberg University Mainz; Mainz Germany
| | - Achim Wöckel
- Department of Gynaecology and Obstetrics; University of Würzburg; Würzburg Germany
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics; Hospital Esslingen; Esslingen Germany
| | - Ricardo Felberbaum
- Department of Gynaecology and Obstetrics; Hospital Kempten; Kempten Germany
| | - Felix Flock
- Department of Gynaecology and Obstetrics; Hospital Memmingen; Memmingen Germany
| | - Wolfgang Janni
- Department of Gynaecology and Obstetrics; University of Ulm; Ulm Germany
| | - Rolf Kreienberg
- Department of Gynaecology and Obstetrics; University of Ulm; Ulm Germany
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Dinkel A, Kremsreiter K, Marten-Mittag B, Lahmann C. Comorbidity of fear of progression and anxiety disorders in cancer patients. Gen Hosp Psychiatry 2014; 36:613-9. [PMID: 25213227 DOI: 10.1016/j.genhosppsych.2014.08.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The relation between fear of progression (FoP) and anxiety disorders remains unclear. Therefore, we investigated the comorbidity between clinical FoP and psychiatric anxiety disorders. METHOD In this cross-sectional study, 341 cancer patients undergoing acute inpatient care participated. A structured clinical interview (Structured Clinical Interview for DSM-IV Axis I) was used to identify Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition anxiety disorders and hypochondriasis. Patients completed measures of FoP (Fear of Progression Questionnaire), worries (Penn State Worry Questionnaire, Worry Domains Questionnaire), depression [Patient Health Questionnaire (PHQ): Depression], anxiety (PHQ: General Anxiety Disorder) and somatic symptoms (PHQ: Somatic Symptoms). We cross-tabulated FoP with the presence of anxiety disorders and studied associated variables. RESULTS Of all patients studied, 17.6% suffered from an anxiety disorder. With regard to comorbidity, 68.3% suffered neither from clinical FoP nor from any anxiety disorder, 13.4% had not been diagnosed with an anxiety disorder but experienced clinical FoP, and 11.6% only suffered from an anxiety disorder. The remaining 6.7% suffered from FoP that was comorbid with an anxiety disorder. Patients with a pure FoP did not differ from patients with a pure anxiety disorder on nearly all symptom measures. Only a few associations between the comorbidity pattern and sociodemographic and clinical variables emerged. CONCLUSION Clinical FoP appears to be a distinct phenomenon. It does not differ from anxiety disorders in its psychological and somatic burdens.
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Affiliation(s)
- Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Katrin Kremsreiter
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Goerling U, Jaeger C, Walz A, Stickel A, Mangler M, van der Meer E. The efficacy of short-term psycho-oncological interventions for women with gynaecological cancer: a randomized study. Oncology 2014; 87:114-24. [PMID: 25012072 DOI: 10.1159/000362818] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/10/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to examine the efficacy of two psycho-oncological interventions in anxiety, depression, and self-perceived as well as physiological stress in inpatients with gynaecological cancer. METHODS Forty-five women were included in the trial. Thirty-five were categorized as being at high risk of anxiety and depression, and were randomized to either a single psycho-oncological therapy session or a single-session relaxation intervention. RESULTS A significant decrease in anxiety [mean (t0) = 12, mean (t1) = 7.47, p = 0.001] and depression [mean (t0) = 9.71, mean (t1) = 6.35, p < 0.001] was observed in the psycho-oncological intervention group. In the relaxation group, anxiety also significantly decreased [mean (t0) = 11.67, mean (t1) = 8.22, p = 0.003], whereas depression did not. A comparative analysis of both interventions showed a trend in favour of psycho-oncological therapy for the treatment of depression (F = 3.3, p = 0.078). However, self-reported stress (p = 0.031) and different objective stress parameters only significantly decreased in the relaxation group. CONCLUSIONS Psycho-oncological interventions should represent an essential part of interdisciplinary care for gynaecological cancer patients. Both types of intervention may reduce anxiety. However, the single psycho-oncological therapy session might be slightly more effective in treating depression, whereas the single-session relaxation intervention seems to have a stronger effect on physiological stress parameters.
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Affiliation(s)
- Ute Goerling
- Charité Comprehensive Cancer Center, Charité Universitätsmedizin, Berlin, Germany
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Wollbrück D, Danker H, Ullrich P, Pabich J, Singer S. [Psycho-oncology for speech therapists: establishment and conception of the course PSYKOL]. HNO 2013; 61:1026-31. [PMID: 24327197 DOI: 10.1007/s00106-013-2778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Head and neck cancer patients show a high psychiatric comorbidity, yet receive only little psychosocial support. Therefore, a specific psychosocial qualification for speech therapists working with head and neck cancer patients seems necessary. MATERIAL AND METHODS A course was developed based on a process model. Questionnaires were completed by speech therapists (self-evaluation of working situation; n = 15) as well as therapists interested in further training (collection of issues in the work with head and neck patients who are under psychological pressure assessed as problematic by the therapists; n = 27), whose competence in communication was also evaluated. In addition, a literature research was conducted and a focus group was formed. RESULTS High psychosocial demands within the therapists' work with tumor patients and difficulties in communication became obvious. Nearly all interviewees frequently used nonconducive communication patterns, yet implicit knowledge existed (usage of a favorable conversational style in multiple choice test: 68 %). The content and concept of the curriculum were discussed within the focus group and led to the final version of the training. CONCLUSION A customised psycho-social training curriculum for speech therapists has been developed.
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Affiliation(s)
- D Wollbrück
- Abteilung Medizinische Psychologie und Medizinische Soziologie, Sektion Psychoonkologie, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland,
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Singer S, Szalai C, Briest S, Brown A, Dietz A, Einenkel J, Jonas S, Konnopka A, Papsdorf K, Langanke D, Löbner M, Schiefke F, Stolzenburg JU, Weimann A, Wirtz H, König HH, Riedel-Heller S. Co-morbid mental health conditions in cancer patients at working age--prevalence, risk profiles, and care uptake. Psychooncology 2013; 22:2291-7. [PMID: 23494948 DOI: 10.1002/pon.3282] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/16/2013] [Accepted: 02/18/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined the prevalence of mental health conditions in cancer patients, the role of socioeconomic position in relation to that, and the use of professional mental health care. METHODS Prospective cohort with measurements at the beginning of inpatient treatment (baseline) and 3, 9, and 15 months after baseline using structured clinical interviews based on DSM-IV, questionnaires, and medical records. RESULTS At baseline, 149 out of 502 cancer patients (30%) were diagnosed with a mental health condition. Prevalence was associated with unemployment (odds ratio [OR] 2.0), fatigue (OR 1.9), and pain (OR 1.7). Of those with mental health conditions, 9% saw a psychotherapist within 3 months of the diagnosis, 19% after 9 months, and 11% after 15 months. Mental health care use was higher in patients with children ≤18 years (OR 3.3) and somatic co-morbidity (OR 2.6). There was no evidence for an effect of sex on the use of mental health care. CONCLUSION Few cancer patients with psychiatric disorders receive professional mental health care early enough. If patients are unemployed or if they suffer from fatigue or pain, special attention should be paid because the risk of having a mental health condition is increased in these patients.
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Affiliation(s)
- S Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg University, Mainz, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- Division of Psychosocial Oncology, University of Leipzig, Leipzig, Germany
| | - C Szalai
- Division of Psychosocial Oncology, University of Leipzig, Leipzig, Germany
| | - S Briest
- Breast Cancer Centre, University of Leipzig, Leipzig, Germany
| | - A Brown
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - A Dietz
- Department of Otolaryngology, University of Leipzig, Leipzig, Germany
| | - J Einenkel
- Department of Obstetrics and Gynecology, University of Leipzig, Leipzig, Germany
| | - S Jonas
- Department of Surgery, University of Leipzig, Leipzig, Germany
| | - A Konnopka
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Papsdorf
- Department of Radiation-Oncology, University of Leipzig, Leipzig, Germany
| | - D Langanke
- Breast Cancer Centre, Hospital St. Elisabeth, Leipzig, Germany
| | - M Löbner
- Department of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany
| | - F Schiefke
- Department of Maxillofacial Surgery, University of Leipzig, Leipzig, Germany
| | - J-U Stolzenburg
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - A Weimann
- Cancer Centre, Hospital St. Georg, Leipzig, Germany
| | - H Wirtz
- Department of Pulmonology, University of Leipzig, Leipzig, Germany
| | - H H König
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Riedel-Heller
- Department of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany
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Reaktive Veränderungen in Befinden und Verhalten von Kindern bei elterlicher Krebserkrankung – Ergebnisse einer epidemiologischen Patientenbefragung. Prax Kinderpsychol Kinderpsychiatr 2012; 61:378-95. [DOI: 10.13109/prkk.2012.61.6.378] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Anxiety and depression disorders in cancer patients: incidence, diagnosis and therapy. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2012. [DOI: 10.1007/s12254-012-0327-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Singer S, Lincke T, Gamper E, Bhaskaran K, Schreiber S, Hinz A, Schulte T. Quality of life in patients with thyroid cancer compared with the general population. Thyroid 2012; 22:117-24. [PMID: 22191388 DOI: 10.1089/thy.2011.0139] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Since patients with thyroid cancer have a very good prognosis overall, clinicians may often assume that their quality of life is comparable to the general population. We hypothesized that quality of life of thyroid cancer patients is lower compared with the general population while controlling the effect of age and gender. METHODS At the beginning of their stay at an inpatient rehabilitation clinic, a cohort of n=121 patients with thyroid cancer were assessed using the quality of life core questionnaire of the European Organisation for Research and Treatment of Cancer (QLQ-C30). Data for comparison were derived from a representative German community sample with n=2037. RESULTS The patients reported significantly more problems than the community sample participants independent of gender and age effects in all but two domains, namely constipation and diarrhea. The strongest effects of the group (patients vs. general population) were found in the following domains: insomnia (B=-43.7, p<0.001), fatigue (B=-38.0, p=<0.001), and role functioning (B=29.7, p=<0.001). Significant interactions between age and group occurred in the social functioning, role functioning, fatigue, nausea/vomiting, and financial difficulties domains. Quality of life was unrelated to the stage of the disease, except in the physical function and global health status domains. CONCLUSIONS At the beginning of inpatient rehabilitation, patients with thyroid cancer often experience more problems than controls from community samples, independent of their age and gender. Clinicians should be aware of the fact that quality of life is not directly related to the severity of the cancer prognosis.
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Affiliation(s)
- Susanne Singer
- Department of Health Psychology and Applied Psychodiagnostics, University of Wuppertal, Wuppertal, Germany.
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Book K, Marten-Mittag B, Henrich G, Dinkel A, Scheddel P, Sehlen S, Haimerl W, Schulte T, Britzelmeir I, Herschbach P. Distress screening in oncology-evaluation of the Questionnaire on Distress in Cancer Patients-short form (QSC-R10) in a German sample. Psychooncology 2011; 20:287-93. [DOI: 10.1002/pon.1821] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Jadoon NA, Munir W, Shahzad MA, Choudhry ZS. Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study. BMC Cancer 2010; 10:594. [PMID: 21034465 PMCID: PMC2988751 DOI: 10.1186/1471-2407-10-594] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 10/29/2010] [Indexed: 01/06/2023] Open
Abstract
Background The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients. Methods This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group). Results The mean age of cancer patients was 40.85 years (SD = 16.46) and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74). Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7%) had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001). Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal malignancies, chest tumors and breast cancer. Conclusions This study highlights high prevalence rates of depression and anxiety in cancer patients. Younger age was associated with a higher likelihood of meeting criteria for psychological morbidity. The findings support screening patients for symptoms of depression and anxiety as part of standard cancer care and referring those at a higher risk of developing psychological morbidity for appropriate care.
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Affiliation(s)
- Nauman A Jadoon
- Department of Medicine, Nishtar Medical College Hospital, Multan, Pakistan.
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Goerling U, Tagmat D, Muffler E, Schramm N, Wernecke KD, Schlag PM. Practice and effectiveness of outpatient psycho-oncological counseling for cancer patients. J Cancer 2010; 1:112-9. [PMID: 20842233 PMCID: PMC2938074 DOI: 10.7150/jca.1.112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 08/23/2010] [Indexed: 11/30/2022] Open
Abstract
Objective: Because of various types of psychological distress, cancer patients are encouraged to attend outpatient psycho-oncological and psychosocial counseling. The aim of this prospective study was an analysis of the impact and success of existing counseling resources. Methods: All cancer patients who had applied at a central counseling center were given a standardized questionnaire (FBK-R23), designed to assess the type and degree of cancer patients' difficulties prior to their first counseling session. Additionally, the psychological condition of the patients was assessed psycho-oncologically by a third party (PO-Bado). After at least 2 and no more than 5 sessions, patients underwent both self-evaluation and third-party assessment, using the same instruments. Results: During the period from September 2008 and August 2009, we looked at a total of 447 people seeking counseling, including 186 family members (42%), 33 professional caregivers (7%), and 228 patients (51%). Out of the 228 patients, 48 attended our counseling sessions personally and 20 of these additionally completed the second questionnaire. Counseling led to only a tendency toward improvement, on average, of total psychological distress (p=0.08). In individual areas - for example, “Social Distress” and “Everyday Limitations”- no change could be measured. Only the problem area identified as “Information Deficit” was improved, on average, after 3 counseling sessions (p=0.008). Conclusion: Our results indicate that while short-term counseling has no concrete effect on the improvement of a patient's psychological well-being, these support sessions do serve to decrease the patient's so-called “Information Deficit”, thereby bringing about an indirect improvement in the sufferer's psychological state. The course of treatment offered should be determined according to the patient's needs. In order to ensure that even the very sickest of the tumor patient group seek outreach groups, we must target this particular group with additional evaluative questions. Further studies must determine whether short-term counseling or other counseling strategies are most effective.
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Affiliation(s)
- Ute Goerling
- 1. Charité Comprehensive Cancer Center, Berlin, Germany
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Singer S, Das-Munshi J, Brähler E. Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis. Ann Oncol 2010; 21:925-30. [DOI: 10.1093/annonc/mdp515] [Citation(s) in RCA: 252] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dietz A, Meyer A, Singer S. [Measuring quality of life in head and neck cancer. Current status and future needs]. HNO 2009; 57:857-65. [PMID: 19629416 DOI: 10.1007/s00106-009-1969-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review presents the current knowledge and methods of measuring disease-related quality of life in oncology, with particular emphasis on laryngeal and hypopharyngeal cancer. In addition to the currently popular and well-established instruments, specifics of the initial interview process, collection of psychiatric comorbidities, and the role of social care and its substantial influence on disease-related quality of life are discussed. At the forefront are the results of the central German head and neck oncology social-medical studies.
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Affiliation(s)
- A Dietz
- Klinik für Hals-, Nasen-, Ohrenheilkunde und Plastische Operationen, Universitätsklinikum Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Deutschland.
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Singer S, Kuhnt S, Götze H, Hauss J, Hinz A, Liebmann A, Krauss O, Lehmann A, Schwarz R. Hospital anxiety and depression scale cutoff scores for cancer patients in acute care. Br J Cancer 2009; 100:908-12. [PMID: 19240713 PMCID: PMC2661775 DOI: 10.1038/sj.bjc.6604952] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of ⩾13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of ⩾6 (specificity 0.21). With scores of ⩾16 and ⩾22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.
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Affiliation(s)
- S Singer
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, UK.
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[The contribution of alcohol to nutrition: addition or substitution according to cultural origins]. BMC Cancer 1986; 13:393. [PMID: 23967823 PMCID: PMC3765872 DOI: 10.1186/1471-2407-13-393] [Citation(s) in RCA: 105] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/31/2013] [Indexed: 11/10/2022] Open
Abstract
The relation of alcohol intake to diet is analyzed through multiple linear regression for a sample of 475 males living in Geneva. Control variables are age, relative weight index, marital status and employment status. Whereas alcohol is associated with higher dietary intake for people of mediterranean origin, it tends to replace food calories for natives of german speaking areas.
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