Objective In this study we wanted to find out what cancer patients expect from professional psychosocial support. Methods Within a multicenter prospective study, patients were asked about their expectations from professional psychosocial support two years after diagnosis. Using qualitative methods, categories were built from the answers. The answers were assigned to the categories. Results 447 patients were contacted and 285 answers were obtained. Getting information as well as interaction with enough time for listening was considered as important. Support should result in enhancement of psychological strength. Discussion Apart from contents, aspects of how support is given such as attention and competence are important. There should be enough time for the consideration of individual needs. Conclusion Both getting information and competence as well as listening and personal conversation are important.

Zusammenfassung Ziel der Studie Ziel der Studie war herauszufinden, welche Erwartungen KrebspatientInnen an professionelle psychosoziale Unterstützung haben. Methodik Im Rahmen einer multizentrischen prospektiven Studie wurden KrebspatientInnen zwei Jahre nach ihrer Diagnose befragt, was sie von professioneller psychosozialer Unterstützung erwarten. Aus den Freitextantworten wurden gemäß qualitativer Methoden Kategorien gebildet und alle Antworten kodiert. Ergebnisse 447 PatientInnen wurden kontaktiert, für die Auswertung lagen 285 Antworten vor. PatientInnen war der Erhalt von Informationen sowie Austausch mit genug Zeit für Zuhören wichtig. Als Resultat der Unterstützung wünschten sie sich vor allem die Förderung psychischer Stärke. Diskussion Neben den Inhalten sind Aspekte des „wie“ der Unterstützung sehr wichtig, vor allem Aufmerksamkeit und fachliche Kompetenz. Es sollte genug Zeit für das Eingehen auf individuelle Bedürfnisse zur Verfügung stehen. Schlussfolgerung Zusätzlich zu Erhalt von Informationen und Kompetenz sind Zuhören und persönlicher Austausch besonders wichtig für Betroffene.

Krebspatienten sind häufig psychosozial belastet, nehmen aber entsprechende Hilfsangebote nur zu einem geringen Teil in Anspruch. Was verstehen Krebspatienten unter dem Begriff psychosoziale Unterstützung? Patienten wurden zu Beginn des Krankenhausaufenthaltes in die Studie eingeschlossen und zwei Jahre später nachbefragt. Sie gaben an, was ihnen einfällt, wenn sie den Begriff psychosoziale Unterstützung hören oder lesen. Die so entstandenen Texte wurden kodiert und folgenden Kategorien zugeordnet: Bewertung im Sinne von Valenz (positiv, neutral, negativ, positiv und negativ), Art der Aussage, Adressat, Akteur, Inanspruchnahme und Gegenstand psychosozialer Unterstützung. Zusammenhänge von Geschlecht, Alter und Bildung mit negativer Bewertung und Nichtwissen wurden anhand logistischer Regressionen geprüft. Es nahmen 447 Patienten an der Befragung teil, von denen 343 Aussagen zu ihrer Vorstellung von „psychosozialer Unterstützung“ machten. 12% der Befragten sagten, sie wüssten nicht, was psychosoziale Unterstützung ist. Das Odds Ratio für Nichtwissen war 1,3 für Männer, 3,2 für Patienten, die 50 bis 65 Jahre alt waren im Vergleich zu Patienten <50 Jahren, 1,3 für Patienten mit mittlerer Reife und 2,3 mit Hauptschule im Vergleich zu Abitur. 48% der Teilnehmer beschrieben psychosoziale Unterstützung als etwas Positives, 5 % als etwas Negatives, 20 % äußerten sich neutral und 10 % äußerten positive und negative Aspekte gleichzeitig. Es gab keine Hinweise auf Zusammenhänge zwischen Alter, Geschlecht, Bildung und negativer Bewertung. Ein Teil der Krebspatienten weiß nicht, was psychosoziale Unterstützung ist, insbesondere ältere und weniger gebildete Menschen. Ein Großteil der Patienten ist der Unterstützung gegenüber positiv oder vorbehaltlos eingestellt.

PURPOSE:Reasons for the social gradient in cancer survival are not fully understood yet. Previous studies were often only able to determine the socio-economic status of the patients from the area they live in, not from their individual socio-economic characteristics.METHODS:In a multi-centre cohort study with 1633 cancer patients and 10-year follow-up, individual socio-economic position was measured using the indicators: education, job grade, job type, and equivalence income. The effect on survival was measured for each indicator individually, adjusting for age, gender, and medical characteristics. The mediating effect of health behaviour (alcohol and tobacco consumption) was analysed in separate models.RESULTS:Patients without vocational training were at increased risk of dying (rate ratio (RR) 1.5, 95% confidence interval (CI) 1.1-2.2) compared to patients with the highest vocational training; patients with blue collar jobs were at increased risk (RR 1.2; 95% CI 1.0-1.5) compared to patients with white collar jobs; income had a gradual effect (RR for the lowest income compared to highest was 2.7, 95% CI 1.9-3.8). Adding health behaviour to the models did not change the effect estimates considerably. There was no evidence for an effect of school education and job grade on cancer survival.CONCLUSIONS:Patients with higher income, better vocational training, and white collar jobs survived longer, regardless of disease stage at baseline and of tobacco and alcohol consumption.

Diese Studie hatte zum Ziel, den Zusammenhang von Lebensqualität und Überlebenszeit bei Patienten mit Ösophaguskarzinom zu bestimmen.

Bei der psychoonkologischen Versorgung stellt sich wegen klinischen und ökonomischen Beweggründen häufig die Frage, ob Patientinnen mit Brustkrebs in frühen Tumorstadien psychisch weniger stark belastet sind als jene mit Krebs in höheren Stadien.

Background Patients with head and neck cancer are known to be more commonly emotionally distressed than patients with other tumors. This study investigates reasons for this difference.Methods. Patients in this prospective cohort study included those with head and neck cancer (n = 113) and those with other cancers (n 1690). The Hospital Anxiety and Depression Scale, measuring emotional distress, along with additional questions regarding emotional support wished and provided were administered.Results. Patients with head and neck tumors were 1.5-fold (at the time of admission), 1.2-fold (before discharge), and 2.7-fold (half a year after admission) more frequently distressed than the other patients with cancer. This association was confounded by perceived social support and sociodemographic factors. Patients with head and neck cancer expressed less frequently the wish for and received less support by psychooncologists.Conclusions. Emotional distress is more common in patients with head and neck tumors; this is largely a result of the psychosocial context the patients live in, especially the amount of social support received. (C) 2011 Wiley Periodicals, Inc. Head Neck 34: 180-187, 2012

BACKGROUND AND OBJECTIVES:Professional psychosocial support of patients with cancer is an essential component of the entire process of medical care of these patients. But so far gender specific differences have only rarely been investigated. Yet some studies have suggested that there are differences between male and female patients regarding their psychological burden and their use of psychosocial support facilities. This article discusses the latter issue, based on empirical data.METHODS:At the beginning of their treatment (t1) the patients were asked to answer a questionnaire exploring their needs and wishes regarding medical and psychological care, as well as regarding self-support. There were 252 patients (60% males; mean age of males = 60.1 ; mean age of females = 55.5) with different kinds of cancer (39.7% of males had prostate cancer; 26.7% of females had breast cancer). The follow-up (t2) took place half a year after t1. As part of the follow-up questionnaire data regarding the meeting of the individual patient's needs was collected. Standardized scales were used (t1, t2), as well as a clinical interview (SKID) (t1), which recorded psychological co-morbidity.RESULTS:The need for support was found not to differ significantly between the genders but depended on the grade of co-morbidity and on the particular group of supporting professionals, respectively. Most frequently, within the overall condition "medical support" the patients' need for support (t1) and the actually received support (t2) were found to be coincident (85.7 - 94.2 %) for women as for men. Particularly with regard to psychological and social care, multivariate analysis revealed the need for care (t1) being a predictor of actually received support (t2). Especially within the group of women the factor "living alone" was found to explain the congruence between the need for care and the received support.CONCLUSION:Few gender-specific differences regarding need for care and actually received support have been found within this cohort of male and female patients with cancer. It is a unclear to what degree such differences could be due to the design of the study. It is important to assess the patient's wishes and needs for multiprofessional care at the beginning of cancer treatment. In addition the family and social situation must be taken into account.

The objective of this study was to compare the prevalence of anxiety and depression in cancer patients with the prevalence found in the general population, using the Hospital Anxiety and Depression Scale (HADS). Participants were 1529 cancer patients treated between 2002 and 2004 in Germany and 2037 persons from the German general population. In the cancer patients, the risk of psychiatric distress was nearly twice that of the general population. While for older age groups (61 years and above) there were only small differences between cancer patients and the general population, the differences in both scales were high for young persons. There were differences between the HADS mean scores of the patients with different tumour localisations, with high values for brain cancer and low scores for prostate cancer. The influence of the tumour stage on anxiety and depression was weak. However, depression scores of patients with a survival time less than 1 year were elevated. The results show that large sample sizes are necessary to evaluate the psychological situation of cancer patients, and that age and gender differences must be taken into account when several samples are compared.

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.

Background and objectives: Professional psychosocial support of patients with cancer is an essential component of the entire process of medical care of these patients. But so far gender specific differences have only rarely been investigated. Yet some studies have suggested that there are differences between male and female patients regarding their psychological burden and their use of psychosocial support facilities. This article discusses the latter issue, based on empirical data.Methods: At the beginning of their treatment (0) the patients were asked to answer a questionaire exploring their needs and wishes regarding medical and psychological care, as well as regarding self-support. There were 252 patients (60% males; mean age of males = 60,1; mean age of females = 55,5) with different kinds of cancer (39,7% of males had prostate cancer; 26,7% of females had breast cancer). The follow-up (t2) took place half a year after t1. As part of the follow-up questionnaire data regarding the meeting of the individual patient's needs was collected. Standardized scales were used (t1, t2), as well as a clinical interview (SKID) (t1), which recorded psychological comorbidity.Results: The need for support was found not to differ significantly between the genders but depended on the grade of comorbidity and on the particular group of supporting professioals, respectively. Most frequently, within the overall condition "medical support" the patients' need for support (t1) and the actually received support (t2) were found to be coincident (85,7-94,2%) for women as for men. Particularly with regard to psychological and social care, multivariate analysis revealed the need for care (t1) being a predictor of actually received support (t2). Especially within the group of women the factor "living alone" was found to explain the congruence between the need for care and the received support.Conclusion: Few gender-specific differences regarding need for care and acutally received support have been found within this cohort of male and female patients with cancer. It is a unclear to what degree such differences could be due to the design of the study. It is important to assess the patient's wishes and needs for multiprofessional care at the beginning of cancer treatment. in addition the family and social situation must be taken into account.

Background: About one third of cancer patients suffers from a psychiatric disorder. However, only few studies feature long-term assessment of psychiatric disease in cancer patients, covering a broad range of diagnoses, and employing high-quality instruments. Patients and Methods: A total of 62 patients underwent assessments during a 3-year follow-up period after initial cancer diagnosis. The Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was used to measure psychiatric morbidity at baseline (t(1)) and 2 follow-up assessments (t(2) and t(3)). Follow-up assessments took place between 6 and 18 months (t(2)) and between 24 and 36 months (t(3)) after baseline measurement. Results: At t(1), at least one DSM-IV diagnosis was found in 29% of the patients. During follow-up, the frequency of psychiatric morbidity increased to 36% at t(2) and 44% at t(3). New occurrence of psychiatric disease during follow-up was 18% at t(2) and 38% at t(3). Conclusion: Persistence and number of newly diagnosed psychiatric disorders during the first 3 years after cancer treatment should be considered in the treatment of cancer patients, especially in individuals with according predictive factors.

BACKGROUND:About one third of cancer patients suffer from a psychiatric disorder. However, only few studies feature long-term assessment of psychiatric disease in cancer patients, covering a broad range of diagnoses, and employing high-quality instruments.PATIENTS AND METHODS:A total of 62 patients underwent assessments during a 3-year follow-up period after initial cancer diagnosis. The Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders was administered to measure psychiatric morbidity at baseline (t₁) and two follow-ups (t₂ and t₃). Follow-up assessments took place from 6 to 18 months (t₂) and from 24 to 36 months (t₃) after baseline. Biomedical and psychosocial factors were evaluated to identify predictors of psychiatric disorders using univariate and multivariate analyses.RESULTS:At t₁, at least one DSM-IV diagnosis was found in 29% of the cases. At follow-ups, the frequency of psychiatric morbidity increased to 36% at t₂ and 44% at t₃, respectively. New occurrence of psychiatric disease at follow-ups was 18% at t₂, and 38%, at t₃. Predictors of psychiatric disorders were low social support, low physical functioning, metastases, complications of disease, and loss of sportive activity.CONCLUSION:Persistence and amount of newly diagnosed psychiatric disorders during three years after cancer treatment should be considered in the treatment of cancer patients, especially in individuals with accordant predictive factors.

OBJECTIVE:The aim of this study was to assess the degree and the course of psychological distress (anxiety and depression) in cancer patients and to detect sociodemographic determinants of the scores. METHODS AND MATERIALS:Patients with prostate cancer (n = 287) and other urogenital cancer (n = 126) were tested with the Hospital Anxiety and Depression Scale (HADS) at the following time points: at the beginning (T1) and the end (T2) of the treatment in the hospital, 6 months later (T3), and 1 year later (T4). RESULTS:Anxiety mean scores were highest at the start of the stay in the hospital. About 36% of the patients were at least doubtful cases at T1. However, the anxiety mean scores from T2 to T4 were similar to those of the general population and lower than those of cardiac patients. Depression mean scores were even lower than those of the general population. Young age and receiving radio- and/or chemotherapy were predictive of higher psychological distress. CONCLUSIONS:The low mean scores of anxiety and depression from T2 to T4 indicate that most of the prostate cancer patients do not need help from mental health professionals. Nevertheless, some patients may profit from mental health support, especially at the beginning of the stay in the hospital.

Background/Aims: The aim of this study was to assess the course of anxiety and depression in cancer patients over time and to detect determinants of the changes in the scores. Patients and Method: Women with breast cancer and gynaecological cancer (n = 367) were tested at the beginning (T1) and at the end (T2) of treatment in the hospital, 6 months later (T3), and 12 months later (T4), using the Hospital Anxiety and Depression Scale (HADS). Results: Anxiety and depression were highest at the start of the stay in the hospital. More than half of the women are at least doubtful cases in at least one of the two HADS dimensions. The mean scores declined from T1 to T4. After 1 year, depression scores are similar to those of the general population, while anxiety scores remain elevated. The decline of the HADS scores depends on treatment, time since diagnosis, and education. Conclusions: Women receiving radio- or chemotherapy (compared with surgery only), with a long time since diagnosis, and with a low educational level are at high risk of maintaining high anxiety and depression scores over time.

{! Objectives:} The aim of this study was to examine the impact of parenthood on the quality of life of cancer patients. {! Methods:} A sample of 246 cancer patients (56 % female) with different cancer locations were surveyed at the beginning of their inpatient medical treatment (t1) and 6 months afterward (t2) using the EORTC QLQ-C30 questionnaire. Three subgroups were compared in a crosssection and a longitudinal design. The variables sex, partnership, distant metastases and age were controlled. {! Results:} A negative impact of parenthood on certain sub-dimensions of quality of life was seen in contrast to patients without children at the time of the acute treatment (t1). After 6 months (t2) quality of life was increased, particularly in the subgroup of patients with younger children. However, there were no other statistically relevant differences between patients with or without children. Some variables such younger age, male sex and partnership have a positive impact on quality of life of patients. {! Conclusions:} In conclusion, the present findings suggest that special psychosocial support during the acute treatment is necessary for cancer patients with children. The presence of younger children can possibly be interpreted as a protective factor in the process of illness. The development of suitable instruments for the measurement of psychosocial burden of parents with cancer and their children and the implementation and evaluation of specific intervention programs should be the goal of further investigations.

Between 2002 and 2004 485 cancer patients in oncological treatment were assessed for mental disorders using the Structured Clinical Interview for DSM-IV (SCID). Socio-demographic, psychosocial and medical data were taken as possible predictors into multivariate analysis. 32 % of the patients suffered from mental diseases. Significant risk factors for anxiety disorders were female sex, precedent mental trauma, children below 18 years; for affective disorders female sex, poor physical functioning; for stress disorders children below 18 years; for addictive disorders male sex, younger age, children from 18 years on, distant metastases. Additional psychosocial risk factors seem to be predominantly responsible for the development of a mental co-morbidity in inpatients with malignant diseases, which should be examined in doctor-patient-talks.