Since 2020, psychotherapists and physicians have been allowed to prescribe digital health applications for mental disorders (DHA-MD). The aim of the study was to examine the actual relevance of DHA-MD for mental health care by asking psychotherapists and physicians for their opinion on the need for DHA-MD and how often they actually prescribe them. Moreover, we wanted to identify reasons for (not) prescribing DHA-MD.In spring 2024, 1000 psychological psychotherapists and physicians registered by the National Association of Statutory Health Insurance Physicians in Germany were selected stratified by region and community size. They received a self-developed questionnaire by post, which was additionally published online by, for instance, expert associations. Additionally, we conducted semi-structured interviews with selected participants. Questionnaires were analysed both descriptively and via Spearman's Rank Correlation Test. A qualitative content analysis according to Mayring was done for the interviews.In total, 321 participants filled out the questionnaires, and 16 were interviewed. The need for DHA-MD on a scale of 0-10 was rated≤2 (median 2) by 61% (n=198) of the participants. The median of DHA-MD prescriptions in a regular calender quarter was 0 with a range up to 20. The share of participants prescribing at least one PsyDiGA was slightly higher (n=23, 29%) among physicians compared to psychological psychotherapists (n=60, 25%). There was no difference in the assessment of need for DHA-MD between the two professions. According to the interviews, requirements for confidence in and prescription of DHA-MD comprised guaranteed data protection, sufficient proof of concept, and knowledge about the contents of DHA-MD.Reasons for the low number of prescriptions and perceived need for DHA-MD may be less experience with DHA-MD or a lack of perceived necessity in participants' practice routine. The demand for transparency concerning data protection, proof of concept, and content of DHA-MD show mental health professionals' expectations of high quality concerning DHA-MD.

Background:The high number of mental disorders poses challenges for health care systems. In 2020, digital health applications (DHAs) were introduced in Germany as a new form of health care financed by the statutory health insurance. They aim to detect, monitor, treat, or alleviate disease, injury, or disability. DHAs for mental disorders (DHA-MD) intend to improve outpatient care for patients with mental disorders. However, evidence on general practitioners' (GPs') perspectives on DHA-MD and their prescribing behavior is limited. Objective:This study aimed to analyze GPs' perspectives on DHA-MD and their prescribing behavior in the care of patients with mental disorders. Methods:A mixed methods study was conducted (January-October 2024), including a Germany-wide online survey and qualitative interviews with GPs and medical assistants (MAs). Sampling was conducted in collaboration with German research practice networks, which distributed the study invitation to their affiliated GPs. The questionnaire as well as the interview guides for GPs and MAs was developed by the study team according to the Consolidated Framework for Implementation Research. Descriptive analyses of prescribing behavior and perceived need (measured on an 11-point scale) for DHA-MD were conducted, followed by multivariate regression analyses to identify predictors of prescribing behavior and perceived need for DHA-MD. The interviews with GPs and MAs were analyzed using qualitative content analysis according to Mayring. Results:A sample of 149 GPs participated, and 12 GPs as well as 5 MAs were interviewed. The median prescription frequency of DHA-MD per quarter was 1, whereas the median estimated need was 3. Working in a half digitized and half paper-based practice (odds ratio 5.133, 95% CI 1.695-15.542) as well as working in a completely digitized practice (odds ratio 3.006, 95% CI 1.296-6.969) positively predicted the prescribing behavior. The duration of GPs' medical practice (b=-0.057; P=.01) negatively predicted the perceived need, while working in a group practice (b=0.980; P=.02) positively predicted the perceived need for DHA-MD. In the interviews, GPs and MAs reported that they valued DHA-MD as a temporary or supplementary option for bridging waiting times for psychotherapy and considered their effectiveness to be highly dependent on indication and patient adherence. Reported barriers of GPs according to DHA-MD included lacking knowledge about DHA-MD, missing effectiveness studies, and difficulties integrating them into existing care processes. Conclusions:GPs are reluctant to prescribe DHA-MD, as the need is considered to be low and their use is primarily seen as a temporary or supplementary treatment option rather than a stand-alone intervention. There are significant reasons for rejection and barriers that hinder prescription in primary care. Addressing these barriers and involving GPs as well as patients in future research are essential for the development of DHA-MD.

Background Conditional outcomes are outcomes defined only under specific circumstances. For example, future quality of life (QoL) can only be ascertained when patients are alive. In prognostic models involving conditional outcomes, a choice must be made on the precise target of prediction: one could target future QoL, given that the individual is still alive (conditional) or target future QoL jointly with the event of being alive (unconditional). We aimed to (1) introduce a probabilistic framework for prognostic models for conditional outcomes, and (2) apply this framework to develop a prognostic model for QoL 3 years after diagnosis in patients with head and neck cancer. Methods A joint probability framework was proposed for prognostic model development for a conditional outcome dependent on a post-baseline variable. The framework involved two submodels: one for QoL and one for survival. Joint probability was estimated with conformal estimators using MAPIE with least absolute shrinkage and selection operator (LASSO) regression and XGBoost models. We included patients with head and neck cancer who were alive with no evidence of disease 12 months after diagnosis from the UK-based Head and Neck 5000 cohort (N=3572) and made QoL predictions 3 years after diagnosis. Predictors included clinical and demographic characteristics and longitudinal measurements of QoL. External validation was performed in longitudinal studies led by the University of Mainz (Mainz, Germany) and the Istituto Nazionale dei Tumori (Milan, Italy). A total of 497 patients were used in external validation of the QoL submodel and 281 were used in external validation of the survival submodel. Model performance was evaluated with C-statistics for discrimination, calibration plots, and R2 or mean absolute error (MAE), or both, for overall performance as appropriate. Findings Of 3572 patients, 400 (11·2%) were dead by the time of prediction (3 years after diagnosis), whereas 73 (26·0%) of 281 patients were dead in the validation set for the survival submodel. Model performance was assessed for prediction of QoL, both conditionally and jointly with survival. C-statistics ranged from 0·66 to 0·74 in internal validation and 0·60 to 0·80 in external validation. In internal validation, R2 and MAEs ranged from 0·37 to 0·5 and 12·2 to 13·5, respectively, whereas R2 and MAEs ranged from 0.35 to 0.41 and 13.0 to 12.3, respectively, in external validation. The calibration plots showed reasonable calibration in external validation. External performance was weaker for the survival submodel than for the QoL submodel. An application programming interface and dashboard were developed. Interpretation Our probabilistic framework for conditional outcomes provides both joint and conditional predictions and thus the flexibility needed to answer different clinical questions. Our model had reasonable performance in external validation and has potential as a tool in long-term follow-up of QoL in patients with head and neck cancer. Funding EU’s Horizon 2020 research and innovation programme.

Background: Since 2020, physicians and psychotherapists in Germany can prescribe digital health applications for mental disorders (PsyDiGA). The numbers of prescriptions and utilization have remained below expectations. To date, no studies have systematically compared the perspectives of patients and psychotherapists. Objective: Investigation of the potentials and limitations of PsyDiGA from the perspectives of psychotherapists as prescribers and patients as users. Methods: A nationwide survey among psychotherapists was conducted using questionnaires, complemented by qualitative telephone interviews with patients and psychotherapists. The data were analyzed descriptively (quantitative) and using thematic content analysis (qualitative) according to Mayring. Results: Questionnaires were completed by 321 psychotherapists and interviews were conducted with 18 patients and 16 psychotherapists. Both groups expressed ambivalence towards PsyDiGA. They identified advantages, such as temporal and spatial availability, the possibility of independent use and the relief of the strained treatment situation with limited places in outpatient psychotherapy. Concerns were raised about data protection, technical barriers, lack of individualization and the loss of the therapeutic relationship. Psychotherapists emphasized the lack of individualization, while patients highlighted the lack of personal contact. Conclusion: The implementation of PsyDiGA depends less on technological than on interpersonal, structural, and trust-related factors. A sustainable integration into psychotherapeutic care requires designing technical innovations that complement rather than replace the therapeutic process.

To investigate sexual health in breast cancer survivors and their partners, focusing on sexual satisfaction, changes in satisfaction with partner sexuality before vs. after the diagnosis, and unmet informational needs on sexual health in the context of breast cancer. Breast cancer patients and their partners were surveyed at a single time point 1–5 years after having completed primary therapy for breast cancer as part of a cross-sectional study. Study participants completed self-report-questionnaires covering personal characteristics, a question on satisfaction with partner sexuality before (retrospective assessment) versus after the diagnosis (based on the Sexual Medicine Questionnaire for Chronic Diseases (SFCE)), the EORTC (European Organisation for Research and Treatment of Cancer) Sexual Health Questionnaire (EORTC QLQ-SH22) together with the EORTC Quality of Life Core Questionnaire (EORTC QLQ-C30), and a questionnaire assessing sexual health care. Descriptive statistics were used to summarize demographic and clinical data. For group comparisons, dyadic dependencies were accounted for, applying paired t tests when normality (Shapiro–Wilk test) was met and Wilcoxon signed-rank test otherwise. A total of 128 participants (64 patients, 64 partners) were enrolled. Sexual satisfaction did not differ between patients (M = 55, SD = 20.9) and partners (M = 56.7, SD = 20) (t test, p = 0.46). A positive correlation was found between patients’ and partners’ sexual satisfaction (r = 0.62, p < 0.0001). Satisfaction with partner sexuality was lower after diagnosis (p < 0.001, r = 0.54)—with both patients and partners being less satisfied after the diagnosis (M = 2.58, SD = 0.95) than before (M = 3.14, SD = 0.74). Overall, 75

Background Worldwide, the high number of mental disorders poses challenges for healthcare systems. In 2020, digital health applications (DHA) were introduced in Germany as a novel type of healthcare financed by the statutory health insurance, aiming to detect, monitor, treat, or alleviate disease, injury, or disability. DHA for mental disorders (DHA-MD) intend to support outpatient care. However, there is limited evidence on general practitioners (GPs) perspectives on the use and benefits of DHA-MD in primary care. Methods A mixed-methods study was conducted between January and October 2024, including a nationwide online survey and qualitative interviews with GPs from Germany. Sampling was conducted in collaboration with German practice-based research networks. The questionnaire and interview guide were developed by the study team using the domains of the Consolidated Framework for Implementation Research. Descriptive analyses of (un)suitable patient groups and treatment contexts for the use of DHA-MD in primary care were conducted. The interviews with GPs were analyzed using qualitative content analysis. Results A total of 149 GPs participated in the survey and 12 GPs were interviewed. Most GPs reported that they would prescribe DHA-MD primarily to patients with prior positive experiences with DHA-MD (84.2%), aged 18-35 years (79.6%), with limited geographical mobility (78.6%), and when there is a need to bridge waiting times for psychotherapy (83.3%). In contrast, they would not prescribe DHA-MD to patients over 80 years (95.2%), under 18 years (87.0%), with multiple mental disorders (80.7%), and as primary treatment method (81.1%). In the interviews, GPs primarily viewed younger to middle-aged patients, with the necessary digital affinity and motivation to use the DHA, as well as with mild to moderate mental disorders as suitable. They reported to prescribe DHA-MD especially in waiting times and to support in-person care. Conclusions GPs take into account patients' individual skills, clinical condition, motivation, and likelihood of engaging with the DHA-MD when prescribing it. However, to avoid the systematic exclusion of certain patient groups, shared decision-making should be used to assess whether individual patients would benefit from using a DHA-MD. This assessment should be based on individual capabilities, such as digital literacy.

A healthy diet and weight can reduce the risk of secondary diseases in child, adolescent, and young adult (CAYA) cancer survivors. The nutrition module of the CARE for CAYA program, a multimodal survivorship program, implemented needs-based dietary interventions for CAYAs (aged 15–39 years) at 14 German university clinics between December 2017 and July 2020 (RCT: January 2018 to July 2019). Individual needs were determined at baseline (T1), and those with high need for dietary intervention received intensified intervention (intervention group (IG)), while the control group (CG) received one basic counseling. Dietary quality was measured after 52 weeks (T3) using the HEI-EPIC. Changes in Mediterranean dietary adherence (MEDAS-FFQ), phase angle, BMI, nutrition-related barriers, fatigue, and quality of life, as well as subjective and objective taste perception were assessed. Overall, 74.4 http://www.germanctr.de/ ).

Because anaplastic thyroid cancer (ATC) is a rare diagnosis, detailed epidemiological data are difficult to find in publicly accessible platforms. The aim of this study was to report current incidence and survival estimates for ATC in Germany and to analyse their trends over time. Data from the population-based cancer registries in Germany were pooled. ATC was classified according to the International Classification of Diseases, 10th edition (ICD-10). Age-standardised incidence rates (per 100,000) for the years 2011 to 2022 were calculated. The relative survival was estimated using period analysis. Annual percentage changes (APC) in the incidence and survival trends over time were computed. The number of new ATC cases diagnosed between 2011 and 2022 was 2127 (924 in men and 1203 in women). The current raw incidence is 0.19 in men and 0.22 in women. The age-standardised incidence in men changed slightly, but not significantly, during this period (APC − 2

Background: The health-related quality of life (HRQoL) of patients with differentiated thyroid carcinoma (DTC), especially their mental health, can be compromised by various factors beyond disease prognosis and treatment stage. However, predictors of poor emotional functioning (EF) in DTC patients have not been thoroughly studied. To inform targeted interventions that could improve or preserve HRQoL in patients with DTC, this study aimed to identify predictors of impaired EF, and particularly modifiable factors. Methods: Data analyzed were from the phase IV international validation study of the European Organization for Research and Treatment of Cancer thyroid cancer-specific HRQoL questionnaire (QLQ-THY34). Patients (n = 196) were assessed at three timepoints before treatment (t1), 6 weeks after the start of treatment (t2), and 6 months after t2 (t3). Multilevel, multivariable logistic regression models were used to assess the likelihood of impaired EF at t3 according to predefined potential predictors at t1 and t2. Results: Impaired EF at t1 or t2 predicted impaired EF at t3. Exhaustion, head and neck discomfort and body image issues were significantly associated with poor EF at t3. More specifically, temporal changes of these three variables from t1 to t2 were independent predictors of poor EF at t3 with an odds ratio of 1.04 (p < 0.001), 1.01 (p = 0.04), and 1.01 (p = 0.001) per score point, respectively. There was no evidence that worry about important others, lacking social support, sex, stage, or Karnofsky performance score are associated with EF at t3. Conclusions: Exhaustion, head and neck discomfort, and body image concerns emerged as modifiable factors that predict future impaired EF in patients with DTC undergoing treatment. These factors could be targeted in prehabilitation, rehabilitation or other interventional programs to potentially improve or preserve patients' EF.

Seit 2020 können Ärzt:innen und Psychotherapeut:innen Digitale Gesundheitsanwendungen für psychische Störungen (PsyDiGA) verordnen. Die Verschreibungs- und Nutzungszahlen blieben hinter den Erwartungen zurück. Bisher fehlen Studien, die Perspektiven von Patient:innen und Psychotherapeut:innen systematisch gegenüberstellen. Untersuchung der Potenziale und Grenzen von PsyDiGA aus Sicht von Psychotherapeut:innen als Verordnende und Patient:innen als Anwendende. Psychotherapeut:innen wurden deutschlandweit mithilfe von Fragebogen befragt. Zusätzlich wurden qualitative Telefoninterviews mit Patient:innen und Psychotherapeut:innen geführt. Die Auswertung erfolgte deskriptiv (quantitativ) und thematisch-inhaltlich (qualitativ) nach Mayring. Fragebogen wurden von 321 Psychotherapeut:innen ausgefüllt, Interviews mit 18 Patient:innen und 16 Psychotherapeut:innen geführt. Beide Gruppen beschrieben Ambivalenzen gegenüber PsyDiGA. Vorteile sahen sie in der zeit- und ortsunabhängigen Verfügbarkeit, der Möglichkeit selbstständiger Nutzung und der Entlastung der angespannten Versorgungssituation mit begrenzten ambulanten Psychotherapieplätzen. Bedenken bestanden hinsichtlich des Datenschutzes, technischer Hürden, fehlender Individualisierung und des Verlusts der therapeutischen Beziehung. Psychotherapeut:innen betonten mangelnde Individualisierung, Patient:innen den fehlenden persönlichen Kontakt. Die Implementierung von PsyDiGA hängt weniger von technologischen als von zwischenmenschlichen, strukturellen und vertrauensbezogenen Faktoren ab. Eine nachhaltige Integration in die psychotherapeutische Versorgung erfordert, technische Innovationen so zu gestalten, dass sie den therapeutischen Prozess ergänzen, nicht ersetzen.

Aufgrund des demographischen Wandels, der Altersstruktur der Hausärzt:innen sowie des Arztmangels werden hausärztliche Praxen in den nächsten Jahren vor vielfältige Herausforderungen gestellt. Diese betreffen neben einer hohen Arbeitslast die spezifischen gesundheitsrelevanten Versorgungsbedarfe der chronisch kranken und multimorbiden Patient:innen. Advanced Practice Nurses (APN) könnten diesbezüglich Abhilfe schaffen. Diese Studie untersucht die Erfahrungen von Hausärzt:innen im ländlichen Raum mit dem Einsatz von APN bei chronisch kranken und multimorbiden Patient:innen. In 9 Hausarztpraxen im ländlichen Raum in Rheinland-Pfalz wurde je eine APN eingesetzt. Nach Verlauf von etwa 2,5 Jahren wurden 10 leitfadenbasierte Telefoninterviews mit den Praxisinhaber:innen geführt. Die Auswertung erfolgte angelehnt an die qualitative Inhaltsanalyse nach Mayring und Fenzl. Die Hausärzt:innen berichteten, dass sie durch die APN entlastet wurden und die Patient:innen sehr zufrieden waren. Um das Berufsbild der APN fest in das Gesundheitssystem zu integrieren, fehlten jedoch rechtliche Rahmenbedingungen sowie eine Strategie zur Finanzierung. Die Erfahrungen mit APN sind überwiegend positiv. Implementierungshürden werden vor allem außerhalb der eigenen Praxis gesehen.

Psychosexual impairments in women with polycystic ovary syndrome (PCOS), often linked to depression, low self-esteem, and negative body image, significantly reduce quality of life. Although metabolic dysfunctions such as insulin resistance and obesity are key features of PCOS, their impact on psychosexual health remains poorly understood. This cross-sectional study aimed to examine the association between metabolic markers and psychosexual functioning in PCOS patients. Participants were recruited from the University Medical Center Mainz and diagnosed using the Rotterdam criteria. Assessments included hormonal and metabolic parameters - such as insulin resistance, body mass index (BMI), fatty liver index (FLI), and visceral adiposity index (VAI) - as well as psychosexual health, using the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). Logistic regression analyses revealed that visceral adiposity was associated with reduced sexual desire (odds ratio (OR) 2.56, p=0.016), and higher BMI (≥25 kg/m²) with reduced sexual satisfaction (OR 3.56, p=0.049). Elevated insulin resistance (homeostatic model assessment for insulin resistance (HOMA-IR) >5) and FLI (≥60) were associated with increased anxiety and depression, respectively. Overall, higher metabolic burden correlated with impaired sexual function and mental health. These findings highlight the importance of integrating metabolic and psychosexual assessments in PCOS care to better address patients' comprehensive well-being.

Background: The use of digital applications in mental health (PsyDiGA) is controversially discussed. Objective: For whom and in which treatment contexts are PsyDiGA considered to be appropriate? Methods: Psychotherapists in Germany received a questionnaire, which we evaluated based on their experience with PsyDiGA prescriptions. We also analyzed semistructured interviews via qualitative content analysis. Results: We received 321 questionnaires and 16 interviews. PsyDiGA are cosidered suitable for patients with limited mobility and unsuitable for persons aged over 65 years. The participants declined use of PsyDiGA as a primary treatment, whereas they were mostly agreed to its use for bridging waiting times. Answers differed considerably depending on their experience with PsyDiGA prescription. Our interviews identified the necessity of personal contact, consideration of mental load, and technical affinity as criteria for suitability. Conclusions: Prescribing PsyDiGA seems to depend on therapeutic orientations as well as the weighting of necessity and possibilities for personal contact.

Das hepatozelluläre Karzinom (HCC) zählt weltweit zu den häufigsten krebsbedingten Todesursachen und entsteht meist infolge einer Leberzirrhose (LZ). Tumordiagnose, eingeschränkte Therapieoptionen, ungünstige Prognose und Komplikationen wie Aszites können die Betroffenen psychisch belasten. Daten zur psychischen Belastung bei HCC-PatientInnen in Deutschland sind jedoch begrenzt. Ziel der Arbeit war die Untersuchung der Häufigkeit und Ausprägung von Angst- und Depressionssymptomen bei HCC- im Vergleich zu LZ-PatientInnen sowie die Analyse des Einflusses von Therapiesituation und Aszites auf die Angst- und Depressionssymptomatik. Daten von 35 HCC- und 104 LZ-PatientInnen wurden ausgewertet. Klinische Daten zur Ätiologie, der Therapiesituation (Erstdiagnose, Zustand nach lokal-ablativer Therapie oder Tumorrezidiv) und dem Vorliegen eines klinischen Aszites wurden aus Patientenakten extrahiert. Die psychische Belastung wurde mit der Hospital Anxiety and Depression Scale (HADS) erfasst. Gruppenvergleiche erfolgten mittels t‑Test, Mann-Whitney- bzw. Chi2-/Fisher-Test. 35

BACKGROUND:Polycystic ovary syndrome (PCOS) is an endocrine disorder that can result in reduced health-related quality of life (HRQOL). Metabolic changes, particularly insulin resistance and obesity, play a significant role in PCOS pathogenesis. This study examined associations between metabolic factors and HRQOL in PCOS patients. METHODS:A cross-sectional study of 77 patients was conducted at University Medical Center Mainz. At the time of inclusion in the study, patients had to be over 18 and not undergoing active PCOS therapy. A desire to conceive or fertility therapy led to exclusion. Participants were over 18, not undergoing PCOS therapy, and not seeking pregnancy. HRQOL and psychological distress were measured using the Modified-PCOS-Questionnaire (MPCOSQ) and Hospital Anxiety and Depression Scale (HADS). Linear regression analyses assessed associations between metabolic markers and HRQOL, with significant variables included in a multivariate model. RESULTS:Worsening metabolic markers were linked to lower HRQOL, especially in body hair and menstrual symptom domains. Markers such as HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) levels (P=0.040), elevated VAI (Visceral Adiposity Index) (P=0.035), and increased FLI (Fatty Liver Index) (P=0.023) were associated with diminished HRQOL. In the multivariate regression analysis, only a BMI ≥25kg/m2 (P=0.001) emerged as a statistically significant value. CONCLUSIONS:This study showed a significant correlation between metabolic markers, including BMI, FLI, VAI, HOMA-IR, and HRQOL in PCOS patients. BMI was the most meaningful predictor for HRQOL. BMI, despite being controversial and prone to errors, may be more indicative of HRQOL than specific metabolic markers.

ABSTRACT Background Because salivary gland cancers (SGC) are rare and include different tumor subtypes, data on their long‐term quality of life and late toxicities are sparse. Methods Multi‐national study including SGC survivors more than 5 years after diagnosis. They completed the European Organisation for Research and Treatment of Cancer (EORTC) quality of life core questionnaire together with its head and neck cancer module and reported problems that were most bothering for them. Toxicity was clinically assessed. Results Altogether, 60 survivors from nine countries participated and reported dry mouth (mean score 37.2), use of painkillers (35.0), problems with sexuality (30.1), insomnia (28.9), fatigue (27.8), trismus (24.9), and sticky saliva (23.3). The most frequently mentioned long‐term problem was dry mouth , mentioned by a third of all participants. The most frequent toxicities were hearing impairment , soft tissue fibrosis , dry mouth , and cranial neuropathies . Conclusions Dry mouth is a frequent and disturbing problem in SGC survivors.

Background Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide and usually develops as a result of liver cirrhosis (LC). Tumor diagnosis, limited treatment options, poor prognosis and complications such as ascites can mentally affect these patients: however, data on mental distress in HCC patients in Germany are limited. The aim of this study was to investigate the frequency and severity of anxiety and depression symptoms in HCC patients compared to LC patients and to analyze the influence of the treatment status and ascites on the anxiety and depressive symptoms. Material and methods Data from 35 HCC and 104 LC patients were evaluated. Clinical data on the etiology, the treatment situation (initial diagnosis, post-local ablative treatment or tumor recurrence), and the presence of clinical ascites were extracted from patient records. Mental well-being was assessed using the Hospital Anxiety and Depression Scale (HADS). Group comparisons were performed using t-tests, Mann-Whitney tests and chi 2/Fisher tests. Results Of the HCC patients 35% showed relevant mental distress. Excessive anxiety symptoms were found in 10% and depressive symptoms in 7%. Untreated patients were more severely affected (42%) than those who had undergone local ablative treatment (0%) or had a recurrence (25%). Ascites did not influence mental well-being in HCC. There were no differences compared to LC but ascites was associated with higher depression scores and increased mental stress in LC. Conclusion Mental stress affects around one third of HCC patients in an outpatient setting, comparable to inpatient data. The burden is particularly high before the start of treatment. In LC patients, ascites in particular have an impact on mental health. The results emphasize the need for early systematic screening and guideline-based psycho-oncological interventions.