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Introduction: Major national and international oncological societies generally recommend treating a significant proportion of oncological patients in clinical trials to improve therapy strategies for cancer patients. At cancer centers, the recommendation about the appropriate therapy for the individual tumor patient is usually made in interdisciplinary case discussions in multidisciplinary tumor boards (MDT). In this study, we examined the impact of MDTs for the inclusion of patients in therapy trials. Methodology: A prospective, explorative study of the Comprehensive Cancer Center Munich (CCCM) was conducted at both university hospitals in 2019. In the first phase, various MDTs' case discussions about oncological situations and their decisions regarding possible therapy trials were recorded in a structured manner. In the second phase, the actual inclusion rates of patients in therapy trials and reasons for non-inclusion were examined. Finally, the data of the respective university hospitals were anonymized, pooled and analyzed. Results: A total of 1797 case discussions were reviewed. Therapy recommendations were made in 1527 case presentations. 38 (2.5%) of 1527 patients were already included in a therapy trial at the time of case presentation. The MDTs recommended inclusion of an additional 107 cases (7%), for a therapy trial. Of these patients, 41 were finally enrolled in a therapy trial which resulted in a total recruitment rate of 5.2%. Despite MDTs' recommendations, 66 patients were not included in a therapy trial. The main reason for non-inclusion was insufficient inclusion or existing exclusion criteria (n = 18, 28%). In 48% of all cases (n = 31), the reason for non-inclusion could not be determined. Conclusion: The potential of MDTs as an instrument for the inclusion of patients in therapy trials is high. To increase the enrollment of patients in oncological therapy trials, structural measures such as the central use of trial administration and MTB software in addition to standardized tumor board discussions must be established to ensure a seamless flow of information about actual recruiting trials and the current status of trial participation of patients. [ABSTRACT FROM AUTHOR]

A cancer disease can be associated with psychological stress for both patients and partners. To date, no psychometrically tested measuring instrument has been available for the assessment of cancer-specific distress in partners of cancer patients. The Questionnaire on Stress in Partners of Cancer Patients (QSC-P) was developed to close this gap. This study validates the QSC-P in two subsamples of n1 = 227 and n2 = 297 partners of cancer patients by application of exploratory factor analysis methods in n1 and confirmatory factor analysis methods in n2. Additionally, correlations with common measures of anxiety, depression, and quality of life were calculated. A cut-off for high distress was determined. A three-factor structure with 23 items that was generated in n1 could be replicated in n2. Reliability and validity analyses resulted in good to very good characteristic values of the resulting QSC-P (α =.84–.93). A cut-off of 68.5 with good sensitivity and specificity was calculated. The QSC-P proved to be a valid and reliable measuring instrument for psychological distress of partners of cancer patients and a helpful tool for clinical care and research. Future directions include development of a short-form and detailed comparison of the sexes. [ABSTRACT FROM AUTHOR]

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Purpose: Despite promising achievements in precision cancer medicine (PCM), participating patients are still faced with manifold uncertainties, especially regarding a potential treatment benefit of molecular diagnostics (MD). Hence, MD poses considerable challenges for patient information and communication. To meet these challenges, healthcare professionals need to gain deeper insight into patients' subjective experiences. Therefore, this qualitative study examined information aspects of MD programs in cancer patients. Methods: In two German Comprehensive Cancer Centers, 30 cancer patients undergoing MD participated in semi-structured interviews on information transfer and information needs regarding MD. Additionally, patients provided sociodemographic and medical data and indicated their subjective level of information (visual analogue scale, VAS, 0–10). Results: On average patients had high levels of information (mean = 7, median = 8); nevertheless 20% (n = 6) showed an information level below 5 points. Qualitative analysis revealed that patients show limited understanding of the complex background of MD and have uncertainties regarding their personal benefit. Further, patients described unmet information needs. Existential threat in awaiting the results was experienced as burdensome. To withstand the strains of their situation, patients emphasized the importance of trusting their physician. Conclusion: The challenges in PCM consist in providing unambiguous information, especially concerning treatment benefit, and providing guidance and support. Therefore, psycho-oncology needs to develop guidelines for adequate patient communication in order to help healthcare providers and cancer patients to handle these challenges in the developing field of PCM. [ABSTRACT FROM AUTHOR]

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Psychosocial distress is common in cancer patients and survivors and encompasses a broad range of concerns and psychological symptoms. The aim of the current study was to identify subgroups of respondents who experience a specific constellation of distress symptoms.Methods: This study uses data from a large data base (n = 21 680) of cancer patients from diverse settings who provided data in the Questionnaire on Distress in Cancer Patients-Short Form (QSC-R10). Cluster analysis was applied to identify subgroups with a distinct constellation of distress symptoms.Results: The results showed five distinct clusters: minimally distressed patients (46.6% of the sample), highly distressed patients (12.7%), mainly physically distressed patients (15.2%), mainly psychologically distressed patients (15.6%), and mainly socially distressed patients (9.9%). These groups differed with regard to age, sex, cancer site, treatment setting, and disease progression.Conclusion: The results revealed large heterogeneity in the experience of distress. Distress clusters were associated with socio-demographic and clinical variables. These associations might aid a clinician to tailor interventions and to address specific types of distress. [ABSTRACT FROM AUTHOR]

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Precision cancer medicine (PCM) aims at identifying tumor-driving molecular characteristics to improve therapy. Despite early successes for some cancers, the approach faces manifold challenges. Patients undergoing extensive molecular diagnostics (MD) may hope for personal benefit, although chances are small. In order to offer suitable support to this group, health-care professionals need to gain insight into patients' experience. Thus, this study sought to explore the expectations of cancer patients undergoing MD of their tumor.Methods: In two German Comprehensive Cancer Centers, 30 patients with advanced-stage cancer who had exhausted conventional treatment and had consented to extensive, research-oriented MD (whole-genome sequencing n = 24, panel sequencing n = 6) participated in semi-structured interviews. Following thematic content analysis by Kuckartz, the interview transcripts were coded for expectations of MD participation and topics closely related. Moreover, patients completed questionnaires on their sociodemographic characteristics, medical history, and psychosocial distress.Results: Patients reported to be expecting (a) an improvement of their treatment, (b) a contribution to research, and/or (c) additional insight to their own cancer. Further, they described to feel individually appreciated and to have a reason to maintain hope for cure or recovery by participating in MD.Conclusions: Molecular diagnostics participation led patients to feel treated in a more "personalized" way, allowing them a greater sense of control in their situation of severe illness. Oncologists and psycho-oncologists need to ensure comprehensive information and empathetic support for patients undergoing extensive MD to balance their expectations and actual chances of clinical benefit. [ABSTRACT FROM AUTHOR]

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Currently available patient-reported outcome measures are limited in the field of sex reassignment surgery (SRS). Standardized questionnaires deliver high evidence data on satisfaction of male-to-female (MTF) transgender patients but do not allow any modification in their clinical application. We therefore designed a prospective study using self-developed indication-specific questionnaires to evaluate the aesthetic, functional, and sexual outcomes of MTF patients undergoing SRS. Methods: Forty-nine adult MTF transgender patients who underwent two-stage SRS were eligible for study inclusion between September 2012 and January 2014. Forty patients (= N) ultimately filled out both parts of the questionnaire sets: 1 day before the first stage (T0) and 6 months after the second stage of SRS (T1). These questionnaires focused on demographic characteristics, the satisfaction with aesthetic and functional results, and sexuality. Results: Patients rated their surgical satisfaction of most items with mean scores above 7 on a 0-10-point scale. Many items evaluating everyday life activities improved significantly after SRS compared to T0 ( p < 0.01). All but one patient (97.5%) reported no regrets about having undergone surgery, and the majority recommended it to other patients with gender dysphoria. Femininity and sexual activity increased significantly postoperatively ( p < 0.01). Satisfaction with intercourse and orgasm was high: 6.70 and 8.21, respectively, on a 0-10 scale. Conclusion: Satisfaction with the cosmetic outcome, as well as the functional and sexual outcomes, reveal positive effects of SRS using the combined technique on transgender patient lives. Nevertheless, standardized and validated SRS-specific questionnaires are lacking. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: Cancer-related cognitive dysfunction has mostly been attributed to chemotherapy; this explanation, however, fails to account for cognitive dysfunction observed in chemotherapy-naïve patients. In a controlled, longitudinal, multisite study, we tested the hypothesis that cognitive function in breast cancer patients is affected by cancer-related post-traumatic stress.Methods: Newly diagnosed breast cancer patients and healthy control subjects, age 65 or younger, underwent three assessments within one year, including paper-and-pencil and computerized neuropsychological tests, clinical diagnostics of post-traumatic stress disorder (PTSD), and self-reported cognitive function. Analysis of variance was used to compare three groups of participants-patients who did or did not receive chemotherapy and healthy control subjects-on age- and education-corrected cognitive performance and cognitive change. Differences that were statistically significant after correction for false discovery rate were investigated with linear mixed-effects models and mediation models. All statistical tests were two-sided.Results: Of 226 participants (166 patients and 60 control subjects), 206 completed all assessment sessions (attrition: 8.8%). Patients demonstrated overall cognitive decline (group*time effect on composite z -score: -0.13, P = .04) and scored consistently worse on Go/Nogo errors. The latter effect was mediated by PTSD symptoms (mediation effect: B = 0.15, 95% confidence interval = 0.02 to 0.38). Only chemotherapy patients showed declined reaction time on a computerized alertness test. Overall cognitive performance correlated with self-reported cognitive problems at one year ( T = -0.11, P = .02).Conclusions: Largely irrespective of chemotherapy, breast cancer patients may encounter very subtle cognitive dysfunction, part of which is mediated by cancer-related post-traumatic stress. Further factors other than treatment side effects remain to be investigated. [ABSTRACT FROM AUTHOR]

Our study group has researched for >10 years in the field of Quality of Life after plastic, aesthetic, and reconstructive surgery, asking the following questions: "Does aesthetic surgery improve the Quality of Life?" and "Can a higher Quality of Life offset the risk of surgical procedures." As part of our series of studies examining the correlation of cosmetic surgery and the postoperative well-being, this study examines the influence of rhinoplasty, as a single indication, specifically on the Quality of Life (QoL) of patients. The data of 90 patients who underwent rhinoplasty between 1997 and 2007 were prospectively collected and were retrospectively analyzed. For a competitive analysis, our evaluation was divided into the following five parts: a self-developed indication-specific questionnaire and the standardized instruments Glasgow Benefit Inventory (GBI), Questions on Life SatisfactionModules (FLZM), Freiburg Personality Inventory (FPI-R), and Rosenberg Self-Esteem Questionnaire (RSES). Numerous improvements in patients' QoL were observed. The result of the GBI (17.19) based on a scale -100 to 100 indicates an improved QoL after rhinoplasty. Significant improvements in the item relationship/sexuality were shown in the general part of the FLZM (p = 0.042). The average score (6.32) on a scale of 0 to 14 in the FPI-R questionnaire resulted in a common emotionality and self-assessment, while the RSES (33.64) on a scale 10 to 40 indicated a high self-confidence and a statistically significant improvement (p = 0.0001) compared with German norm data. The knowledge of positive social and psychological benefits and an improved sexuality in the partnership support the meaningfulness of rhinoplasty. [ABSTRACT FROM AUTHOR]

Background: Prospective clinical studies are the most important tool in modern medicine. The standard in good clinical practice in clinical trials has constantly improved leading to more sophisticated protocols. Moreover, translational questions are increasingly addressed in clinical trials. Such trials must follow elaborate rules and regulations. This is accompanied by a significant increase in documentation issues which require substantial manpower. Furthermore, university-based clinical centers are interested in increasing the amount of patients treated within clinical trials, and this number has evolved to be a key quality criterion. The present study was initiated to elucidate the obstacles that limit clinical scientists in screening and recruiting for clinical trials. Methods: A specific questionnaire with 28 questions was developed focusing on all aspects of clinical trial design as well as trial management. This included questions on organizational issues, medical topics as well as potential patients' preferences and physician's goals. The questionnaire was established to collect data anonymously on a web-based platform. The survey was conducted within the Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich; physicians of all levels (Department Chairs, attending physicians, residents, as well as study nurses, and other study-related staff) were addressed. The answers were analyzed using the Survio analyzing tool (http://www.survio.com/de/). results: We collected 42 complete sets of answers; in total 28 physicians, 11 study nurses, and 3 persons with positions in administration answered our survey. The study centers reported to participate in a range of 3-160 clinical trials with a recruitment rate of 1-80%. Main obstacles were determined: 31/42 (74%) complained about limited human resources and 22/42 (52%) reported to have a lack on technical resources, too. 30/42 (71%) consented to the answer, that the documentation effort of clinical trials is too large. A possible increase of the patients' study participation rate up to over 20% was deemed to be possible if the described limitations could be overcome. Discussion: The increasing documentation effort in clinical trials has led to a strong increase in the work load of scientific personnel. Recruiting of patients into clinical trials therefore is not only limited by patient issues, but also by the infrastructure of the centers. Especially the lack of study nurses is likely to be a major limitation. Furthermore, technical resources for time efficient and safe documentation within clinical routine as well as in clinical trials are required. By optimization of these factors, a significant increase in the amount of patients treated in clinical trials seems to be possible. [ABSTRACT FROM AUTHOR]

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: There is ongoing debate whether cancer qualifies as traumatic stressor. We investigated prevalence and course of posttraumatic stress in patients with early breast cancer (BC) during their first year after diagnosis and determined effects of mastectomy and chemotherapy.Methods: Patients with stage 0-III BC aged ≤65 years were evaluated with the Structured Clinical Interview for DSM-IV modules for acute and posttraumatic stress disorder (ASD and PTSD, respectively) before treatment, after chemotherapy, and 1 year after diagnosis. Matched controls were assessed at matched intervals. Effects of time, mastectomy, and chemotherapy on BC-related PTSD symptom severity were tested with linear mixed model analysis.Results: Stress disorder (ASD or PTSD) related to BC was diagnosed in 6 (3.6%) of 166 patients before treatment and in 3 patients (2.0%) 1 year later. The rate of patients who experienced PTSD symptoms related to BC decreased from 82.5 to 57.3% (p < 0.001), and the mean of BC-related PTSD symptoms diminished from 3.1 to 1.7 (p < 0.001). Only university education significantly predicted the course of BC-related PTSD symptom severity (p = 0.009). In 60 controls, no diagnosis of stress disorder, a rate of 18% women experiencing PTSD symptoms, and a mean of 0.4 PTSD symptoms (p vs. patients <0.001) were found.Conclusions: Most newly diagnosed patients with BC experience PTSD symptoms, whereas full diagnoses of DSM-IV stress disorder are rare. Symptoms diminish somewhat within 1 year furthered by university education but independently from mastectomy and chemotherapy. Throughout the year after diagnosis, having BC entails markedly increased PTSD symptom burden. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Pretreatment cognitive impairment in cancer patients is well established but unexplained. Similar cognitive compromise has been observed in post-traumatic stress disorder (PTSD) patients, and PTSD symptoms are a frequent concomitant of cancer diagnosis. We tested the hypothesis that pretreatment cognitive impairment is attributable to cancer-related post-traumatic stress. Methods: Women aged 65 years or younger who were diagnosed with breast cancer (case patients) or had undergone negative routine breast imaging (control patients) at one of six participating breast centers underwent traditional and computerized neuropsychological testing, clinician-administered diagnostic assessment of stress disorders, and self-report assessments of cognitive function and depression. To minimize confounding, case patients were evaluated prior to any local or systemic treatment. Cognitive indices of case patients, control patients, and normative samples were compared. The patients' risk of overall cognitive impairment was determined. Linear regression and a mediation model were used to test the study hypothesis. All statistical tests were two-sided. Results: The 166 case patients and 60 well-matched control patients showed near-identical deviations from population norms. Case patients scored worse than control patients on two of 20 cognitive indices (Go/Nogo commission errors, Go/Nogo omission errors). Self-reported cognitive problems were associated with Go/Nogo omission errors and more pronounced in case patients. Only PTSD symptoms (Beta = 0.27, P = .004) and age (Beta = 0.22, P = .04) statistically significantly predicted Go/Nogo errors. The effect of having cancer on Go/Nogo errors was mediated by PTSD symptoms. Case patients did not have an increased risk of overall cognitive impairment. Conclusion: Prior to any treatment, breast cancer patients may show limited cognitive impairment that is apparently largely caused by cancer-related post-traumatic stress. [ABSTRACT FROM AUTHOR]

Purpose: Many cancer patients experience fear of progression (FoP). The purpose of this study was to test psychometric properties of the questionnaire FoP-Q-12, to examine age and gender differences of FoP, and to explore prognostic factors of FoP. Methods: A sample of 2059 patients with a cancer diagnosis who had participated in a cancer rehabilitation program was examined 6 months after discharge from the rehabilitation clinic. Participants filled in the Fear of Progression questionnaire FoP-Q-12, the Hospital Anxiety and Depression Scale (anxiety subscale), and the Generalized Anxiety Disorder Questionnaire GAD-2 and answered a list of questions concerning their cancer disease. Results: Reliability of the FoP-Q-12 (Cronbach's alpha = 0.90) was good. While exploratory factorial analysis supported the one-dimensional structure of the FoP-Q-12, confirmatory factorial analysis only partially supported the one-dimensional model. A proportion of 16.7 % of the sample scored above the FoP-Q-12 cutoff score. Females showed higher FoP scores than males (effect size d = 0.52), and older patients had slightly lower levels of FoP than younger patients ( d = 0.17). There were substantial and significant correlations between FoP-Q-12 and Hospital Anxiety and Depression Scale (HADS) anxiety ( r = 0.71) as well as GAD-2 anxiety ( r = 0.57). The highest FoP mean scores were found for the following cancer locations: ovary ( M = 29.5), thyroid gland ( M = 28.8), and breast ( M = 27.9), while the lowest scores were found for Hodgkin lymphoma ( M = 23.6), testis ( M = 21.8), and prostate ( M = 21.7). Conclusions: The FoP-Q-12 proved to be a valid instrument for measuring fear of progression in cancer patients. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to validate the Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF), a six item interview-based expert rating scale for distress screening in cancer patients.Methods: Using a heterogeneous multicenter study sample (n = 1551), we examined validity, reliability, and dimensionality of the PO-Bado SF. The Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer, the Questionnaire on Stress in Cancer, and the Patient Health Questionnaire were used to investigate convergent validity. Confirmatory factor analysis was applied to address unidimensionality. An optimal cutoff point was determined by ROC analysis and the maximum of Youden's index. An additional study with n = 41 audio recorded PO-Bado SF interviews was carried out to assess inter-rater reliability.Results: Mean age of the study sample was 64.0 (SD = 12.0), 42% were women. About 24% of the patients suffered from metastases. The one-factor solution was confirmed; internal consistency of the PO-Bado SF was high (α = 0.84). The PO-Bado SF total score correlated significantly with all psychosocial measures, the highest correlation was with the HADS total score (r = 0.64). Patients with severe disease conditions (metastases, psychological/psychiatric treatment in the past, low performance status) received higher distress ratings (p < 0.001). Using HADS total score (>13) as external criterion, an optimal PO-Bado SF cutoff score of >9 emerged (sensitivity 0.75; specificity 0.82). Inter-rater reliability was satisfactory for each of the six items (intra class correlation of 0.75 to 0.85).Conclusions: The PO-Bado SF is a short, reliable and valid expert rating scale to identify distressed cancer patients. [ABSTRACT FROM AUTHOR]

Background The aim of this study is to validate the Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF), a six item interview-based expert rating scale for distress screening in cancer patients. Methods Using a heterogeneous multicenter study sample ( n = 1551), we examined validity, reliability, and dimensionality of the PO-Bado SF. The Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer, the Questionnaire on Stress in Cancer, and the Patient Health Questionnaire were used to investigate convergent validity. Confirmatory factor analysis was applied to address unidimensionality. An optimal cutoff point was determined by ROC analysis and the maximum of Youden's index. An additional study with n = 41 audio recorded PO-Bado SF interviews was carried out to assess inter-rater reliability. Results Mean age of the study sample was 64.0 (SD = 12.0), 42% were women. About 24% of the patients suffered from metastases. The one-factor solution was confirmed; internal consistency of the PO-Bado SF was high ( α = 0.84). The PO-Bado SF total score correlated significantly with all psychosocial measures, the highest correlation was with the HADS total score ( r = 0.64). Patients with severe disease conditions (metastases, psychological/psychiatric treatment in the past, low performance status) received higher distress ratings ( p < 0.001). Using HADS total score (>13) as external criterion, an optimal PO-Bado SF cutoff score of >9 emerged (sensitivity 0.75; specificity 0.82). Inter-rater reliability was satisfactory for each of the six items (intra class correlation of 0.75 to 0.85). Conclusions The PO-Bado SF is a short, reliable and valid expert rating scale to identify distressed cancer patients. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to establish whether mental health (MH) outcomes, attitudes towards cancer-specific MH (CSMH) resources, and the availability of such resources differ between rural and urban cancer patients. Methods: Three months after surgery for colorectal cancer, patients received a questionnaire for completion at home assessing distress, depression, anxiety, acceptance, knowledge and use of CSMH resources and the doctor-patient relationship. We adjusted our sample to reference data of the Munich Cancer Registry and documented CSMH resources (e.g. cancer-specific information centres and cancer support groups) using a systematic Internet search. Results: Five hundred thirty-four patients participated with a mean age of 68.9 years; 44.5 % were female. Urban patients talked less with their doctor about their emotional state (65 %, p < 0.01) and showed poorer knowledge of CSMH resources (60 %, p < 0.002). A good doctor-patient relationship was associated with a better MH outcome. A significant predictor for acceptance was distress. Ninety-four percent of patients without a nearby support facility lived in rural areas ( p < 0.001). There were no group differences concerning distress, MH outcomes, or acceptance of CSMH resources. Conclusion: Despite a higher availability of CSMH resources, urban patients showed poorer doctor-patient relationships and less knowledge of such resources than rural patients. Overall, knowledge and use of these resources were poor. The amount of support facilities available therefore appears to be less important than establishing an efficient communication network between patients, doctors and providers of CSMH resources to achieve satisfaction with treatment of urban and rural cancer patients. [ABSTRACT FROM AUTHOR]

Familial clustering is common in prostate cancer (PCa), but the psychosocial consequences of being a PCa patient in an affected family are not well understood. This study investigated the effects of family history of PCa on psychosocial distress and perceived psychosocial treatment need. Data were gathered within the German national research project 'Familial Prostate Cancer'. 4.123 PCa survivors who had undergone prostatectomy at least 4 years ago received a questionnaire set. 3.623 of the respondents [68.3 % sporadic, sporadic prostate cancer (SPCa); 31.7 % familial, familial prosate cancer (FPCa)] filled in measures of cancer-specific distress (QSC-R10), depression (PHQ-2), and anxiety (GAD-2). Perceived psychosocial treatment need was assessed using a single item. The prevalence of psychosocial distress did not differ between SPCa and FPCa survivors (cancer-specific distress: 16.2 vs. 16.7 %; depression: 5.8 vs. 6.4 %; anxiety: 6.6 vs. 5.8 %; ps ≥ .397). Similarly, psychosocial treatment need did not differ between SPCa (11.8 %) and FPCa (13.1 %) cases ( p = .303). However, family history moderated the effect of cancer-specific distress on treatment need (OR 2.67, 95 % CI 1.43-4.96, p = .002). Exploratory analyses for the hereditary subtype (HPCa) revealed that cancer-specific distress was lower in HPCa survivors who had only daughters compared to survivors without any children or with at least one son. No such effect was observed in SPCa survivors ( p = .040). PCa survivors with a positive family history do not experience increased psychosocial distress. Nonetheless, family history may exert subtle effects that deserve further research. [ABSTRACT FROM AUTHOR]

Background: Although breast augmentation is a common intervention in esthetic surgery, there aren't enough reports evaluating accurately patients' satisfaction retrospectively. In a previous study, we evaluated the quality of life in patients undergoing esthetic surgery. In the present study, we split up the operative indication and examined the quality of life, self-esteem, and emotional stability after breast augmentation only. Methods: Seventy-three patients underwent esthetic breast augmentation (1995-2009) were included in the study. The testing instruments consisted of a self-developed indication specific questionnaire especially for breast augmentation and three widely used standardized questionnaires (FLZM, FPI-R, and the RSES), which can be compared to norm data. Results: Although expected by just 11 % preoperatively, an improved sexuality was stated by 71 % of the patients postoperatively. A very high percentage (74 %) of the participants declared a better quality of life overall. Both of these findings were parallel confirmed by the FLZM. Significantly increased values were found for the following FLZM items: 'housing/living conditions' ( p = 0.008), 'partner/sexuality' ( p = 0.042), 'mobility' ( p = 0.019), and 'independence from help/care' ( p = 0.026). In the module 'Satisfaction with Appearance/Body Image', satisfaction with breasts ( p < 0.001) and 10 further body parts increased significantly. The data revealed by the FPI questionnaire and the RSES questionnaire showed that participants' emotional stability was very well balanced and their self-esteem very high. Conclusions: Breast augmentation is a common surgical intervention widely accepted and very well tolerated among female patients, achieving a better quality of life, due to significant changes to their sexuality, satisfaction with their body image, and personal well-being. Level of Evidence: Level III, risk/prognostic study. [ABSTRACT FROM AUTHOR]

Objective The objective of this study is to determine whether the inclusion of a 'psychooncological statement' (PO-statement) in the discharge summary enhances patient-physician communication about psychosocial issues across the inpatient and outpatient sector. Methods A total of 1416 cancer patients were randomly assigned to the intervention (with PO-statement in the discharge summary) or control group (discharge summary without PO-statement). Shortly before discharge from the hospital (T1), patients from the intervention group were screened for psychosocial distress. Based on the electronic clinical documentation system, screening results were subsequently integrated into the discharge summary, which automatically generated a PO-statement. To determine the effect of the PO-statement, patients as well as their primary care physicians ( n = 596) were asked during follow-up care (T2) whether psychosocial distress was discussed during the last consultation. Results Including a PO-statement in the discharge summary did not result in more frequent discussions about psychosocial issues compared with the control group from the patients' and physicians' perspectives. Instead, discussions about psychosocial well-being were significantly associated with women of the patient ( p = <0.001) and the physician ( p = 0.011), medical discipline (gynecologists; p = 0.002), cancer diagnosis (gynecological cancer; p = 0.002), metastases ( p = <0.001), professional training of patients (none, p = 0.026), and psychosocial qualification of physicians ( p = 0.018). Conclusion Written information on psychosocial distress in the discharge summary alone does not affect communication. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background. To investigate the prognostic value of several psychosocial factors for long-term survival in cancer patients. Material and methods. Baseline data were gathered in routine radiotherapy practice during 44 months. The analysis is based on 938 patients for whom follow-up data were available. Baseline psychosocial distress, depression, health-related quality of life (HRQOL), and life satisfaction were assessed using Questionnaire on Stress in Cancer Patients (QSC-R23), Self-Rating Depression Scale (SDS), Functional Assessment of Therapy - General (FACT-G) questionnaire, and Questions on Life Satisfaction (FLZM). Patients were followed up for 7 to 10 years. Kaplan-Meier plots and Cox proportional hazards models were used to investigate associations between sociodemographic, clinical, psychosocial factors and overall survival (OS). Results. Patients' median survival time was 35 months (95% CI 28.9-41.1). Significant multivariate predictors of OS were age, health insurance type, Karnofsky performance status, cancer site, and cancer stage. Controlling for these variables, HRQOL was the only psychosocial predictor of survival (hazard ratio 0.988, 95% CI 0.979-0.997, p =0.009). The physical well-being and the functional well-being subscales of the FACT-G emerged as the relevant HRQOL facets predictive of survival. Conclusion. HRQOL has incremental predictive value for long-term survival in cancer patients. [ABSTRACT FROM AUTHOR]

Background: There are few interventions for couples facing cancer. Purpose: This study aims to investigate the utility of providing dyadic skills to these couples. Methods: Woman recently diagnosed with breast or gynecological cancer and their partners were randomly assigned to either a couple-skills intervention ( Side by Side) or to cancer education ( Couples Control Program). Assessments with self-report and behavioral observation of both partners were conducted four times over 16 months. Results: Multilevel analyses of data from 72 participating couples suggest that females receiving Side by Side showed larger reductions in fear of progression, and couples reported less avoidance in dealing with the cancer, more posttraumatic growth, and better relationship skills relative to the Couples Control Program. All differences favoring Side by Side disappeared by 16 months after the diagnosis. Conclusion: Short-term changes in functioning may be improved by enhancing couples' dyadic skills during acute medical treatment of the disease. [ABSTRACT FROM AUTHOR]

Prior work demonstrated that cognitive–behavioral (CBT) and supportive–experiential (SET) group interventions can reduce dysfunctional fear of progression (FoP) in patients with chronic diseases. In this secondary analysis of a randomized controlled study, we investigated determinants of long-term response to group therapy for FoP. Response to therapy after 12 months was assessed using the Reliable Change Index (RCI). Outcome data were available for 129 patients with cancer and 116 patients with chronic arthritis. 37.9% of the patients in the CBT group and 32.7% of those attending the SET group indicated response to therapy (p = .402). Educational level predicted long-term response to therapy (OR 2.53, 95% CI 1.33–4.81; p = .005). Medical patients with lower education may need additional attention in order to gain long-lasting benefit from brief group psychotherapy. However, this investigation needs to be replicated in a study that includes a broader range of psychological predictors. [ABSTRACT FROM PUBLISHER]

Fear of progression (FoP) is one of the most prevalent symptoms in cancer patients. This chronic disease does not only have a profound impact on patients, but also on their spouses. The aim of this study was to evaluate the psychometric properties of a spouse FoP questionnaire (FoP-Q-SF/P) in 227 partners of chronically ill patients (breast cancer, prostate cancer, and diabetes mellitus) in Germany. Estimates of reliability were high (α = 0.88). The original one-factor structure of the FoP-Q-SF for patients was replicated. We used the Hamilton Anxiety and Depression Scale, Impact of Event Scale-revised, Short Form–8 Health Survey, Quality of Marriage Index, Partnership Questionnaire, and Dyadic Coping Inventory to validate the FoP-Q-SF/P. Significant positive correlations were found for anxiety, hyperarousal and intrusion (r > .61) as well as for depression and avoidance (r > .51). Partners of patients with cancer reported significantly higher levels of FoP than did partners of patients with diabetes mellitus. The FoP-Q-SF/P is a reliable and valid instrument that can be recommended for further use in research and clinical care. [ABSTRACT FROM PUBLISHER]

Background: In the last decades, several surgical approaches have been used to improve the appearance and quality of life of female Poland syndrome patients. The aim of this study was to analyze the women's quality of life and long-term outcome after breast reconstruction. Methods: Forty-nine women with Poland syndrome who were treated surgically between 1974 and 2007 received standardized questionnaires to evaluate their quality of life and satisfaction after surgical treatment. Results: Patient response was 65%, with 32 completed questionnaires by 16 women who had pedicled latissimus dorsi myocutaneous (LDM) flaps, 12 with tissue expander or silicone implants, and 4 who had free transverse rectus abdominis myocutaneous (TRAM) flaps. Of these patients, 16 were satisfied or highly satisfied with their postoperative appearance (13 with LDM, 2 with prosthesis, and 1 with TRAM), 16 patients would recommend the same surgery to others under similar circumstances (10 with LDM, 5 with prosthesis, and 1 with TRAM), and 18 patients would choose the same method again (14 with LDM, 3 with prosthesis, and 1 with TRAM). Conclusions: In our study, we found that satisfactory outcome in breast reconstruction was achieved particularly when using the LDM flap, which remains the only method that recreates the anterior axillary fold. Future studies on reconstruction methods with autogenous tissue (e.g., TRAM, deep inferior epigastric perforator [DIEP] flap) are needed, however, to analyze quality of life and long-term outcome in patients with Poland syndrome. [ABSTRACT FROM AUTHOR]

Objective: The aim was to examine the psychometric properties of the Questionnaire on Stress in Cancer Patients (QSC-R10), a 10-item screening instrument for self-assessment of psychosocial distress in cancer patients. Methods: A total of 1850 cancer patients were assessed with the QSC-R10. Patients were recruited from different inpatient and outpatient settings in Germany between 2007 and 2009. Results: Mean age of the sample was 62.9 (SD=12.4) with breast cancer as the most frequent diagnosis (35.2%). The analysis indicated high reliability (Cronbach's α=0.85) and test-retest reliability (ICC=0.89). Validation scales included the Hospital Anxiety and Depression Scale (HADS), Distress-Thermometer (DT), European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30) and Karnofsky Performance Status (KPS). Convergent validity was highest for the HADS total score ( r=0.74) and the lowest correlation for KPS ( r=−0.36). The QSC-R10 significantly distinguished subgroups by their clinical characteristics (metastases, illness duration, previous psychiatric treatment and psycho-oncological support; p<0.001). A cutoff score of >14 demonstrated good sensitivity (81.0%) and specificity (73.2%) and is suitable to determine the need for psychosocial support. Conclusion: The QSC-R10 is a valid and reliable questionnaire to detect distress in cancer patients with high acceptance among professionals and patients. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Hintergrund: Psychische Erkrankungen bei Eltern werden als Risikofaktor für die psychische Entwicklung von Kindern angesehen. Ob und in welchem Ausmaß dies auch für ernsthafte körperliche Erkrankungen der Eltern gilt, ist bisher seltener untersucht worden. Diese Pilotstudie berichtet über die psychischen Auffälligkeiten von Kindern bei Frauen mit Brust- oder gynäkologischem Krebs. Patienten und Methoden: 19 Paare mit 27 Kindern im Alter zwischen 4 und 16 Jahren beantworteten zu mehreren Messzeitpunkten (T1: innerhalb von 8 Wochen nach Diagnose; T2: 3-5 Monate nach Diagnose; T3: 6 Monate nach T2; T4: 1 Jahr nach T2) einen Fragebogen zu Stärken und Schwächen des Kindes sowie zur eigenen Belastung durch die Erkrankung, dem Ausmaß sozialer Unterstützung sowie der partnerschaftlichen Bewältigung der Erkrankung. Aufgrund der geringen Fallzahlen zu T3 und T4 konzentriert sich die gegenwärtige Untersuchung auf die ersten beiden Messzeitpunkte. Ergebnisse: Zu jedem Messzeitpunkt schätzten beide Eltern die Kinder als überwiegend psychisch unauffällig und prosozial ein. Diejenigen Mütter, die zu T1 stärker durch die Krebserkrankung belastet waren, berichteten zu T2 auch mehr psychische Auffälligkeiten bei ihren Kindern. Dieser prospektive Zusammenhang wurde vollständig über das Ausmaß der partnerschaftlichen Bewältigung der Erkrankung zu T1 mediiert. Diskussion: Sollten diese Ergebnisse repliziert werden, könnten sie darauf hin weisen, dass indizierte Präventionsmaßnahmen bei Familien mit einem krebskranken Elternteil das Erleben einer manifesten psychischen Störung bei betroffenen Kindern und Jugendlichen unter Umständen verhindern. Eine Möglichkeit, die Indikation für eine solche Maßnahme zu stellen, kann in der Einschätzung der individuellen Belastung durch die Krebserkrankung und des Ausmaßes an Unterstützung innerhalb der Partnerschaft liegen. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background Anxiety disorders are widespread in patients with chronic diseases such as rheumatoid arthritis (RA). This paper targets the cost-effectiveness analysis of a cognitive-behavioral group therapy (CBT) in comparison to a client-centered, supportive-experiential group therapy (SET) in arthritis patients with dysfunctional fear of progression. Methods From the societal perspective, direct costs were compared with the reduction of fear of progression over time. Means, their 95% confidence intervals (95% CI), the incremental cost-effectiveness graphic and the acceptability curve were obtained using 1000 non-parametric bootstrap replications. Results A total of 174 RA patients were included in the economic evaluation. The estimated means (95% CI) of direct costs and reduction of fear of progression were, respectively, €7945.34 (5075.59; 11335.08) and 0.25 (−0.48; 0.99) for patients in the SET and 5619.25 € (3950.67; 7708.52) and 0.94 (0.29; 1.62) for patients in the CBT. As the majority of the cost-effect pairs after bootstrap analysis were located in the southeast quadrant of the cost-effectiveness plane, the CBT can be considered a dominant intervention. Conclusion The main result of our study is the higher cost-effectiveness of CBT in comparison to SET in RA patients with dysfunctional fear of progression. [ABSTRACT FROM PUBLISHER]

Purpose This paper aims to evaluate the effects of two psychotherapeutic interventions on dysfunctional fear of progression (FoP) in cancer patients and to investigate illness-specific influences. Methods One hundred seventy-four cancer patients were recruited from two rehabilitation clinics and randomly assigned to either a four-session cognitive-behavioral group therapy or a supportive-experiential group therapy. The main outcome criterion was FoP that was assessed with the Fear of Progression Questionnaire (FoP-Q) directly before (T1) and after (T2) the intervention, as well as 3 (T3) and 12 months (T4) after discharge. Secondary outcomes were anxiety, depression, and quality of life that were assessed with the following questionnaires: Questions on Life Satisfaction, Questionnaire for General Health Status, and the Hospital Anxiety and Depression Scale. Patients from the control group (n=91) who received treatment as usual were recruited 1 year later with the same inclusion criteria and assessed with the FoP-Q at T1, T2, and T4. Results Analyses showed a significant main effect for time and a significant interaction for group × time for the main outcome variable. FoP decreased significantly over time in both intervention groups in contrast to the control group that showed only short-term improvements. The interventions were also effective in improving secondary outcomes except general life satisfaction. Analyses of cancer specific influences on FoP indicated a significant influence of disease status, i.e., patients with metastases and recurrence of cancer gained most from the interventions. Conclusions Fear of progression, one of the main sources of distress for cancer patients, can be reduced with short psychotherapeutic interventions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate changes in the quality of life (QoL) and body image among breast cancer patients over 2 years and to examine different predictive factors for QoL 2 years after the primary operation. Methods: A total of 203 women with a primary diagnosis of breast cancer completed the questionnaires 2 weeks and 6, 12, 18, and 24 months after surgery. Quality of Life Questionnaire (QLQ-C30), Breast Cancer Specific Quality of Life Questionnaire Module (QLQ-BR23), Questionnaire on Stress in Cancer Patients (QSC-R23), Freiburg Personality Inventory (FPI-R), Life Orientation Test (LOT) were used as standardized measures. Results: The overall QoL and most functional and symptom scales improved during the 2-year period. However, cognitive functioning, body image, and the three symptom scales of insomnia, constipation, and diarrhea did not change. Age was only capable of predicting physical functioning, whereas tumor size, axillary surgery, and adjuvant chemotherapy were not predictive of the long-term QoL functional scores. Initial distress was the most potent predictive factor for long-term QoL. Baseline functioning predicted functional QoL scores 2 years later. And higher scores for neuroticism were associated with a poorer QoL. However, optimism was not capable of predicting the QoL 2 years later. Conclusion: Screening measures should be implemented at the time when breast cancer is diagnosed, in order to identify psychologically vulnerable patients and offer them professional psycho-oncological help. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To assess the character and frequency of fear of progression (FoP) and to clarify its relationship with cancer-related intrusive cognitions in breast cancer survivors. Methods: A sample of 1083 patients was recruited in this cross-sectional study through a population-based Cancer Registry an average of 47 month following diagnosis (66% response rate). Participants completed self-report measures assessing fear of cancer progression (FoP-Q-SF), posttraumatic stress-disorder symptoms (PCL-C), coping strategies (DWI) and quality of life (QoL) (SF-8). Results: In total, 23.6% of women were classified as having moderate to high FoP. Being nervous prior to doctors' appointments or examinations and being afraid of relying on strangers for activities of daily living were the most frequent fears. FoP was significantly associated with younger age, having children, disease progress, chemotherapy, perceived amount of impairments, physical and mental QoL, but not with time since initial diagnosis. Intrusive cognitions were screened in 37% of the sample. We found significant correlations between FoP and intrusive thoughts (r=0.63), avoidance (r=0.57), hyperarousal (r=0.54) and posttraumatic stress disorder diagnosis (r=0.42). Factors significantly associated with moderate and high FoP included a depressive coping style as well as an active problem-oriented coping style, intrusion, avoidance and hyperarousal symptoms (Nagelkerke's R2=0.44). Conclusions: Findings of this study give information regarding the frequency and the character of anxiety in breast cancer survivors and underline the relation of FoP to the reality of living with breast cancer. Results suggest that intrusive cognitions as well as avoidance and hyperarousal symptoms seem to be closely related to future-oriented fears of cancer recurrence. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Determine age and gender differences and interaction effects in domain-specific life satisfaction in the German population and examine to which degree depressive and anxiety symptoms are associated with life satisfaction in addition to sociodemographic variables, and which domains are affected. Representative survey of the German population conducted 2006 with 5,036 participants (53.6% female). Mean age was 48.4 years (SD = 18.0). Measurements included domain-specific life satisfaction (FLZM), anxiety (GAD-7), depressive symptoms (PHQ-2), and sociodemographic variables (e.g., marital status, income, employment, education, urbanity, part of Germany, religiousness, age and gender). Women were more satisfied with their family life, men showed greater satisfaction with their leisure activities. Age-group differences appeared in every life satisfaction domain. Age by gender interaction emerged in the field of satisfaction with health, income, and family life. Anxiety and depressive symptoms contributed significantly to the explained variance of domain-specific life satisfaction. Depressive and anxiety symptoms as two psychological variables have an additional impact on domain-specific life satisfaction. Further investigation is needed regarding the impact of psychological variables on domain-specific life satisfaction. [ABSTRACT FROM AUTHOR]