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Eine körperliche oder psychische Erkrankung trifft neben Patient*innen auch das familiäre Umfeld. Gerade den direkten (pflegenden) Angehörigen kommt dabei eine besondere Bedeutung in der Krankheitsbewältigung zu. Sie werden allerdings oft als unsichtbare Patient*innen in der zweiten Reihe übersehen. An den Beispielen Krebs, Demenz und Schmerz wird die psychotherapeutische Arbeit mit Angehörigen und Paaren dargestellt.

Die Psychoonkologie befasst sich als Teildisziplin der Onkologie mit den psychischen und sozialen Belastungen Krebserkrankter und ihrer Angehörigen. Dabei fokussieren die evidenzbasierten psychoonkologischen Unterstützungs- und Beratungsangebote auf eine Reduktion von Ängsten und Depressivität sowie eine Steigerung der Lebensqualität. Psychoonkologische Unterstützung kann sowohl während der akuten Behandlung als auch danach erfolgen – im stationären und ambulanten Setting.

Purpose Anxiety in the perioperative period is not only an unpleasant emotional state, but can also negatively affect the outcomes and quality of life of surgical patients. The present study investigated anxiety in patients with gastrointestinal cancer scheduled for primary surgery. Methods A total of 101 patients in four non-university surgical departments were included. Anxiety (GAD-7), depression (PHQ-9), distress (Distress thermometer), and illness perception (Brief IPQ) were assessed at four time points: first outpatient contact before surgery (t1), preoperative inpatient contact (t2), postoperative inpatient contact before hospital discharge (t3), and postoperative outpatient follow-up contact after 30 days (t4). Results 56% of patients had an episode of mild or moderate anxiety and 5% had an episode of severe anxiety and/or depression. Subjectively perceived anxiety and depression were highest at t1, followed by t3. 30% of patients had elevated anxiety and depression scores at t1. Regression analyses showed that high subjectively perceived mental distress at t1 was associated with higher anxiety scores at t3 and t4. Women, and younger women in particular, were significantly more likely to experience stress than men. Higher levels of subjectively perceived stress at t1 were associated with higher levels of anxiety at t3 and t4. Sociodemographic factors were not relevant predictors of anxiety. Conclusion Anxiety and depression appear to be a persistent problem during the perioperative course in patients with gastrointestinal tumors. Identifying patients at risk for clinically relevant anxiety and depression remains a particular challenge. The results confirm the relevance of repeated screening for mental distress.

Provision of psychosocial care is obligatory in cancer centers certified in accordance with the criteria of the German Cancer Society, but the extent to which it is utilized differs greatly between centers. Anomalous utilization percentages are discussed during certification audits. This analysis aims to describe (1) how certified centers explain psychosocial care utilization percentages during audits and (2) the measures they then plan for improving psychosocial care utilization. The aim of the analysis is to help understand patterns of psychosocial care utilization in oncology and reduce potential disparities by describing the challenges that cancer centers face and their strategies for integrating psychosocial care into routine oncological care.The content of free-text comments regarding psychosocial utilization percentages by certified centers during certification audits in 2019 was analyzed. In total, 178 comments were analyzed from 116 prostate, colorectal, and breast cancer centers in Germany, Switzerland, Austria, Italy, and Luxembourg.The explanations for utilization percentages most often mentioned involved patients' levels of interest and need, outpatient care, staff shortages, inclusion of psychosocial care in other processes in the center, documentation issues, and factors regarding different legal regulations in countries outside Germany. The measures most often planned for improving psychosocial care utilization involved adjusting work processes, increasing staff resources, optimizing documentation, and establishing quality-assurance groups/task forces.This exploratory analysis shows that the challenges and strategies involved in incorporating psychosocial care into routine oncological care are diverse. Further research should identify process-level strategies that can promote the integration of psychosocial care.

ZusammenfassungEine Krebserkrankung stellt nicht nur für die erkrankte Person eine Herausforderung dar, sondern kann auch mit psychosozialen Beeinträchtigungen der Angehörigen, insbesondere der Partner und Partnerinnen und der minderjährigen Kinder, einhergehen. Obwohl Studien zu langfristigen Auswirkungen einer Krebserkrankung auf Partner und Partnerinnen, die Partnerschaft und die kindliche Entwicklung noch selten sind, gibt es Hinweise für die Chronifizierung der psychischen Belastungen von Angehörigen und für Risiken der Entwicklung psychischer Störungen bei Kindern erkrankter Eltern. Darüber hinaus erhöht eine Verschlechterung der partnerschaftlichen Zufriedenheit auch das Trennungsrisiko.In der psychoonkologischen Versorgung sollten daher nicht nur die psychosozialen Belastungen der Erkrankten, sondern auch die der Partner und Partnerinnen und die Auswirkungen auf die Partnerschaft berücksichtigt werden und entsprechende Angebote z. B. zur Erhöhung der partnerschaftlichen und sexuellen Zufriedenheit, der Kommunikation oder dem dyadischen Coping erfolgen. Auch Kinder sollten in der Versorgung als Angehörige betrachtet werden. Ein Fokussieren auf die kindlichen Belastungen sowie auf die Verbesserung der Eltern-Kind-Beziehung und des Erziehungsverhaltens kann Kindern bei der Bewältigung der elterlichen Erkrankung auch langfristig helfen. Somit sollte eine Krebserkrankung immer auf individueller, dyadischer und familiärer Ebene betrachtet werden und psychosoziale Versorgungsangebote sollten auf allen Ebenen erfolgen.

Conventional manufacturing techniques allow the production of photoresponsive cellulose nanocrystals (CNC)-based composites that can reversibly modify their optical, mechanical, or chemical properties upon light irradiation. However, such materials are often limited to 2D films or simple shapes and do not benefit from spatial tailoring of mechanical properties resulting from CNC alignment. Herein, we propose the direct ink writing (DIW) of 3D complex structures that combine CNC reinforcement effects with photoinduced responses. After grafting azobenzene photochromes onto the CNC surfaces, up to 15 wt % of modified nanoparticles can be introduced into a polyurethane acrylate matrix. The influence of CNC on rheological properties allows DIW of self-standing 3D structures presenting local shear-induced alignment of the active reinforcements. The printed composites, with longitudinal elastic modulus of 30 MPa, react to visible-light irradiation with 30-50% reversible softening and present a shape memory behavior. The phototunable energy absorption of 3D complex structures is demonstrated by harnessing both geometrical and photoresponsive effects, enabling dynamic mechanical responses to environmental stimuli. Functionalized CNC in 3D printable inks have the potential to allow the rapid prototyping of several devices with tailored mechanical properties, suitable for applications requiring dynamic responses to environmental changes., ACS Nano, 16 (11), ISSN:1936-0851, ISSN:1936-086X

The diagnosis of a hereditary cancer syndrome can be psychologically stressful and influence family planning. This study aimed to gain insights into the relationship between the desire for children and the distress of female carriers. Women (N = 255) with different hereditary cancer syndromes were assessed from November 2019 to July 2021 at genetic counseling centers, the centers of the German HBOC-Consortium and the centers of the German HNPCC-Consortium regarding their distress levels with the NCCN Distress Thermometer (DT). The desire for children was measured by self-developed questions. Levels of distress and desire for children were evaluated descriptively. Factors influencing the desire for children and distress were calculated using binary logistic regression: 56% (n = 51) of 18- to 39-year-old participants reported a desire to have children; 70.6% of the carriers with a desire for children indicated a need for advice from their physicians regarding family planning. The diagnosis led 61.5% to postpone the timing of family planning, and the majority (68.8%) opted for an earlier birth. Carriers had higher levels of distress. Younger carriers (p = 0.037) and those living in poorer economic circumstances (p = 0.011) were more distressed. The diagnosis of hereditary cancer syndrome affects family planning. The results emphasize the importance of physicians addressing family planning in their counseling sessions.

Adequate, needs-oriented psycho-oncological care contributes to reducing psychological distress in cancer patients and their relatives and improving quality of life. Regarding the precise determination of objective and subjective needs, there are often discrepancies in practice between the screening instrument completed by patients, the clinical impression of the treatment team, and the judgment of the psycho-oncology team. The present multicenter-study “OptiScreen”, involving three German Comprehensive Cancer Centers (Hannover, Leipzig, Dresden), aims to professionalize psychosocial screening to enable targeted and needs-based allocation to psycho-oncological support. Optimization and professionalization of the screening process will be achieved by training of oncological nursing staff to improve the targeted identification of distressed patients and provide them with needs-based psycho-oncological care. The non-randomized pre-post study will include inpatients with gastrointestinal cancers from the visceral oncology centers at the three sites. First, the comparison group (CG) will be assessed of N = 300. After completion of nursing training, the intervention group (IG) with N = 600 patients will be evaluated by validated questionnaires. The aim is to reduce barriers on both the patient and treatment side by promoting interdisciplinary dialogue and linking the screening with a personal consultation offer provided by the nurses, which should help to increase utilization and reduce patients' fears, shame and information deficits. It is not sufficient to establish a well-validated screening procedure, it also has to be feasible and useful in clinical practice. "OptiScreen" aims to improve the psycho-oncological care situation. In parallel, the study enables the professionalization of psycho-oncological care with the involvement of important professional groups (e.g. nursing) and thus aims to develop a "best practice model".

In diesem Kapitel erhalten Sie Informationen zur Krebserkrankung und zu wichtigen Begriffen, die damit zusammenhangen. Fragen zu den haufigsten Krebserkrankungen bei Frauen, der Krebsentstehung, der Entdeckung von Krebs und den Uberlebenschancen werden beantwortet.

The PSY-HEART-I trial indicated that a brief expectation-focused intervention prior to heart surgery improves disability and quality of life 6 months after coronary artery bypass graft surgery (CABG). However, to investigate the clinical utility of such an intervention, a large multi-center trial is needed to generalize the results and their implications for the health care system. The PSY-HEART-II study aims to examine whether a preoperative psychological intervention targeting patients' expectations (EXPECT) can improve outcomes 6 months after CABG (with or without heart valve replacement). EXPECT will be compared to Standard of Care (SOC) and an intervention providing emotional support without targeting expectations (SUPPORT). In a 3-arm multi-center randomized, controlled, prospective trial (RCT), N = 567 patients scheduled for CABG surgery will be randomized to either SOC alone or SOC and EXPECT or SOC and SUPPORT. Patients will be randomized with a fixed unbalanced ratio of 3:3:1 (EXPECT: SUPPORT: SOC) to compare EXPECT to SOC and EXPECT to SUPPORT. Both psychological interventions consist of 2 in-person sessions (à 50 minute), 2 phone consultations (à 20 minute) during the week prior to surgery, and 1 booster phone consultation post-surgery 6 weeks later. Assessment will occur at baseline approx. 3-10 days before surgery, preoperatively the day before surgery, 4-6 days later, and 6 months after surgery. The study's primary end point will be patients' illness-related disability 6 months after surgery. Secondary outcomes will be patients' expectations, subjective illness beliefs, quality of life, length of hospital stay and blood sample parameters (eg, inflammatory parameters such as IL-6, IL-8, CRP). This large multi-center trial has the potential to corroborate and generalize the promising results of the PSY-HEART-I trial for routine care of cardiac surgery patients, and to stimulate revisions of treatment guidelines in heart surgery.

Das Thema Krebs und Sexualitat ist oftmals noch ein Tabuthema. Fragen wie „Ist Sexualitat jetzt uberhaupt noch wichtig?“ oder „Darf man jetzt an sowas denken?“ stellen sich viele Betroffene. Sexualitat ist ein zentraler Aspekt im Leben eines Menschen, der untrennbar mit Gesundheit, Wohlbefinden und Lebensqualitat verbunden ist. Sexualitat wird erfahren und findet Ausdruck in Gedanken, Phantasien, Wunschen, Uberzeugungen, Einstellungen, Werten, Verhaltensweisen, Praktiken, Rollen und Beziehungen.

Wissenschaftliche Forschung ist unerlasslich, auch im Feld der Krebserkrankungen. Wie sonst liesen sich Aussagen treffen zu den Problemen, Schwierigkeiten, Belastungen, aber auch zu den langerfristigen Auswirkungen der Krankheit fur die Patientin, den Partner oder das Paar? Nicht zuletzt: Nur auf diesem Weg ist es moglich, zielgenaue und effektive Unterstutzungsangebote zu entwickeln, in die Praxis zu uberfuhren und zu bewerten. Es bleibt immer Ihre Entscheidung, einer Studienteilnahme zuzustimmen oder nicht. Einige der hier aufgefuhrten Argumente sollen Sie bei der Entscheidungsfindung unterstutzen.

Background Cancer can cause physical changes and affect satisfaction with a persons’ physical appearance, which in turn can affect overall quality of life. Previous studies have primarily focused on women with breast cancer and few is known about body image in patients with other cancers and especially men. The present study compares satisfaction with body image of patients with different types of cancer with the general population and across sexes and identifies risk factors for diminished body image. Additionally, patients that were diagnosed within the last year and those living with cancer for longer are compared. Methods In this cross-sectional study, N = 531 cancer patients answered the German Self-Image Scale to assess body image. One sample t-tests are utilized to compare the body image of cancer patients with the general population. Stepwise regression analyses were used to identify factors associated with body image and ANOVAs with posthoc tests as well as t-tests were used to examine group differences. Results Cancer patients showed diminished body image compared to the general population. For men, higher relationship satisfaction and lower cancer-specific distress were associated with more positive body self-acceptance (SA), whereas younger age, higher relationship satisfaction, and lower cancer-specific distress resulted in better perceived partner-acceptance of one’s body (PA). In women, higher education, lower anxiety and cancer-specific distress were associated with more positive SA. Female cancer patients with breast/gynecological cancer reported better SA than those with visceral cancers. Higher relationship satisfaction and lower cancer-specific distress were found to be associated with more satisfactory PA in females. Time since diagnosis did not affect body image in this study. Conclusions Results indicate that cancer patients regardless of sex tend to have decreased body image satisfaction. Future research directions include examination of additional entities of cancer, deeper research in men and the role of time since diagnosis.

Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study) Background: E-health based patient-reported outcome measures (PROMs) have the potential to automate early identification of both nutrition status and distress status in cancer patients while facilitating treatment and encouraging patient participation. This cross-sectional study assessed the acceptability, accuracy, and clinical utility of PROMs collected via E-Health tools among patients undergoing treatment for stomach, colorectal, and pancreatic tumors. Results: Eight-nine percent mostly, or completely, agreed that PROMs via tablets should be integrated in routine clinical care. Men were significantly more likely to require help completing the questionnaires than women (inv.OR = 0.51, 95% CI = (0.27, 0.95), p = 0.035). The level of help needed increased by 3% with each 1-year increase in age (inv. OR = 1.03, 95% CI = (1.01, 1.06), p = 0.013). On average, a patient tended to declare weight which was 0.84 kg inferior to their true weight (Bland and Altman 95 % CI = (–3.9, 5.6); SD: 2.41) and a height which was 0.95 cm superior to their true height (Bland and Altman 95 % CI = (–5, 3.1); SD 2.08). Patient-reported nutrition status was significantly associated with the professionally generated assessment (95% CI = (2.27, 4.15), p < 0.001). As nutrition status declined, the distress score increased (95%CI = (0.88, 1.68), p < 0.001). Of the patients, 48.8% who were both distressed and malnourished requested supportive care to address their problems. Conclusion: Patient-reported assessments utilizing E-health tools are an accurate and efficient method to encourage patient participation in cancer care while simultaneously ensuring that regular assessment of psycho-social and nutritional aspects of care are efficiently integrated in the daily clinical routine.

Objective Psychosocial screening is a standard of care in pediatric oncology, but there is limited information about how to intervene after screening. This pilot trial aimed to determine feasibility of the novel Enhanced Psychosocial Screening Intervention (EPSI) and explore its preliminary efficacy outcomes. We examined rates of recruitment, retention, intervention acceptability, and monthly distress screening completion, as well as exploratory efficacy outcomes (Patient-Reported Outcomes Measurement Information System: depression, anxiety and fatigue; distress thermometer, pain and sleep). Methods Parallel-group randomized pilot trial: Caregiver-youth (10–17 years at enrollment, newly diagnosed with cancer) dyads were randomly allocated to either EPSI or standard care with 1:1 ratio allocation. EPSI consists of having a Psychosocial Navigator who shares screening results conducted near diagnosis and monthly for one year with treating teams and families, and provides recommendations tailored to screening results. Results Enrollment rate was 54% (38 dyads); retention was 90% and acceptability 86% (caregivers) and 76% (youth). Exploratory symptoms of depression, anxiety, distress and fatigue outcomes consistently improved mainly for caregivers. Conclusions Results suggest EPSI is feasible and acceptable and exploratory mental and physical efficacy outcomes are promising for use in a future confirmatory multisite efficacy trial.