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In a German multi-center prospective cohort study, we wanted to assess the course of psychiatric comorbidity, utilization of mental health care and psychosocial care needs in laryngeal cancer patients during the first year after partial laryngectomy (PRL). Structured interviews with patients were conducted before surgery, 1 week (1 w), 3 months (3 m) and 1 year (12 m) after PRL. Psychiatric comorbidity was assessed using the Structured Clinical Interview for DSM-IV (SCID). Psychosocial care needs and utilization of mental health care were evaluated with standardized face-to-face interviews. In 176 patients, psychiatric disorders were prevalent in 11 % (1 w), 15 % (3 m) and 14 % (12 m), respectively, of which 4 % (12 m) underwent psychiatric treatment or psychotherapy. Two percent had acute, 15 % emerging and 6 % chronic psychiatric comorbidity. Chronically mental ill patients were more frequently younger than 65 years (p = 0.026), female (p = 0.045) and experienced more often a need for psychological counseling (p ≤ 0.001). One year after surgery, 27 % of the comorbid psychiatric patients expressed a need for additional psychological counseling. Alcohol-related disorders were diagnosed in 3 % (1 w), 3 % (3 m) and 8 % (12 m), respectively. Only one of these patients received psychological treatment, while 14 % expressed a need for psychological counseling and 7 % for additional medical consultations. The non-treatment of alcohol-related disorders measured in our sample indicates a major problem since continued alcohol consumption in laryngeal cancer patients is associated with reduced global quality of life, increased functional impairments and reduced overall survival. Screening instruments integrated into acute care are necessary to detect harmful drinking behavior.

Einleitung: Die Nachsorge von Kopf-Hals-Tumoren (KHT) fokussiert bisher auf die Therapiekontrolle. Daneben ist die Langzeitfunktionalitat sehr wichtig. Diese wird beobachtet, aber nicht standardisiert erfasst. Zusatzlich bestehen bei den Patienten oft psychoonkologische Komorbiditaten, die die objektive Bewertung erschweren. Aus diesem Grunde wurde von Tschiesner et al. ein auf dem „ICF Core Set for Head and Neck Cancer“ basierender Leitfaden zur Erfassung von funktionellen Beeintrachtigungen bei Patienten mit KHT entwickelt und ein Screening-Tool vorgestellt. Mit den positiven Erfahrungen bei anderen Tumorentitaten wurde eine elektronische Version des Tools entwickelt (OncoFunction). Methoden: In einer Machbarkeitsuntersuchung wurden alle KHT-Patienten der Klinik von 07/13 bis 03/14 eingeschlossen. OncoFunction wurde auf Tablet-PCs zum Selbstausfullen angeboten. Die Ergebnisse standen dem Arzt zu Beginn der Konsultation zur Verfugung und wurden durch den Arztfragebogen erganzt. Bei 202 Patienten wurde die Nutzerfreundlichkeit evaluiert. Ergebnisse: Es fanden 682 Kontakte im Beobachtungszeitraum statt. 530 (77,7%) mal fullten die Patienten den Fragebogen aus. Zudem wurden 470 Arztchecklisten vollstandig ausgefullt. Insgesamt liegen von 68,9% der Kontakte vollstandige Datensatze vor. Zwischen Teilnehmern und Nicht-Teilnehmern wurden keine Unterschiede gesehen. Zusammenfassung: Die Nutzung eines computergestutzten Screening- und Feedbacksystems (OncoFunction) im Alltag war machbar und wurde von den Patienten gut angenommen. Die Patientendaten werden sofort fur den Arzt aufbereitet und ruckgekoppelt, so dass fur Arzt wie Patienten ein sofortiger Nutzen entsteht. Die Daten stehen fur zusatzliche Anwendungen und fur eine standardisierte Verlaufsdokumentation zur Verfugung.

BACKGROUND There is extensive evidence that patients with cancer and cancer survivors have a strong need for expert support in relation to the psychological and social consequences of the disease. The requirements set out in the German Cancer Society's cancer center certification system include the routine provision of psycho-oncologic care (POC) and social service counseling for every patient. The current study investigated which organizational and structural characteristics in hospitals account for variations in psychosocial care provision in these centers. METHODS Data routinely collected during the certification process regarding the percentages of psychosocial care provision and characteristics of center sites and hospitals were matched with data with regard to size of the municipality, teaching hospital status, and institutional ownership. Linear multilevel regression analyses were performed to identify the characteristics of hospitals and center sites that were related to psychosocial care provision. RESULTS Substantial differences were found for different types of cancer (eg, a greater provision of psychosocial care in centers specializing in breast rather than prostate cancer). There was more POC provision in longer-certified centers and less in rural areas and university hospitals. Much of the variation between hospitals remains unexplained. CONCLUSIONS Although the implementation of mandatory psychosocial services generally provides patients with access to POC and social service counseling, the wide differences in the provision of counseling indicate that additional measures are needed to avoid inequalities resulting from the center at which a patient receives cancer treatment. Cancer 2016;122:3538–3545. © 2016 American Cancer Society

We explored the relationship between socio-economic characteristics and cancer stage at presentation. Patients admitted to a university hospital for diagnosis and treatment of cancer provided data on their education, vocational training, income, employment, job, health insurance and postcode. Tumor stage was classified according to the Union International Contre le Cancer (UICC). To analyze disparities in the likelihood of late-stage (UICC III/IV vs. I/II) diagnoses, logistic regression models adjusting for age and gender were used. Out of 1,012 patients, 572 (59%) had late-stage cancer. Separately tested, increased odds of advanced disease were associated with post-compulsory education compared to college degrees, with apprenticeship and no vocational training, with unemployment, disability pension, jobs with a low hierarchy level, blue collar jobs and with low income. Health insurance and community size were not related with late-stage cancer. Jointly modelled, there was evidence for an independent effect of unemployment (odds ratio (OR) 1.7, CI 1.0-2.8), disability pension (OR 1.8, CI 1.0-3.2) and very low income (OR 2.6, CI 1.1-6.1) on the likelihood of advanced disease stage. It is of great concern that these socio-economic gradients occur even in systems with equal access to health care.

Background We examined the relation of tobacco and alcohol consumption after total laryngectomy with overall survival (OS). Methods Tobacco and alcohol consumption was assessed at 5 time points after total laryngectomy. Patients were followed up for survival until December 31, 2014. A multivariate Cox regression was fitted to test for differences in OS. Results Three hundred fifty-nine patients were included in this study. Compared to former smokers, never smokers had hazard ratios (HRs) of 0.88 (95% confidence intervals [CIs] = 0.50–1.59), and continuous smokers 1.31 (95% CI = 0.87–1.96). Constantly high alcohol consumption after total laryngectomy had an HR of 2.19 (95% CI = 1.30–3.67). Duration of smoking (HR = 1.00; 95% CI = 0.99–1.01) and last known status of alcohol consumption (HR = 1.00; 95% CI = 0.76–1.33) was not related to OS. Conclusion Patients who smoke after total laryngectomy have a 30% higher risk of dying than people who gave up smoking, and constant high alcohol consumption is also a strong risk factor for dying. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Background: The grade of recommendation for adjuvant dose-dense chemotherapy in patients with high risk primary breast cancer is heterogeneous among international guidelines. Understanding the impact on quality of life (QOL) by adjuvant dose dense chemotherapy in comparison to standard adjuvant chemotherapy is thereby a crucial factor, especially if the benefit is potentially low. This study aims to assess the impact on QOL by adjuvant dose dense chemotherapy in the prospective randomized multi-center ADEBAR trial. Methods: QOL was assessed at baseline (t1), before cycle 4 FEC (Epirubicin 60mg/m2 i.v. d 1 + 8, 5-Fluoruracil 500mg/m2 i.v. d 1 + 8, Cyclophosphamide 75mg/m2 p.o. d 1–14, q4w x 6) and cycle 5 EC-DOC (Epirubicin 90mg/m2 plus Cyclophosphamide 600mg/m2 q3w x 4, sequentially followed by Docetaxel 100mg/m2 q3w x 4) (t2), 4 weeks after chemotherapy (t3), 6 weeks after radiation (t4) and 1 year after baseline (t5) using the European Organization for Research and Treatment for Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Breast Cancer-Specific Module (QLQ-BR23). A multivariate mixed model was fitted to test for differences between the two treatment arms. Primary endpoint was global QOL, secondary endpoints physical functioning, nausea&vomiting, fatigue and systemic therapy side effects. A minimum clinically meaningful difference was considered to be 10 points. Results: 1306 patients were recruited between 3/2002 and 5/2005 675 were assigned to the FEC and 688 to the EC-DOC arm. Compliance to QOL assessment was 74% at baseline and 58% four weeks after therapy, but dropped to 11% after one year follow up. After the beginning of treatment global QOL dropped in both arm by 3 to 4 points. In the EC-DOC arm QOL dropped further at t3 by 7 points and stayed stable in the FEC arm. 6 weeks after radiation QOL exceeded baseline in both arms by 6 to 8 points. The differences between treatment arms were strongest at t3 (54.1 vs. 49.7) but did not reach clinical relevance at any point in time. Physical functioning, nausea vomiting, fatigue and systemic therapy side effects followed with some minor exceptions similar patterns, but showed higher amplitudes. Conclusion: In conclusion we could not detect a statistically significant difference between the two treatment arms in QOL parameters, indicating that dose dense adjuvant chemotherapy did not impact QOL at a clinically relevant level compared to standard adjuvant chemotherapy. Citation Format: Schwentner L, Harbeck N, Singer S, Eichler M, Rack B, Forstbauer H, Wischnik A, Scholz C, Fink V, Huober J, Friedl T, Weissenbacher T, Härtl K, Kiechle M, Janni W. Short term quality of life with epirubicin-fluorouracil-cyclophosphamid (FEC) and sequential epirubicin/cyclophosphamid-docetaxel (EC-DOC) chemotherapy in patients with primary breast cancer – Results from the prospective multi-center randomized Adebar trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-12-03.

It has been demonstrated that physical exercise benefits younger patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT). We designed a prospective pilot study investigating whether elderly patients (>60 years) would also be able to participate in such a programme. It consisted of physiotherapist-supervised alternating endurance and resistance workouts on 6 of 7 days a week. Sixteen consecutive patients undergoing allo-HSCT were enrolled into the study. The median age was 64.5 years. Twelve patients participated in the programme until the time of discharge (75%) from the transplant unit. Therefore, the predefined criteria regarding feasibility were met. The reason for drop out was transplantation associated mortality in all patients (n = 4). Adherence was very good with a median of 85% attended training sessions. No adverse events were recorded. The endurance capacity dropped by 7% and lower extremity strength improved by 2% over time. Quality of life decreased during the study period, with global health being significantly worse at the time of discharge. In conclusion, a combined and intensified strength and endurance exercise programme is feasible and safe in a population of elderly patients undergoing allo-HSCT. Further research should focus on exploring effect sizes of such an intervention by conducting randomised controlled trials.

In high-risk early breast cancer, adjuvant taxane-Gemcitabine combinations result in a recurrence-free survival similar to single-agent taxanes. However, haematologic toxicities and need for dose reductions are more frequent in combinations. Which option ultimately provides a better quality of life (QoL) is unknown. We compared the QoL curves before, during, and up to one year after three cycles of Fluorouracil–epirubicin–cyclophosphamide followed by three cycles of Docetaxel–Gemcitabine or Docetaxel. Overall, 3691 women with recent R0-resection of a primary epithelial breast cancer participated in the nationwide SUCCESS A clinical trial. The centres sent QoL questionnaires of the European Organisation for Research and Treatment of Cancer before and up to 15 months after randomisation to Docetaxel–Gemcitabine versus Docetaxel. Multilevel analysis by chemotherapy arm estimated the QoL time curves, questionnaire return, and dropout. The combination caused one-point higher global QoL (95% confidence ±1; p = 0.05) and 1.1 lower odds of adherence to the outcome (95% confidence 1.0–1.1; p = 0.23) than the monotherapy. In both groups, a 10-point decrease during therapy preceded a 16-point increase after chemotherapy (p

BACKGROUND: Due to cognitive or physical limitations, glioma patients might not be able to validly complete self-reporting tools assessing quality of life, distress, and unmet needs. This not only impairs individual patient care and therapy monitoring but also creates bias in studies applying patient reported outcome measures (PROMs). In our study, we searched for signaling questions implementable in patient-doctor consultations in order to optimize the assessment. METHODS: We performed 1) a literature research to find out the most important questions for glioma patients that are also covered by standard questionnaires. 2) After a pretest in n=10 patients, we performed structured interviews in n=50 patients in an outpatients setting and 3) an online expert survey. Inclusion criteria for the patients were cerebral glioma, understanding German language and legal capacity, exclusion criterion was aphasia. Patients and experts estimated the most important items and questions of psychosocial topics on a Likert scale (0–6). Patients responded to whether the item afflicted them during the last week or not. Further, demographic and clinical data were obtained. Applying a weighted scoring procedure based on experts’ and patients’ ratings as well as whether or not the items affected the patients, we identified the three most important main topics. RESULTS: From July to October 2017, n=96 eligible patients were approached and n=51 were interviewed. Mean age was 56 years (range 30–79), n=35 patients were male and n=46 patients (90%) had a high-grade glioma. Mean time of interview was 17min (range 9-35min). Patients indicated the topics “cognitive”, “mental” and “physical problems” as well as “problems concerning job and free time” to be nearly equally important with emphasis on the issues “fatigue” and “future uncertainty”. N=36 experts (neuro-oncologists) participated; we observed a tendency towards “physical” and “cognitive problems” with emphasis to “seizure” and “depressive symptoms”. Weighted scoring procedure revealed the following signaling main questions: “Has your mood worsened within the last week?”, “Are you strained by physical changes?”, “Do you have memory problems?”. CONCLUSION: Our study indicated 3 areas most important for patients with gliomas: cognitive, physical and mental problems. The corresponding signaling questions could be implemented in clinical consultation.

The objective was to assess quality of life (QoL) in lung cancer survivors, compare it to the general population, and identify factors associated with global QoL, physical functioning, emotional functioning, fatigue, pain, and dyspnea.Data from NSCLC patients who had survived 1 year or longer after diagnosis were collected cross-sectionally in a multicenter study. QoL was assessed with the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and the lung cancer module QLQ-LC13 across different clinical subgroups and compared to age- and sex-standardized general population reference values. Multivariable linear regression analyses were performed to test the associations of patient-, tumor-, and treatment-related factors with the six primary QoL scales.Six hundred fifty-seven NSCLC patients participated in the study with a median time since diagnosis of 3.7 years (range, 1.0-21.2 years). Compared to the age- and sex-standardized general population, clinically meaningful differences in the QoL detriment were found on almost all domains: lung cancer survivors had clinically relevant poorer global QoL (10 points, p0.001). Whereas in 12 months or longer treatment-free patients this detriment was small (8.3), it was higher in patients currently in treatment (16.0). Regarding functioning and symptom scales, respective detriments were largest for dyspnea (41 points), role function (33 points), fatigue (27 points), social function (27 points), physical function (24 points), and insomnia (21 points) observed across all subgroups. The main factor associated with poorer QoL in all primary QoL scales was mental distress (β |19-31|, all p0.001). Detriments in QoL across multiple primary QoL scales were also observed with current treatment (β |8-12|, p0.01), respiratory comorbidity (β |4-5|, p0.01), and living on a disability pension (β |10-11|, p0.01). The main factor associated with better QoL in almost all primary QoL scales was higher physical activity (β |10-20|, p0.001). Better QoL was also observed in patients with high income (β |10-14|, p0.01).Lung cancer survivors experience both functional restrictions and symptoms that persist long term after active treatment ends. This substantiates the importance of providing long-term supportive care.

Following the total removal of the larynx (TL) as a result of laryngeal cancer, both, patients and partners face significant challenges caused by altered speech intelligibility. We analysed effects of the altered speech intelligibility on dyadic communication and marital quality from the partners' point of view.70 partners of cancer patients with laryngectomy from 13 hospitals in Central Germany were interviewed 2 (t1) and 3 (t2) years after laryngectomy. Partners were administered a battery of questionnaires to assess speech intelligibility, coping with altered speech intelligibility and post-laryngectomy dyadic communication pattern. Hahlwegs Partnership Questionnaire (PFB) was used to analyse martial quality. Patients with laryngectomy completed Post-Laryngektomie-Telefonverständlichkeits-Test (PLTT) to measure speech intelligibility.Speech intelligibility was classified by partners as 'good' in 37% (t1) and 57% (t2). Female partners did not generally indicate an increased dispute behavior, compared with woman in general. However, dyadic communication and mutual activities were less satisfactory. Partners of aphonic patients argued more frequently, coped less adequately with the altered dyadic communication and perceived more frequently a decline in marital quality since the onset of the disease.Results indicate need and importance of logopaedic support also with respect to marital quality. Further, interventions which emphasize the improvement of dyadic communication and enhancement of mutual activities should be stimulated.Nach einer vollständigen Entfernung des Kehlkopfes (Laryngektomie; LE) aufgrund von Kehlkopfkrebs verändert sich die Sprechverständlichkeit der Patienten, was auch erhebliche Auswirkungen auf deren partnerschaftliche Kommunikation und Partnerschaftsqualität haben kann. Die vorliegende Studie untersucht die Folgen der veränderten Sprechverständlichkeit der Patienten auf partnerschaftliche Kommunikation und Partnerschaftsqualität aus Sicht der Partner.70 Partner von Kehlkopfkrebs-Patienten mit einer Laryngektomie aus 13 Kliniken in Mitteldeutschland wurden 2 (t1) und 3 (t2) Jahre nach LE zu ihrer Partnerschaftsqualität (Hahlwegs Partnerschaftsfragebogen, PFB) und ihrer partnerschaftlichen Kommunikation befragt. Außerdem wurde die Sprechverständlichkeit der Patienten (Post-Laryngektomie-Telefonverständlichkeitstest, PLTT) gemessen und die Sprechverständlichkeit aus Sicht der Partner erfragt.37% (t1) bzw. 57% (t2) der Partner bewerteten die Sprechverständlichkeit der Patienten mit einer Laryngektomie als gut. Im Vergleich zu Frauen der Allgemeinbevölkerung stritten sich die Partnerinnen nicht häufiger, gaben aber weniger gemeinsame Aktivitäten und Kommunikation in ihrer Partnerschaft an. Partner aphoner Patienten stritten sich zu beiden Messzeitpunkten häufiger, kamen schlechter mit dem veränderten Sprechen zurecht und erlebten häufiger eine Verschlechterung ihrer Paarbeziehung seit der Erkrankung.Die Ergebnisse unterstreichen die Bedeutung der logopädischen Betreuung auch im Hinblick auf die Partnerschaftsqualität. Außerdem weisen sie darauf hin, dass Interventionen zur Förderung der partnerschaftlichen Kommunikation und zum Ausbau von Paaraktivitäten angeregt werden sollten.

To date, only a few studies have investigated oral health-related quality of life (OH-QoL) in cancer patients. The European Organisation for Research and Treatment of Cancer (EORTC) has therefore developed a questionnaire, the Quality of Life Questionnaire - Oral Health Module 15 (EORTC QLQ-OH15), to enable investigation of OH-QoL. The aim of this study was to examine OH-QoL in a real-world setting.OH-QoL was measured using the EORTC QLQ-OH15 in cancer patients at a non-specified time during treatment (tAt baseline 40 patients participated in the study. At tOH-QoL is of clinical importance in cancer patients. It seems to be decreased after the end of treatment, and not only in patients with head and neck cancer. Despite its brevity, the EORTC QLQ-OH15 is able to capture these differences, and is well accepted by patients. It can be recommended for future studies in this area.Bis dato existieren wenige Studien über die mundgesundheitsbezogene Lebensqualität (MLQ) bei Patienten mit Krebserkrankungen. Die European Organisation for Research and Treatment of Cancer (EORTC) hat kürzlich einen Fragebogen zur Erfassung der MLQ erstellt, den Quality of Life Questionnaire – Oral Health Module 15 (EORTC QLQ-OH15). Ziel dieser Arbeit war die Identifizierung möglicher Einschränkungen von MLQ bei Krebspatienten im klinischen Alltag.Die MLQ wurde zu einem nicht näher definierten Zeitpunkt während der Akutbehandlung (t40 Patienten nahmen initial an der Studie teil. Im Vergleich zu t

Distress impacts the daily life of glioma patients. This study explored its course over time and the usage of psychosocial care. A consecutive sample of glioma patients completed the Hospital Anxiety and Depression Scale to assess distress levels at admission to the hospital (t1), before discharge (t2), after 3 months (t3), and after 6 months (t4). They were interviewed with the Structured Clinical Interview for DSM-IV to ascertain psychiatric disorders at t2. Psycho-oncological care in the hospital was determined with the Hospital Information System, and the use of outpatient treatment was evaluated with the Health Care Usage Questionnaire at t4. We compared the percentages of elevated distress, psychiatric co-morbidity, and care usage between men and women. During the study period, 37 patients were enrolled. Nineteen percent of the patients were diagnosed with a psychiatric disorder. The percentages of patients with elevated distress were 56, 59, 39, and 40% at t1, t2, t3, and t4, respectively. Participants who did not survive the 6 months presented with higher levels of distress. In the hospital, 14% of those with elevated distress were visited by a psycho-oncologist. In the outpatient setting, 43% of those with elevated distress visited a neuro-psychiatrist, and 14% went to a psychotherapist. There was no evidence for an effect of gender on psychiatric co-morbidity, distress, or care use. A significant proportion of glioma patients report elevated distress during the hospital stay and thereafter. Only a fraction of them receive mental health care.

Purpose This study examined the frequency of psychiatric co-morbidity in patients with breast cancer, its changes over time and predictors for these changes. Methods In a prospective study with measurements before surgery (t1, baseline), 1 month (t2) and 8 months thereafter (t3) using the Patient Health Questionnaire, we examined the course of psychiatric co-morbidity in breast cancer patients. The co-morbidity courses were grouped into healthy (no co-morbidity during the study), acute (co-morbidity at t1 and/or t2, but not at t3), emerging (no co-morbidity at t1, but at t3) and chronic (co-morbidity at t1 and t3). Results Of the 598 participants, 19% had acute, 10% emerging and 9% chronic psychiatric co-morbidity. Acute co-morbidity was more common in patients with poor quality of life (odds ratio (OR) 9.6, 95% confidence interval (CI) 4.4–20.8) and somatic co-morbidity (OR 3.8, CI 1.1–12.4). Patients who perceived support from their doctors had acute co-morbidity less frequently (OR 0.7, CI 0.5–1.0). Emerging co-morbidity occurred more often in younger patients (OR 2.4, CI 1.2–4.7) and in patients with another cancer in their own (OR 2.0, CI 1.1–3.9) or family (OR 2.1, CI 1.1–4.3) histories, less often in patients with support from doctors (OR 0.6, CI 0.4–1.0). Chronic co-morbidity was related to poor quality of life (OR 12.1, CI 3.6–39.9). Conclusion We found acute and emerging psychiatric co-morbidities less often in patients who reported having a supportive doctor–patient relationship. Patients that require psycho-oncological support often have poor quality of life and have experienced cancer before. Copyright © 2015 John Wiley & Sons, Ltd.

Background We provided preliminary psychometric data for the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire–Head and Neck Module, updated version (QLQ-H&N43) from a group of Serbian laryngectomized patients. Methods The study included 170 subjects. The QLQ-H&N43 is a 43-item questionnaire, with 12 multi-item scales and 7 single-item symptom scales. All subjects also completed the Quality of Life Questionnaire-Core 30-questions (QLQ-C30). Results Good internal consistency (Cronbach's α of above 0.7) was found for 5 of the 7 scales. All QLQ-H&N43 scales correlated negatively as predicted with all QLQ-C30 functioning scales. The correlations with the QLQ-C30 symptoms supported discriminant validity, with only one exception: the head and neck social eating scale overlapped with the QLQ-C30 pain scale. For 14 of 19 QLQ-H&N43 scale scores, significant known-group differences were observed between those who differ in type of laryngectomy, adjuvant therapy, or 5-year survival. Conclusion Preliminary evidence suggests that a great majority of the QLQ-H&N43 scales have acceptable internal consistency and promising construct validity, but more research studies are needed with other cancer groups to extend these findings. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

Purpose – The purpose of the paper is to examine whether reported food habits (vegan, vegetarian, or carnivore diet) are associated with right-wing authoritarianism, prejudices against minorities and acceptance of social dominance. Design/methodology/approach – In total, 1,381 individuals completed validated questionnaires on dietary habits and attitudes. Associations were analysed using analyses of covariance on attitudes, adjusted for age with gender and diet as factors. Findings – Of the respondents, 35 per cent reported eating mixed food (including meat and fish), 31 per cent vegetarian food (excluding meat and fish) and 34 per cent vegan food (excluding animal products entirely). Authoritarianism was more frequent in carnivores compared to vegetarians and vegans; this difference was more distinctive in men (mean 2.4 vs 1.9 vs 1.7) than in women (2.2 vs 1.9 vs 1.8). Women with a mixed diet were more inclined to social dominance than vegetarians and vegans (1.8 vs 1.6 vs 1.6). Men with a mixed diet had a stronger tendency to dominance (2.0 vs 1.7 vs 1.5) and prejudices (2.5 vs 2.3 vs 2.1); this difference was less distinct among women (2.2 vs 2.1 vs 2.1). Originality/value – This research is of academic value and of value to policy makers and practitioners in the food supply chain. The results show that individuals with vegetarian or vegan diets less frequently report having prejudices against minorities, supporting social dominance and accepting authoritarian structures than individuals with a mixed diet.

Patients with locally advanced head and neck cancer (LAHNC) undergo life-changing treatments that can seriously affect quality of life (QoL). This prospective study examined the key QoL domains during the first year after intensity-modulated radiotherapy (IMRT) and identified predictors of these changes in order to improve patient outcomes. A consecutive series of patients with LAHNC completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core module (QLQ-C30) and the HNC-specific QLQ-HN35 before (t0) and at the end (t1) of definitive or adjuvant IMRT, then at 6–8 weeks (t2), 6 months (t3), and 1 year (t4) after IMRT. Patients (n = 111) completing questionnaires at all five time points were included (baseline response rate: 99 %; dropout rate between t0 and t4: 5 %). QoL deteriorated in all domains during IMRT and improved slowly during the first year thereafter. Many domains recovered to baseline values after 1 year but problems with smelling and tasting, dry mouth, and sticky saliva remained issues at this time. Increases in problems with sticky saliva were greater after 1 year in patients with definitive versus adjuvant IMRT (F = 3.5, P = 0.05). QoL in patients with LAHNC receiving IMRT takes approximately 1 year to return to baseline; some domains remain compromised after 1 year. Although IMRT aims to maintain function and QoL, patients experience long-term dry mouth and sticky saliva, particularly following definitive IMRT. Patients should be counseled at the start of therapy to reduce disappointment with the pace of recovery.

Bei der psychoonkologischen Versorgung stellt sich wegen klinischen und okonomischen Beweggrunden haufig die Frage, ob Patientinnen mit Brustkrebs in fruhen Tumorstadien psychisch weniger stark belastet sind als jene mit Krebs in hoheren Stadien. In einer prospektiven Studie wurde die psychische Belastung von Patientinnen mit Mammakarzinom mehrfach erfasst: bei Aufnahme ins Krankenhaus (t1), bei Entlassung (t2) sowie ein halbes Jahr (t3) und 1 Jahr (t4) nach Aufnahme ins Krankenhaus. Anhand der Leistungsdokumentation wurde auserdem festgestellt, wie viele der Patientinnen eine psychoonkologische Versorgung erhielten. Insgesamt 246 Patientinnen nahmen an der Studie teil. 56 % von ihnen hatten ein fruhes Mammakarzinom und bei 79 % handelte es sich um einen Primartumor. Das psychische Befinden unterschied sich nicht bei Patientinnen mit fruhen vs. hoheren Tumorstadien; die Belastungswerte lagen bei 15,7 vs. 16,8 (t1), 14,5 vs. 12,1 (t2), 11,9 vs. 12,9 (t3) und 11,0 vs. 11,3 (t4). Zu keinem Zeitpunkt war der Unterschied statistisch signifikant (p

Objective We examined psychosocial and informational services used by long-term survivors of breast, colon and prostate cancer in immigrants versus non-immigrants. Methods Patients were sampled from population-based cancer registries in Germany. They completed a questionnaire assessing immigration biography, service use and socio-demographic characteristics. Results Data of 6143 cancer survivors were collected of whom 383 (6%) were immigrants. There was no evidence of an association between immigration status and service use. However, immigration biography played a role when patients' and their parents' birthplace were taken into account. When parents were born outside Europe, survivors less frequently used information from the Internet (ORadj 0.4, 95% CI 0.2; 0.8). Web-based information (ORadj 0.7, 95% CI 0.5; 0.9) was less frequently used when the participant was born outside Germany. Conclusion The differences in the use of psychosocial and informational services between immigrants and non-immigrants seem to be generally small. Acculturation may play a role in service uptake. In survey-based health services research, investigators should not stratify by census-defined immigration status, but rather by cultural background. Copyright © 2014 John Wiley & Sons, Ltd.

Einleitung: Diese Studie ging der Frage nach, wie viele Krebspatienten psychoonkologische Versorgung im Krankenhaus oder in Krebsberatungsstellen erhalten und welche Faktoren diese Inanspruchnahme beeinflussen. Methode: Personen, die vor mindestens 5 Jahren an Brust-, Darm- oder Prostatakrebs erkrankt waren, erhielten im Rahmen der Studie „Cancer Survivorship – a multiregional population-based study (CAESAR)“ einen Fragebogen, in dem sie angaben, ob sie psychoonkologische Versorgung im Krankenhaus oder in einer Krebsberatungsstelle erhalten hatten. Geschlecht, Alter, Wohnortgrose, Bildung, Einkommen und Tumorausbreitung bei Diagnose wurden als Pradiktoren der Inanspruchnahme untersucht. Ergebnis: Von 6 143 befragten Krebsuberlebenden gaben 547 (9%) an, im Krankenhaus psychologisch betreut worden zu sein, 183 (3%) hatten eine Krebsberatungsstelle besucht. Stationare Versorgung erhielten hoher Gebildete (OR 1,5), Frauen (OR 1,3) und Patienten mit fortgeschrittener Erkrankung (OR 1,3) haufiger, altere Personen seltener (OR 0,6). Wohnortgrose und Einkommen spielten hingegen keine Rolle. Krebsberatungsstellen wurden von Frauen (OR 2,2), hoher Gebildeten (OR 2,1), Patienten mit fortgeschrittener Erkrankung (OR 1,6) und Personen aus Gemeinden mit >100 000 Einwohnern (OR 2,4) haufiger aufgesucht, von alteren Patienten (OR 0,4) hingegen seltener. Diskussion: Insbesondere bei Krebsberatungsstellen stand die Inanspruchnahme mit Kontext- und Personenfaktoren im Zusammenhang, wahrend dies bei Konsildiensten nicht so stark der Fall war. Dies bedeutet einerseits, dass aufsuchende psychoonkologische Versorgung besser geeignet ist, alle Personengruppen zu erreichen als Versorgungsmodelle, bei denen die Betroffenen selbst aktiv auf die Versorger zugehen mussen. Andererseits legt es auch nahe, dass Nicht-Inanspruchnahme z. B. von ambulanter Versorgung nicht bedeutet, dass die Betroffenen diese Hilfe nicht wunschen oder ihrer nicht bedurfen, sondern dass es hier Zugangsbarrieren gibt, die bei aufsuchender Versorgung nicht bestehen.

Hintergrund: Epidemiologische Daten zu Kopf-Hals-Malignomen werden trotz ihrer anatomisch-histologischen Heterogenitat oft aggregiert berichtet. In Deutschland gibt es bisher nur wenige Studien, die Trends von Inzidenz und Mortalitat detailliert nach Tumorentitaten analysiert haben. Weiterhin ist wenig daruber bekannt, ob die Inzidenz von HPV-assoziierten Tumorentitaten der Kopf-Hals-Region zugenommen hat. Methoden: Anhand von Krebsregisterdaten aus Rheinland-Pfalz von 2000–2009 wurden altersstandardisierte Inzidenz- und Mortalitatsraten fur alle Kopf-Hals-Tumorentitaten einzeln und nach Lokalisationsgruppen, die HPV-assoziiert sein konnten, berechnet. Zeitliche Trends wurden mittels Joinpoint-Regression analysiert und als jahrliche prozentuale Veranderung (JPV) dargestellt. Ergebnisse: Im Studienzeitraum wurden 8055 Neuerkrankungs- und 3177 Sterbefalle registriert. Die Inzidenz von Kopf-Hals-Malignomen nahm bei Frauen zu (JPV:+2,2%), bei Mannern geringfugig ab (−0,9%). Die Inzidenz von Malignomen der Mundhohle (+2,7%) und des Oropharynx (+3,6%) nahm bei Frauen signifikant zu, wahrend bei Mannern Hypopharynx- (− 3,4%) und Larynxtumoren (− 2,7%) abnahmen. Manner und Frauen erkrankten zunehmend haufig an Malignomen, die aufgrund der Lokalisation wahrscheinlich mit HPV-assoziiert sind (Manner:+3,3%, Frauen:+4,3%). Bei beiden Geschlechtern zeigte sich ein Ruckgang der Mortalitat durch Larynxkarzinome (Manner:−5,8%, Frauen:−9,1%). Schlussfolgerung: Eine nach Lokalisationen detaillierte Analyse der Kopf-Hals-Malignome zeigte signifikante und oft gegenlaufige Trends bei Mannern und Frauen, sowohl bei Inzidenz als auch Mortalitat. Der Anstieg der Inzidenz von wahrscheinlich HPV-assoziierten Tumoren stellt ein wichtiges Argument fur die Einfuhrung einer routinemasigen Bestimmung des HPV-Status bei Kopf-Hals-Malignomen dar.

Diese Studie hatte zum Ziel, den Zusammenhang von Lebensqualitat und Uberlebenszeit bei Patienten mit Osophaguskarzinom zu bestimmen. In einer prospektiven Studie wurde die Lebensqualitat von Patienten mit Osophaguskarzinom mit dem Fragebogen EORTC QLQ-C30 dreimalig erfasst: bei Aufnahme ins Krankenhaus (t1), bei Entlassung (t2) und ein halbes Jahr nach Aufnahme ins Krankenhaus (t3). Die Patienten wurden bis zu 11 Jahre nachbeobachtet und das Todesdatum anhand von Krebsregisterangaben ermittelt. Die Sterberaten bei Patienten mit niedriger vs. hohere Lebensqualitat wurden mittels Poisson-Regression verglichen, adjustiert fur Alter, Geschlecht und Tumorstadium. Es konnten 36 Patienten in die Studie eingeschlossen werden, von denen 27 im Beobachtungszeitraum verstarben (Sterberate: 20,7/100 Personenjahre). Bei Aufnahme ins Krankenhaus gaben 27 % eine niedrige Lebensqualitat an. Diese Personen hatten in der Folge ein 3-fach erhohtes Risiko zu versterben. Nach Adjustierung fur Alter, Geschlecht und Tumorstadium erhohte sich dieser Zusammenhang auf 6,7 (95 %-CI 2,0–22,1). Bei Entlassung gaben 37 % (7 von 19) eine niedrige Lebensqualitat an. Nach Adjustierung hatten diese Patienten ein niedrigeres Risiko zu versterben (RR 0,3; 95 %-CI 0,1–1,0). Ein halbes Jahr nach Aufnahme hatten 56 % (10 von 18) eine niedrige Lebensqualitat. Nach Adjustierung standen diese Werte nicht uberzufallig mit dem Uberleben in Zusammenhang (RR 1,9; 95 %-CI 0,4–8,5). Die pratherapeutische Lebensqualitat konnte ein unabhangiger prognostischer Faktor fur das Uberleben nach Osophaguskarzinom sein und sollte auch vor diesem Hintergrund bei der Behandlung berucksichtigt werden.

Diagnosis and treatment of malignant diseases affect in many ways the lives of patients, relatives and friends. Common reactions immediately after the diagnosis are shock and denial, frequently followed by depression, anxiety and/or anger. About a third of all cancer patients suffer from a co-morbid mental health condition, requiring professional support by the entire medical team, including psycho-oncologists. Often overlooked issues are financial and social problems due to inability to work or due to out-of-pocket costs for the medical treatment.

OBJECTIVE In this retrospective investigation of patient pathways to psycho-oncological treatment (POT), we compared the number of POT referrals before and after implementation of electronic screening for POT needs and investigated psychosocial predictors for POT wish at a nuclear medicine department. METHODS We extracted medical chart information about number of referrals and extent of follow-up contacts. During standard referral (November 2014 to October 2015), POT needs were identified by clinical staff only. In the screening-assisted referral period (November 2015 to October 2016), identification was supported by electronic screening for POT needs. Psychosocial predictors for POT wish were examined using logistic regression. RESULTS We analysed data from 487 patients during standard referral (mean age 56.4 years; 60.2% female, 88.7% thyroid carcinoma or neuroendocrine tumours) of which 28 patients (5.7%) were referred for POT. Of 502 patients in the screening-assisted referral period (mean age 57.0 years; 55.8% female, 86.6% thyroid carcinoma or neuroendocrine tumours), 69 (13.7%) were referred for POT. Of these, 36 were identified by psycho-oncological (PO) screening and 33 by clinical staff. After PO-screening implementation, referrals increased by a factor of 2.4. The strongest predictor of POT wish was depressive mood (P

Background: The European Organisation for Research and Treatment of Cancer (EORTC) Group has developed a new multidimensional instrument measuring cancer-related fatigue to be used in conjunction with the quality of life core questionnaire (EORTC QLQ-C30). The module EORTC QLQ-FA13 assesses physical, cognitive, and emotional aspects of cancer-related fatigue.Methods: The methodology follows the EORTC guidelines for phase IV validation of modules. This paper focuses on the results of the psychometric validation of the factorial structure of the module. For validation and cross-validation confirmatory factor analysis (maximum likelihood estimation), intraclass correlation and Cronbach alpha for internal consistency were employed. The study involved an international multicenter collaboration of 11 European and non-European countries.Results: A total of 946 patients with various tumor diagnoses were enrolled. Based on the confirmatory factor analysis, we could approve the three-dimensional structure of the module. Removing one item and reassigning the factorial mapping of another item resulted in the EORTC QLQ-FA12. For the revised scale, we found evidence supporting good local (indicator reliability >= 0.60, factor reliability >= 0.82) and global model fit (GFI(t1 vertical bar t2) = 0.965/0.957, CFIt1 vertical bar t2 = 0.976/0.972, RMSEA(t1 vertical bar t2) = 0.060/0.069) for both measurement points. For each scale, test-retest reliability proved to be very good (intraclass correlation: Rt1-t2 = 0.905-0.921) and internal consistency proved to be good to high (Cronbach alpha = .79-.90).Conclusion: Based on the former phase III module, the multidimensional structure was revised as a phase IV module (EORTC FA12) with an improved scale structure. For a comprehensive validation of the EORTC FA12, further aspects of convergent and divergent validity as well as sensitivity to change should be determined.

Quality of life measurements are well established in cancer clinical trials. In daily clinical practice, where cancer patients often suffer from disease-specific symptoms and report unmet needs regarding their treatment, these measurements are not systematically implemented. The systematic (often computer-based) assessment of quality of life in daily cancer care has shown to be beneficial for patient-physician communication, symptom management, shared decision-making, and in creating a learning health system. Unfortunately, to date, routine electronic quality of life assessments are usually limited to large cancer facilities. Patient and physician barriers as well as barriers from the administrative side in particular are currently hindering the implementation of these systems into the broad spectrum of clinical cancer care. Cost-effectiveness analyses of existing systems, the inclusion of all relevant stakeholders, and clear implementation guidelines are required to introduce quality of life measurements in clinical cancer practice to improve the treatment of cancer survivors and to create a health care system that addresses all their disease-related needs.

Context Cancer patients frequently suffer from fatigue. Recently, the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life group developed a new 12-item fatigue assessment instrument. Objectives The aim of this study was to psychometrically test this questionnaire in comparison with the three-item fatigue scale of the EORTC QLQ-C30. Methods A sample of 354 patients who were being treated for breast cancer or gynecologic cancer were examined using the new fatigue questionnaire EORTC QLQ-FA12 and the EORTC QLQ-C30 during their hospital stay (t1) and three months after hospital discharge (t2). Confirmatory factorial analyses, item analyses, test-retest reliability analyses, and correlation analyses were performed. Results The analyses roughly supported the three-factorial structure of the FA12, which comprised the subscales physical, emotional, and cognitive fatigue. The fit indices of the confirmatory factorial analysis were worse than those of the original article but nevertheless acceptable. Cronbach alpha of the total scale was 0.92; the coefficients of the subscales were between 0.79 and 0.93. The correlation between the EORTC QLQ-FA12 total scale and the fatigue scale of the EORTC QLQ-C30 was 0.69 and the correlation between the t1 and t2 scores was 0.45 for the EORTC QLQ-FA12 total scale and between 0.37 and 0.47 for the subscales. Conclusion The psychometric coefficients justify the calculation of a sum score, which can be used by clinicians to assess the general degree of fatigue. Although the three-item fatigue scale of the EORTC QLQ-C30 stresses the physical aspect of fatigue, the new EORTC QLQ-FA12 covers its emotional and cognitive aspects as well.

Hypoparathyroidism is a rare endocrine disorder for which replacement therapy of the missing parathyroid hormone is not the standard therapeutic option. Current standard treatment consists of calcium and vitamin D supplementation. The intake of calcium and vitamin D supplementation can lead to complications and therefore might negatively influence patients’ quality of life. A systematic literature review was performed to assess the current knowledge on the influence of hypoparathyroidism on patients’ quality of life. The literature search was conducted in PubMed and Web of Science; all relevant literature published by August 24, 2016, was included. In total 372 records were found. After title and abstract screening, 14 studies remained for a full-text screening. The full-text screening resulted in five studies which were included into the systematic review. Comparing the results with a norm-based reference population, three studies reported lower SF-36 scores for hypoparathyroidism patients. Two studies showed a reduced quality of life in hypoparathyroidism patients when their results were compared to control populations. Most hypoparathyroidism patients receiving standard treatment show stable calcium and vitamin D levels. However, hypoparathyroidism patients still report reduced quality of life and experience physical, mental, and emotional symptoms. Therefore, it is assumed that the lack of parathyroid hormone directly influences the patients’ quality of life. This review indicates that patients with hypoparathyroidism have a reduced quality of life in comparison to norm-based populations or matched controls. Further studies are required to quantify the effect of hypoparathyroidism on patients’ quality of life using disease-specific questionnaires and controlling for the co-morbidities and etiologies of the patients.

Multimodal therapies affect the quality of life (QoL) of patients with primary breast cancer (PBC). The objectives of this prospective study were to explore the changes in QoL from diagnosis to conclusion of adjuvant therapy and to identify predictive factors of QoL. Before surgery (t1), before onset of adjuvant treatment (t2) and after completion of adjuvant chemo- or radiotherapy (t3), patients with PBC (n = 759) completed the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire, Charlson Comorbidity Index, Patient Health Questionnaire and Perceived Involvement in Care Scales. Predictors of the course of global QoL were estimated using multinomial logistic regression. Effect estimates are odds ratios (OR) and their 95% confidence intervals (CIs). Global QoL improved between t1 and t3, while physical functioning, emotional functioning and fatigue deteriorated. QoL before surgery was more often poor in patients

Background The objective of this study was to analyse the incidence of lip malignancies in Germany. Methods Data from population-based cancer registries covering a population of 39 million inhabitants from 14 federal states were pooled. Lip malignancies were classified according to the International Classification of Diseases (ICD-10). Age-standardised incidence rates and annual percentage changes in the incidence trends of lip cancer (C00), melanoma of the lip (C43.0), and non-melanoma skin cancer of the lip (C44.0) were calculated. Results Lip cancer (C00) incidence rate was 0.57/0.15 per 100 000 (men/women) in 2003 and 0.52/0.18 in 2012. In women, the change was statistically significant. Melanoma lip cancer (C43.0) incidence rates both in men and women were 0.02 in 2003 and 0.01 in 2012. Incidence rates of non-melanoma skin cancer of the lip (C44.0) significantly increased from 1.6 in 2003 to 2.1 in 2012 in men and from 1.5 in 2003 to 2.4 in 2012 in women. In lip cancer (C00), the vast majority (98% in men/93% in women) were squamous cell carcinomas and 2%/7% were basal cell carcinoma. In men, 56% of non-melanoma skin cancers (C44.0) were squamous cell carcinoma, whereas these were only 27% in women. Conclusions The incidences of non-melanoma skin cancer of the lip increased over time in Germany in both sexes. Lip cancer incidence increased in women, while it stayed stable in men. Melanoma of the lip did not change in incidence. The distribution of histology in non-melanoma skin cancer of the lip differed by sex.

The purpose of the study was to pilot-test a questionnaire measuring health-related quality of life (QoL) in thyroid cancer patients to be used with the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire EORTC QLQ-C30. A provisional questionnaire with 47 items was administered to patients treated for thyroid cancer within the last 2 years. Patients were interviewed about time and help needed to complete the questionnaire, and whether they found the items understandable, confusing or annoying. Items were kept in the questionnaire if they fulfilled pre-defined criteria: relevant to the patients, easy to understand, not confusing, few missing values, neither floor nor ceiling effects, and high variance. A total of 182 thyroid cancer patients in 15 countries participated (n = 115 with papillary, n = 31 with follicular, n = 22 with medullary, n = 6 with anaplastic, and n = 8 with other types of thyroid cancer). Sixty-six percent of the patients needed 15 min or less to complete the questionnaire. Of the 47 items, 31 fulfilled the predefined criteria and were kept unchanged, 14 were removed, and 2 were changed. Shoulder dysfunction was mentioned by 5 patients as missing and an item covering this issue was added. To conclude, the EORTC quality of life module for thyroid cancer (EORTC QLQ-THY34) is ready for the final validation phase IV.

A total laryngectomy (TLE) leads to a variety of functional restrictions, which reduce the quality of life of cancer patients as well as their spouses. However, to date, there is little research focusing on the psychological distress of spouses of total laryngectomised cancer patients. The current study assesses psychological distress, need for psycho-oncological treatment and use of professional psychological care among spouses of total laryngectomised cancer patients. A prospective multi-centre cohort study was conducted. Participants were interviewed in person 1, 2 and 3 years subsequent to their spouses’ TLE with standardised questionnaires (HADS, Hornheide Screening) and self-designed items. One year after their partners’ TLE, 154 spouses were interviewed. Over half of spouses (57 %) reported a high level of psychological distress and 33 % reported restlessness. Majority of spouses (21 %) reported wanting to learn relaxation methods and eight (5 %) had received psychological treatment in the past. Sixty-two spouses took part in the complete study. Over all three time points, psychological distress, the need for psycho-oncological support and the use of professional support among spouses remained stable. The need for additional professional counselling was low. In view of the stability of psychological distress among half of the spouses within 3 years after TLE and their refusal of professional support, there is a need for the development and evaluation of new treatment strategies to help spouses cope with psychological distress. Our results indicated the most common additional professional need was learning relaxation methods, which may be used as a starting point for the investigation of new coping strategies in future studies.

Background The objective of this study was to pilot test an updated version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N60). Methods Patients with head and neck cancer were asked to complete a list of 60 head and neck cancer-specific items comprising the updated EORTC head and neck module and the core questionnaire EORTC QLQ-C30. Debriefing interviews were conducted to identify any irrelevant items and confusing or upsetting wording. Results Interviews were performed with 330 patients from 17 countries, representing different head and neck cancer sites and treatments. Forty-one of the 60 items were retained according to the predefined EORTC criteria for module development, for another 2 items the wording was refined, and 17 items were removed. Conclusion The preliminary EORTC QLQ-H&N43 can now be used in academic research. Psychometrics will be tested in a larger field study. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1358–1367, 2015

Fragestellung: Um die Qualitat der Versorgungsablaufe auf einer Station verbessern zu konnen, ist es unerlasslich, die Sicht der Patienten systematisch zu erfragen. Der (SFB) wurde entwickelt, um dies zu ermoglichen. Die vorliegende Studie ging der Frage nach, welche psychometrischen Kennwerte der SFB aufweist und wie viele Fehlwerte auftreten. Methodik: Im Zeitraum von 4 Monaten wurde der Bogen auf zwei Stationen (interdisziplinar und onkologisch) an alle Patienten verteilt. Zur Uberprufung der Ubereinstimmungsvaliditat wurden die PICS-Skalen (Patient Involvement in Care) angewendet. Ergebnisse: Von 99 ausgeteilten Bogen wurden 68 ausgefullt abgegeben (Response-Rate 69 %). Der Prozentsatz fehlender Werte pro Item lag im Median bei 6 % (Range 0 %-28 %). Die Skalen des SFB hatten eine interne Konsistenz von 0,87 (Organisation und Ablauf), 0,68 (Erreichbarkeit Arzte), 0,82 (Erreichbarkeit Pflege), 0,94 (Arztliche Aufklarung) und 0,87 (Visite). Cronbach’s Alpha des Gesamtscores war 0,94. Die Skalenfehler lagen bei 0 % (Visite, Arztliche Aufklarung, Erreichbarkeit Pflege) bis 17 % (Erreichbarkeit Arzte). Die Varianz pro Skala ist relativ gering. SFB und PICS korrelieren in einer Weise, die die Validitat des SFB belegt. Folgerungen: Mit dem SFB liegt ein Instrument vor, das sich im stationaren Alltag zur Einschatzung der von den Patienten erlebten Qualitat der stationaren Versorgung (bezogen auf Visite, Erreichbarkeit von medizinischem Personal und Organisation generell) bewahrt hat und das gute psychometrische Eigenschaften aufweist. Eine Validierung in einer groseren Patientenstichprobe erscheint sinnvoll.

BACKGROUND: The authors investigated whether cancer patients who have comorbid mental health disorders (MD) are at greater risk of early retirement compared with those who do not have MD. METHODS: Individuals ages 18 to 55 years from a consecutive sample of patients who were admitted for inpatient oncologic treatment were interviewed using structured clinical interviews to ascertain MD. The patients were followed for 15 months, and the date of early retirement was documented. Rates of early retirement per 100 person-years (py) in patients with and without MD were compared using multivariate Poisson regression models. RESULTS: At baseline, 491 patients were interviewed, and 150 of those patients (30.6%) were diagnosed with MD. Forty-one patients began full early retirement during follow-up. In patients with MD, the incidence of early retirement was 9.3 per 100 py compared with 6.1 per 100 py in mentally healthy patients. The crude rate ratio (RR) was 1.5 (95% confidence interval [CI], 0.8-2.8). The effect of MD on early retirement was modified in part by income: in patients with low income, the adjusted RR was 11.7, whereas no effect was observed in higher income groups. Patients with depression were at greater risk of retirement when they had higher income (RR, 3.4; P 5.05). The effects of anxiety (RR, 2.4; P 5.05), adjustment disorders (RR, 1.7; P 5.21), and alcohol dependence (RR, 1.8; P 5.40) on early retirement were equal across income groups. CONCLUSIONS: Mental health conditions are risk factors for early retirement in cancer patients, although this effect differs according to the type of disorder and the patient’s income level. Cancer 2014;000:000-000. V C 2014 American Cancer Society.

Background In this exploratory study, employment and psychological factors were investigated in head and neck cancer survivors with survivorship of ≥2 years. Methods Fifty-five head and neck cancer survivors ≤60 years old completed a survey including subscales from the Functional Assessment of Cancer Therapy (FACT) instrument, the Miller Behavioral Style Scale, the General Perceived Self-Efficacy Scale, the Patient Health Questionnaire-9 (PHQ-9), and the Hornheider–Fragebogen short version (HFB) measuring the need for psychological interventions. Exploratory analyses of associations to the employment status were performed. Results The rate of employed patients dropped from three-fourths of patients before diagnosis to one-third at an average of 66.8 months after diagnosis. Current unemployment was associated with harder physical work before cancer diagnosis, surgical treatment, and current risky alcohol consumption. Unemployed survivors reported decreased FACT functional and social well-being and higher PHQ depression scores. Conclusion Psychosocial variables were significantly related to employment. Further research is needed to examine these relationships. © 2014 Wiley Periodicals, Inc. Head Neck 37: 585–593, 2015

Zusammenfassung Fragestellung: Der Fragebogen zur sozialen Integration (FSI) ist eine deutschsprachige Adaptierung der Social Adjustment Scale (SAS-SR). Bislang gibt es noch keine Aussagen zu den Testgutekriterien des FSI bei Krebspatienten.Methode: Die Skalen Freizeit, Verwandte und Partnerschaft des FSI wurden bei hamato-onkologischen Patienten teststatistisch analysiert. Konkordante Validitat wurde anhand des Fragebogens zur Sozialen Unterstutzung (F-Sozu) und einer Skala des EORTC QLQ-C30 untersucht. Ergebnisse: Bei 184 Befragten gab es bezuglich der Einzelitems 1 %-20%fehlendeWerte. Deckeneffekte zeigten sich fur die Skala Verwandte (1.22-2.20), wahrend der Range in den Skalen Freizeit etwas (1.27-2.95) und bei Partnerschaft deutlich (1.51-3.91) groser war. Die interne Konsistenz lag bei 0.75 (Freizeit, Partnerschaft) beziehungsweise 0.69 (Verwandte). Die Validitatsprufung ergabWerte zwischen -0.23 und -0.50 (F-Sozu) beziehungsweise -0.29 bis -0.40 (EORTC QLQ-C30). Diskussion: Mit dem FSI kann die so...

The aims of this study are to present the results of a new general population normative study of the quality of life questionnaire EORTC QLQ-C30 and to give European reference values averaged across six studies.The empirical study was based on a representative sample of the German adult population (N = 2448). The subjects were asked to fill in several questionnaires, one of them being the EORTC QLQ-C30.EORTC QLQ-C30 mean scores of this sample indicated slightly better quality of life (QoL) than in previous European studies. QoL decreased with age, but there were only small gender differences. The mean scores were compared with the age and gender adjusted scores of five other European normative studies from Sweden, the Netherlands, Norway, and Germany (N between 1731 and 4910). Finally, the data of these five studies and the new study were combined to arrive at averaged European normative values for the scales and the symptom items of the questionnaire.The reference values of the scales pooled across six European studies (N = 16 151) can be used as general population references for QoL scores of cancer patients.

Background Electronic cigarettes (e-cigarettes) are a consumer product whose benefits and risks are currently debated. Advocates of the "tobacco harm reduction" strategy emphasize their potential as an aid to smoking cessation, while advocates of the precautionary principle emphasize their risks instead. There have been only a few studies to date on the prevalence of e-cigarette use in Germany. Methods In May 2016, in collaboration with Forsa, an opinion research firm, we carried out a survey among 4002 randomly chosen persons aged 14 and older, asking them about their consumption of e-cigarettes with and without nicotine, reasons for using e-cigarettes, plans for future use, estimation of danger compared to that of tobacco products, smoking behavior, and sociodemographic features. Results 1.4% of the respondents used e-cigarettes regularly, and a further 2.2% had used them regularly in the past. 11.8% had at least tried them, including 32.7% of smokers and 2.3% of persons who had never smoked. 24.5% of ex-smokers who had quit smoking after 2010 had used e-cigarettes at least once. 20.7% of the respondents considered electronic cigarettes less dangerous than conventional cigarettes, 46.3% equally dangerous, and 16.1% more dangerous. An extrapolation of these data to the general population suggests that about one million persons in Germany use e-cigarettes regularly and another 1.55 million have done so in the past. Conclusion The consumption of electronic cigarettes in Germany is not very widespread, but it is not negligible either. Nearly 1 in 8 Germans has tried e-cigarettes at least once. Regular consumers of e-cigarettes are almost exclusively smokers and ex-smokers.

Quality of life (QoL) issues most relevant for head and neck cancer patients are swallowing, eating, talking, dry mouth, sticky saliva, pain, skin problems and anxiety. QoL is strongly related to the patient’s emotional wellbeing, which can be improved by good communication between doctor and patient. It is helpful to address the patient’s psychological concerns proactively as head and neck cancer patients tend to conceal their concerns. Patients should be asked routinely about their wellbeing and help should be offered by the doctors and by psychosocial experts such as psycho-oncologists, psychotherapists, social workers, psychiatrists, and counsellors.

Objective The aim of this study was to delineate the challenges that psychotherapists encounter when they treat cancer patients and how they organise their practices to be able to treat them. Methods A random sample of certified psychotherapists, licensed by the health authorities, with training in psycho-oncology, was asked to complete a questionnaire covering the following issues: therapists' qualifications, organisation of the practice, dealing with appointment cancellations, financing, and networking. Practices with ≥50% cancer patients in their patient load were defined as “practices specialising in cancer” (PSC) and were compared to practices with a smaller proportion of cancer patients (non-PSC). Results Of 120 contacted therapists, 83 replied and 77 were eligible. The median waiting time for a first consultation was 10 days in PSC and 14 days in non-PSC (P = .05). Seventy-five of PSC and 56% of non-PSC can offer psychotherapy within 4 weeks. Time spent on dealing with the social problems of the patients was higher in PSC than in non-PSC (P = .04). They spent also more time communicating with other health care professionals such as private practice oncologists (P = .001). Cancer patients need to cancel appointments more frequently than noncancer patients (58% vs 48% cancel ≥1× per quarter). Sixty-six percent of the psychotherapists do not ask for financial reimbursement of these sessions. Conclusion Psychotherapy for cancer patients in the outpatient setting requires different organisation of the practice. Sessions are cancelled more frequently, waiting time is considerably shorter, and psychotherapists communicate more often with other health care providers than in general psychotherapy.

Background The EORTC QLQ-STO22 (STO22) was developed in 2001 to measure quality of life (QOL) of gastric cancer (GC) patients and is a well validated instrument. However, there are some points worth considering. Firstly, the treatment strategies have dramatically changed since 2001. In contrast to 20 years ago, diverse combination regimens with cytotoxic drugs and molecular agents are administered for advanced GC and multidisciplinary approaches including neoadjuvant therapy and minimally invasive surgery are the mainstay of treatment. Thus, the original STO22 might not adequately assess QOL of GC patients currently treated. Secondly, specialists and patients from East Asia were not involved in the development of the STO22. Consequently, QOL issues of East Asian patients might not be reflected in the original ST022. The EORTC QOL group in collaboration with the EORTC Gastrointestinal Tract Cancer Group and the JCOG, aim to update the existing STO22. Methods Updating the STO22 consists of four steps. Pre-phase 1: literature review of studies using the ST022 in East Asia. Phase 1: Compiling an exhaustive list of relevant QOL issues captured from the literature review and interviews with patients and health care professionals. Phase 2: operationalising new issues into items to make a provisional module. Phase 3: Pilot testing the provisional updated ST022 alongside the EORTC QLQ-C30 with patients who meet the eligibility criteria from Europe and East Asia to obtain a response score for each item, together with a rating of relevance and importance. Results This study is in progress and a grant application to the EORTC QOL group is under review. An interim report from pre-phase 1 and phase 1 will be presented at the congress. Conclusions The current STO22 module might need updating to capture the QOL issues related to the new and diverse treatments and to include the East Asian perspective. The updated STO22 would be used more globally across Europe and Asia.

Soziale Netzwerke und gesellschaftliche Teilhabe wirken sich im Allgemeinen positiv auf das psychische Befinden aus. Inwiefern Patienten nach einer Kehlkopfentfernung wieder in die Gesellschaft eingebunden werden, ist jedoch wenig untersucht. Ziel der Studie war es, zu prufen, inwieweit Patienten nach einer Laryngektomie sozial integriert sind und ob die soziale Integration mit bestimmten Bereichen der Lebensqualitat zusammenhangt. In einer multizentrischen Studie wurden 161 Patienten ein Jahr nach Laryngektomie befragt. Die soziale Integration wurde anhand eines Index erhoben. Dieser setzt sich aus Fragen zur sozialen Unterstutzung und dem Fragenkomplex zur Einbindung in die Gesellschaft, welcher mit dem Fragebogen zur „Psychosozialen Anpassung nach Laryngektomie“ (FPAL) ermittelt wurde, zusammen. Die Lebensqualitat wurde mit dem Fragebogen der European Organisation for Research and Treatment of Cancer, EORTC QLQ-C30, bestimmt. 1 Jahr nach Operation beschreiben sich 58% (N=93) als gut sozial integriert. Sozial integrierte Personen haben weniger Probleme in den Funktionsbereichen, aus denen sich die Lebensqualitat zusammensetzt. Sie berichten weniger von Einschrankungen im Umgang mit anderen Menschen (OR 4,07; CI: 1,96–8,47) oder in beruflichen bzw. Freizeitaktivitaten (OR 3,59; CI: 1,61–8,02). Hohe soziale Integration geht auch mit einem guten emotionalen Befinden einher (OR 8,57; CI: 3,59–20,46). Uber ein Drittel der Patienten nimmt ein Jahr nach Kehlkopfentfernung nur noch wenig am gesellschaftlichen Leben teil. Aufgrund des Zusammenhangs von sozialer Integration mit dem emotionalen Befinden sollten die Patienten bei der Re-Integration in das soziale Leben unterstutzt werden.

Background The International Classification of Functioning, Disability and Health Core Set for Head and Neck Cancer (ICF-HNC) covers the typical spectrum of problems in functioning in head and neck cancer. This study is part of a multistep process to develop practical guidelines in Germany. The purpose of this study was to identify instruments for the assessment of functioning using the ICF-HNC as reference. Methods Four Delphi surveys with physicians, physiotherapists, psychologists, and social workers were performed to identify which aspects of the ICF-HNC are being treated and which assessment tools are recommended for the assessment of functioning. Results Ninety-seven percent categories of the ICF-HNC were treated by healthcare professionals participating in the current study. Altogether, 33 assessment tools were recommended for therapy monitoring, food intake, pain, further organic problems/laboratory tests, and psychosocial areas. Conclusion Although the ICF-HNC is being currently implemented by the head and neck cancer experts, several areas are not covered regularly. Additionally, validated tools were rarely recommended. © 2013 Wiley Periodicals, Inc. Head Neck 36: 954–968, 2014