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The aim of this study was to document how many patients with malignant diseases in an acute care hospital can be supported by one full time psycho-oncologist and how long each procedure takes. Over the course of 2 years, frequency and duration of all interventions provided by a psycho-oncologist were documented at 6 hospitals in Germany. A total of 4 947 patients received 20 366 psycho-oncological interventions. One full time position could care for 351 (1st year) and 436 (2nd year) patients respectively. The most frequent intervention was supportive counselling to single patients (22%) with an average duration of 29 min. Patients received on average 4 consultations. In addition, many short contacts with a duration of 10 min were provided. On average, psycho-oncological care could be provided by a person with a full-time position to 393 patients with malignant diseases. Most of the consultations were of short duration (10-30 min).

Objective: The objective of this study is to examine the course of fatigue in female cancer patients during the first months after treatment. Methods: We examined a sample of 110 patients suffering from gynecological or breast cancer. Fatigue was assessed with two questionnaires, the Multidimensional Fatigue Inventory (MFI) and the fatigue scale of the quality of life questionnaire European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30). Participants were tested during their stay in the hospital (t1), two weeks after discharge (t2), and three months after discharge (t3). Results: Fatigue in the patients’ sample was markedly higher than the general population reference values. At t1, the effect sizes are d=0.81 (MFI) and d=1.21 (EORTC QLQ-C30 fatigue scale). Age and tumor stage had no significant influence on fatigue, but patients with a long time since diagnosis had higher fatigue levels than patients with a shorter time since diagnosis. From t1 to t3, fatigue mean scores decreased. The correlations between the t1 and the t3 fatigue scores were weak, with correlation coefficients of only about 0.30. Conclusion: Though the mean scores of fatigue, averaged across all patients, decreased over the first three months, the individual courses could not be predicted from the t1 score.

Cancer patients are showing increased interest in shared decision-making. Patients with haematological illnesses, however, express considerably less desire for shared decision-making as compared with other oncological patient groups. The goal of the current project was to identify the reasons for the lower desire for shared decision-making among patients with haematological illness. We conducted qualitative, semi-structured interviews with 11 haematological patients (39-70 years old) after the beginning of therapy concerning the course and evaluation of medical shared decision-making. The patients were often overwhelmed by the complexity of the illness and the therapy and did not want to assume any responsibility in medical decision-making. They reported a great deal of distress and very traditional paternalistic role expectations with regards to their health care providers, which limited the patients' ability to partake in the decision-making process. In contrast to the socio-cultural support for many other oncological diseases, haematological diseases are not as well supported, e.g. there is a lack of self-help materials, systematic provision of information and support groups for patients, which may be related to a lower empowerment of this patient population. Results show the limits of patient participation in the context of highly complicated medical conditions. In addition to already researched preferences of the physicians and patients for shared decision-making, future research should pay greater attention to the process and other variables relevant to this aspect of the doctor-patient relationship.

Background The purpose of this study was to determine what quality of life (QOL) areas improve and deteriorate during the first year after total laryngectomy and to identify predictors of these changes. Methods One hundred seventy-four patients completed the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaires before laryngectomy, n = 133 before discharge from hospital, n = 110 at the end of rehabilitation, and n = 86 1 year after laryngectomy. Multivariate regression analysis was performed to estimate the effect of potential predictors on QOL. Results Areas that did not recover to baseline level were physical functioning, role functioning, social functioning, fatigue, dyspnea, appetite loss, financial difficulties, senses, speech, and social contact, whereas global health status, coughing, and weight improved. There was no evidence for predicting effects of age, sex, education, and tumor site. Tumor stage, recurrent disease, radiotherapy, and mental health did display predicting effects. Smoking status before the treatment had marginally significant effects. Conclusion QOL decreases initially after laryngectomy; some QOL areas recover slowly over the course of the year after surgery, and some remain significantly worse than at baseline. © 2013 Wiley Periodicals, Inc. Head Neck 36: 359–368, 2014

Ziel dieser Studie war es herauszufinden, wie viele Patienten nach einer Laryn­gektomie (LE) erfolgreich ins Berufsleben zuruckkehren und welche Faktoren eine berufliche Wiedereingliederung unterstutzen. Laryngektomierte (n=231) im Alter von bis zu 60 Jahren wurden vor der LE (t1), vor der Anschlussheilbehandlung (AHB) (t2), am Ende der AHB (t3), 1 Jahr nach LE (t4), 2 Jahre nach LE (t5) und 3 Jahre nach LE (t6) mithilfe von strukturierten Interviews und Fragebogen befragt. Vor der LE waren n=76 (38%) der Befragten erwerbstatig, 34% erwerbslos, 23% erhielten eine Erwerbsminderungsrente und 3% waren in Vorruhestand. 1 Jahr nach der LE waren 13% erwerbstatig, 2 Jahre nach LE 15% und 3 Jahre nach LE 14%. Erwerbslos waren nach der LE 10% (t4), 5% (t5) und 7% (t6). Fur 59% der Befragten war es sehr wichtig oder extrem wichtig, eine Arbeit zu haben. Pradiktoren erfolgreicher beruflicher Wiedereingliederung waren eine Erwerbstatigkeit vor der LE, Alter Nur wenigen Laryngektomierten im erwerbsfahigen Alter gelingt die berufliche Wiedereingliederung. Allerdings hat auch schon vor der LE nur ein Drittel eine Arbeitsstelle, ein Drittel ist arbeitslos. Die Meisten erhalten nach der LE eine Rente. Da es fur viele Patienten wichtig ist, eine Arbeit zu haben, und da Daten aus anderen Landern zeigen, dass die Wiederaufnahme einer beruflichen Tatigkeit nach LE in hoherem Umfang moglich ist als in unserer Studie, sollten in Zukunft mehr Moglichkeiten der beruflichen Rehabilitation uberdacht werden, bevor den Patienten eine Rente nahe gelegt wird.

Funktionelle Beeintrachtigungen bei Kopf-Hals-Tumoren werden bisher im klinischen Alltag selten standardisiert erhoben. Klinische Studien mit der Zielgrose Funktionserhalt bei KHT verwenden viele verschiedene Instrumente. Die Ergebnisse sind deshalb oft schlecht vergleichbar und lassen zu wenig klinische Schlussfolgerungen zu. Es war daher notwendig und Ziel dieser Studie, die nach bisheriger Evidenz und interdisziplinarem Expertenkonsens am besten geeigneten Instrumente zur Beurteilung von Funktionsfahigkeit bei KHT zu identifizieren und Empfehlungen fur deren Verwendung in einem Leitfaden zusammenzustellen. In Vorstudien wurde unter Verwendung festgelegter Kriterien eine Vorauswahl an Instrumenten getroffen. Teilnehmer einer interdisziplinaren Konsensuskonferenz bewerteten die Instrumente und stimmten ab, welche Instrumente empfohlen werden fur die Anwendungsbereiche: Screening, Therapiebeurteilung und klinische Studien. Beteiligte Berufsgruppen waren HNO-Arzte, Radioonkologen, Mund-Kiefer-Gesichtschirurgen, internistische Onkologen, Phoniater, Logopaden, Psychologen, Physiotherapeuten und Sozialarbeiter. 98 Instrumente wurden auf der Konsensuskonferenz detailliert bewertet. 21 Teilnehmer empfahlen daraus fur die 3 Anwendungsbereiche jeweils Instrumente zur Beurteilung von 6 Funktionsbereichen: Therapiekon­trolle – Schmerz – Nahrungsaufnahme – Stimme, Sprechen, Atmung – weitere organische Probleme – Psychosoziale Funktion. Es wurden Instrumente ausgewahlt, interdisziplinar bewertet und fur die Anwendung im klinischen Alltag und in klinischen Studien empfohlen. Damit steht ein Tool zur schnellen, umfassenden funktionellen Beurteilung von Patienten mit KHT zur Verfugung, das nun implementiert und auf seine Praxistauglichkeit getestet werden kann.

An art therapy intervention for cancer patients in the ambulant aftercare – results from a non-randomised controlled study Art therapy in psycho-oncology is gaining increasing importance, but systematic evaluations of its effects are rare. The aim of this study is to investigate the effects of an art therapy intervention for cancer patients in ambulant aftercare on psychological distress and coping. The intervention consisted of 22 sessions. At three points of measurement (t1: before intervention, t2: following intervention, t3: 6 months after t2), participants responded to questionnaires (Freiburg Questionnaire on Coping with Illness, Perceived Adjustment to Chronic Illness Scale, Hospital Anxiety and Depression Scale). A group of haemato-oncological patients served as the comparison group (CG). Pre–post comparisons and analyses of variance were applied for statistical analysis. Relevant confounders were controlled. Fifty-four patients (intervention group, IG) with various cancer diagnoses completed the intervention. One hundred and twenty-nine data sets were available for the CG. Analyses of variance included group membership (IG vs. CG) and the following factors: gender, other psychosocial help and major life events. None of these variables was a predictor for changes in depression, anxiety and coping. Therefore, we could not prove intervention effects over time. Our results contradict those of preliminary studies and raise important questions. Further work on evaluating art therapy is necessary to explore which intervention concepts in which setting at which treatment stage show significant effects. Therefore, controlling for relevant confounders is needed.

Background: Fatigue is a frequent symptom in cancer patients. In Europe and Northern America fatigue questionnaires were developed and tested, but their generalizability to other cultural contexts is largely unknown. The aim of this study is to provide normative values for the Multidimensional Fatigue Inventory (MFI-20) based on a representative sample of the general population in Colombia and to test psychometric properties. Methods: 1,500 individuals completed a questionnaire that contained the MFI-20, as well as other questionnaires, and questions on sociodemographic variables and chronic diseases. Results: The mean values of the scales were marginally higher than those for 2 European samples. The mean value of the total score was 44.3 ± 14.1. Women were affected by fatigue more than men, and there was an almost linear age trend, with higher mean scores for older subjects. People with chronic diseases were affected by fatigue more than people without chronic conditions. The best psychometric properties were obtained for the total scale (sum score) of the MFI-20. Conclusion: The normative values presented here can help us to assess the individual burden of fatigue in a Latin American context. Psychometric properties of the MFI-20 in Colombia are similar to those obtained in Europe.

Selbsthilfegruppen (SHG) dienen als Informationsquelle, Bewaltigungsressource und zur Vertretung von Patienteninteressen. Unbekannt war bisher, wie haufig diese von Laryn­gektomierten genutzt werden und wodurch sich Inanspruchnehmer von Nichtinanspruchnehmern unterscheiden. In einer multizentrischen Studie wurden 224 laryngektomierte Pa­tienten ein Jahr postoperativ hinsichtlich der Teilnahme an SHG und moglicher Pradiktoren mittels eines halbstrukturierten Interviews und standardisierter Fragebogen befragt. Insgesamt 23% der laryngektomierten Patienten gehen regelmasig in eine SHG. Die Mitgliedschaft ist wahrscheinlicher bei Pa­tienten mit hoherem Bildungsgrad und besserem Einkommen, beim Vorhandensein einer festen Partnerschaft, bei geringerer familiarer Unterstutzung und beim Vorhandensein des Wunsches nach zusatzlichen Arztgesprachen. Die SHG scheint eine Art „Puffer“ zu bilden, um Bedurfnisse auszugleichen, welche die Familie naturgemas nur bedingt auffangen kann. Andererseits sind SHG-Mitglieder sozial abgesichert und leben in fester Partnerschaft. Arzte und Logopaden als wichtige Vermittler zu Selbsthilfegruppen sollten vor allem Patienten der unteren sozialen Schicht und alleinstehende Patienten uber das Angebot des Bundesverbandes der Kehlkopfoperierten e. V. informieren.

Background Gaining a new voice is one of the major aims after total laryngectomy. The objective of this study was to describe the process and results of speech rehabilitation during the first year after surgery. Methods Speech intelligibility was measured 6 months (n = 273) and 1 year (n = 225) after total laryngectomy. Results Objective (23.4 to 47.5 points, p < .0001) and subjective (51.6 to 64.7 points, p < .0001) speech intelligibility improved between 6 months and 1 year after total laryngectomy. Patients who used tracheoesophageal puncture (TEP) had the best results in speech intelligibility 6 months and 1 year after total laryngectomy. In all, 12% of the patients who used TEP initially no longer used it 1 year later. Patients who had received rehabilitation had better objective speech intelligibility than those who did not. Conclusions Speech improves considerably between 6 months and 1 year after total laryngectomy. Nonattendance of rehabilitation is associated with a worse functional outcome in speech rehabilitation. Head Neck, 35: 1583–1590, 2013

Gebarmutterhalskrebs ist in Deutschland der dritthaufigste Genitaltumor der Frau. Standardtherapie fur die Tumorstadien B und A ist die radikale Hysterektomie. Mittlerweile existieren neue nervenschonende Techniken, wie die totale mesometriale Resektion (TMMR). Hinsichtlich medizinischer Parameter zeigt die TMMR einen besseren therapeutischen Index als die konventionelle Radikaloperation. Aussagen zur Lebensqualitat (LQ) nach einer TMMR-Behandlung liegen bislang nicht vor. Fur die Querschnittsstudie wurden 78 Zervixkarzinompatientinnen (ZP) anhand standardisierter Verfahren (EORTC QLQ-C30, HADS) befragt. Als Vergleich diente eine altersparallelisierte Stichprobe der weiblichen Allgemeinbevolkerung (VG=234). Die TMMR lag im Mittel 2,5 Jahre zuruck. Die korperliche Funktion der ZP war im Vergleich zur VG reduziert (ZP=89,1; VG=92,2; p=0,02), im Vergleich mit der VG wurden eine starkere Belastung fur Fatigue (ZP=22,9; VG=15,5; p=0,04) und Schlafstorungen (ZP=26,5; VG=15,5; p=0,02) festgestellt. Weitere LQ-Unterschiede fanden sich nicht. Die Angstlichkeit war in beiden Gruppen gleich ausgepragt (MW jeweils 5,0). Die VG hatte hohere Depressivitatswerte als die ZP (VG=4,5; ZP=2,6; p=0,01). Frauen mit einem fruh erkannten Zervixkarzinom haben nach einer TMMR-Behandlung eine gute und mit der der Allgemeinbevolkerung vergleichbare Lebensqualitat bzw. psychische Befindlichkeit.

Soft tissue sarcoma comprises a heterogeneous group of solid malignant tumours. Comorbidities are important prognostic factors for survival and adversely impact quality of life. We examined the complex relationship between soft tissue sarcoma and comorbidities over time in a large population-based sample. The study uses routine data from the German statutory healthcare system (n = 2,615,865). Case identification of soft tissue sarcoma and comorbid diseases was based on ICD-10 codes and diagnostic modifiers. Uni- and multivariate regression models were used to obtain risk estimates for chronic somatic and mental comorbidities in soft tissue sarcoma patients compared to a cancer-free control group. At diagnosis, patients with soft tissue sarcoma were significantly more likely to be affected with prevalent bronchial asthma, ≥1 cardiovascular risk factor (hypertension, angina pectoris, heart failure, peripheral arterial disease and thrombosis), back pain, depression, anxiety disorder and adjustment disorder than cancer-free controls. During the course of disease, sarcoma patients were at a significantly higher risk to develop incident depression, anxiety disorder and adjustment disorder. Comorbidities need to be considered in clinical decision making regarding the treatment of soft tissue sarcoma patients. Psycho-oncological treatment should be incorporated into medical care of patients with sarcoma.

Background To estimate the burden of diseases, it is important to consider patient-reported outcomes including Quality of Life (QoL). The aim of this study is to provide population-based reference data for the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25), stratified by sex and age. Methods The Gutenberg Health Study (GHS) is a population-based, prospective, observational cohort study in Germany, including 15,010 participants aged between 35 and 74. The baseline examination was conducted between 2007 and 2012. To overcome known shortcomings of the NEI VFQ-25, we calculated the previously proposed visual functioning scale and the socio-emotional scale based on Rasch-transformed person-level data. We present mean values, standard deviations and percentiles for age decades stratified by sex. We used a linear regression model to assess the influence of age, sex, socioeconomic status, distance-corrected visual acuity (better-seeing eye) and the absolute difference in distance-corrected visual acuity of both eyes on vision-related QoL. Results NEI VFQ-25 data are available from 12,231 participants (82%). Both the long-form visual functioning scale (LFVFS) and the long-form socio-emotional scale (LFSES) showed a clear age dependency, with an average LFVFS score of 92.8 for men and 90.5 for women in the youngest age group and 85.7 and 83.4 in the oldest age group, and a LFSES score of 98.3 for men and 98.1 in women in the youngest and 94.7 and 94.5 in the oldest decade. The largest difference was observed between the youngest age group (35–44 years) and the 45–54 years group. Men tended to have slightly higher scores than women. In the multivariable linear regression analysis, age (per 5 years −0.42), female sex (−1.57), worse distance-corrected visual acuity of the better eye (per 0.1 increase in logMAR −2.92) and the difference between both eyes (per 0.1 increase in logMAR −0.87) were associated with a reduced LFVFS score (all p

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

Annals of hematology 96(2), 171-181 (2017). doi:10.1007/s00277-016-2867-8, Published by Springer, Berlin

Health-related quality of life (QoL) is a self-assessed construct indicating how people feel in regard to aspects of their health. Performance status (PS) is evaluated by the treating physician. We examined whether pretreatment QoL and PS are related to subsequent treatment discontinuation and treatment changes in high-risk breast cancer patients receiving chemotherapy. We conducted a prospective cohort study with data from a randomized phase III trial comparing FEC- and EC-DOC-chemotherapy in patients with primary breast cancer (ADEBAR). We examined the patient’s request to discontinue the study, discontinuation due to toxicity, the prolongation of therapy, and dose reduction. Baseline QoL was assessed using the EORTC QLQ-C30. PS was evaluated using the Eastern Cooperative Oncology Group Scale (ECOG). Four QoL scales were selected prior to analysis as outcomes: global health, physical functioning, emotional functioning, and fatigue. Multivariate binary logistic regression analyses were used to test for differences within the independent variables. 1322 patients were included. 1094 (82.8 %) patients completed therapy according to protocol. 6.3 % stopped therapy due to toxicity and 4.4 % refused treatment. Global health was not related to any of the four QoL outcomes. Physical functioning had the strongest impact on QoL, when comparing the fittest group to the lowest quintile [OR 2.14 (95 % CI 1.00–4.60)]. ECOG 0 compared to worse than 1 was strongly correlated to therapy discontinuation due to toxicity [OR 20.15 (95 % CI 9.48–42.83)] and treatment refusal [OR 8.32 (95 % CI 3.81–18.14)]. Pretreatment QoL, especially physical functioning, is associated with subsequent therapy discontinuation due to toxicity and with changes of the treatment protocol. Pretreatment performance status is strongly associated with therapy discontinuation due to toxicity and with treatment refusal.

Item does not contain fulltext BACKGROUND: The objectives of this study were to determine quality of life (QoL) issues that are relevant to thyroid cancer patients cross-culturally, and to identify those with highest relevance to them in addition to the more general issues covered by the core European Organisation for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30). METHODS: A systematic literature search provided a list of potentially relevant QoL issues to supplement the core questionnaire EORTC QLQ-C30, which is widely used in research and in care and addresses QoL issues relevant to all groups of cancer patients. A panel of experts revised this list, and thyroid cancer patients rated the issues regarding their relevance for QoL by selecting the 25 issues that they would include in a thyroid cancer-specific QoL module. RESULTS: The literature search and expert discussion provided a list of 71 QoL issues that was rated by thyroid cancer patients (n = 110) from seven countries. All issues were of high priority to at least some of the patients. The most frequently selected issues were sudden attacks of tiredness, exhaustion, quality of sleep, employment, social support, fear of cancer progression, fear of second operation, difficulties swallowing, and globus sensation. CONCLUSIONS: Thyroid cancer patients cross-culturally rate fatigue-related issues as highly important for their QoL, calling for increased efforts to find successful treatments for this problem. Vocational rehabilitation is also highly relevant for them and should therefore be an important aim of multidisciplinary care. The third important area of concern is psychological issues, especially fear of progression and of additional treatments.

BackgroundRole functioning (RF) as a core construct of health-related quality of life (HRQOL) comprises aspects of occupational and social roles relevant for patients in all treatment phases as well as for survivors. The objective of the current study was to improve its assessment by developing a computer-adaptive test (CAT) for RF. This was part of a larger project whose objective is to develop a CAT version of the EORTC QLQ-C30 which is one of the most widely used HRQOL instruments in oncology.MethodsIn accordance with EORTC guidelines, the development of the RF-CAT comprised four phases. Phase I involved the conceptualization of RF. In Phase II, a provisional list of items was defined and revised by experts in the field. In phase III, feedback was obtained from cancer patients in various countries. Phase IV comprised field testing in an international sample, calibration of the item bank, and evaluation of the psychometric performance of the RF-CAT.ResultsPhases I-III yielded a list of 12 items eligible for phase IV field-testing. The field-testing sample included 1,023 patients from Austria, Denmark, Italy, and the UK. Psychometric evaluation and item response theory analyses yielded 10 items with good psychometric properties. The resulting item bank exhibits excellent reliability (mean reliability = 0.85, median = 0.95). Using the RF-CAT may allow sample size savings from 11 % up to 50 % compared to using the QLQ-C30 RF scale.ConclusionsThe RF-CAT item bank improves the precision and efficiency with which RF can be assessed, promoting its integration into oncology research and clinical practice.

PURPOSE: This international EORTC validation study (phase IV) is aimed at testing the psychometric properties of a quality of life (QoL) module related to oral health problems in cancer patients.METHODS: The phase III module comprised 17 items with four hypothesized multi-item scales and three single items. In phase IV, patients with mixed cancers, in different treatment phases from 10 countries completed the EORTC QLQ-C30, the QLQ-OH module, and a debriefing interview. The hypothesized structure was tested using combinations of classical test theory and item response theory, following EORTC guidelines. Test-retest assessments and responsiveness to change analysis (RCA) were performed after 2 weeks.RESULTS: Five hundred seventy-two patients (median age 60.3, 54 % females) were analyzed. Completion took CONCLUSION: The EORTC module QLQ-OH15 is a short, well-accepted assessment tool focusing on oral problems and QoL to improve clinical management.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01724333.

Tinnitus ist eine Erkrankung mit hoher Pravalenz, welche haufig psychische Storungen nach sich zieht. Mit der vorliegenden Studie sollte untersucht werden, in welchen konkreten Dimensionen die gesundheitsbezogene Lebensqualitat bei Tinnituspatienten eingeschrankt ist, und wie sich diese Einschrankungen wahrend und nach Therapie, einschlieslich einer hyperbaren Sauerstofftherapie, andern. 120 ambulant oder stationar behandelte Patienten mit Tinnitus wurden zu 3 Zeitpunkten untersucht: am Beginn (t1) und am Ende (t2) der 2-wochigen Therapie sowie 4 Wochen danach (t3). Eingesetzt wurden die Hospital Anxiety and Depression Scale, das Multidimensional Fatigue Inventory und der Lebensqualitatsfragebogen EORTC QLQ-C30. Im Vergleich zu Personen der Allgemeinbevolkerung waren die Tinnituspatienten in allen Bereichen beeintrachtigt, am starksten in den Skalen Soziale, Kognitive, Emotionale und Rollen-Funktionsfahigkeit sowie im Bereich finanzieller Schwierigkeiten mit hohen Effektstarken um 1,5. Im Laufe der Therapie verbesserten sich die Werte, sodass sich der Abstand zum Niveau der Allgemeinbevolkerung etwa halbierte. Die durch die Patienten direkt eingeschatzte Verbesserung durch die Therapie korrespondierte nur geringfugig mit der Verbesserung, die sich aus dem Vergleich der Pra- und Post-Fragebogen ergab. Zwar gestatten die Ergebnisse wegen des Fehlens einer Kontrollgruppe keine Schlusse uber die Wirksamkeit der hyperbaren Sauerstofftherapie, sie zeigen aber das vielfaltige Belastungsspektrum der Patienten (insbesondere im psychosozialen Bereich) auf und vermitteln Ansatzpunkte fur unterstutzende Angebote.

The aim of this study was to determine the effect of art therapy on post-traumatic growth in patients with haematological malignancies in a non-randomised trial ( n = 36, intervention group; n = 129, control group). Art therapy was administered over a period of 22 weeks in small groups. Post-traumatic growth was measured with the Stress-Related Growth Scale. After controlling for the effect of potential confounders, no difference in post-traumatic growth was observed between the intervention and control groups after 22 weeks. There was no evidence for an effect of weekly group sessions with art therapy on post-traumatic growth in patients with haematological malignancies.

There are normative data of the quality of life (QoL) questionnaire EORTC QLQ-C30 (the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire) for several European countries and Korea, but not for Latin America. The aim of this study was to provide these normative values for the general population in Colombia and to assess differences in terms of age and sex. For that reason, a sample of 1500 representatively selected individuals of the Colombian population completed the EORTC QLQ-C30 form. Results showed that mean scores of the Colombian population are similar to those obtained in European countries; whereas the mean values from a Korean study were lower (worse QoL). Age and sex differences were found in several scales and symptom items. Linear regression analyses were calculated to help quantify the influence of age and gender on QoL. Men reported better functioning and less symptoms than women on all scales, and older individuals reported worse global scores in terms of functioning and lower QoL than younger ones. In sum, the normative values presented can be used to assess QoL scores of Latin American cancer patients and to compare groups of patients with unequal age and sex distributions.

BACKGROUND Improvements in surgical techniques have led to a higher percentage of larynx preservations. These do not always include preservation of the swallowing function. This study investigates the prevalence of swallowing disorders after partial laryngectomy and their predictors. PATIENTS AND METHODS In a multicenter cross-sectional study with patients who received a partial laryngectomy (n=154) the prevalences of problems related to swallowing and eating were gathered. Additionally, medical and sociodemographic data were obtained as well as information about alcohol and tobacco consumption. RESULTS Twenty percent of the patients had problems related to swallowing and eating; more specifically, eating solid foods and eating in public. Chances of having swallowing disorders were significantly lower for patients who received laser therapy (OR=0.12; 95% CI: 0.04-0.37; p

Background: No existing stand-alone measures of spiritual wellbeing have been developed in cross-cultural and multiple linguistic contexts. Aim: Cross-cultural development of a stand-alone European Organisation for Research and Treatment of Cancer (EORTC) measure of spiritual wellbeing for palliative care patients with cancer. Design: Broadly following EORTC Quality of Life Group (QLG) guidelines for developing questionnaires, the study comprised three phases. Phase I identified relevant issues and obtained the views of palliative care patients and professionals about those issues. Phase II operationalised issues into items. Phase III pilot-tested those items with palliative care patients. Amendments to the guidelines included an intermediate Phase IIIa, and debriefing questions specific to the measure. Setting/participants: Phase III pilot-testing recruited 113 people with incurable cancer from hospitals and hospices in six European countries and Japan. Results: A provisional 36-item measure ready for Phase IV field-testing, the EORTC QLQ-SWB36, has been developed. Careful attention to translation and simultaneous development in multiple languages means items are acceptable and consistent between different countries and languages. Phase III data from 113 patients in seven countries show that the items are comprehensible across languages and cultures. Phase III patient participants in several countries used the measure as a starting point for discussing the issues it addresses. Conclusion: The EORTC QLG’s rigorous cross-cultural development process ensures that the EORTC QLQ-SWB36 identifies key issues for spiritual wellbeing in multiple cultural contexts, and that items are comprehensible and consistent across languages. Some cross-cultural differences were observed, but data were insufficient to enable generalisation. Phase IV field-testing will investigate these differences further.

Background It has often been argued that if patients' success with speech rehabilitation after laryngectomy is limited, it is the result of lacking motivation on their part. This project investigated the role of motivation in speech rehabilitation. Methods In a multicenter prospective cohort study, 141 laryngectomees were interviewed at the beginning of rehabilitation and 1 year after laryngectomy. Speech intelligibility was measured with a standardized test, and patients self-assessed their own motivation shortly after the surgery. Logistic regression, adjusted for several theory-based confounding factors, was used to assess the impact of motivation on speech intelligibility. Results Speech intelligibility 1 year after laryngectomy was not significantly associated with the level of motivation at the beginning of rehabilitation (odds ratio [OR], 1.3; 95% confidence interval [CI], 0.7–2.3; p = .43) after adjusting for the effect of potential confounders (implantation of a voice prosthesis, patient's cognitive abilities, frustration tolerance, physical functioning, and type of rehabilitation). Conclusions Motivation is not a strong predictor of speech intelligibility 1 year after laryngectomy. © 2012 Wiley Periodicals, Inc. Head Neck, 2012

The aim of this paper is to test the psychometric properties of sum scores of the quality of life questionnaire EORTC QLQ-C30. A sample of cancer patients (n= 1529) and a sample of the general population (n= 1185) were tested with the EORTC QLQ-C30, the Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory. Three sum scores of the EORTC QLQ-C30 are defined: a score concerning functioning, a score concerning symptoms and a total score. Compared with the two-item quality of life scale of the EORTC QLQ-C30, the psychometric quality of the total score and the functioning score is superior with respect to reliability, convergent validity and discriminant validity. Cronbach's alpha of the total score is 0.94 (cancer patients) and 0.95 (general population). The effect size discriminating between patients and controls is d= 0.83 for the total score, compared to only 0.50 obtained with the two-item quality of life scale. The results prove that the calculation of sum scores provides useful information for clinicians who are interested in one generalising score of quality of life.

BACKGROUND: European Organisation for Research and Treatment of Cancer (EORTC) has developed a new multidimensional instrument measuring cancer-related fatigue that can be used in conjunction with the quality of life core questionnaire, EORTC QLQ-C30. The paper focuses on the development of the phase III module, collaborating with seven European countries, including a patient sample of 318 patients. METHODS: The methodology followed the EORTC guidelines for developing phase III modules. Patients were assessed by questionnaires (EORTC QLQ-C30 with the EORTC Fatigue Module FA15) followed by an interview, asking for their opinions on the difficulty in understanding, on annoyance and on intrusiveness RESULTS: The phase II FA15 was revised on the basis of qualitative analyses (comments of the patients), quantitative results (descriptive statistics) as well as the multi-item response theory analyses. The three dimensions (physical, emotional and cognitive) of the scale could be confirmed CONCLUSIONS: As a result, EORTC QLQ-FA13 is now available as a valid phase III module measuring cancer-related fatigue in clinical trials and will be psychometrically improved in the upcoming phase IV.

Objectives This study explored whether patients with painful temporomandibular disorders (TMD) differ from the general population in the frequency of self-reported disability to concentrate, because altered processing of sensory information had been reported previously. Additionally, the correlation of the frequency of concentration problems with the dysfunctional grade of TMD pain shall be evaluated. Methods Subjects were 286 consecutive German patients with painful TMD diagnosed using the Research Diagnostic Criteria (RDC/TMD) and 2026 members of a representative German community sample. Concentration was measured using two questions, one from the ‘Oral Health Impact Profile (OHIP-49 G)' and one from the German version of ‘Center for Epidemiologic Studies – Depression Scale (CES-D)'. The dysfunctional grade of TMD pain was measured using the Graded Chronic Pain Scale. Results Responses between the two individual questions concerning the ability to concentrate (OHIP item and CES-D item) correlated moderately (rSpearman = 0.58, P

In einer multizentrischen Querschnittsstudie wurde an 106 Partnern laryngektomierter Patienten analysiert, bezuglich welcher Faktoren sich Partner ohne eine psychische Erkrankung von Partnern mit einer psychischen Erkrankung unterscheiden. Die Auftrittswahrscheinlichkeit einer psychischen Erkrankung hing vor allem mit partnerschaftsbezogenen Faktoren zusammen: Partner, die die Partnerschaftsqualitat besser beurteilten (OR=0,77; 95% CI: 0,631–0,939; p=0,010), deren sexuelles Verlangen durch die Erkrankung nicht eingeschrankt war (OR=0,077; 95% CI: 0,011–0,527; p=0,009) und die keine Probleme im Umgang mit dem Stoma auserten (OR=0,062; 95% CI: 0,006–0,619; p=0,018), waren seltener psychisch erkrankt. Das Querschnittstudiendesign ermoglicht keine Aussagen zur Kausalitat. Die Ergebnisse mussen daher in einer Langsschnittstudie uberpruft werden. Dennoch weisen sie darauf hin, dass kehlkopflosen Patienten und ihren Familien neben Einzel- auch Paarinterventionen angeboten werden sollten.

The impact of cancer on patients' lives can be measured using self-reported questionnaires, known as Health-Related Quality of Life (HRQOL) measures. HRQOL is defined as a multi-dimensional construct covering disease and treatment-related symptoms, physical, psychological, and social functioning.The EORTC Quality of Life Group (QLG) was created in 1984 with the mission to develop measures of HRQOL and to promote and coordinate clinical studies concerning the quality of life of cancer patients. The EORTC Quality of Life Department (QL Department) was founded in 1993 with the support of an EU grant to provide administrative, practical and scientific support to co-operative groups conducting clinical trials with HRQOL outcomes.We are proud to report significant scientific achievements that have made us international leaders in HRQOL research and have led to real changes to cancer patient treatments.We developed a modular system for HRQOL measurement consisting of the EORTC QLQ-C30, a core cancer quality of life questionnaire and supplementary questionnaire modules. The EORTC-QLQ-C30 has been one of the most widely used cancer questionnaires in randomized trials in oncology as demonstrated by systematic reviews. To date, the EORTC QLQ-C30 has been translated and linguistically validated into more than 60 languages.HRQOL outcome measures have been an integral part of EORTC clinical trials for the last 30 years. We present examples of significant, practice-changing clinical trials evaluating HRQOL in several cancer sites, such as brain tumors, breast and ovarian cancers, and malignant melanoma. In a series of systematic reviews, we examined the quality of reporting HRQOL in international cancer clinical trials, and the impact of the results on oncology practice that led to a recommendation to improve CONSORT (Consolidated Standards of Reporting Trials) with regard to reporting of HRQOL.The QLG is an international leader in methodological research in the measurement of HRQOL in oncology and pursues research in several key areas, such as cross-cultural differences between populations in HRQOL assessment, Computer-Adaptive Testing, electronic administration of EORTC QLQ-C30, and summary scores for EORTC QLQ-C30.In summary, the QLG and QL Department have been international leaders in the field. Our questionnaires have brought HRQOL assessment to the fore in many international trials that have changed oncology practice and brought the patient's perspective into cancer research.

Informationen zur psychosozialen Situation laryngektomierter Frauen sind selten. Da alle Ersatzstimmarten einen tiefe Grundfrequenz und einen rauen Klang haben, uberpruft diese Studie, ob Frauen ihre Ersatzstimme im Alltag seltener verwenden und emotional belasteter sind als Manner. In einer multizentrischen Querschnittstudie wurden 12 Frauen und 138 Manner nach Laryngektomie mithilfe strukturierter Interviews und Fragebogen befragt. Ausgewertet wurde, in wieweit das Geschlecht einen Risikofaktor hinsichtlich der Haufigkeit der verwendeten Ersatzstimmart und dem emotionalem Befinden darstellt. Die Berechnungen wurden nach Alter, Zeit seit der Laryngektomie, korperlichem Befinden, sozialer Aktivitat und dem Vorhandensein von Stigmatisierungsgefuhlen adjustiert. 83% der Frauen und 57% der Manner verwendeten die Ruktusstimme manchmal im Alltag. Die Prothesenstimme wurde von 17% der Frauen und 20% der Manner und die elektronische Sprechhilfe von 17% der Frauen und 29% der Manner gelegentlich benutzt. Nach der Laryngektomie waren signifikant mehr Frauen sozial aktiv (83% vs. 54%; p=0,05), wahrend es keine Geschlechtsunterschiede hinsichtlich korperlichem Befinden und Stigmatisierungsgefuhlen gab. In Bezug auf die emotionale Belastung erwiesen sich ein schlechtes korperliches Befinden (OR=2,48; p=0,02) sowie Stigmatisierungsgefuhle (OR=3,94; p=0,00) als potentielle Risikofaktoren. Das Geschlecht steht weder in Zusammenhang mit der stimmlichen Rehabilitation noch mit dem emotionalen Befinden nach einer Kehlkopfentfernung. Es ergaben sich dennoch Hinweise auf eine unterschiedliche soziale Aktivitat von laryngektomierten Mannern und Frauen, die anhand groserer Fallzahlen uberpruft werden mussen.

Providing sufficient information about diagnosis and treatment is an important feature of high-quality patient care in oncology. To measure patient satisfaction with information received, the European Organisation for Research and Treatment of Cancer Quality of Life Group has recently developed a new tool, the information module (INFO25). The aim of this study was to evaluate the scale structure of the INFO25. A total of n = 423 patients completed the INFO25 after finishing cancer therapy. The internal consistency of multi-item subscales was calculated using Cronbach’s Alpha. The scale structure was evaluated using multi-trait methods and confirmatory factor analysis. Cronbach’s Alpha of the multi-item scales ranged from 0.79 to 0.88. Only two items correlated somewhat higher with another scale than with their own, indicating a good scale structure. Construct validity with latent variable models, including a general information factor and four multi-item scales, resulted in the following fit indices CFI = 0.96, RMSEA = 0.08, TLI = 0.99 and WRMR = 1.03. The suggested construct of the INFO25 with a total score (general factor) in addition to the subscales is valid.

ZusammenfassungEine psychoonkologische Betreuung hat sich zu einem integrierten Bestandteil der Versorgung von Tumorpatienten entwickelt. Sie umfasst das gesamte Spektrum von psychosozialer Beratung bis hin zu einer spezifischen Psychotherapie. Um den individuellen Bedarf für die psychoonkologischen Interventionen festzustellen, liegen validierte Instrumente der Diagnostik vor. Insbesondere haben sich Screening-Instrumente für den klinischen Alltag bewährt. Die psychoonkologische Behandlung ist dem supportiven Psychotherapiekonzept zuzuordnen und baut auf einer engen interdisziplinären Zusammenarbeit auf. In Deutschland hat sich die psychoonkologische Versorgung innerhalb der letzten beiden Jahrzehnte deutlich verbessert, wobei sie in den drei Sektoren Akutversorgung, Rehabilitation und ambulante Nachsorge unterschiedlich ausgebaut ist. Insbesondere in den letzten Jahren konnten Standards sowie Maßnahmen zur Qualitätssicherung entwickelt werden, die in Form einer evidenzbasierten Leitlinie weiter ausgearbeitet wird.

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.

We analysed factors that might influence patients’ and physicians’ decisions against the initiation of guideline adherent adjuvant endocrine therapy (ET). In a prospective multi-centre study, including four certified breast cancer centres in Germany, patients with primary breast cancer were included from 2009 to 2012. Patients completed a questionnaire prior to surgery, adjuvant therapy, and 6 months after adjuvant therapy. This questionnaire assessed health-related quality of life (QoL), psychiatric co-morbidity, demographic characteristics, and the intensity of fear for ET. Guideline adherence was classified based on an algorithm derived from international guidelines. The tumour board’s (TB) decisions against or for ET was documented. The TB was blinded regarding the guideline results. In 666 patients, adjuvant ET was indicated according to the guideline recommendations. The TB decided in 92.3 % (n = 615) of those that adjuvant ET was indicated. TB’s decision against ET was associated with the younger age of patients (OR = 0.5; 95 % CI 0.3–0.9) and poor QoL (OR = 1.7; 95 % CI 1.0–2.8). In 93 patients, ET was not indicated according to the guidelines, and the TB decided in 84 of those not to prescribe ET. The TB decided in 93.4 % of the cases according to the guidelines. Of the patients, where the TB prescribed ET, 5 % (n = 31) decided against ET. This decision was associated with fear of ET (OR = 2.2; 95 % CI 1.0–5.2) and higher age (OR 9; 95 % CI 1.0–48.1). Psychiatric co-morbidity (OR = 1.8; 95 % CI 0.7–4.2), poor QoL (OR = 0.4; 95 % CI 0.2–1.2), and education (OR = 1.2; 95 % CI 0.5–2.6) were not associated with the decision. Guideline adherent implementation of adjuvant ET is high. Physicians’ decision against ET is mainly associated with patients’ younger age and poor quality of life, whereas patients’ decision, once the TB decided to initiate ET and if ET is indicated by guidelines, is associated with higher age and fear of ET.

BACKGROUND: Patients with platinum-refractory recurrent or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) have limited treatment options and poor prognosis. Nivolumab significantly improved survival of this patient population when compared with standard single-agent therapy of investigator’s choice (IC) in Checkmate 141; here we report the impact of nivolumab on patient-reported outcomes (PROs). METHODS: CheckMate 141 (NCT02105636) was a randomised, open-label, phase 3 trial in patients with R/M SCCHN who progressed within 6 months after platinum-based chemotherapy. Patients were randomised 2:1 to nivolumab 3 mg/kg every 2 weeks (n=240) or IC (n=121) of methotrexate (40–60 mg/m(2) of body surface area), docetaxel (30–40 mg/m(2)), or cetuximab (250 mg/m(2) after a loading dose of 400 mg/m(2)). On 26 January 2016, the independent data monitoring committee reviewed the data at the planned interim analysis and declared overall survival superiority for nivolumab over IC therapy (primary endpoint; described previously). The protocol was amended to allow patients in the IC arm to cross over to nivolumab. All patients not on active therapy are being followed for survival. As an exploratory endpoint, PROs were assessed at baseline, week 9, and every 6 weeks thereafter using the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire–Core 30 (QLQ-C30), the EORTC head and neck cancer–specific module (EORTC QLQ-H&N35), and the three-level European Quality of Life–5 Dimensions (EQ-5D) questionnaire. Differences within and between treatment arms in PROs were analysed by analyses of covariance (ANCOVA) among patients with baseline and ≥1 other assessment (n=129). Among all randomised patients (N=361), median time to clinically meaningful deterioration was analysed by Kaplan-Meier methods. FINDINGS: Treatment with nivolumab resulted in adjusted mean changes from baseline to week 15 ranging from −2·1 to +5·4 across functional and symptom domains measured by the EORTC QLQ-C30, with no domains indicating clinically meaningful deterioration. In contrast, 8 (53%) of the 15 domains in the IC arm demonstrated clinically meaningful deterioration (10 points or more) at week 15 (change from baseline range, −24·5 to +2·4). Similarly, on the EORTC QLQ-H&N35, clinically meaningful worsening at week 15 was seen in 0 domains in the nivolumab arm and 8 (44%) of 18 domains in the IC arm. Patients in the nivolumab arm experienced a clinically meaningful improvement (according to a difference of 7 points or greater) in adjusted mean change from baseline to week 15 on the EQ-5D visual analogue scale, in contrast to a clinically meaningful deterioration in the IC arm (+7·3 vs −7·8). Differences between arms were statistically significant and clinically meaningful at weeks 9 and 15 in favour of nivolumab for role functioning, social functioning, fatigue, dyspnoea, and appetite loss on the EORTC QLQ-C30 and pain and sensory problems on the EORTC QLQ-H&N35. Median time to deterioration was significantly longer with nivolumab vs IC for 13 (37%) of 35 domains assessed across the three questionnaires. INTERPRETATION: In this exploratory analysis of CheckMate 141, nivolumab stabilised symptoms and functioning from baseline to weeks 9 and 15, whereas IC led to clinically meaningful deterioration. Nivolumab delayed time to deterioration of patient-reported quality-of-life outcomes compared with single-agent therapy of IC in patients with platinum-refractory R/M SCCHN. Given the significant unmet need in this population and the importance of maintaining or improving quality of life for patients with R/M SCCHN, these data support nivolumab as a new standard-of-care option in this setting. FUNDING: Bristol-Myers Squibb.

Hintergrund: Psychologische Probleme kommen bei Krebspatienten haufig vor. Fur die Planung psychoonkologischer Interventionen und Dienstleistungen, die auf die be

Zielstellung dieser Studie war es, einen Uberblick uber das psychosoziale Beratungsangebot fur Krebspatienten in Sachsen zu gewinnen und zu prufen, inwieweit die Vorgaben der S1-Leitlinie zur Ambulanten Psychosozialen Krebsberatung in der Versorgungspraxis umgesetzt werden konnten. Inhouse-Befragung aller Krebsberatungsstellen im Freistaat Sachsen (n=30) anhand von strukturierten Interviews sowie Analyse der Tatigkeitsberichte. Die Mehrzahl der Beratungsstellen (n=25) war an Gesundheitsamtern angesiedelt. In allen Einrichtungen wird die Tatigkeit dokumentiert und Weiterbildungsmasnahmen in Anspruch genommen. Leistungsangebote bestehen vor allem in Informationen zu, Beratung uber und der Vermittlung von Hilfen im sozialrechtlichen Bereich, wahrend psychologische und psychotherapeutische Angebote selten sind. Bezogen auf einen Stellenschlussel von 1 Vollzeitkraft auf 75 000 Einwohner besteht ein Defizit von 23 Stellen. Die Ansiedlung von Krebsberatungsstellen an Gesundheitsamtern ermoglicht eine geografisch nahezu flachendeckende, aufgrund der fehlenden Personalressourcen qualitativ jedoch noch nicht ausreichende Versorgung der Bevolkerung hinsichtlich leitliniengerechter Beratung.

Die Arbeitsgruppe Quality of Life der European Organisation for Research and Treatment of Cancer (EORTC) entwickelt seit vielen Jahren gemeinsam Lebensqualitatsfragebogen auf hohem methodischem Niveau. Diese Fragebogen werden vorrangig fur die Anwendung in Klinischen Studien konzipiert. Aufgrund veranderter Behandlungsmodalitaten, die in klinischen Studien gepruft werden sollen, und aufgrund vereinzelter methodischer Kritik am bisherigen Modul wird der bisherige Fragebogen fur die Kopf-Hals-­Tumorpatienten (EORTC QLQ-H&N35) im Moment uberarbeitet. In diesem Beitrag soll der Stand der Uberarbeitung dargestellt und uber weitere aktuelle Entwicklungen berichtet werden.

Ziel dieser Studie war es, Daten zur psychoonkologischen Versorgungssituation von Krebspatienten im ambulanten und im stationaren Bereich unter Routinebedingungen zu gewinnen. Dabei interessierten vorrangig die Versorgungsdichte sowie der Bedarf an und der Wunsch nach psychosozialer Versorgung. Die Versorgungsdichte wurde anhand des Vergleichs von Inzidenzzahlen des Tumorregisters Leipzig, der Zahl der durch den psychoonkologischen Konsil-/Liaisondienst des Universitatsklinikums Leipzig betreuten Patienten und der Zahl der Ratsuchenden in der an der Universitat angesiedelten ambulanten Krebsberatungsstelle im Jahr 2008 ermittelt. Bedarf an und Wunsch nach psychosozialer Hilfe wurden anhand von Daten einer Patientenbefragung am gleichen Klinikum untersucht. Im stationaren und im ambulanten Bereich wurden jeweils 11% der Krebspatienten psychoonkologisch betreut. Demgegenuber stehen ein sozialer Hilfebedarf bei 37% und ein psychologischer Hilfebedarf bei 52% der Patienten wahrend des Krankenhausaufenthalts (1/2 Jahr spater: je 42%). Insgesamt 41% der Befragten wunschten sich zu Beginn des Krankenhausaufenthalts Hilfe von einem Sozialarbeiter und 29% von einem Psychologen. Zwischen Patienten verschiedener Tumorentitaten bestanden grose Unterschiede hinsichtlich der Versorgungssituation. Im Vergleich zum Hilfebedarf und ihren Versorgungswunschen waren die Krebspatienten unter Routinebedingungen in einem Krankenhauses der Maximalversorgung als psychoonkologisch deutlich unterversorgt einzuschatzen.

Purpose To compare long-term quality of life (QoL) of colorectal cancer survivors with QoL in the general population and investigate changes in QoL of survivors during the 10 years after diagnosis. Patients and Methods Health-related QoL was assessed 1, 3, 5, and 10 years after diagnosis in a population-based cohort starting with 439 patients with colorectal cancer from Saarland, Germany, using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. QoL after 5 and 10 years and time course of QoL during the 10 years after diagnosis were compared with controls from the general population of Germany, after controlling for sex and age. Results Overall, 234 and 196 patients were still alive after 5 and 10 years, respectively. Of these survivors, 178 (76%) responded in the 5-year follow-up, 133 (68%) in the 10-year follow-up, and 117 (60%) participated in all follow-ups. Over the entire follow-up, younger survivors (age at diagnosis, < 60 years) reported restrictions in role, social, emotional, and cognitive functioning and specific problems like constipation, diarrhea, fatigue, and insomnia. Older survivors (age at diagnosis, ≥ 70 years) reported comparable or even better QoL than controls within the first 3 to 5 years after diagnosis and comparable to worse QoL 5 to 10 years after diagnosis. Conclusion Although younger survivors continuously reported detriments in various QoL dimensions during the 10-year period after diagnosis, detriments in older survivors became apparent in the long run only.

Clin. Otolaryngol. 2011, 36, 336–344 Objective: The aim of the study was the analysis of drinking behaviour in laryngectomised patients and its concomitants in quality of life and mental health. Study design: Multi-centered cross-sectional study. Participants and setting: Two hundred and twenty-five laryngectomised patients were asked to participate in the study. One hundred and seventy nine patients (80%) were interviewed after laryngectomy at six different ENT clinics in Germany. Main outcome measures: ‘Questionnaire of Health Behaviour’ (FEG), ‘Short Questionnaire of Alcohol Risk’, Hospital Anxiety and Depression Scale (HADS), Hornheider Questionnaire (HFB), Visual Analogue Scales (VAS) and the Quality of Life Questionnaires of the European Organization of Research and Treatment of Cancer (EORTC) (EORTC QLQ-C30, EORTC QLQ-H & N35). Results: Alcohol dependence was found in 7% of the patients. Half of the respondents showed a constant consumption of alcohol with 6% of the patients who wanted to change their consumption. Patients with alcohol dependence indicated in comparison with non-dependent persons increased anxiety (p = 0.03), problems in coping with illness (p = 0.03), increased psychosocial care needs (p = 0.02), fatigue (p = 0.04), shortness of breath (p = 0.04), diarrhoea (p = 0.02) and a worse emotional functioning level (p = 0.03). Alcohol intake was independent of tumour stage (p = 0.48), employment status (p = 0.54), social class (p = 0.82), the time interval since laryngectomy (p = 0.64) and type of voice substitute (p = 0.76). The quality of life and mental state were independent of the amount of alcohol consumed. Conclusions: The results show that alcohol dependence is associated with adverse psychosocial and medical consequences, which require treatment. Socio-demographic and medical parameters do not allow any conclusions to alcoholism risk. Therefore, an individual exploration of the patients’ drinking behaviour is needed, which could prepare the ground to specific treatment.

Background: The aim of this longitudinal study was to determine age- and sex-standardised prevalence rates of cancer-related fatigue in different groups of patients. Methods: This was a prospective study in a cohort of N=1494 cancer patients investigating fatigue at three time points t1–t3 (t1: admission to hospital, t2: discharge, t3: half a year after t1). Fatigue was measured with the Multidimensional Fatigue Inventory. Age- and sex-adjusted norms were derived from a representative community sample of N=2037, using a cutoff at the 75th percentile. Results: At admission to the hospital, 32% of the patients were classified as fatigued. At discharge, the overall prevalence rate was 40%, and at half a year after t1, prevalence was 34%. Fatigue prevalence rates differed according to tumour stage, site, age, and sex of the patients. Conclusion: The prevalence rates provided by this study can be used for the planning of research and clinical routine.

Fatigue wird sehr haufig von Krebspatienten wahrend, aber auch Monate und Jahre nach einer Krebserkrankung und Behandlung beschrieben. Fatigue geht mit starken Beeintrachtigungen im Wohlbefinden und in der Lebensfuhrung der Betroffenen einher. Ziel der vorgestellten Arbeit war es, Faktoren zu identifizieren, die in einem fruhen Stadium der Krebsbehandlung die Herausbildung einer Fatigue langere Zeit nach Akutbehandlung vorhersagen helfen. Dazu wurde eine heterogene Gruppe von Tumorpatienten (n=551) im Akutkrankenhaus (t1) und 2 bis 2,5 Jahre danach (t2) zu Fatigue, psychischen, (psycho-)somatischen, soziodemografischen und behandlungsspezifischen Aspekten befragt. Mithilfe von Regressionsanalysen wurde die Fatigue-Belastung wahrend der Akutbehandlung als starkster Pradiktor fur „spate“ tumorassoziierte Fatigue ermittelt. Weitere relevante Faktoren stellen Strahlentherapie und Schmerzen dar. Die Ergebnisse legen nahe, die Diagnostik und Behandlung von akuter Fatigue fruhzeitig zu berucksichtigen, um einer moglichen Chronifizierung vorzubeugen. Geeignete diagnostische Instrumente und Behandlungsoptionen werden in ubersichtlicher Form vorgestellt.

The assessment of quality of life in cancer patients is hampered because patients may change their frames of reference during the course of the disease. The aim of this study was to test individual differences in these response shift effects. Urologic cancer patients (n= 275) were examined during the stay in the hospital (T1), 2 weeks later (T2) and 3 months later (T3). Furthermore, at T3 they were asked to retrospectively assess their situation at T1 (then-test). The difference between this retrospective assessment and the original assessment at T1 was used to determine the response shift effect (recalibration). Anxiety (Generalized Anxiety Disorder Questionnaire-2), depression (Patient Health Questionnaire-2) and health dissatisfaction (Questionnaire on Life Satisfaction) were obtained at all points in time. The effect sizes of the mean response shift effects (recalibration) ranged between 0.26 and 0.48. Nevertheless, a large proportion of the sample showed no response shift (22-38%) or even negative response shift effects (20-30%). There were significant correlations among the response shift measures of the domains (anxiety, depression and health dissatisfaction) with coefficients between 0.29 and 0.51. The results indicate that response shift should not only be assessed on the mean score level, since it is also a dimension of individual difference.

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

In this paper the formal and contentual structure of the outpatient art education programme for oncological patients is presented. The group intervention was comprised of 22 separate sessions. The course consisted of 3 phases. The first unit helped to foster mutual understanding and to learn various experimental drawing techniques using a given topic. The second unit merged into the shaping of personal thoughts and feelings with the aim of encouraging self-perception and reflection. The aim in the third phase is to create a personal book. The effects of the intervention for the participants were examined in studies. The art therapist as well as the supervisor sees development of better coping strategies, contact with other patients and enhancement of scope of action through the regular activities as main effects. Participants reported the enlargement of means of expression, emotional stabilization, coping with illness, personal growth and contacts with other patients as meanings. This art education course enlarges the field of psycho-oncological interventions in outpatient care with a low-treshhold and ressource-oriented creative programme.

Tumorpatienten mit psychischer Komorbiditat leiden unter vermehrten Lebensqualitatseinbusen und haben oft psychoonkologischen Behandlungsbedarf. Insgesamt 99 Tumorpatienten in chirurgischer Behandlung wurden mit dem Strukturierten Klinischen Interview zur Diagnostik psychischer Storungen und mit Fragebogen zur Lebensqualitat und zur psychischen Belastung (EORTC QLQ-C30, HADS) langsschnittlich untersucht. 31 Arzte und 41 Pflegekrafte beurteilten den psychoonkologischen Behandlungsbedarf. Psychische Begleiterkrankungen bestanden bei 19% der chirurgischen Patienten, wobei 10% psychoonkologisch unmittelbar behandlungsbedurftig waren. Diese wurden zu 38–60% von den Behandlern erkannt, zu 78% durch die HADS. Noch 6 Monate nach der Operation litten die Patienten mit psychischen Begleiterkrankungen massiv unter Lebensqualitatseinbusen, Angst und Depressivitat, wahrend sich Patienten ohne Begleiterkrankungen besser erholten. Ein Zehntel der chirurgisch behandelten Krebspatienten leidet unter psychischen Begleiterkrankungen, die von unmittelbarer psychoonkologischer Relevanz sind und zugig identifiziert und fachgerecht behandelt werden sollten.

Ziel der Studie: Kreative Verfahren gewinnen in der psychoonkologischen Versorgung zunehmend an Bedeutung. Ziel dieser Studie war, herauszufinden, ob ein kunsttherapeutisches Angebot in der ambulanten Nachsorge von onkologischen Patienten angenommen wird und inwieweit das Gestalten eines eigenen Buches zur Krankheitsverarbeitung beitragt. Methodik: An der Universitat Leipzig wurde eine kunstpadagogische Intervention fur Krebspatienten in der ambulanten Nachsorge entwickelt und erprobt. Kursziel ist die Gestaltung eines personlichen Buchobjektes, in dem die Krebserkrankung thematisiert werden kann. Vor und nach der Intervention wurden die Teilnehmenden mittels halbstrukturierter Interviews befragt. Neben der qualitativen Analyse der Interviews werden am Beispiel einer Brustkrebspatientin der Kursverlauf und der Prozess der Buchentstehung dargelegt. Ergebnisse: Die Teilnehmer berichteten vielfaltige Kurswirkungen. Insgesamt haben 17 der 23 Kursteilnehmer ein eigenes Buch gestaltet. Mehr als dreiviertel der entstandenen Bucher thematisieren die eigene Krebserkrankung, wobei sich die Teilnehmer auf unterschiedliche Art und Weise mit der Erkrankung auseinandersetzten. Alle Teilnehmenden ruckten sich in den Mittelpunkt und die meisten erstellten das Buch fur sich selbst. Schlussfolgerung: Die Ergebnisse zeigen, dass die kunstlerische Gestaltung eines individuellen Buches in einem geschutzten Rahmen eine konstruktive Auseinandersetzung mit der Krebserkrankung ermoglicht und unterstutzend bei der Krankheitsverarbeitung wirken kann. Aims: Art therapy is increasingly gaining in importance in psychooncological care. At the university of Leipzig an art therapy intervention was developed for cancer patients in ambulant aftercare and was tested in retrospect. The aim of the course was making an individual book-object, in which the cancer could be a central topic. Methods: Before and after the intervention the participants were questioned using semi-structured interviews. Beside the qualitative analysis of the interviews the process of the course and the making of the book were demonstrated using the example of a breast cancer patient. Results: The participants reported various effects of the intervention. In all, 17 of 23 participants have created her own book. More than 75 % of the books created pick out their own cancer disease as a central theme. The participants deal with the subject in different ways. All participants placed themselves at the center and the majority created the book for themselves. Conclusion: The results show that the making of an individual book permits a constructive analysis with the cancer disease in a protected framework and can have a supportive effect on the participants in dealing with their disease.