Alexandra Meyer

Social withdrawal after laryngectomy

This investigation focuses on the psychosocial concomitants of a laryngectomy. Semistructured interviews were conducted with 218 laryngectomized patients. Standardised questionnaires were used to assess patients’ social activity (FPAL, EORTC QLQ-C30), intelligibility of speech (PLTT, FPAL), mental well-being (HADS), and perceived stigmatisation (FPAL). More than 40% of the patients withdrew from conversation. Only one-third of all patients regularly took part in social activities. About 87% perceived stigmatisation because of their changed voice and more than 50% felt embarrassed because of their tracheostoma. Almost one-third of the patients had increased anxiety and depression scores. Moderate objective speech intelligibility was found, though patients were not particularly satisfied with their voice. Social activity emerged to be independent from age, gender, treatment variables, and stage of disease. Multivariate analysis resulted in two independent factors representing two patterns of social withdrawal. On the one hand, there was withdrawal from conversation accompanied by increased depression and poor speech intelligibility. On the other hand, there were reduced social activities accompanied by increased anxiety and perceived stigmatisation.

The Course of Anxiety and Depression in Patients with Breast Cancer and Gynaecological Cancer

Background/Aims: The aim of this study was to assess the course of anxiety and depression in cancer patients over time and to detect determinants of the changes in the scores. Patients and Method: Women with breast cancer and gynaecological cancer (n = 367) were tested at the beginning (T1) and at the end (T2) of treatment in the hospital, 6 months later (T3), and 12 months later (T4), using the Hospital Anxiety and Depression Scale (HADS). Results: Anxiety and depression were highest at the start of the stay in the hospital. More than half of the women are at least doubtful cases in at least one of the two HADS dimensions. The mean scores declined from T1 to T4. After 1 year, depression scores are similar to those of the general population, while anxiety scores remain elevated. The decline of the HADS scores depends on treatment, time since diagnosis, and education. Conclusions: Women receiving radio- or chemotherapy (compared with surgery only), with a long time since diagnosis, and with a low educational level are at high risk of maintaining high anxiety and depression scores over time.

One‐to‐one peer support in cancer care: a review of scholarship published between 2007 and 2014

The primary goal of this review was to determine whether one-to-one peer support programmes benefit cancer patients. The secondary goal was to assess the quality of the research methodology and of the peer programme description as reported in original research studies. MEDLINE and PsycINFO databases were systematically searched in order to identify relevant studies published between May 2007 and July 2014. Eligible articles were evaluated using pre-existing criteria based on the Consolidated Standards of Reporting Trials Statement Checklist. This review included 13 studies: four randomised controlled trials, one non-randomised comparative study and eight one-group descriptive studies. All studies reported high participant satisfaction with the peer support intervention, and the majority noted positive outcomes regarding psychological adjustment. The quality of the description of the peer support programmes as well as the research methodology of the studies was rated as fair. Methodological weaknesses included biased recruitment strategies and limited information regarding peer volunteers, non-users of peer support and those who withdrew from support programmes. One-to-one peer support programmes have the unique advantage of being a low-cost intervention approach, but also showing potential for relieving the health-care system by reallocating some aspects of the cancer care to community settings. Future research should address the methodological weaknesses in study design and reporting.

Early retirement in cancer patients with or without comorbid mental health conditions: A prospective cohort study

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.

Lebensqualitätsmessungen bei Patienten mit Kopf-Hals-Malignomen

ZusammenfassungDer Übersichtsartikel befasst sich überwiegend mit der Darstellung des aktuellen Wissens und der Messmethoden der krankheitsbezogenen Lebensqualität in der Onkologie unter besonderer Berücksichtigung von Larynx- und Hypopharynxkarzinomen. Neben den aktuell gängigen und etablierten Instrumenten werden die Besonderheiten der initialen Gesprächsführung, Erfassung der psychiatrischen Komorbiditäten sowie die Rolle der psychoonkologischen und sozialmedizinischen Betreuung und ihr erheblicher Einfluss auf die krankheitsbezogene Lebensqualität erörtert. Im Vordergrund stehen die Ergebnisse der mitteldeutschen Kopf-Hals-onkologischen sozialmedizinischen Studien, die zusammengefasst dargestellt werden.AbstractThis review presents the current knowledge and methods of measuring disease-related quality of life in oncology, with particular emphasis on laryngeal and hypopharyngeal cancer. In addition to the currently popular and well-established instruments, specifics of the initial interview process, collection of psychiatric comorbidities, and the role of social care and its substantial influence on disease-related quality of life are discussed. At the forefront are the results of the central German head and neck oncology social-medical studies.This review presents the current knowledge and methods of measuring disease-related quality of life in oncology, with particular emphasis on laryngeal and hypopharyngeal cancer. In addition to the currently popular and well-established instruments, specifics of the initial interview process, collection of psychiatric comorbidities, and the role of social care and its substantial influence on disease-related quality of life are discussed. At the forefront are the results of the central German head and neck oncology social-medical studies.

Mental disorders and psychosocial support during the first year after total laryngectomy: A prospective cohort study

To assess the frequency of mental disorders and the use of psychosocial services in laryngectomised patients during the first year after surgery.

Quality of Life of Colorectal Cancer Patients in Certified Centers versus Non-Certified Hospitals

Background: Since 2006, in Germany colorectal cancer patients can be treated in certified colorectal cancer centers. The aim of this explorative study was to investigate whether there are differences in the quality of life (QoL) of colorectal cancer patients who were treated in certified versus noncertified centers. Patients and Methods: A total of 284 colorectal cancer patients participated in the study: 184 patients from certified colorectal cancer centers and 100 patients from noncertified centers. Data on QoL (using the Quality of Life Questionnaire of the European Organization for Research and Treatment of Cancer (EORTC-QLQ C30)), patient satisfaction, mental distress and sociodemographic data were assessed with a questionnaire in a written survey after the hospital stay. The moderating influence of patientrelated characteristics (e.g. age, sex, patient satisfaction, and psychological distress) and cancerrelated factors (Union internationale contre le cancer (UICC) stage) were tested. Results: On a descriptive level, patients from noncertified centers had a higher QoL in 5 subdimensions (higher physical and role functioning and less insomnia, appetite loss and financial difficulties). After adjustment, only 2 differences remained significant: physical functioning (p < 0.01) and role functioning (p = 0.02). Conclusion: Structural improvements in the oncological care are not necessarily reflected in a better QoL of the patients treated in certified colorectal cancer centers. The findings are discussed in the context of the applied study design.

Psychische Morbidität bei Partnern kehlkopfloser Karzinompatienten: Womit hängt die Auftrittswahrscheinlichkeit zusammen?

In a multicenter cross-sectional study of 106 spouses of laryngectomized patients differences between spouses with a mental disorder and spouses without were analyzed. The probability of occurrence was mainly related to relationship factors: Spouses, who reported a better quality of their relationship with the patient (OR=0.77; 95% CI: 0.631-0.939; p=0.010), whose sexual desire was not diminished in response to their partners disease (OR=0.077; 95% CI: 0.011-0.527; p=0.009) and who had no problems in dealing with the tracheostomy (OR=0.062; 95% CI: 0.006-0.619; p=0.018) presented a mental disorder less frequently. The cross-sectional nature of this study does not allow conclusions regarding causality. The results should be reappraised in a longitudinal study. However, the findings suggest that patients with laryngectomy and their families should be also offered couple interventions besides individual counseling.

Die Rolle des Geschlechts bei stimmlicher Rehabilitation und emotionalem Befinden nach Laryngektomie

BACKGROUND Data on psychosocial factors of laryngectomized women is rare. All means of alaryngeal voice production sound male due to low fundamental frequency and roughness, which makes postlaryngectomy voice rehabilitation especially challenging to women. Aim of this study was to investigate whether women use alaryngeal speech more seldomly and therefore are more emotionally distressed. MATERIAL AND METHODS In a cross-sectional multi-centred study 12 female and 138 male laryngectomees were interviewed. To identify risc factors on seldom use of alaryngeal speech and emotional functioning, logistic regression was used and odds ratios were adjusted to age, time since laryngectomy, physical functioning, social activity and feelings of stigmatization. RESULTS Esophageal speech was used by 83% of the female and 57% of the male patients, prosthetic speech was used by 17% of the female and 20% of the male patients and electrolaryngeal speech was used by 17% of the female and 29% of the male patients. There was a higher risk for laryngectomees to be more emotionally distressed when feeling physically bad (OR=2,48; p=0,02) or having feelings of stigmatization (OR=3,94; p≤0,00). Besides more women tended to be socially active than men (83% vs. 54%; p=0,05). CONCLUSIONS There was no influence of sex neither on use of alaryngeal speech nor on emotional functioning. Since there is evidence for a different psychosocial adjustment in laryngectomized men and women, more investigation including bigger sample sizes will be needed on this special issue.

Quality of life during the first year after partial laryngectomy: Longitudinal study

This prospective study was conducted to assess changes in quality of life (QOL) of patients who undergo a partial laryngectomy.