Anja Mehnert

Employment and work-related issues in cancer survivors

Purpose of this systematic literature review was to identify current knowledge about employment in cancer survivors. Sixty-four studies met inclusion criteria that were original papers published between 01/2000 and 11/2009. Overall, 63.5% of cancer survivors (range 24-94%) returned to work. The mean duration of absence from work was 151 days. Factors significantly associated with a greater likelihood of being employed or return to work were perceived employer accommodation, flexible working arrangements, counseling, training and rehabilitation services, younger age and cancer sites of younger individuals, higher levels of education, male gender, less physical symptoms, lower length of sick leave and continuity of care. Cancer survivors had a significantly increased risk for unemployment, early retirement and were less likely to be re-employed. Between 26% and 53% of cancer survivors lost their job or quit working over a 72-month period post diagnosis. Between 23% and 75% of patients who lost their job were re-employed. A high proportion of patients experienced at least temporary changes in work schedules, work hours, wages and a decline in work ability compared to non-cancer groups.

Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors

OBJECTIVE Psychosocial comorbidity and quality of life (QOL) and its association with knowledge, utilization, and need for psychosocial support have been studied in long-term breast cancer survivors. METHODS One thousand eighty-three patients were recruited through a population-based cancer registry an average of 47 months following diagnosis (66% response rate). Self-report measures (e.g., Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist--Civilian Version, and Short-Form Health Survey) were used. RESULTS Thirty-eight percent of patients had moderate to high anxiety, and 22% had moderate to high depression; posttraumatic stress disorder was observed in 12%. The overall psychological comorbidity was 43% and 26% for a possible and probable psychiatric disorder. Disease progress, detrimental interactions, less social support, a lower educational level, and younger age were predictors of psychological comorbidity (P<.004). Lower QOL (P<.01) and higher levels of anxiety (P<.001) were observed in cancer survivors compared to age-adjusted normative comparison groups. Time since diagnosis had no significant impact on psychological comorbidity as well as QOL. Forty-six percent of women felt insufficiently informed about support offers. Insufficient knowledge was associated with older age and lower education (P<.05). Since diagnosis, 57% had participated in cancer rehabilitation and 24% in other psychosocial support programs. Fifteen percent of all patients and 23% of those with a possible psychiatric disorder expressed their need for psychosocial support. Women with distress and perceived support needs who did not participate in past support programs were older, less educated, and less informed (P<.05). CONCLUSION Findings show the long-term impact of breast cancer and indicate need for patient education, screening for psychosocial distress, and implementation of psychological interventions tailored in particular for older women.

Four-Week Prevalence of Mental Disorders in Patients With Cancer Across Major Tumor Entities

PURPOSE To provide the 4-week prevalence estimates of mental disorders in cancer populations. PATIENTS AND METHODS We enrolled adult patients with cancer from in- and outpatient care facilities, using a proportional stratified random sample based on the nationwide cancer incidence in Germany. Patients who scored 9 or above on the Patient Health Questionnaire (PHQ-9) were administered to the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for cancer patients (CIDI-O). A random sample of those with a PHQ-9 score that was less than 9 were selected for a CIDI-O. RESULTS A total of 5,889 patients were identified, which led to 4,020 participants (a 68.3% response rate); of those, 2,141 patients were interviewed. The 4-week total prevalence for any mental disorder was 31.8% (95% CI, 29.8% to 33.8%); this included any anxiety disorder (11.5%; 95% CI, 10.2% to 12.9%), any adjustment disorder (11.1%; 95% CI, 9.7% to 12.4%), any mood disorder (6.5%; 95% CI, 5.5% to 7.5%), any somatoform/conversion disorder (5.3%; 95% CI, 4.3% to 6.2%), nicotine dependence (4.5%; 95% CI, 3.6% to 5.4%), alcohol abuse/dependence (0.3%; 95% CI, 0.1% to 0.6%), any mental disorder resulting from general medical condition (2.3%; 95% CI, 1.7% to 2.9%), and any eating disorder (0%). The highest prevalence for any mental disorder was found in patients with breast cancer (41.6%; 95% CI, 36.8% to 46.4%), followed by patients with head and neck cancer (40.8%; 95% CI, 28.5% to 53.0%). The lowest prevalence was found in patients with pancreatic cancer (20.3%; 95% CI, 8.9% to 31.6%) and stomach/esophagus cancers (21.2%; 95% CI, 12.8% to 29.6%). CONCLUSION Our findings provide evidence for the strong need for psycho-oncological interventions.

Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors.

Objective: To assess the character and frequency of fear of progression (FoP) and to clarify its relationship with cancer‐related intrusive cognitions in breast cancer survivors.

Die deutsche Version des NCCN Distress-Thermometers

Zusammenfassung: Das NCCN Distress-Thermometer ist ein vom National Comprehensive Cancer Network (NCCN) entwickeltes Screeninginstrument zur Erfassung psychosozialer Belastungen bei onkologischen Patienten. Es besteht aus einer Skala von 0 bis 10 und einer Problemliste als Uberweisungsschema zu entsprechenden professionellen Diensten. International wird ein Cut-off-Wert von 5 als Signal empfohlen, dass ein Patient auffallig belastet ist und Unterstutzung benotigt. Die deutsche Adaptation erfolgte an einer Stichprobe von n = 475 Krebspatienten in der onkologischen Rehabilitation. Zur Validierung wurde die Hospital Anxiety and Depression Scale (HADS-D) und die Kurzform des Fragebogens zur Progredienzangst (PA-F 12) eingesetzt. Die Diskriminationsfahigkeit des Distress-Thermometers ist besonders zur Identifikation einer hohen Belastung (HADS Cut-off > 11) mit AUC-Werten von 0.71 bis 0.76 gut. Bei einem Cut-off-Wert von 5 im Distress-Thermometer zeigen sich bei moderater Belastung in den Merkmalen Angst und/o...

Health-related quality of life in breast cancer: A cross-cultural survey of German, Japanese, and South Korean patients

PurposeThe aim of this study was to evaluate health-related quality of life (HRQOL) in breast cancer patients across countries, and to cross-culturally examine the impact of psychosocial factors on HRQOL.Patients and methodsA total of 413 women with breast cancer from Germany (n=195), Japan (n=112), and Korea (n=106) completed a survey assessing HRQOL and HRQOL-related factors. HRQOL was measured using the Short-Form Health Survey (SF-8). Measures of psychological distress (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised), coping (Dealing with Illness Inventory-German Revised), and social support (Illness-Specific Social Support Scale-German Revised) were included.ResultsThe effect of the factor country on physical QOL was seen to be significant, but small (P=0.049, ES=0.018). The scales of General Health (P=0.023), Vitality (P=0.004), and Role Emotional (P=0.003) differed across countries, with the South Korean patients having lower scores compared to the German and Japanese patients. The nature of the impact of psychosocial factors on HRQOL did not differ greatly across countries except with regard to avoidance, however, the degree to which these factors influence HRQOL did differ greatly. Overall, depression, depressive coping, and problematic support showed a strong detrimental effect on the HRQOL of breast cancer patients.ConclusionsResults from this study suggest that strategies which target an improvement of HRQOL in cancer patients should also consider the patients’ cultural and healthcare system contexts. Interventions are needed to improve detrimental psychosocial factors.

Employment Challenges for Cancer Survivors

There is a considerable body of evidence about the adverse effects of cancer and cancer treatments on employment, work ability, work performance, and work satisfaction among cancer survivors. There is also a growing consensus that cancer survivorship research needs to address the large variety of short‐term and long‐term work‐related problems and that programs to support return to work and employment should be developed and integrated into the follow‐up survivorship care of cancer patients. Cancer survivorship and employment can be considered from the perspective of the cancer survivor, the caregiver and the family, the employer and coworkers, the health care providers, and the community or society—elements that comprise many similarities but also differences between Europe and the Unites States and that may affect employment and return to work among cancer survivors in different ways. Previous research has specifically addressed the likelihood and timeliness of work return, including factors that promote and hinder return to work and work performance, and intervention studies and programs that focus on psychological, physical, pharmacologic, or multidisciplinary approaches to work. The area of work disability has emerged as an international field with research from areas throughout the globe. In this article, the authors provide an overview of the current state of scientific research in these areas and further provide a cancer survivorship and work model that integrates significant individual cancer‐related, treatment‐related, and work‐related factors and outcomes. The report concludes with a discussion of European and American contributions and possible future directions for the enhancement of current efforts. Cancer 2013;119(11 suppl):2151‐59.

Prävalenz affektiver und Angststörungen bei Krebs: Systematischer Literaturreview und Metaanalyse

We aimed to systematically summarize the empirical evidence on the 4-week-, 12-month-, and lifetime prevalence of affective and anxiety disorders in cancer patients. We evaluated 89 English or German language original papers and systematic reviews that assessed the prevalence of affective and anxiety disorders using structured clinical interviews published between 1995 and 2010. Adjusted prevalence rates were calculated using a random-intercept model. The pooled adjusted 4-week prevalence of affective disorders was 11.1% (95% CI 8.1-15.1), and 10.8% (95% CI 6.8-16.7) based on German studies. The pooled adjusted 4-week prevalence of anxiety disorders was 10.2% (95% CI 6.9-14.8), and 13.5% (95% CI 7.1-24.3) based on German studies. The findings show the need for further research on representative studies that take into account the range of psychosocial stressors and supportive care needs in addition to the prevalence of mental disorders.

Beyond treatment - Psychosocial and behavioural issues in cancer survivorship research and practice.

The population of cancer survivors has grown steadily over the past several decades. Surviving cancer, however, is not synonymous with a life free of problems related to the disease and its treatment. In this paper we provide a brief overview of selected physical and psychosocial health problems prevalent among cancer survivors, namely pain, fatigue, psychological distress and work participation. We also address issues surrounding self-management and e-Health interventions for cancer survivors, and programmes to encourage survivors to adopt healthier lifestyles. Finally, we discuss approaches to assessing health-related quality of life in cancer survivors, and the use of cancer registries in conducting psychosocial survivorship research. We highlight research and practice priorities in each of these areas. While the priorities vary per topic, common themes that emerged included: (1) Symptoms should not be viewed in isolation, but rather as part of a cluster of interrelated symptoms. This has implications for both understanding the aetiology of symptoms and for their treatment; (2) Psychosocial interventions need to be evidence-based, and where possible should be tailored to the needs of the individual cancer survivor. Relatively low cost interventions with self-management and e-Health elements may be appropriate for the majority of survivors, with resource intensive interventions being reserved for those most in need; (3) More effort should be devoted to disseminating and implementing interventions in practice, and to evaluating their cost-effectiveness; and (4) Greater attention should be paid to the needs of vulnerable and high-risk populations of survivors, including the socioeconomically disadvantaged and the elderly.

Predictors of employment among cancer survivors after medical rehabilitation--a prospective study.

OBJECTIVES This study aimed to (i) investigate cancer survivors employment status one year after the completion of a medical rehabilitation program and (ii) identify demographic, cancer, and psychosocial, treatment-, and work-related predictors of return to work (RTW) and time until RTW. METHODS A total of 1520 eligible patients were consecutively recruited on average 11 months post diagnosis and assessed at the beginning (t(0)) (N=1148) and end of rehabilitation (t(1)) (N=1060) and 12 months after rehabilitation (t(2)) (N=750). Participants completed validated measures assessing functional impairments, pain, anxiety, depression, quality of life, social support, and work-related characteristics including work ability, sick leave absence, job requirements, work satisfaction, self-perceived employer accommodation, and perceived job loss. Physicians estimated the degree of cancer-entity-specific functional impairment. RESULTS In a mean time of six weeks after rehabilitation, 568 patients (76%) had returned to work. The multivariate hierarchical logistic regression analysis indicated that baseline RTW intention [odds ratio (OR) 6.22, 95% confidence interval (95% CI) 1.98-19.51], perceived employer accommodation (OR 1.93, 95% CI 0.33-0.99), high job requirements (OR=1.84, 95% CI 1.02-3.30), cancer recurrence or progression (OR=0.27, 95% CI 0.12 - 0.63), baseline sick leave absence (OR=0.26, 95% CI 0.09-0.77), and problematic social interactions (OR=0.58, 95% CI 0.33-0.99) emerged as significant predictors for RTW. The explained variance of the total model was Nagelkerkes R²=0.59 (P<0.001). CONCLUSION Our findings emphasize the high relevance of motivational factors. Occupational motivation and skepticism towards returning to work should be carefully assessed at the planning of the rehabilitation program.