Corinna Bergelt

Cancer rehabilitation: A Nordic and European perspective.

Abstract Background. The increasing incidence of cancer combined with prolonged survival times seen throughout the western world increases the need for rehabilitation. Diagnosis and treatment for cancer may have substantial effects on the patients’ physical, psychological, social and existential well-being. The aim of this paper is to describe the current situation in cancer rehabilitation in the Nordic countries, the Netherlands and Germany. Material and methods. Description of the current situation in cancer rehabilitation in the Nordic countries and literature review. Results. Rehabilitation as defined by multiple organizations covers a multidimensional view on chronic disease and its effect on the patients life. The rehabilitation systems in Denmark, Finland, Sweden, Germany and the Netherlands differ depending on the differing social security and health-care systems, but rehabilitation provided is largely based on a similar, multidimensional and multidisciplinary understanding of cancer rehabilitation. Research on rehabilitation efforts in European countries indicates that there is substantial evidence with regard to single interventions which can be part of cancer rehabilitation. Discussion. In order to assure patients and families continuing quality of life, rehabilitation should be an integral and continuous part of all cancer care.

Intensity-modulated radiotherapy versus conventional and 3D conformal radiotherapy in patients with head and neck cancer: Is there a worthwhile quality of life gain?

BACKGROUND Intensity-modulated radiotherapy (IMRT) is a technique that allows delivery of lower doses of radiation to normal tissue, while maintaining or increasing the tumour dose, compared with two-dimensional radiotherapy (2DRT) or three-dimensional conformal radiotherapy (3DCRT). This review of published data was undertaken to assess whether IMRT is associated with quality of life (QoL) benefits versus 2DRT and 3DCRT. DESIGN English-language literature published between January 2005 and August 2010 was searched for studies comparing IMRT versus 2DRT or 3DCRT in head and neck cancers that included QoL evaluation. Fourteen studies (five prospective and nine retrospective) were identified, two in abstract form only. Only one study was randomised. Studies included patients with nasopharyngeal cancer only, oropharyngeal cancer only and mixed populations. RESULTS The EORTC QLQ-C30 was the most widely used instrument, generally supplemented with the head and neck cancer module H&N35. IMRT was associated with statistically significant improvements in certain QoL domains versus 2DRT and 3DCRT, particularly those relating to xerostomia, including dry mouth, sticky saliva and eating-related domains. Improvements in global QoL were also observed in the IMRT groups in some studies. CONCLUSION Based on the studies reviewed, patients treated with IMRT experience statistically significant improvements in several important QoL domains versus 2DRT and 3DCRT. However, studies included heterogeneous populations, different timepoints for measurements and a variety of instruments for QoL assessment. Accepting the difficulties in execution, IMRT should be compared with 3DCRT in prospective randomised studies in homogeneous patient populations, using appropriate QoL assessments and clinical end points, to establish if IMRT provides enough value for the additional resources involved.

Psychological distress in cancer patients with underage children: gender-specific differences.

Findings on gender differences in the psychological distress of cancer patients have been inconsistent. The objectives of the current study were to examine whether being a parent differentially modulates anxiety and depression in men and women and to compare whether psychological distress differs in male and female patients with and without children.

Use and need for psychosocial support in cancer patients: a population-based sample of patients with minor children.

Cancer patients and their minor children have been shown to experience psychological distress. The objectives of the current study were to 1) describe the need for and use of psychosocial support and 2) determine predictors of family‐centered support use in patients with minor children.

Messung der gesundheitsbezogenen Lebensqualität mit dem SF-8 Deutsche Normdaten aus einer repräsentativen schriftlichen Befragung

Zusammenfassung. Der Short-Form Health Survey SF-8 ist ein Instrument zur Messung der gesundheitsbezogenen Lebensqualitat, einem wichtigen Outcomekriterium klinischer Studien und in den Gesundheitswissenschaften. Das Instrument ist eine Kurzform des haufig verwendeten SF-36, mit dem acht Dimensionen der subjektiven Gesundheit gemessen sowie zwei Summenskalen Korperlicher und Psychischer Gesundheit berechnet werden konnen. Der SF-8 wurde im Jahr 2004 im Rahmen einer bundesweit durchgefuhrten Mehrthemenbefragung eingesetzt. Basierend auf diesen Daten konnen erstmalig reprasentative Normdaten zum SF-8 (N = 2 552) aus einer schriftlichen Befragung fur die deutsche Bevolkerung vorgelegt werden. Die Referenzdaten werden alters- sowie geschlechtsdifferenziert berichtet und auf Zusammenhange mit soziodemografischen Merkmalen analysiert. Seltene fehlende Werte in den Antworten weisen auf eine gute Akzeptanz des Instruments hin. Auch wenn der SF-8 in verschiedenen Subskalen mit Deckeneffekten behaftet ist, kann sein Einsatz aufgrund seiner Okonomie empfohlen werden. Schlusselworter: SF-8, gesundheitsbezogene Lebensqualitat, Normdaten, schriftliche Befragung Measuring health-related quality of life with the SF-8: German norms from a representative self-administered survey

Children of cancer patients: Prevalence and predictors of emotional and behavioral problems

Children of patients with cancer are at increased risk for developing emotional and behavioral problems. This study explored the prevalence and predictors of emotional and behavioral problems in Children of cancer patients in a multisite research project.

Psychosoziale Versorgung von Kindern mit einem an Krebs erkrankten Elternteil – Eine Bestandsaufnahme spezifischer Versorgungsangebote in Deutschland

Children of a parent having cancer are at greater risk to develop mental health problems. Aim is to investigate specific psychosocial care for children having a parent with cancer, as well as to characterize and assess utilization and needs of affected minor children. Employees of institutions in Germany supplying psychosocial care to families with a parent having cancer were surveyed, using a semi-structured interview (n = 29). Specific psychosocial care for affected children is limited and heterogeneous in Germany. Regarding different distress stages of those families, the situation could be interpreted as eligible. However, this primarily reflects the low quality assurance of care. Results suggest that in addition to preventive care needs of children having a parent with cancer, increased needs exist in specific risk constellations, like in single parent families.

Work-related predictors of not returning to work after inpatient rehabilitation in cancer patients.

Abstract Background. The purpose of the study was to explore the association between work-related factors and not returning to work in cancer patients. The identification of any special issues contributes to the development of occupation-related rehabilitation programmes. This study focused on aspects that may be influenced by patients with the help of counselling (e.g., handling occupational stress). Material and methods. At the beginning and one year after the end of rehabilitation, we asked patients to answer occupation-related questionnaires. We used t-tests and χ2-tests as well as logistic regression analyses to address our research questions. Results. Of 333 patients, 21% had not returned to work one year after the end of rehabilitation. In comparison with working patients, patients who were not working reported poorer mental health and more occupational problems at the beginning of rehabilitation. Unemployment at the beginning of rehabilitation, an elevated risk of early retirement and limited self-assessed work ability increased the probability of not returning to work. Conclusion. Patients who did not return to work represent a subgroup within rehabilitation. These patients need special support and should receive counselling beyond the time of rehabilitation. This is particularly true for unemployed patients who need intensive help to return to the workforce. Furthermore, patients’ estimations of their work ability and their plans for returning to work play a crucial role and should be discussed during rehabilitation.

Psychosocial Interventions for Families with Parental Cancer and Barriers and Facilitators to Implementation and Use - A Systematic Review.

Background Parental cancer has a significant impact on minor children and families. Psychosocial interventions for affected families can provide support where necessary. This systematic review aims at providing an overview of existing interventions and support programs and focuses on the systematic investigation of barriers and facilitators for using psychosocial interventions for families affected by parental cancer (PROSPERO; registration number CRD42014013020). Methods A search of five electronic databases (EMBASE, MEDLINE, PsycInfo, Psyndex, CINAHL) was conducted in June 2014, and updated in September 2015. We included any kind of studies reporting psychosocial support services or interventions for families affected by parental cancer. Study quality was assessed using the Mixed Method Assessment Tool. Narrative synthesis and thematic analyses were undertaken to examine the included interventions and to identify barriers and facilitators for use and implementation. Results A total of 36 studies covering 19 interventions and support services were included in the systematic review. Interventions focused on children, parents or several family members and analyses revealed a broad picture of theoretical background and primary aims. Several studies focused on developmental or implementation phases or descriptions of interventions. Other included studies reported results of evaluations using qualitative and quantitative methods. Results suggest that interventions are helpful and that participants improved in various outcomes. The thematic analyses indicate that barriers for use of support services refer to aspects concerning the patients and families, such as practical difficulties, perceived need for support or fear of stigma. Cancer patients who understood the need and benefit of support services may have used them more often. Additionally, intervention characteristics such as a flexible structure and accessibility were important to reach families affected by parental cancer. Disease characteristics and complications in collaborations were identified as potential barriers. The provision of information about interventions by clinicians and understanding the support as part of routine care seem to be key issues for implementation and use of psychosocial support. Conclusion This review identified a broad number of intervention concepts for families with minor children affected by parental cancer. Findings provide a basis for existing or future psychosocial interventions to anticipate potential barriers and facilitators to implementation and use and can help to reach a wider range of families in need for support.

Occupational stress and its association with early retirement and subjective need for occupational rehabilitation in cancer patients

Returning to work often plays an important role for cancer survivors. Occupational stress may hamper a successful return to work, so cancer survivors should be given the opportunity to address occupational stress issues before returning to work. We investigated the amount of occupational stress among cancer patients and whether it is associated with their well‐being, their subjective need for occupational rehabilitation and elevations in their risk of early retirement.