Gertrud Krüskemper

Psychological aspects affect quality of life in patients with oral squamous cell carcinomas

Quality of life (QoL) in head and neck cancer patients has been of increasing interest for some years. Unfortunately, only poor data exist regarding the impact of professional psychological support on QoL.

Age- and localization-dependent functional and psychosocial impairments and health related quality of life six months after OSCC therapy

OBJECTIVES The aim of the current study was to evaluate the functional and psychosocial impacts and changes in overall quality of life (QoL) following oral squamous cell carcinoma (OSCC) therapy in different age groups and in different oral locations. MATERIALS AND METHODS The study assessed questionnaire responses from patients with OSCC (n = 1319) after 6 months of oncologic therapy, as collected in the DÖSAK Rehab Study. Oncological variables, dental status, sensory, QoL, psychosocial outcomes and coping strategies in younger (45-60 years) and older (61-100 years) patients were assessed for different OSCC locations including the entire oral cavity, maxilla, mandible and others besides the maxilla and mandible. RESULTS Younger patients were generally less satisfied with their dental status and experienced more sensory and QoL impairments, as well as more psychological burden, compared to the older patients. Depending on the age group, different coping strategies were used. Oncologic therapy targeted to the mandible and other locations besides the maxilla and mandible led to the strongest sensory and QoL limitations. CONCLUSIONS Regardless of age, oncologic OSCC therapy leads to profound sensory and psychosocial restrictions and to limitations in QoL. Reasons for the poorer functional and QoL outcomes in younger patients include a more invasive treatment and a lower psychosocial resilience. The identification of patients with depressive and dysfunctional coping strategies should be carried out for all ages, but especially in younger patients, in order to develop functional coping strategies through individualized counseling, treatment and rehabilitation. REGISTRATION OF CLINICAL TRIALS Observational study, therefore not required.

Regular Dental Visits: Influence on Health-Related Quality of Life in 1,607 Patients with Oral Squamous Cell Carcinoma

Background The incidence of oral squamous cell carcinoma (OSCC) is in the top 10 of all cancer entities. Regular oral examinations by dentists play an important role in oral cancer prevention. Methods Patients with OSCC (n = 1,607) and physicians (n = 1,489) completed questionnaires during the DÖSAK Rehab Study. The psychosocial and functional factors collected in these questionnaires were assessed in the present study. We compared patients who visited their dentist at least once a year (group A) with those who visited their dentist less than once a year (group B). Results Patients in group A had significantly better health-related quality of life after tumor treatment than patients in group B. Patients in group A also had a smaller tumor size and less lymph node metastasis and lost fewer teeth during the treatment. This resulted in better prosthetic rehabilitation and better psychological status after tumor treatment. Conclusions Dentists play an important role in the early recognition of oral cancer. This study should encourage dentists to take a more active role in oral cancer prevention.

Untersuchung zur Änderungssensitivität und Konstruktvalidität der Revidierten Mehrdimensionalen Schmerzskala

ZusammenfassungProblem: Die Schmerzmessung und -dokumentation stellt ein interdisziplinäres Problem dar. In der vorliegenden Untersuchung wurde der Frage nach der Änderungssensitivität und der Konstruktvalidiät der Revidierten Mehrdimensionalen Schmerzskala (MSS) nach Cziske et al. nachgegangen. Methode: 72 gesunde Probanden wurden einer Kontrollgruppe sowie 2 Experimentalgruppen zugeordnet. In letzterer wurden Schmerzreize durch Aufpumpen einer Riva-Rocci-Blutdruckmeßmanschette appliziert, und zwar in der einen Gruppe mit einem maximalen Druck von 175 mm Hg, in der anderen mit einem Druck von 300 mm Hg. Die sich ergebenden kardiovaskulären Reaktionen wurden kontinuierlich und nichtinvasiv mittels der Penaz-Methode aufgezeichnet. Den Probanden wurde die Revidierte Mehrdimensionale Schmerzskala (MSS), das State-and-Trait-Anxiety-Inventory (STAI) sowie eine numerische Likert-Skala (1–28) vorgelegt, um die Druckwahrnehmung während der Blutdruckmessung erfassen zu können. Ergebnisse: Die Gruppen unterschieden sich in der numerischen Likert-Skala, und zwar war der Score in den Experimentalgruppen signifikant höher als in der Kontrollgruppe (p<0,05). Jedoch zeigten sich keine Unterschiede zwischen den Gruppen in bezug auf die Subskalen der MSS. Lediglich die Subskala VIII (elektrisch) und X (thermisch) der MSS war in der Gruppe mit einem Druckstimulus von 175 mm Hg stärker akzentuiert als in der Kontrollgruppe (p<0,05). Ebenfalls zeigten sich keine Unterschiede hinsichtlich der Angsteinschätzung zwischen den Versuchsgruppen. Korrelationsanalysen ergaben positive Zusammenhänge zwischen Zustandsangst und den Subskalen VII (Harnäckigkeit), IX (chemisch) und X der MSS. Dispositionsangst war korreliert mit den Subskalen VI (Lästigkeit), VII und IX. Des weiteren ergab sich eine positive Korrelation zwischen dem systolischen Blutdruckanstieg während der Druckapplikation und der Subskala IV (Allgemeinheit) der MSS. Diskussion: Die Untersuchung belegt, daß die MSS nur eine begrenzte Änderungssensitivität gegenüber Kurzzeitschmerzstimuli, wie einem als aversiv empfundenen Druckreiz am Oberarm, besitzt. Angsteinschätzung ist mit verschiedenen Subskalen des MSS korreliert. Hieraus ergibt sich, daß die MSS eher affektiv-motivationale Aspekte als die physikalische Intensität eines aversiven Reizes abbildet.SummaryProblem: Assessment and evaluation of perceived pain is an interdisciplinary task. This study focused on the change sensitivity and construct validity of the German version of the Revised Multidimensional Pain Scale (MSS). Methods: In this experiment, 72 students were assigned to one of three treatments:a) Applying a blood pressure spyghmomanometry cuff with a maximum pressure of 300 mm Hg, b) or with a maximum pressure of 175 mm Hg, c) or a control condition, applying a cuff with no pressure. During the treatment, blood pressure was continuously non-invasively measured by the Penazmethod. At the end of the experiment, the subjects worked on the revised multidimensional pain scale, on the state/trait anxiety inventory (STAI) and a Likert-scale (range 1–28) for perceived pressure. Results: As expected, inflating the arm cuff induced a significant increase in pressure perception compared to the control group. However, only the subscales electrical and thermic of the MSS showed an increase across the treatment groups. No differences were found for the anxiety ratings. Correlation analysis showed that state anxiety was positively related with the subscales chronic, chemical, and thermic. Trait anxiety was related with the subscales chronic, inconvenient, and chemical. Systolic blood pressure increase was positively correlated with the subscale general of the MSS. Discussion: The study shows that the MSS has a limited change sensitivity for short term pain stimuli like arm cuff pressure. Anxiety was correlated with three subscales of the MSS, indicating that perceived pain intensity assessed with the MSS is more related to emotional factors rather to the physical intensity of the arm cuff pressure.