Gregor Weißflog

Psychosocial interventions for adolescents and young adult cancer patients: A systematic review and meta-analysis.

Adolescent and young adult (AYA) cancer patients experience unique psychosocial needs and developmental challenges. A cancer diagnosis can stress this development and disrupt AYAs in their normal life. The aim of this systematic review and meta-analysis was to assess the impact of psychosocial interventions on mental health in AYAs. A literature research was conducted, which resulted in twelve eligible studies. The standardized mean difference between intervention and control conditions was 0.13 (95% CI: -0.16 to 0.42) for quality of life, 0.27 (95% CI: -0.22 to 0.76) for cancer-related knowledge and -0.16 (95% CI: -0.73 to 0.42) on psychological distress indicating, small and non-significant effects for interventions improving mental health. This work strengthens the need for age-appropriated interventions in psycho-oncology. Future research should develop interventions more graduated by age. Randomized intervention studies with larger samples and focusing psychosocial outcomes are needed to establish evidence-based psycho-oncological interventions for AYAs.

Efficacy of psychodynamic short-term psychotherapy for depressed breast cancer patients: study protocol for a randomized controlled trial

BackgroundThere is a lack of psychotherapeutic trials of treatments of comorbid depression in cancer patients. Our study determines the efficacy of a manualized short-term psychodynamic psychotherapy and predictors of outcome by personality and quality of the therapeutic relationship.Methods/designEligible breast cancer patients with comorbid depression are assigned to short-term psychodynamic psychotherapy (up to 20 + 5 sessions) or to treatment as usual (augmented by recommendation for counseling center and physician information). We plan to recruit a total of 180 patients (90 per arm) in two centers. Assessments are conducted pretreatment, after 6 (treatment termination) and 12 months (follow-up). The primary outcome measures are reduction of the depression score in the Hospital Anxiety and Depression Scale and remission of depression as assessed by means of the Structured Clinical Interview for DSM IV Disorders by independent, blinded assessors at treatment termination. Secondary outcomes refer to quality of life.DiscussionWe investigate the efficacy of short-term psychodynamic psychotherapy in acute care and we aim to identify predictors for acceptance and success of treatment.Trial registrationISRCTN96793588

Beteiligung von Patienten an medizinischen Entscheidungen – ein Überblick zu Patientenpräferenzen und Einflussfaktoren

The involvement of patients in medical treatment decisions has been intensively discussed for several years. The present review article is concerned with the patient participation in medical decision making mainly in the field of oncology. Also discussed are methodological aspects of the measurement of patient involvement and the theoretical approach of shared decision -making. The preference to be involved in decisions is expressed from 16-50% of the patients and depends on socio-demographic and disease-related variables. Positive impact of patient participation is observed essentially as short-term effects and for psychosocial outcome criteria. Further research should consider the methodological aspects and focus on dyadic concepts and various dimensions of patient involvement. It is also important to focus on evaluation of the decision and on the possible (long time) effects in terms of recovery, progression of disease, psychosocial consequences and economic impact.

Partner von Krebspatientinnen mit minderjährigen Kindern – Psychische Belastung im Vergleich zur Allgemeinbevölkerung und zur krebskranken Partnerin

The psychological distress of men with underage children, whose female partners have cancer, was examined using the Hospital Anxiety and Depression Scale (HADS). The sample (N=141) was compared with the partners who have cancer and a comparison group of men from the general population (N=154). The male partners of cancer patients were psychological strongly distressed. About half of the partners showed increased scores in anxiety and one third of the partners had a high level of depression. There was a high correlation within the couple. The male partners of cancer patients were significantly more distressed than the comparison group of men with underage children from the general population. It is very important to assess psychosocial support needs of partners of cancer patients and to provide adequate options of possible psychosocial treatment.

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.

Gesundheitsbezogene Lebensqualität und Posttraumatische Belastungsstörungen bei in der DDR politisch Inhaftierten

PURPOSE Political persecution was and is a reality in our world. The study investigated effects of political imprisonment in the former German Democratic Republic on the current health-related quality of life and on the existence of a post-traumatic stress disorder (PTSD). METHODS A sample of 157 former political prisoners was surveyed with a questionnaire containing the EORTC QLQ-C30 and the IES-R. RESULTS Former political prisoners of the GDR reported a lower quality of life than the general population. There is no consistent impact of imprisonment-related variables (e. g. duration of imprisonment) on health-related quality of life. At least, based on questionnaire data it can be estimated that 50% of the people in the sample suffer from a PTSD. CONCLUSION The results provide further evidence that former political prisoners suffer from the traumatic experience of political persecution also in a long term.

[Patient participation in medical decision making among breast cancer patients--a comparison of breast centre care units and non-centre hospitals].

This study investigated the extent of involvement of breast cancer patients in medical decisions in comparison between certified breast cancer centres vs. non-centres. Data on the participation in medical decision making were collected in a retrospective cross-sectional design from 652 breast cancer patients. 9 different dimensions of participation were analysed. In the descriptive analysis, there is only one significant difference in participation between breast centres and non-centres (dimension: time of treatment). In multivariate analysis, the treatment in a breast cancer centre was a predictor for increased patient participation in 3 dimensions of participation in medical decisions (p <0.05). In particular, younger age and good health are of statistical significance for participation in medical decision making. There is a higher participation of patients in breast centres in only few subdimensions of medical decision making, but not in general.

[Increased anxiety and depression as long-term consequences of political imprisonment].

OBJECTIVE By recent estimates, 200,000 persons were imprisoned for political reasons in the German Democratic Republic (GDR) between 1949 and 1989. Former political prisoners suffer from the experience of political persecution also in a long-term. The aim of this study was to assess long-term effects on anxiety and depression. METHODS Anxiety and depression were assessed by using the Hospital Anxiety and Depression Scale, German version (HADS). RESULTS The anxiety of the former political detainees is significantly increased in comparison to an age- and gender matched subsample of the general population (10 vs. 4,8; p < 0,001, effect size d = 1,33). The same applies to the depression (9.7 vs. 5,6; p < 0,001; effect size d = 0,92). CONCLUSIONS Even many years after the political detention people report highly increased anxiety and depression.

Stigmatisierende Einstellungen gegenüber Krebspatienten – Ergebnisse einer repräsentativen Bevölkerungsbefragung

OBJECTIVE To investigate stigmatizing attitudes towards cancer patients in the general population and to examine their association with socio-structural characteristics and perceived causes of disease. METHODS We recruited a representative sample from the German general population (n=2420; mean age: 52 years; 54% women). Stigmatizing attitudes were assessed with a 9-item scale. Predictors of stigmatizing attitudes were identified using a regression analysis. RESULTS Agreement with stigmatization items ranged from 3.6% (item: work together with a cancer patient) to 18.9% (item: use the same dishes as a cancer patient). Perceived causes of disease with a high levels of personal responsibility showed only weak correlations with stigmatizing attitudes (all r<0.31) and were partially statistical significant (e. g. food intake) or not significant (e. g. alcohol). The strongest predictors of stigmatizing attitudes were lack of cancer-related experiences (Beta=-0,26), age <60 years (Beta=0,1) and the assumption that one cannot protect oneself from cancer (Beta=0,11) (all p<0.001). Further predictors were male gender and living in rural area (p<0.01). CONCLUSION The results demonstrate a need for further research and the development of valid methodological instruments to assess stigmatization towards cancer patients.

Akzeptanz- und Commitmenttherapie bei chronischen körperlichen Erkrankungen

Acceptance and Commitment Therapy (ACT) is an intervention representing a transdiagnostic and contextual approach that assumes that psychological suffering is caused by experiential avoidance. The primary intention of ACT is not to eliminate symptoms and to treat mental disorders. Instead, ACT aims to increase psychological flexibility, i. e. to broaden the repertoire of cognitions and behaviors when facing inner and outer aversive events or experiences. Psychological flexibility can be enhanced by working with the 6 core components of the ACT model. Experience-focused methods like metaphors and exercises for acceptance play a crucial role in the therapeutic work. In short, with ACT patients can learn: ▪ that rigid and inflexible attempts to fight aversive experience are problematic ▪ a mindful experience of inner and outer experience ▪ to differentiate between unchangeable and changeable events (acceptance) ▪ to identify values or respectively life goals and to behave in a way that is consistent with them (commitment)The therapeutic focus of ACT is to create a balance between acceptance and behavioral change consistent with chosen values. Chronic diseases are often associated with aversive inner and outer experiences. A growing number of studies support the efficacy of ACT. There is evidence that ACT can increase psychological flexibility and potentially also lead to better self-management within the context of chronic somatic diseases.