O. Krauß

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care.

The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of ⩾13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of ⩾6 (specificity 0.21). With scores of ⩾16 and ⩾22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.

Predictors of emotional distress in patients with head and neck cancer

Patients with head and neck cancer are known to be more commonly emotionally distressed than patients with other tumors. This study investigates reasons for this difference.

Shared decision making bei Tumorpatienten

ZusammenfassungDie Stellung des Patienten im System der medizinischen Versorgung verändert sich. Tradierte Beziehungsstrukturen zwischen Arzt und Patient weichen partnerschaftlichen und patientenorientierten Modellen. Durch die Stärkung der Rechtslage der Patienten sollen diese befähigt werden, aktiv an medizinischen Entscheidungen zu partizipieren. Die Reformen im Gesundheitswesen befördern diese Prozesse mittels zahlreicher Maßnahmen, von denen Impulse für mehr Effizienz und Wirtschaftlichkeit ausgehen sollen. Gleichwohl sind partnerschaftliche Kooperationsbeziehungen zwischen Patient und Arzt nur bedingt durchsetzbar, bleiben die Rahmenbedingungen des Behandlungsgeschehens unberücksichtigt. Eine Studie zum Shared decision making bei Tumorpatienten verweist auf Chancen, aber auch auf konzeptionelle Schwierigkeiten des Ansatzes sowie auf die Bedingtheit dessen Umsetzung in Abhängigkeit von krankheits- und ressourcenbedingten Besonderheiten.AbstractThe role of the patient in the medical system is undergoing rapid changes. The traditional form of relationship between doctors and patients are gradually giving way to a more partnership- and patient-oriented model. Strengthening their legal position is to enable patients to take an active role in the decision-making processes. Health care reforms foster these developments which are to give an impetus to a higher degree of efficiency. However, cooperation between the patient and the doctor cannot be achieved disregarding the general medical care environment (frame work condition). Our study of tumour patients’ Shared Decision Making does not just point out conceptual problems of this approach but also highlights the practical implementation’s limits caused by the circumstances of the actual disorder and available resources.

Psychische Begleiterkrankungen bei Krebspatienten in der Viszeralchirurgie

BACKGROUND Cancer patients with mental disorders suffer from a decreased quality of life (QoL) and are in need of appropriate treatment. METHODS A total of 99 cancer patients were interviewed during surgical inpatient treatment with a structured clinical interview for diagnosis of mental disorders (SCID). The QoL and distress were examined prospectively using the validated questionnaires EORTC QLQ-C30 and HADS. Patient psychological well-being and the need for psycho-oncological treatment were assessed by 31 doctors and 41 nurses. RESULTS Of the patients 19% were diagnosed with having a mental disorder and in 10% immediate treatment was deemed necessary. This was identified by doctors and nurses in 38-60% and by HADS in 78% of the cases. The QoL of patients with psychiatric comorbidities was diminished 6 months after surgery, while patients without comorbidities recovered significantly better. CONCLUSION Of the visceral surgery cancer patients studied 10% had a relevant mental disorder. To prevent symptoms becoming chronic they should be detected and treated early and efficiently.

Socio-economic disparities in long-term cancer survival—10 year follow-up with individual patient data

PurposeReasons for the social gradient in cancer survival are not fully understood yet. Previous studies were often only able to determine the socio-economic status of the patients from the area they live in, not from their individual socio-economic characteristics.MethodsIn a multi-centre cohort study with 1633 cancer patients and 10-year follow-up, individual socio-economic position was measured using the indicators: education, job grade, job type, and equivalence income. The effect on survival was measured for each indicator individually, adjusting for age, gender, and medical characteristics. The mediating effect of health behaviour (alcohol and tobacco consumption) was analysed in separate models.ResultsPatients without vocational training were at increased risk of dying (rate ratio (RR) 1.5, 95% confidence interval (CI) 1.1–2.2) compared to patients with the highest vocational training; patients with blue collar jobs were at increased risk (RR 1.2; 95% CI 1.0–1.5) compared to patients with white collar jobs; income had a gradual effect (RR for the lowest income compared to highest was 2.7, 95% CI 1.9–3.8). Adding health behaviour to the models did not change the effect estimates considerably. There was no evidence for an effect of school education and job grade on cancer survival.ConclusionsPatients with higher income, better vocational training, and white collar jobs survived longer, regardless of disease stage at baseline and of tobacco and alcohol consumption.

Die Einbeziehung von Tumorpatienten in medizinische Entscheidungsprozesse

ZusammenfassungDas shared-decision-making-Modell (SDM) erlangt sowohl in der gesundheitspolitischen Diskussion als auch im medizinischen Behandlungsprozess wachsende Bedeutung. Im Kern beinhaltet es die aktive Mitwirkung des Patienten an ihn betreffenden medizinischen Entscheidungen, und empirische und praktische Erfahrungen belegen die Angemessenheit einer solchen Vorgehensweise. Dies gilt auch für den Bereich onkologischer Krankheitsbilder, wenngleich eine bessere Datenlage wünschenswert ist. Die Ergebnisse der vorliegenden Studie verweisen auf die Bedeutsamkeit einer partnerschaftlichen Entscheidungsstrategie, zeigen aber auch, dass eine differenzierte Herangehensweise nötig ist. So erscheint eine Mitwirkung der Patienten nicht nur bei der Therapiewahl, sondern auch in anderen medizinischen Handlungsfeldern möglich und sinnvoll. Darüber hinaus sind aus Patientenperspektive die einzelnen Elemente des SDM von unterschiedlichem Gewicht. Ohne die Berücksichtigung der Rahmenbedingungen der medizinischen Behandlung wird es nicht möglich sein, SDM tatsächlich in die Praxis umzusetzen.AbstractThe significance of shared decision making (SDM) is increasing in the area of health policy as well as in the course of medical treatment. SDM is mainly based on active participation of patients in decisions concerning their own medical treatment. Empirical studies and practical experience support the adequacy of that approach. This applies especially for oncological treatments, albeit evidence is still lacking in this field. The results of the present study show the importance of a decision in partnership in general but a differentiated approach in detail. Thus, participation of patients seems to be functional and possible both for the treatment choice and for other medical fields of action. Moreover, from the patients’ perspective single elements of SDM are of different importance. Finally, realisation of SDM in oncological practise is impossible without considering the conditions of the prevailing medical treatment.

Psychische Begleiterkrankungen bei Krebspatienten in der Viszeralchirurgie@@@Psychiatric comorbidities in visceral surgery patients with cancer

BACKGROUND Cancer patients with mental disorders suffer from a decreased quality of life (QoL) and are in need of appropriate treatment. METHODS A total of 99 cancer patients were interviewed during surgical inpatient treatment with a structured clinical interview for diagnosis of mental disorders (SCID). The QoL and distress were examined prospectively using the validated questionnaires EORTC QLQ-C30 and HADS. Patient psychological well-being and the need for psycho-oncological treatment were assessed by 31 doctors and 41 nurses. RESULTS Of the patients 19% were diagnosed with having a mental disorder and in 10% immediate treatment was deemed necessary. This was identified by doctors and nurses in 38-60% and by HADS in 78% of the cases. The QoL of patients with psychiatric comorbidities was diminished 6 months after surgery, while patients without comorbidities recovered significantly better. CONCLUSION Of the visceral surgery cancer patients studied 10% had a relevant mental disorder. To prevent symptoms becoming chronic they should be detected and treated early and efficiently.