Reinhold Schwarz

Fatigue in the General Population

Background: Fatigue symptoms are often found in cancer patients. One test to assess fatigue is the Multidimensional Fatigue Inventory (MFI-20). It has been successfully applied to specific groups of cancer patients. However, until now population-based norm values are missing. Methods: We conducted an investigation on a representative sample of the adult German population, which comprised 2,037 subjects aged 14–92 years. Results: The reliability of the 5 MFI-20 subscales (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) is satisfying. The correlations between MFI-20 subscales and the fatigue scale of the quality-of-life questionnaire EORTC indicate convergent validity. As an important result we found that all subscales of the MFI-20 showed a clear and nearly linear dependency on age with higher fatigue values for older subjects (p < 0.0001). Females as compared with males are characterized by higher mean values in all MFI-20 subscales (p < 0.001). Conclusions: The results show that it is necessary to take into account age and sex when different groups of cancer patients have to be compared.

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.

Anxiety and depression in cancer patients compared with the general population

The objective of this study was to compare the prevalence of anxiety and depression in cancer patients with the prevalence found in the general population, using the Hospital Anxiety and Depression Scale (HADS). Participants were 1529 cancer patients treated between 2002 and 2004 in Germany and 2037 persons from the German general population. In the cancer patients, the risk of psychiatric distress was nearly twice that of the general population. While for older age groups (61 years and above) there were only small differences between cancer patients and the general population, the differences in both scales were high for young persons. There were differences between the HADS mean scores of the patients with different tumour localisations, with high values for brain cancer and low scores for prostate cancer. The influence of the tumour stage on anxiety and depression was weak. However, depression scores of patients with a survival time less than 1 year were elevated. The results show that large sample sizes are necessary to evaluate the psychological situation of cancer patients, and that age and gender differences must be taken into account when several samples are compared.

Fatigue in Cancer Survivors – Prevalence and Correlates

Background: The aim of this study was to determine the prevalence and influencing factors of fatigue in cancer survivors. Patients and Methods: 646 cancer survivors completed the Multidimensional Fatigue Inventory (MFI-20), in addition to the Hospital Anxiety and Depression Scale (HADS), the Quality Of Life questionnaire EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer QLQ-C30), the subscale ‘social support’ of the Functional Assessment of Cancer Therapy Scale (FACT), the Perceived Adjustment to Chronic Illness Scale (PACIS), and a questionnaire containing items on demographic and clinical data. Results: 36% of cancer survivors suffer from moderate, 12% from severe fatigue. Fatigue was significantly associated with depression, anxiety, sleep difficulties, adjustment to the illness, pain, dyspnoea, age, lacking social support, and sex. Other socio-demographic, cancer-related, and treatment-related factors had no influence on fatigue. Conclusion: Fatigue in cancer survivors is strongly linked to physical and psychological aspects.

Quality of life in chronic pancreatitis: a prospective trial comparing classical whipple procedure and duodenum-preserving pancreatic head resection.

Few data are available with respect to quality of life after pancreatic head resection in patients with chronic pancreatitis. The aim of this study was to compare the classical Whipple pancreatoduodenectomy (PD) with the Beger duodenum-preserving pancreatic head resection (DPPHR), in terms of quality of life, using standardized, valid, and reliable questionnaires. Sixty-five consecutive patients were included in this study. The PD procedure was chosen when pancreatic cancer could not be ruled out (n = 30); otherwise DPPHR was performed (n = 35). Quality of life was measured prospectively three times with the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ-C30) and the Gastrointestinal Quality-of-Life Index (GIQLI). Both procedures led to a significant improvement in quality of life, especially with regard to pain status. However, at the second follow-up examination (18 to 24 months postoperatively), all functional scales and the most important symptom scales of the EORTC QLQ-C30 revealed a better quality of life in the DPPHR group compared to the PD group. After classical PD, more patients seem to develop diabetes mellitus. The EORTC QLQ-C30 was found to be a better tool for quality-of-life assessment than the GIQLI in patients with chronic pancreatitis.

VALIDATION OF THE EORTC QLQ-C30 AND EORTC QLQ-H&N35 IN PATIENTS WITH LARYNGEAL CANCER AFTER SURGERY

The aim of this study was to test the validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (QLQ‐C30) and Head and Neck Module (QLQ‐H&N35) for patients who have undergone surgery due to laryngeal cancer.

Quality of Life Correlates After Surgery for Laryngeal Carcinoma

Objectives: To assess the correlation of operation mode, postoperative radiotherapy, and disease stage factors with the health‐related quality of life (HRQL) measures after surgery for laryngeal carcinoma.

The Course of Anxiety and Depression in Patients with Breast Cancer and Gynaecological Cancer

Background/Aims: The aim of this study was to assess the course of anxiety and depression in cancer patients over time and to detect determinants of the changes in the scores. Patients and Method: Women with breast cancer and gynaecological cancer (n = 367) were tested at the beginning (T1) and at the end (T2) of treatment in the hospital, 6 months later (T3), and 12 months later (T4), using the Hospital Anxiety and Depression Scale (HADS). Results: Anxiety and depression were highest at the start of the stay in the hospital. More than half of the women are at least doubtful cases in at least one of the two HADS dimensions. The mean scores declined from T1 to T4. After 1 year, depression scores are similar to those of the general population, while anxiety scores remain elevated. The decline of the HADS scores depends on treatment, time since diagnosis, and education. Conclusions: Women receiving radio- or chemotherapy (compared with surgery only), with a long time since diagnosis, and with a low educational level are at high risk of maintaining high anxiety and depression scores over time.

Sexual Problems After Total or Partial Laryngectomy

Objectives: To investigate sexual problems that can occur after laryngeal and hypopharyngeal cancer surgery and to specify possible influencing factors.

Comorbid mental disorders in laryngectomees.

Objectives: This study attempted to determine the prevalence of mental disorders among laryngectomees and to assess the current status of the supplied psychooncological care. Patients and Methods: Patients who were laryngectomized between 1970 and 2001 were recruited at 6 different otolaryngology clinics in the region of Central Germany. 189 interviews were conducted. Structured clinical interviews (SCID) and standardized questionnaires (HADS, KFA) were used to assess patients’ mental health. The past and the current status of received psychotherapeutic care was evaluated. Results: 23% of the patients were diagnosed with mental disorders. The most frequently occurring disorder was alcohol dependency with 8%, followed by affective disorders (7% major depression, 5% minor depression). Only one patient was currently receiving psychotherapeutic or psychiatric treatment. Conclusion: Only a small fraction of the laryngectomy patients suffering from mental illness were receiving appropriate treatment.