Sigrun Vehling

Prävalenz affektiver und Angststörungen bei Krebs: Systematischer Literaturreview und Metaanalyse

We aimed to systematically summarize the empirical evidence on the 4-week-, 12-month-, and lifetime prevalence of affective and anxiety disorders in cancer patients. We evaluated 89 English or German language original papers and systematic reviews that assessed the prevalence of affective and anxiety disorders using structured clinical interviews published between 1995 and 2010. Adjusted prevalence rates were calculated using a random-intercept model. The pooled adjusted 4-week prevalence of affective disorders was 11.1% (95% CI 8.1-15.1), and 10.8% (95% CI 6.8-16.7) based on German studies. The pooled adjusted 4-week prevalence of anxiety disorders was 10.2% (95% CI 6.9-14.8), and 13.5% (95% CI 7.1-24.3) based on German studies. The findings show the need for further research on representative studies that take into account the range of psychosocial stressors and supportive care needs in addition to the prevalence of mental disorders.

Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients.

Objective: This longitudinal study examines the extent to which global meaning, existential distress in terms of demoralization, and depression are predicted by tumor stage (UICC stages 0–II vs III/IV), palliative treatment, and physical problems in cancer patients.

Symptom burden, loss of dignity, and demoralization in patients with cancer: a mediation model.

Demoralization is a syndrome of existential distress that occurs in a substantial minority of cancer patients and is associated with a higher number of physical problems. Loss of dignity refers to a range of specific existential concerns. This study examines whether the association between number of physical problems and demoralization is mediated by loss of dignity.

Prävalenz von Anpassungsstörung, Akuter und Posttraumati­scher Belastungsstörung sowie somatoformen Störungen bei Krebspatienten

We aimed to systematically summarize the empirical evidence on the 4-week-, 12-month-, and lifetime prevalence of adjustment disorders, acute and posttraumatic stress disorders as well as somatoform disorders in cancer patients. We evaluated 64 English or German language original papers and systematic reviews that assessed the prevalence of affective and anxiety disorders using structured clinical interviews published between 1995 and 2010. Adjusted prevalence rates were calculated using a random-intercept model. We found the following pooled adjusted 4-week prevalence rates: For adjustment disorder 12.5% (95% CI 9.9-15.7), for posttraumatic stress disorder 2.6% (95% CI 1.7-4.0), for acute stress disorder 4.8% (95% CI 2.2-10.0) and for somatoform disorders 3.1% (95% CI 1.6-5.8). Our findings show the need for further research on representative studies that take into account the range of psychosocial stressors and supportive care needs.

Assessment of Patients' Dignity in Cancer Care: Preliminary Psychometrics of the German Version of the Patient Dignity Inventory (PDI-G)

CONTEXT The Patient Dignity Inventory (PDI) is a valid and reliable instrument designed to measure different sources of dignity-related distress in cancer patients receiving palliative care. OBJECTIVES We investigated item characteristics, factor structure, reliability, and concurrent validity of the German version of the PDI (PDI-G) among patients with cancer. METHODS PDI was translated into the German language following state-of-the-art criteria. In a sample of 112 inpatients with mixed tumor types, principal component analysis, reliability analysis (Cronbachs coefficient alpha), and correlation analysis were performed. Concurrent validity was evaluated by validated measures of distress, demoralization, anxiety, depression, hopelessness, quality of life, sense of meaning and purpose, and supportive care needs. RESULTS Cronbachs coefficient alpha for PDI-G was 0.96; factor analysis resulted in a four-factor solution, accounting for 71% of the overall variance, with factor loadings ranging from 0.49 to 0.86. Factor labels include Loss of Sense of Worth and Meaning, Anxiety and Uncertainty, Physical Symptom Distress and Body Image, and Loss of Autonomy, showing high internal consistencies ranging from Cronbachs α 0.80 to 0.95. Evidence for concurrent validity was established by significant associations between PDI-G scales and concurrent measures of distress. CONCLUSION Although we were unable to replicate the five-factor structure provided by Chochinov, this study gave strong support to an alternative four-factor solution of PDI-G, capturing all 25 items. We conclude that PDI-G is a psychometrically sound instrument assessing a broad range of dignity-related distress issues in patients with cancer.

Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer.

Background Existential distress is an important factor affecting psychological well-being in cancer patients. We studied occurrence and predictors of demoralization, a syndrome of existential distress, in particular the interaction of age, gender, and curative vs. palliative treatment phase. Methods A cross-sectional sample of N = 750 patients with different tumor sites was recruited from in- and outpatient treatment facilities. Patients completed the following self-report questionnaires: Demoralization Scale, Patient Health Questionnaire-9, Illness-Specific Social Support Scale Short Version-8, and physical problems list of the NCCN Distress Thermometer. Moderated multiple regression analyses were conducted. Results We found high demoralization in 15% and moderate demoralization in 8% of the sample. Curative vs. palliative treatment phase moderated the impact of age and gender on demoralization (three-way interaction: b = 1.30, P = .02): the effect of age on demoralization was negative for women receiving palliative treatment (b = −.26, P = .02) and positive for men receiving palliative treatment (b = .25, P = .03). Effects of age and gender were not significant among patients receiving curative treatment. Female gender was associated with higher demoralization among younger patients receiving palliative treatment only. Analyses were controlled for significant effects of the number of physical problems (b = 6.10, P<.001) and social support (b = −3.17, P<.001). Conclusions Existential distress in terms of demoralization is a relevant problem within the spectrum of cancer-related distress. It is associated with a complex interaction of demographic and medical patient characteristics; existential challenges related to palliative treatment may exacerbate the impact of age- and gender-related vulnerability factors on demoralization. Psychosocial interventions should acknowledge this interaction in order to address the individual nature of existential distress in subgroups of cancer patients.

The association of demoralization with mental disorders and suicidal ideation in patients with cancer

Demoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co‐occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness.

Anxiety and depression in long-term testicular germ cell tumor survivors

OBJECTIVE Despite a good prognosis, the typically young age at diagnosis and physical sequelae may cause psychological distress in germ cell tumor survivors. We aimed to determine the frequency of anxiety and depression and analyze the impact of demographic and disease-related factors. METHOD We enrolled N=164 testicular germ cell tumor survivors receiving routine follow-up care at the University Cancer Center Hamburg and a specialized private practice (mean, 11.6 years after diagnosis). Patients completed the Generalized Anxiety Disorder Screener-7, the Patient Health Questionnaire-9 and the Memorial Symptom Assessment Scale-Short Form. RESULTS We found clinically significant anxiety present in 6.1% and depression present in 7.9% of survivors. A higher number of physical symptoms and having children were significantly associated with higher levels of both anxiety and depression in multivariate regression analyses controlling for age at diagnosis, cohabitation, socioeconomic status, time since diagnosis, metastatic disease and relapse. Younger age at diagnosis and shorter time since diagnosis were significantly associated with higher anxiety. CONCLUSION Although rates of clinically relevant anxiety and depression were comparably low, attention toward persisting physical symptoms and psychosocial needs related to a young age at diagnosis and having children will contribute to address potential long-term psychological distress in germ cell tumor survivors.

One in two cancer patients is significantly distressed: Prevalence and indicators of distress

Psychological distress is common in cancer patients, and awareness of its indicators is essential. We aimed to assess the prevalence of psychological distress and to identify problems indicative of high distress.

A concept map of death-related anxieties in patients with advanced cancer

Objectives Fear of death and dying is common in patients with advanced cancer, but can be difficult to address in clinical conversations. We aimed to show that the experience of death anxiety may be deconstructed into a network of specific concerns and to provide a map of their interconnections to aid clinical exploration. Methods We studied a sample of 382 patients with advanced cancer recruited from outpatient clinics at the Princess Margaret Cancer Centre, Toronto, Canada. Patients completed the 15-item Death and Dying Distress Scale (DADDS). We used item ratings to estimate a regularised partial correlation network of death and dying-related concerns. We calculated node closeness-centrality, clustering and global network characteristics. Results Death-related anxieties were highly frequent, each associated with at least moderate distress in 22%–55% of patients. Distress about ‘Running out of time’ was a central concern in the network. The network was organised into two areas: one about more practical fears concerning the process of dying and another about more psychosocial or existential concerns including relational problems, uncertainty about the future and missed opportunities. Both areas were yet closely connected by bridges which, for example, linked fear of suffering and a prolonged death to fear of burdening others. Conclusions Patients with advanced cancer may have many interconnected death-related fears that can be patterned in individual ways. The bridging links between more practical and more psychosocial concerns emphasise that the alleviation of death anxiety may require interventions that integrate symptom management, advance care planning and psychological treatment approaches.