Susanne Singer

Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis

BACKGROUND To what extent is professional psychosocial care of cancer patients in acute hospitals necessary? In a previous meta-analysis, prevalence of psychological sequelae was found to be the same as in the general population. New studies with advanced methodology have been published since; therefore, an updated meta-analysis was needed. METHODS We systematically reviewed studies assessing the prevalence of mental health conditions in acute care hospitals with comprehensive structured clinical interviews. RESULTS Of 46 retrieved manuscripts, eight were deemed eligible for this meta-analysis. Within the studies, 1448 cancer patients had been assessed, whereby 456 were diagnosed having a mental health disorder. The prevalence rates ranged from 23% (breast cancer patients in Turkey) to 53% (elderly cancer patients in Uganda). The combined prevalence estimate is 32% (95% confidence interval 27% to 37%). CONCLUSION One-third of the cancer patients in acute care hospitals is suffering from mental health disorders and need appropriate treatment.

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.

The European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life questionnaire cervical cancer module: EORTC QLQ-CX24.

The authors report on the development and validation of a cervical cancer module for the European Organization for Research and Treatment of Cancer (EORTC) Quality‐of‐Life (QoL) questionnaire (QLQ), which was designed to assess disease‐specific and treatment‐specific aspects of QoL in patients with cervical cancer.

Function, postoperative morbidity, and quality of life after cervical sentinel node biopsy and after selective neck dissection.

Sentinel node biopsy (SNB) has been proposed for staging of N0 neck in oral/oropharyngeal carcinomas. It is claimed that SNB may be superior to selective neck dissection (SND) with respect to quality of life (QOL) and postoperative morbidity.

Health-Related Quality of Life During the 10 Years After Diagnosis of Colorectal Cancer: A Population-Based Study

PURPOSE To compare long-term quality of life (QoL) of colorectal cancer survivors with QoL in the general population and investigate changes in QoL of survivors during the 10 years after diagnosis. PATIENTS AND METHODS Health-related QoL was assessed 1, 3, 5, and 10 years after diagnosis in a population-based cohort starting with 439 patients with colorectal cancer from Saarland, Germany, using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. QoL after 5 and 10 years and time course of QoL during the 10 years after diagnosis were compared with controls from the general population of Germany, after controlling for sex and age. RESULTS Overall, 234 and 196 patients were still alive after 5 and 10 years, respectively. Of these survivors, 178 (76%) responded in the 5-year follow-up, 133 (68%) in the 10-year follow-up, and 117 (60%) participated in all follow-ups. Over the entire follow-up, younger survivors (age at diagnosis, < 60 years) reported restrictions in role, social, emotional, and cognitive functioning and specific problems like constipation, diarrhea, fatigue, and insomnia. Older survivors (age at diagnosis, ≥ 70 years) reported comparable or even better QoL than controls within the first 3 to 5 years after diagnosis and comparable to worse QoL 5 to 10 years after diagnosis. CONCLUSION Although younger survivors continuously reported detriments in various QoL dimensions during the 10-year period after diagnosis, detriments in older survivors became apparent in the long run only.

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 long-term breast cancer survivors – a 10-year longitudinal population-based study

Abstract Background. Breast cancer survivors may experience adverse effects of cancer and/or treatment years after completion of therapy, which can considerably decrease quality of life (QoL). Little is known about the time course of QoL in breast cancer survivors beyond the fifth year post-diagnosis, when routine follow-up care has usually terminated. We therefore explored in detail whether and to what extent restrictions in breast cancer survivors persist and whether changes or aggravations in QoL occurred over time. Material and methods. QoL was assessed 1, 3, 5, and 10 years post-diagnosis in a population-based cohort of initially 387 female breast cancer patients from Saarland (Germany), using the EORTC QLQ-C30 and QLQ-BR23. Time course of QoL over 10 years post-diagnosis was assessed for survivors and survivors’ QoL was compared cross-sectionally to the German general population after adjustment for age. Results. A total of 182 out of 238 patients alive (76.5%) responded in the 10-year, 160 patients (67.2%) participated in all follow-ups. Although breast cancer survivors and controls reported comparable general health and overall QoL, survivors reported significantly more restrictions on most functioning and symptom scales at each follow-up. Detriments in various QoL dimensions (e.g. physical and social functioning; pain, financial difficulties) aggravated from year 5 to 10. Generally, restrictions were largest for the youngest survivors. Conclusion. Relevant restrictions in QoL persist over years in breast cancer survivors and affect predominantly younger women. The aggravation of restrictions in QoL beyond the fifth year may indicate deficits in health care and psychosocial support of breast cancer patients after completion of routine follow-up care.

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.

European reference values for the quality of life questionnaire EORTC QLQ-C30: Results of a German investigation and a summarizing analysis of six European general population normative studies

Abstract Background. The aims of this study are to present the results of a new general population normative study of the quality of life questionnaire EORTC QLQ-C30 and to give European reference values averaged across six studies. Methods. The empirical study was based on a representative sample of the German adult population (N = 2448). The subjects were asked to fill in several questionnaires, one of them being the EORTC QLQ-C30. Results. EORTC QLQ-C30 mean scores of this sample indicated slightly better quality of life (QoL) than in previous European studies. QoL decreased with age, but there were only small gender differences. The mean scores were compared with the age and gender adjusted scores of five other European normative studies from Sweden, the Netherlands, Norway, and Germany (N between 1731 and 4910). Finally, the data of these five studies and the new study were combined to arrive at averaged European normative values for the scales and the symptom items of the questionnaire. Conclusion. The reference values of the scales pooled across six European studies (N = 16 151) can be used as general population references for QoL scores of cancer patients.

Prevalence of Symptoms of Anxiety and Depression in German Patients With Cystic Fibrosis

BACKGROUND Chronic illness is a significant risk factor for the development of internalizing psychopathology; however, evidence for the prevalence of these symptoms in patients with cystic fibrosis (CF) is limited. We investigated the prevalence of symptoms of anxiety and depression in German-speaking patients with CF and the association of these symptoms to physical health status. METHODS A representative sample of German patients with CF (N = 670; age range, 12-64 years; 52.7% men) completed the Hospital Anxiety and Depression Scale. Their medical data were taken from the German CF registry. Data on the study sample were compared with data on a control group from the German general population. RESULTS Elevated anxiety scores were found in 20.6% of the patients with CF, and 9.6% reported high levels of symptoms of depression. Adult patients with CF reported more elevated symptoms of anxiety than healthy control subjects, whereas no age group of patients was more or less depressed than the general population. Younger patients reported fewer symptoms of anxiety and depression than older patients, and women reported more symptoms of anxiety than men. Recent hemoptysis/pneumothorax and recent diagnosis of diabetes were associated with anxiety, whereas impaired lung function and transplant listing status were associated with depression. CONCLUSIONS Anxiety in particular is an important issue for a large proportion of patients with CF. The risk of depression increased with greater impairment in pulmonary function. Annual screening of symptoms of anxiety and depression as well as appropriate referrals for those in the clinically elevated range are recommended.