Health-related quality of life and distress in cancer patients: results from a large randomised study.

To compare the effectiveness of individual support, group rehabilitation and a combination of the two in improving health-related quality of life (HRQOL) and psychological well-being in cancer patients during 24 months after diagnosis, as compared with standard care (SC). Furthermore, to compare the study sample and a random sample of the Swedish population with regard to HRQOL. A total of 481 consecutive patients, newly diagnosed with cancer, were randomly assigned to one of the four alternatives. Data on HRQOL and psychological well-being were collected at baseline and after 3, 6, 12 and 24 months. The interventions did not improve HRQOL or psychological well-being, as compared with SC. At 3 months, the study sample reported an HRQOL comparable with the normal population. Many cancer patients are able to manage their cancer-related concerns with the support available from SC. However, it is reasonable to assume that the findings suffer from a lack of data from especially vulnerable patients and a possible Hawthorne effect. It cannot be concluded that cancer patients have no need for additional psychosocial interventions. Future projects should include screening and target interventions for those at risk for significant and prolonged psychological distress.

Prediction of post-operative pain after a laparoscopic tubal ligation procedure.

BACKGROUND: Pre-operative identification of reliable predictors of post-operative pain may lead to improved pain management strategies. We investigated the correlation between pre-operative pain, psychometric variables, response to heat stimuli and post-operative pain following a laparoscopic tubal ligation procedure. METHODS: Assessments of anxiety, mood, psychological vulnerability and pre-operative pain were made before surgery using the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety Depression Scale (HADS), a psychological vulnerability test and the Short-Form McGill Pain Questionnaire (SF-MPQ), respectively. Pre-operative assessments of thermal thresholds and pain response to randomized series of heat stimuli (1 s, 44-48 degrees C) were made with quantitative sensory testing technique. Post-operative pain intensity was evaluated daily by a visual analogue scale during rest and during standardized dynamic conditions for 10 days following surgery. Univariate and multivariate regression analyses were used to construct prediction models. RESULTS: Fifty-nine patients completed the study. Post-operative pain was significantly correlated with pre-operative pain (SF-MPQ), heat pain perception, psychological vulnerability, STAI and HADS. In the multiple regression model pre-operative pain and heat pain perception were significant predictive factors (R=0.537-0.609). CONCLUSION: The study indicates that pre-surgical pain and heat pain sensitivity are important pre-operative indicators of post-operative pain intensity, while psychological factors like vulnerability and anxiety seem to contribute to a lesser degree after laparoscopic tubal ligation. The prediction model accounted for 29-43% of the total variance in post-operative movement-related pain.

Reduced utilisation of specialist care among elderly cancer patients: a randomised study of a primary healthcare intervention.

The aim of this study was to evaluate the effect of an individual support (IS) intervention including intensified primary healthcare on the utilisation of specialist care among cancer patients, and to investigate if such an effect was modified by the patient's age (less than 70 years or 70 years and more). Newly diagnosed cancer patients (n=416) were randomised between the intervention and a control condition, and data were collected on the utilisation of specialist care within 3 months from inclusion. Intensified primary healthcare comprised extended information from the specialist clinics, and education and supervision in cancer care for general practitioners (GPs) and home-care nurses. The support given also included interventions designed to diminish problems of weight loss and psychological distress. The intervention reduced the number of admissions (NoA) and the days of hospitalisation (DoH) after adjustment for weight loss and psychological distress, but only for older patients. Older patients randomised to the intervention (n=82) experienced 393 fewer DoH than the older control patients (n=79). In addition, the proportion of older patients in the IS group who utilised acute specialist care was smaller compared with older control patients group. The conclusion is that older cancer patients' utilisation of specialist care may be reduced by intensified primary healthcare services.

Individual psychological support for cancer patients: utilisation and patient satisfaction.

A short-term, problem-focused Individual Psychological Support (IPS) intervention was evaluated. The IPS was one of the interventions in a study where 527 patients newly diagnosed with breast, colorectal, gastric or prostate cancer were randomised between IPS (n = 265) and a control condition (n = 262). The IPS made use of cognitive-behavioural techniques and aimed at reducing depression and anxiety, to increase the feeling of mastery of the situation and to facilitate active participation in medical treatments. Half of the patients receiving the IPS had more than 2 sessions. After termination of the IPS, the patients were mailed a questionnaire concerning satisfaction with and perceived benefit from the IPS. A majority of the responding patients stated that their problems were addressed to a great extent, that the number of contacts was adequate and that the IPS came at the right time. Patients reporting problems received more sessions and perceived more benefits than patients reporting no problems.

Assessment and treatment of psychosocial problems in cancer patients: an exploratory study of a course for nurses.

A course in psychosocial oncology for nurses was developed and evaluated within the framework of a prospective randomised study. Six nurses participated. Areas covered were basic techniques for assessment of psychosocial problems, for relieving anxiety and depression, solving problems in conjunction with treatment and disease, and improving communication. Participants met for four 3h weekly lessons. Between meetings, they met to train assessment and techniques. Follow-up discussions were held at termination and 5 months later. Participants reported that the new knowledge and skills had made them feel more confident when handling patients' psychosocial situation. However, treatment of psychological problems did not prove to be a predominant aspect of their patient work. The evaluation of the course suggests that participants improved their skills for assessment of patient problems and, therefore, felt more confident when handling psychosocial issues.