Distress in hospitalized cancer patients: Associations with personality traits, clinical and psychosocial characteristics.

OBJECTIVE: To improve allocation of psychosocial care and to provide patient-oriented support offers, identification of determinants of elevated distress is needed. So far, there is a lack of evidence investigating the interplay between individual disposition and current clinical and psychosocial determinants of distress in the inpatient setting. METHODS: In this cross-sectional study, we investigated 879 inpatients with different cancer sites treated in a German Comprehensive Cancer Center. Assessment of determinants of elevated distress included sociodemographic, clinical and psychosocial characteristics as well as dimensions of personality. Multiple linear regression was applied to identify determinants of psychosocial distress. RESULTS: Mean age of the patients was M = 61.9 (SD = 11.8), 48.1% were women. In the multiple linear regression model younger age (ß = -0.061, p = 0.033), higher neuroticism (ß = 0.178, p = <0.001), having metastases (ß = 0.091, p = 0.002), being in a worse physical condition (ß = 0.380, p = <0.001), depressive symptoms (ß = 0.270, p = <0.001), not feeling well informed about psychological support (ß = 0.054, p = 0.046) and previous uptake of psychological treatment (ß = 0.067, p = 0.020) showed significant associations with higher psychosocial distress. The adjusted R2 of the overall model was 0.464. CONCLUSION: Controlling for sociodemographic characteristics and dispositional vulnerability, that is neuroticism, current clinical and psychosocial characteristics were still associated with hospitalized patients' psychosocial distress. Psycho-oncologists should address both, the more transient emotional responses, such as depressive symptoms, as well as more enduring patient characteristics, like neuroticism.

[Differences in Area Specific Life Satisfaction Between East and West Germans in the Years 1991, 2006 and 2020]. / Unterschiede in der Zufriedenheit verschiedener Lebensbereiche zwischen Ost- und Westdeutschen in den Jahren 1991, 2006 und 2020.

RESEARCH: Question How did the general and area specific life satisfaction evolve between East and West Germany between 1991 and 2020? METHODS: Based on three representative surveys in the years 1991, 2006 and 2020 life satisfaction between East and West Germany was examined using mean comparison with tests of significance. The influence of relevant sociodemographic variables was calculated using Univariate Variance Analyses. RESULTS: 1991 large differences in the general life satisfaction as well as with satisfaction in the areas of living, spare time, health, finances and occupational did occur, with people in East Germany reporting to be less satisfied. These differences align during the observation time. DISCUSSION: The discrepancy in the general and area specific life satisfaction between East and West Germans did align during the last 30 years. A reason might be the improved economical living conditions in East Germany.

Information, communication, and cancer patients' trust in the physician: what challenges do we have to face in an era of precision cancer medicine?

PURPOSE: Despite promising achievements in precision cancer medicine (PCM), participating patients are still faced with manifold uncertainties, especially regarding a potential treatment benefit of molecular diagnostics (MD). Hence, MD poses considerable challenges for patient information and communication. To meet these challenges, healthcare professionals need to gain deeper insight into patients' subjective experiences. Therefore, this qualitative study examined information aspects of MD programs in cancer patients. METHODS: In two German Comprehensive Cancer Centers, 30 cancer patients undergoing MD participated in semi-structured interviews on information transfer and information needs regarding MD. Additionally, patients provided sociodemographic and medical data and indicated their subjective level of information (visual analogue scale, VAS, 0-10). RESULTS: On average patients had high levels of information (mean = 7, median = 8); nevertheless 20% (n = 6) showed an information level below 5 points. Qualitative analysis revealed that patients show limited understanding of the complex background of MD and have uncertainties regarding their personal benefit. Further, patients described unmet information needs. Existential threat in awaiting the results was experienced as burdensome. To withstand the strains of their situation, patients emphasized the importance of trusting their physician. CONCLUSION: The challenges in PCM consist in providing unambiguous information, especially concerning treatment benefit, and providing guidance and support. Therefore, psycho-oncology needs to develop guidelines for adequate patient communication in order to help healthcare providers and cancer patients to handle these challenges in the developing field of PCM.

Quality of Life and Satisfaction in Transgender Men After Phalloplasty in a Retrospective Study.

BACKGROUND: Partly as a result of the increasing attention directed toward transgender individuals and despite much research work on the topic of quality of life (QOL) of transgender, there is still a lack of studies using standardized questionnaires in their evaluation. AIMS: We designed a survey to evaluate the influence of surgery after phalloplasty (osteofasciocutaneous fibula free flap or osteofasciocutaneous radial free forearm flap) on QOL, emotional stability, self-esteem, and psyche of postoperated transgender men. METHODS: The present study included 32 transgender men who had undergone gender-affirming surgery (GAS) exclusively in our department between 2000 and 2012. Apart from our self-developed, indication-specific questionnaire with questions on socioeconomic and demographic data as well as postoperative satisfaction, the testing instrument included 4 frequently used, standardized testing instruments, which we compared with normative data. These included (a) a self-assessment test Fragebogen zur Lebenszufriedenheit with questions on QOL consisting of 3 modules (general satisfaction, satisfaction with health, and satisfaction with body image/outer appearance), (b) the Freiburg Personality Inventory, (c) the Rosenberg Self-Esteem Questionnaire, and (d) the Patient Health Questionnaire 4. FINDINGS: Our self-developed, indication-specific questionnaire showed that 88% of our patients were very satisfied with the aesthetic result, 75% have had sex after surgery, and 72% were very satisfied with sexual function after GAS. Eighty-one percent had a strong improvement of QOL, and 91% would undergo the same treatment again. Eighty-four percent would recommend GAS to others. All patients lived as men fulltime. DISCUSSION: Our study reveals that GAS plays an important part in the interdisciplinary treatment of transgender individuals as it improves the QOL in transgender men in most aspects of everyday life and has a positive influence on the patients' psyche and self-esteem in a retrospective study.

Cancer patients' expectations when undergoing extensive molecular diagnostics-A qualitative study.

OBJECTIVE: Precision cancer medicine (PCM) aims at identifying tumor-driving molecular characteristics to improve therapy. Despite early successes for some cancers, the approach faces manifold challenges. Patients undergoing extensive molecular diagnostics (MD) may hope for personal benefit, although chances are small. In order to offer suitable support to this group, health-care professionals need to gain insight into patients' experience. Thus, this study sought to explore the expectations of cancer patients undergoing MD of their tumor. METHODS: In two German Comprehensive Cancer Centers, 30 patients with advanced-stage cancer who had exhausted conventional treatment and had consented to extensive, research-oriented MD (whole-genome sequencing n = 24, panel sequencing n = 6) participated in semi-structured interviews. Following thematic content analysis by Kuckartz, the interview transcripts were coded for expectations of MD participation and topics closely related. Moreover, patients completed questionnaires on their sociodemographic characteristics, medical history, and psychosocial distress. RESULTS: Patients reported to be expecting (a) an improvement of their treatment, (b) a contribution to research, and/or (c) additional insight to their own cancer. Further, they described to feel individually appreciated and to have a reason to maintain hope for cure or recovery by participating in MD. CONCLUSIONS: Molecular diagnostics participation led patients to feel treated in a more "personalized" way, allowing them a greater sense of control in their situation of severe illness. Oncologists and psycho-oncologists need to ensure comprehensive information and empathetic support for patients undergoing extensive MD to balance their expectations and actual chances of clinical benefit.

Distress in cancer patients: Who are the main groups at risk?

OBJECTIVES: Psychosocial distress is common in cancer patients and survivors and encompasses a broad range of concerns and psychological symptoms. The aim of the current study was to identify subgroups of respondents who experience a specific constellation of distress symptoms. METHODS: This study uses data from a large data base (n = 21 680) of cancer patients from diverse settings who provided data in the Questionnaire on Distress in Cancer Patients-Short Form (QSC-R10). Cluster analysis was applied to identify subgroups with a distinct constellation of distress symptoms. RESULTS: The results showed five distinct clusters: minimally distressed patients (46.6% of the sample), highly distressed patients (12.7%), mainly physically distressed patients (15.2%), mainly psychologically distressed patients (15.6%), and mainly socially distressed patients (9.9%). These groups differed with regard to age, sex, cancer site, treatment setting, and disease progression. CONCLUSION: The results revealed large heterogeneity in the experience of distress. Distress clusters were associated with socio-demographic and clinical variables. These associations might aid a clinician to tailor interventions and to address specific types of distress.

Psychometric Properties of the Fear of Progression Questionnaire for Children (FoP-Q-SF/C).

BACKGROUND: Recent research shows that parents of children suffer from fear of progression (FoP), the fear of further disease progression. It is most possible that children also develop FoP, which could impair treatment and psychological health. The aim of this study is to adapt the adult's version of the Fear of Progression Questionnaire - Short Form (FoP-Q-SF) for children and to examine the psychometric properties in pediatric cancer patients. PATIENTS: 32 pediatric cancer patients between 10 and 18 years with different diagnoses and in different treatment states participated in this study. METHOD: In the cross-sectional study participants completed the adapted Fear of Progression Questionnaire - Short Form for Children (FoP-Q-SF/C) and self-report measures assessing quality of life, depression, fear and coping satisfaction. RESULTS: The questionnaire (FoP-Q-SF/C) showed adequate psychometric properties (Cronbachs α=0.86) and good results for construct validity. Significant medium to large correlations of children's FoP was observed with quality of life (r=- 0.37), depression (r=0.52), fear (r=0.33 - 0.76), and satisfaction with coping (r=- 0.44). One-fifth of the sample was classified as having high FoP with values over 37. CONCLUSIONS: The FoP-Q-SF/C is a short, economic questionnaire that is applicable in children with cancer. Clinicians can use the questionnaire to explore specific fear and the need for psychosocial support. Further research for specific treatment approaches for FoP in pediatric cancer patients are warranted. HINTERGRUND: Aktuelle Forschungsergebnisse zeigen, dass Eltern krebskranker Kinder unter Progredienzangst (PA), der Angst vor dem Fortschreiten einer Erkrankung leiden. Es scheint naheliegend, dass auch Kinder diese Ängste entwickeln, was die Behandlung und die psychologische Gesundheit beeinflussen kann. Ziel der Studie ist die Adaption des Progredienzangst-Fragebogens (FoP-Q-SF) für Kinder und die Ermittlung der psychometrischen Eigenschaften für pädiatrische Onkologiepatienten. PATIENTEN: 32 pädiatrische Krebspatienten zwischen 10 und 18 Jahren mit unterschiedlichen Krebsdiagnosen und in unterschiedlichen Behandlungsstadien nahmen an der Studie teil. METHODE: In der Querschnittsstudie beantworteten die Teilnehmenden den adaptierten Progredienzangst-Fragebogen-Kurzversion für Kinder (FoP-Q-SF/C) und Selbstbeantwortungsfragebögen zu Lebensqualität, Depression, Angst und Copingzufriedenheit. ERGEBNISSE: Der Fragebogen (FoP-Q-SF/C) zeigte adäquate psychometrische Eigenschaften (Cronbachs α=0,86) und Konstrukvalidität. Signifikante Korrelationen wurden zwischen Progredienzangst und Lebensqualität (r=- 0,37), Depression (r=0,52), Angst (r=0,33-0,76), und Copingzufriedenheit (r=- 0,44) gefunden. Ein Fünftel der Stichprobe zeigte hohe Progredienzangstwerte mit Werten über 37. SCHLUSSFOLGERUNG: Der FoP-Q-SF/C ist ein kurzer, ökonomischer Fragebogen, der für krebskranke Kinder passend ist. Kliniker können den Fragebogen einsetzen, um PA und die Notwendigkeit von psychosozialer Unterstützung zu erfassen. Weitere Forschungsarbeiten für spezifische Behandlungsansätze von PA in der pädiatrischen Onkologie sind wünschenswert.

Psychological Pathologies and Sexual Orientation in Transgender Women Undergoing Gender Confirming Treatment.

BACKGROUND: There are few studies evaluating depression, self-esteem, and mental health after gender confirming treatment of transgender women. Most of these studies include different surgical techniques and nonvalidated questionnaires. With our survey, we are aiming to assess psychopathologies and mental health as well as sexuality among a group of patients treated by the same surgeon performing our self-developed combined surgical technique. This vaginoplasty approach is characterized by constructing the vaginal cavity with parts of the penile and scrotal skin as well as the longitudinally incised urethra. MATERIALS AND METHODS: Forty-seven transgender women who underwent gender confirming treatment between 2007 and 2013 were included in a retrospective study. The assessment of our study group was performed by means of self-developed indication-specific questionnaires and 3 standardized questionnaires that can be compared with norm data. RESULTS: Preoperative psychotherapy was mostly considered as helpful by the patients, yet postoperatively, only a third of our study participants were still under therapeutic treatment. Furthermore, we could show a change in sexual preference toward a more bisexual orientation. Gender confirming treatment satisfied the expectations for most of the patients and, in their opinion, should have been performed earlier. Results of the standardized Patient Health Questionnaire 4, a short depression screening questionnaire, did not significantly differ from healthy norm data. The Freiburg Personality Inventory, Revised, revealed normal emotionality and sane self-assessment within our study group. High self-esteem and significantly higher scores than norm data were found for the Rosenberg Self-esteem Scale. CONCLUSIONS: Gender confirming treatment with the combined technique is an important part of a multi-structured treatment of transgenders and does have effects on psychological well-being. It seems to decrease psychopathologies and implicates several ameliorations for transgender women. Findings need to be verified in prospective studies including preoperative evaluations.

Factors associated with the decline of psychological support in hospitalized patients with cancer.

OBJECTIVE: Many distressed cancer patients do not want or, finally, do not use psychological support. This study aimed at identifying factors associated with the decline of psychological support during hospital stay. METHODS: This cross-sectional study included inpatients with different cancer diagnoses. Distress was assessed using the short form of the Questionnaire on Stress in Cancer Patients-Revised (QSC-R10) and the Distress Thermometer (DT). Multivariable logistic regression was used to identify factors associated with decline. RESULTS: Of 925 patients, 71.6% (n = 662) declined psychological support. Male sex (OR = 2.54, 95% CI = 1.69-3.80), low psychosocial distress (OR = 3.76, CI = 2.50-5.67), not feeling depressed (OR = 1.93, CI = 1.24-2.99), perceived overload (OR = 3.37, CI = 2.19-5.20), no previous psychological treatment (OR = 1.88, CI = 1.25-2.83), and feeling well informed about psychological support (OR = 1.66, CI = 1.11-2.46) were associated with decline. Among the patients who indicated clinical distress (46.2%), 53.9% declined psychological support. Male sex (OR = 2.96, CI = 1.71-5.12), not feeling depressed (OR = 1.87, CI = 1.12-3.14), perceived overload (OR = 5.37, CI = 3.07-9.37), agreeableness (OR = 0.70, CI = 0.51-0.95), and feeling well informed about psychological support (OR = 1.81, CI = 1.07-3.07) were uniquely associated with decline in this subgroup. CONCLUSIONS: Decline of psychological support is primarily due to psychological factors. Feeling well informed about support emerged as a relevant factor associated with decline. Thus, design of informational material and education about available psychological services seem crucial.

The Effect of Blepharoplasty on Our Patient's Quality of Life, Emotional Stability, and Self-Esteem.

BACKGROUND: Several studies have been conducted evaluating psychological effects following aesthetic surgery, however few of them following blepharoplasty! PURPOSE: To determine whether blepharoplasty affects quality of life and satisfaction as well as, emotional stability and self-esteem in patients who underwent only blepharoplasty. DESIGN: A retrospective study including transdermal blepharoplasty operations between the years 1995 and 2008. METHODS: A self-developed and indication-specific questionnaire especially for blepharoplasty, as well as the standardized testing instruments FLZM, FPI-R, and RSES, concerning quality of life, body image, personality, and self-esteem was utilized. PARTICIPANTS: A total of 123 patients were included in the study. Forty-six patients participated in the study. MAIN OUTCOMES AND MEASURES: Results were compared with the existing representative norm data from the German speaking countries. RESULTS: In the indication-specific questionnaire, 44 patients reported a positive influence on their personal wellbeing, and 33 were more satisfied with their appearance (follow-up 3-95 months; average 48.5 months); 20 felt more self-confident, and 25 felt more attractive.Statistically significant increased values in quality of life (FLZM) were found in the aspects work (P = 0.02), mobility (P < 0.001) and independence from assistance or help (P < 0.001).Higher scores concerning personality and self-esteem compared with the respective random sample were found in the questionnaires FPI-R (P = 0.02) and RSES (P < 0.001). CONCLUSION AND RELEVANCE: Among plastic surgical interventions, blepharoplasty is a minimal invasive operation, which is very well tolerated by patients. Patients take advantage in personal wellbeing, self-esteem, and different aspects of their daily life.

[Quality of life and Potential Incriminating Factors Among Palliative Care Givers: A German Survey of the KOMPACT Working Group]. / Belastungen im Berufsalltag von Palliativpflegekräften ­ eine Befragung in Kooperation mit dem KompetenzZentrum Palliative Care Baden-Württemberg (KOMPACT).

AIM OF THE STUDY: Due to the aging population in Germany, the need for palliative care institutions will increase. Considering the lack of resources, work stress of palliative care nurses could increase significantly. It was the aim of this study to identify risk factors for job overload and work stress of palliative care nurses in the inpatient and outpatient setting. METHODS: In cooperation with the KOMPACT Working Group, we conducted an anonymous survey of palliative care givers in Baden-Württemberg, Germany. We used a paper questionnaire to inquire about job stress and workload, self-assessment of health condition and aspects about mental and emotional well-being. 167 palliative care nurses from 34 different institutions participated in the survey. RESULTS: The results showed a significant difference between inpatient and outpatient palliative care workers regarding the type and intensity of work stress. The overall stress level was significantly higher for the nurses in inpatient palliative care units (p<0.001). A high weekly working time combined with missing work experience in the field of palliative care led to a poorer compatibility of job and family. Higher stress levels resulted in a lower satisfaction with the work. Dissatisfaction with the working conditions was associated with a worse health status defined by self-assessment. Mental and emotional condition of palliative care nurses was significantly worse in comparison with the norm sample, many nurses showed "strikingly" or even "seriously" high values. The survey also showed that the structural conditions in inpatient palliative care units were not optimal. CONCLUSION: Compared to outpatient palliative care services, working conditions seem to be worse in inpatient palliative care setting, which could result in higher stress for the nurses. Interventions to reduce work-related stress appear not to be well implemented in the daily work of palliative care nurses. Standards for care as well as advanced training programs for palliative care nurses should be reevaluated.

Fear of Progression in Cancer Patients and Survivors.

Fear of progression (or fear of recurrence) is an appropriate, adequate response to the real threat of cancer. However, elevated levels of fear of progression can become dysfunctional, affecting well-being, quality of life, and social functioning. Research has shown that fear of progression is one of the most frequent distress symptoms of patients with cancer. As a clear consensus concerning clinically relevant states of fear of progression is still lacking, it is difficult to provide a valid estimate of the rate of cancer patients who clearly suffer from fear of progression. Current evidence suggests that probably 50% of cancer survivors experience moderate to severe fear of progression. Furthermore, many patients express unmet needs in dealing with the fear of cancer spreading. These results underscore the need to provide effective psychological treatments for clinical states of fear of progression. Some psychosocial interventions for treating fear of progression have been developed. Our own, targeted intervention study showed that clinical fear of progression can be effectively treated with brief group therapy.

Male-to-Female Sex Reassignment Surgery using the Combined Vaginoplasty Technique: Satisfaction of Transgender Patients with Aesthetic, Functional, and Sexual Outcomes.

BACKGROUND: Currently available patient-reported outcome measures are limited in the field of sex reassignment surgery (SRS). Standardized questionnaires deliver high evidence data on satisfaction of male-to-female (MTF) transgender patients but do not allow any modification in their clinical application. We therefore designed a prospective study using self-developed indication-specific questionnaires to evaluate the aesthetic, functional, and sexual outcomes of MTF patients undergoing SRS. METHODS: Forty-nine adult MTF transgender patients who underwent two-stage SRS were eligible for study inclusion between September 2012 and January 2014. Forty patients (= N) ultimately filled out both parts of the questionnaire sets: 1 day before the first stage (T0) and 6 months after the second stage of SRS (T1). These questionnaires focused on demographic characteristics, the satisfaction with aesthetic and functional results, and sexuality. RESULTS: Patients rated their surgical satisfaction of most items with mean scores above 7 on a 0-10-point scale. Many items evaluating everyday life activities improved significantly after SRS compared to T0 (p < 0.01). All but one patient (97.5%) reported no regrets about having undergone surgery, and the majority recommended it to other patients with gender dysphoria. Femininity and sexual activity increased significantly postoperatively (p < 0.01). Satisfaction with intercourse and orgasm was high: 6.70 and 8.21, respectively, on a 0-10 scale. CONCLUSION: Satisfaction with the cosmetic outcome, as well as the functional and sexual outcomes, reveal positive effects of SRS using the combined technique on transgender patient lives. Nevertheless, standardized and validated SRS-specific questionnaires are lacking. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Cognitive-Behavioral Group Therapy Addressing Fear of Progression in Cancer Out-Patients]. / Ambulante verhaltenstherapeutische Gruppentherapie zur Behandlung von Progredienzangst bei Krebspatienten.

Fear of progression (FoP) is an appropriate, rational response to the real threat of cancer and its treatments. However, patients experiencing elevated, dysfunctional levels of FoP often feel severely distressed and are in need of treatment. We previously conducted a (partly-)randomized controlled study with cancer patients undergoing in-patient rehabilitation and showed that a brief, four-session cognitive-behavioral group therapy significantly reduced dysfunctional FoP. In this report, we describe the adaption of the cognitive-behavioral group therapy program for use with cancer out-patients. This group therapy program was conducted in the psycho-oncological out-patient department of a large university hospital. It comprises 6 group sessions lasting 90 min each. Because of the larger number of sessions there is more room for the use of exposure-based techniques. Imaginal exposure is used to confront the patient's cancer-related fears and worries. Patients are asked to vividly recount their worries and to think of what would be the worst that can happen (worst-case scenario exercise). In addition, interventions that focus the patient's ressources are applied. The completion of 3 group therapies in the pilot phase supported the feasibility of the program. Pre-post evaluation (n=10) revealed a significant decline of FoP (Fear of Progression Questionnaire, FoP-Q) from M=12,0 (SD=2,0) to M=10,3 (SD=1,7), p=0.029. This represents a large effect (Cohen's d=0.9). Three out of 14 participants (21%) quit treatment after 2 sessions. In sum, the results and our experiences show that this out-patient group therapy program is feasible and probably effective. However, it also shows that some patients regard confronting their cancer-related fears and worries as too stressful. High ambivalence with regard to exposure seems to increase the risk for premature termination. Thus, cancer patients should be thoroughly educated before starting exposure-based treatment of dysfunctional FoP.

Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery.

BACKGROUND: Surveys on quality of life (QOL) of male-to-female (MTF) transsexuals have found low QOL scores before and increased satisfaction scores after sex-reassignment surgery (SRS). To our knowledge, many of them lack standardized questionnaires and comparisons with normative data to evaluate different vaginoplasty techniques. AIM: To analyze patient satisfaction and QOL after SRS. METHODS: Forty-seven patients participated in this study. All patients had surgery with our self-developed combined technique on average 19 months before the survey. They completed a self-developed indication-specific questionnaire concerning demographic and socioeconomic issues and postoperative satisfaction. Furthermore, a standardized self-assessment questionnaire on satisfaction and QOL (Fragen zur LebenszufriedenheitModule [FLZM]; Questions on Life SatisfactionModules) was used. The FLZM consists of three modules (general life satisfaction, satisfaction with health, and satisfaction with body image) with scores of weighted satisfaction for each item. Results of the general and health modules were compared with normative data. OUTCOMES: Demographics, QOL, general life satisfaction, satisfaction with health, and satisfaction with body image. RESULTS: The self-developed indication-specific questionnaire showed that 91% experienced an improvement of QOL. All patients stated they would undergo SRS again and did not regret it at all. Patients stated their femininity significantly increased. For the FLZM, the sum score for general life satisfaction (P < .001) was significantly lower than the normative data, whereas the sum score of the satisfaction with health module (P = .038) did not reach statistical significance. The two modules also showed positive trends for different items. Values of the body image module showed a significant increase in satisfaction with breasts (P < .001) and genitals (P = .002). CLINICAL IMPLICATIONS: The findings of this survey emphasize the importance of SRS in the interdisciplinary gender-reassignment process. The detailed description of our combined technique could help to improve the surgical outcome and patient satisfaction of this complex and non-standardized surgery. STRENGTHS AND LIMITATIONS: This is the first description of a new surgical technique (combined technique) for MTF SRS. QOL was assessed by a large number of patients by standardized questionnaires and could be compared with normative data. Because this is a retrospective study, we can draw only careful conclusions for pre- and postoperative changes. CONCLUSION: Our self-developed combined surgical technique seemed to have a positive influence on QOL after SRS. Satisfaction with breasts, genitals, and femininity increased significantly and show the importance of surgical treatment as a key therapeutic option for MTF transsexuals. Papadopulos NA, Lellé J-D, Zavlin D, et al. Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery. J Sex Med 2017;14:721-730.

Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study.

OBJECTIVE: There is ongoing debate whether cancer qualifies as traumatic stressor. We investigated prevalence and course of posttraumatic stress in patients with early breast cancer (BC) during their first year after diagnosis and determined effects of mastectomy and chemotherapy. METHODS: Patients with stage 0-III BC aged ≤65 years were evaluated with the Structured Clinical Interview for DSM-IV modules for acute and posttraumatic stress disorder (ASD and PTSD, respectively) before treatment, after chemotherapy, and 1 year after diagnosis. Matched controls were assessed at matched intervals. Effects of time, mastectomy, and chemotherapy on BC-related PTSD symptom severity were tested with linear mixed model analysis. RESULTS: Stress disorder (ASD or PTSD) related to BC was diagnosed in 6 (3.6%) of 166 patients before treatment and in 3 patients (2.0%) 1 year later. The rate of patients who experienced PTSD symptoms related to BC decreased from 82.5 to 57.3% (p < 0.001), and the mean of BC-related PTSD symptoms diminished from 3.1 to 1.7 (p < 0.001). Only university education significantly predicted the course of BC-related PTSD symptom severity (p = 0.009). In 60 controls, no diagnosis of stress disorder, a rate of 18% women experiencing PTSD symptoms, and a mean of 0.4 PTSD symptoms (p vs. patients <0.001) were found. CONCLUSIONS: Most newly diagnosed patients with BC experience PTSD symptoms, whereas full diagnoses of DSM-IV stress disorder are rare. Symptoms diminish somewhat within 1 year furthered by university education but independently from mastectomy and chemotherapy. Throughout the year after diagnosis, having BC entails markedly increased PTSD symptom burden. Copyright © 2016 John Wiley & Sons, Ltd.

How Satisfied Are Patients with Arthroscopic Bankart Repair? A 2-Year Follow-up on Quality-of-Life Outcome.

PURPOSE: To report general life and health satisfaction after arthroscopic Bankart repair in patients with post-traumatic recurrent anterior glenohumeral instability and to investigate postoperative time lost to return to work at 2-year follow-up. METHODS: Between 2011 and 2013 patients treated with arthroscopic Bankart repair in the beach chair position for acute shoulder instability were included in this study. Questions on Life Satisfaction Modules (FLZM) and the Short Form 12 (SF-12) were used as quality-of-life outcome scales. Oxford Instability Score (OIS), Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and self-reported American Shoulder and Elbow Surgeons (ASES) shoulder index were used as functional outcome scales. Return to work (months) was monitored and analyzed depending on physical workload. Data were assessed the day before surgery and prospectively monitored until 24 months postoperatively. Quality-of-life outcome was correlated with functional shoulder outcome and compared with normative age-adjusted data. Paired t-test, Wilcoxon test, Mann-Whitney U-Test, and Spearman's correlation coefficient were used for statistical analysis. RESULTS: Fifty-three patients were prospectively included. The mean age at surgery was 29.4 years. Satisfaction with general life and satisfaction with health (FLZM) as well as physical component scale (SF-12) improved significantly to values above normative data within 6 to 12 months after surgery (each P < .001). OIS, QuickDASH, and ASES improved significantly from baseline until 24 months after surgery (each P < .001). For ASES, improvement above minimal clinically important difference was shown. There was a positive correlation between quality of life and functional outcome scores (P < .05; rho, 0.3-0.4). Mean time to return to work was 2 months (range, 0-10; standard deviation, 1.9), with significantly longer time intervals observed in patients with heavy physical workload (3.1 months; range, 0 to 10; standard deviation, 2.4; P = .002). CONCLUSIONS: Following arthroscopic Bankart repair, quality of life was impaired during early course after surgery and increased significantly above preoperative levels within 6 to 12 months after the procedure. A steady state of excellent quality-of-life and functional outcomes was noted after 12 months of follow-up. Quality-of-life outcome scales correlated significantly with the functional outcome. Heavy physical workload must be considered as a risk factor for prolonged time lost to return to work. LEVEL OF EVIDENCE: Level III, prospective noncomparative therapeutic case series.

The Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF)--an expert rating scale for distress screening: development and psychometric properties.

BACKGROUND: The aim of this study is to validate the Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF), a six item interview-based expert rating scale for distress screening in cancer patients. METHODS: Using a heterogeneous multicenter study sample (n = 1551), we examined validity, reliability, and dimensionality of the PO-Bado SF. The Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer, the Questionnaire on Stress in Cancer, and the Patient Health Questionnaire were used to investigate convergent validity. Confirmatory factor analysis was applied to address unidimensionality. An optimal cutoff point was determined by ROC analysis and the maximum of Youden's index. An additional study with n = 41 audio recorded PO-Bado SF interviews was carried out to assess inter-rater reliability. RESULTS: Mean age of the study sample was 64.0 (SD = 12.0), 42% were women. About 24% of the patients suffered from metastases. The one-factor solution was confirmed; internal consistency of the PO-Bado SF was high (α = 0.84). The PO-Bado SF total score correlated significantly with all psychosocial measures, the highest correlation was with the HADS total score (r = 0.64). Patients with severe disease conditions (metastases, psychological/psychiatric treatment in the past, low performance status) received higher distress ratings (p < 0.001). Using HADS total score (>13) as external criterion, an optimal PO-Bado SF cutoff score of >9 emerged (sensitivity 0.75; specificity 0.82). Inter-rater reliability was satisfactory for each of the six items (intra class correlation of 0.75 to 0.85). CONCLUSIONS: The PO-Bado SF is a short, reliable and valid expert rating scale to identify distressed cancer patients.

Fear of progression in patients 6 months after cancer rehabilitation-a- validation study of the fear of progression questionnaire FoP-Q-12.

PURPOSE: Many cancer patients experience fear of progression (FoP). The purpose of this study was to test psychometric properties of the questionnaire FoP-Q-12, to examine age and gender differences of FoP, and to explore prognostic factors of FoP. METHODS: A sample of 2059 patients with a cancer diagnosis who had participated in a cancer rehabilitation program was examined 6 months after discharge from the rehabilitation clinic. Participants filled in the Fear of Progression questionnaire FoP-Q-12, the Hospital Anxiety and Depression Scale (anxiety subscale), and the Generalized Anxiety Disorder Questionnaire GAD-2 and answered a list of questions concerning their cancer disease. RESULTS: Reliability of the FoP-Q-12 (Cronbach's alpha = 0.90) was good. While exploratory factorial analysis supported the one-dimensional structure of the FoP-Q-12, confirmatory factorial analysis only partially supported the one-dimensional model. A proportion of 16.7 % of the sample scored above the FoP-Q-12 cutoff score. Females showed higher FoP scores than males (effect size d = 0.52), and older patients had slightly lower levels of FoP than younger patients (d = 0.17). There were substantial and significant correlations between FoP-Q-12 and Hospital Anxiety and Depression Scale (HADS) anxiety (r = 0.71) as well as GAD-2 anxiety (r = 0.57). The highest FoP mean scores were found for the following cancer locations: ovary (M = 29.5), thyroid gland (M = 28.8), and breast (M = 27.9), while the lowest scores were found for Hodgkin lymphoma (M = 23.6), testis (M = 21.8), and prostate (M = 21.7). CONCLUSIONS: The FoP-Q-12 proved to be a valid instrument for measuring fear of progression in cancer patients.

Use of cancer-specific mental health resources-is there an urban-rural divide?

PURPOSE: The purpose of this study is to establish whether mental health (MH) outcomes, attitudes towards cancer-specific MH (CSMH) resources, and the availability of such resources differ between rural and urban cancer patients. METHODS: Three months after surgery for colorectal cancer, patients received a questionnaire for completion at home assessing distress, depression, anxiety, acceptance, knowledge and use of CSMH resources and the doctor-patient relationship. We adjusted our sample to reference data of the Munich Cancer Registry and documented CSMH resources (e.g. cancer-specific information centres and cancer support groups) using a systematic Internet search. RESULTS: Five hundred thirty-four patients participated with a mean age of 68.9 years; 44.5 % were female. Urban patients talked less with their doctor about their emotional state (65 %, p < 0.01) and showed poorer knowledge of CSMH resources (60 %, p < 0.002). A good doctor-patient relationship was associated with a better MH outcome. A significant predictor for acceptance was distress. Ninety-four percent of patients without a nearby support facility lived in rural areas (p < 0.001). There were no group differences concerning distress, MH outcomes, or acceptance of CSMH resources. CONCLUSION: Despite a higher availability of CSMH resources, urban patients showed poorer doctor-patient relationships and less knowledge of such resources than rural patients. Overall, knowledge and use of these resources were poor. The amount of support facilities available therefore appears to be less important than establishing an efficient communication network between patients, doctors and providers of CSMH resources to achieve satisfaction with treatment of urban and rural cancer patients.