The cancer patient's soul. / Die Seele des Krebspatienten Psychoonkologie: Management psychischer Belastungen.

In general, every cancer patient should have access to psycho-oncological treatment, aiming at helping patients to deal with the difficult situation. The patient's individual need for treatment can be ascertained by measuring the patient's degree of distress. The general and individual treatment goal should be to maintain a certain quality of life and to assess and treat serious psychiatric diseases resulting from the cancer diagnosis such as anxiety disorder or depression. Treatment possibilities include: psycho-oncological psychotherapy as depth psychology, supportive, analytic or behavioral psychology, as well as group therapy in terms of support groups, with relatives or without as a mere patient group.

Seroma formation following breast cancer surgery.

A seroma is the most frequent complication of breast cancer surgery, the etiology of which remains obscure. We reviewed our data to determine the factors related to the incidence of seroma formation in our patients. A retrospective analysis of the records of 359 consecutive patients (334 Hispanic; 93%) who underwent primary surgical therapy from January 1, 1996 to December 31, 2000, with either modified radical mastectomy (MRM) or wide local excision (WLE) and axillary lymph node dissection (ALND) was performed. In all cases, removal of the breast was performed using electrocoagulation, and sharp dissection was used in the axilla. One-eighth inch closed suction round drains were used. Early arm motion was encouraged. The seroma rate was compared to the age of the patient, the presence and number of positive axillary lymph nodes, the total number of axillary lymph nodes removed, tumor size, weight of the patient, the use of neoadjuvant chemotherapy, and the type of surgery performed. The overall seroma rate was 15.8%. Seromas occurred in 19.9% of patients undergoing MRM and in 9.2% of patients undergoing breast-conserving surgery (p=0.01). The seroma rate was not influenced by any other tested variables. All seromas were easily managed with aspiration and pressure; this technical maneuver allowed seroma resolution in all patients except one following one to six aspirations. A seroma did not delay initiation of chemotherapy. No patient developed a capsule requiring excision. In our experience, a seroma is a "necessary evil;" it will occur unpredictably in a predictable number of patients.