Oncologist recommendation matters!-Predictors of psycho-oncological service uptake in oncology outpatients.

OBJECTIVE: Highly distressed cancer patients often do not use psycho-oncological services (POS). Research on predictors of POS uptake has mainly focused on patient-related variables and less on communication variables, so we examined the link between patient-oncologist communication (ie, talking about psychosocial distress, providing detailed information, and recommending POS) and POS uptake. METHODS: We conducted a prospective, observational study in an Oncology Outpatient Clinic in Switzerland. Predictors (ie, patient-related variables and patient's reports of the patient-oncologist communication) were assessed via semistructured interviews, and information on outpatient POS uptake was assessed after 4 months. For statistical analysis, a multivariate logistic regression was performed. RESULTS: Of 333 participants (mean age 61 years; 55% male; 54% distress thermometer ≥5), 77 (23%) had used POS during a 4-month period. Patients who reported an oncologist-recommended POS (odds ratio [OR] = 6.27, 95% confidence interval [CI] = 3.14-12.85) and those who were not sure if they had received a recommendation (OR = 4.64, 95% CI = 1.83-11.97) were more likely to attend POS than those who reported receiving no recommendation. Talking about psychosocial distress (OR = 0.74, 95% CI = 0.38-1.46) and providing detailed information about POS did not predict POS uptake (OR = 1.06, 95% CI = 0.46-2.38). CONCLUSIONS: Oncologists' expert recommendations to attend POS were strongly associated with patients' uptake of POS. The central role played by oncologists should be accounted for in stepped psycho-oncological care when POS referral pathways are defined.

Risk of depression in patients with inflammatory bowel disease.

OBJECTIVE: Depression is more prevalent in patients with inflammatory bowel disease (IBD) than in the general population. This study evaluated disease-related risk factors for depression in Crohn's disease (CD) and ulcerative colitis (UC). METHODS: Altogether 348 patients with IBD (228 with CD, 120 with UC) were included at our Outpatient IBD Clinic. Their characteristics, laboratory results and scores of depression, quality of life and clinical disease activity were retrospectively retrieved from questionnaires and medical records. The patient health questionnaire 9 (PHQ-9) was used as an algorithm for a probable diagnosis of major depression employing a cut-off point ≥10. Logistic regression analyses were performed to identify risk factors for depression. RESULTS: Among these patients, 163 (46.8%) had no or minimal depression (PHQ-9 score 0-4), 108 (31.0%) had mild depression (PHQ-9 score 5-9) and 77 (22.1%) were at risk of major depression (PHQ-9 score ≥10). Patients with CD had a higher risk of major depression than those with UC (25.4% vs 15.8%, P = 0.040). PHQ-9 scores correlated strongly with clinical disease activity and quality of life scores in both groups but only weakly and solely in the CD group with biochemical disease activity. Clinical disease activity was identified as the only independent risk factor for depression in CD (odds ratio 7.814, 95% CI 2.688-22.717, P < 0.001), while no independent risk factor for depression was detected in UC. CONCLUSION: Achieving clinical remission in patients with IBD seems to be the most important factor to reduce the risk of depression.