Mental health after laryngectomy and partial laryngectomy: a comparative study.

Patients treated for laryngeal cancer are confronted daily with the effects of the operation. The choice of treatment method can have a significant impact on psychosocial adjustment. Three hundred and six out-patients who underwent surgical treatment for laryngeal cancer within the last two decades were interviewed in their own homes using the structured clinical interview for DSM-IV (SCID).Psychiatric disorders were diagnosed among 17.3% of the partial laryngectomy patients (PL) and 22.2% of the patients with total laryngectomy (LE). In comparing four variables (age, time elapsed since diagnosis, gender and subjective speech intelligibility), subjective speech intelligibility and age were the variables with a unique, significant effect on the frequency of psychiatric disorders, albeit only in the case of PL patients. The need for psychosocial rehabilitation for patients with partial laryngectomy tends to be underestimated. It is concluded that screening for psychological variables and subjective speech intelligibility can be beneficial for the identification of out-patients lacking appropriate treatment.

Health-related quality of life of prostate cancer patients compared to the general German population: age-specific results.

OBJECTIVE: The objective of this study was to examine the age-specific health-related quality of life (HRQOL) of prostate cancer patients (PCPs). PATIENTS AND METHODS: 387 PCPs were asked to self-assess their HRQOL with the EORTC QLQ-C30 questionnaire. Patients' data were compared with those of the general German population. RESULTS: The reported global health/QOL scores of the study group and the general German population are nearly equal. However, most of the subdomains of HRQOL are negatively affected in PCPs, especially in younger patients (

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.

[Art therapy for cancer patients in outpatient care. Psychological distress and coping of the participants]. / Gestaltungskurs fur Krebspatienten in der ambulanten Nachsorge. Psychische Belastung und Krankheitsverarbeitung der Teilnehmer.

BACKGROUND: Various types of art therapy increasingly gain importance in psycho-oncology. The aim of this article is to determine whether art therapy may help decrease psychological distress and increase coping skills in cancer patients. PATIENTS AND METHODS: An art therapy course for use in psycho-oncological care for outpatients was developed and implemented in a prospective observation study of the Department of Social Medicine,Leipzig University. Participants' levels of psychological distress (HADS) as well as their coping skills (TSK) were quantitatively evaluated before (t1) and after (t2) the intervention. RESULTS: After completion of the course mean anxiety of the participants(n = 18) had significantly decreased from 11.06 to 9.33 (p < 0.04). On average, however, participants reported more anxiety both before and after the intervention than a representative comparison group of n = 48 cancer patients (anxiety: mean= 5.51). Regarding depression no significant change could be observed after completion of the intervention (t1 = 6.94, t2 =6.22; p < 0.32). Also in relation to the comparison group (mean= 5.24) no significant difference in depression could be detected (t1: p < 0.066, t2: p < 0.519). No significant change in participants' coping skills could be observed. CONCLUSIONS: The level of psychological distress among cancer patients in outpatient care is above average. This underlines the need for psycho-oncological aftercare services. Art therapy interventions can make an important contribution to the psychological well-being of cancer patients.

[Measurement of change with the Hospital Anxiety and Depression Scale (HADS): sensitivity and reliability of change]. / Veränderungsmessung mit der Hospital Anxiety and Depression Scale (HADS): Anderungssensitivität und Anderungsreliabilität.

Responsiveness or sensitivity to change of a questionnaire is an important criterion in the assessment of the effect of a medical intervention. In the literature there are several criteria for responsiveness, based on changes in the population mean. Here we present an alternative approach for the measurement of change (change reliability), applying the criteria of internal consistency to change scores. Using the Hospital Anxiety and Depression Scale HADS, these approaches are demonstrated and compared for 2 subject samples, comprising 901 oncologic patients and 2 695 cardiac patients. The effect size d is well suited to assess the effect of an intervention, based on changes of the sample mean. The analyses of the 2 samples yielded effect sizes of about 0.25. The newly created change reliability yielded coefficients of about .70 which indicate the reliability of the individual changes in anxiety and depression.

Validation of the EORTC QLQ-C30 and EORTC QLQ-H&N35 in patients with laryngeal cancer after surgery.

BACKGROUND: The aim of this study was to test the validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (QLQ-C30) and Head and Neck Module (QLQ-H&N35) for patients who have undergone surgery due to laryngeal cancer. METHODS: A total of 323 patients from 6 different centers in Germany who had been operated on completed the QLQ-C30 and the QLQ-H&N35 in addition to being surveyed in a personal interview. RESULTS: Multitrait scaling analysis confirmed the proposed scale structure of both questionnaires. Cronbach's alpha of the QLQ-C30 scales ranged from 0.64 (Cognitive Functioning) to 0.94 (Global Health Status); the alpha of the QLQ-H&N35 ranged from 0.55 (Speech) to 0.90 (Sexuality). Known-groups comparisons showed multiple differences in sociodemographic and clinical variables. CONCLUSION: It can be concluded that the QLQ-H&N35, in conjunction with the QLQ-C30, is a reliable instrument that is able to differentiate between diverse groups of patients with laryngeal cancer after surgery.

Anxiety and depression in patients with prostate cancer and other urogenital cancer: a longitudinal study.

OBJECTIVE: The aim of this study was to assess the degree and the course of psychological distress (anxiety and depression) in cancer patients and to detect sociodemographic determinants of the scores. METHODS AND MATERIALS: Patients with prostate cancer (n = 287) and other urogenital cancer (n = 126) were tested with the Hospital Anxiety and Depression Scale (HADS) at the following time points: at the beginning (T1) and the end (T2) of the treatment in the hospital, 6 months later (T3), and 1 year later (T4). RESULTS: Anxiety mean scores were highest at the start of the stay in the hospital. About 36% of the patients were at least doubtful cases at T1. However, the anxiety mean scores from T2 to T4 were similar to those of the general population and lower than those of cardiac patients. Depression mean scores were even lower than those of the general population. Young age and receiving radio- and/or chemotherapy were predictive of higher psychological distress. CONCLUSIONS: The low mean scores of anxiety and depression from T2 to T4 indicate that most of the prostate cancer patients do not need help from mental health professionals. Nevertheless, some patients may profit from mental health support, especially at the beginning of the stay in the hospital.

[Long-term survival of adult cancer patients from a psychosomatic perspective - literature review and consequences for future research]. / Langzeitüberleben von Erwachsenen nach Krebs aus psychosomatischer Sicht-Literaturübersicht und Forschungsdesiderate.

OBJECTIVES: The increasing survival of cancer patients is the result of early detection, improved treatment, and demographic change. This poses urgent questions regarding the stresses and needs for care long-term survivors face. METHODS: A literature survey (PubMed, Scopus) was conducted based on all publications with a psychooncological background from 2004 to 2008 concerning long-term survivors. RESULTS: Of the 164 publications found, 74 referred to breast cancer; 62 % came from the United States and only 4 % from Germany. Although overall quality of life among long-term survivors appears to be good, considerable adverse somatic effects (long-term effects, late consequences, recidivism, second tumors) and mental effects (e.g., fear of recurrence) persist. Somatic and psychosocial determinants of long-term adjustment, health behaviour, health care needs and utilization, and the quality of life of next-to-kin have hardly been studied. The effects of psychotherapy on survival remain controversial. CONCLUSIONS: In light of the growing number of long-term surviving cancer patients, it is necessary to study their strains and needs for care under a lifespan perspective.

Sexual problems after total or partial laryngectomy.

OBJECTIVES: To investigate sexual problems that can occur after laryngeal and hypopharyngeal cancer surgery and to specify possible influencing factors. STUDY DESIGN: Multi-institutional cross-sectional study. METHODS: Two hundred six patients were interviewed in person using the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Head and Neck Module (EORTC QLQ-H&N35), the Hospital Anxiety and Depression Scale, and a structured interview assessing alcohol and tobacco consumption, sociodemographic data, and specific sexual problems. Type of surgery, tumor site, and tumor stage were documented according to the participants' medical records. Multivariate analysis of variance was used to assess the independent impact of each factor. RESULTS: More than half of the patients in our study reported having reduced libido and sexual enjoyment after treatment. Sixty percent considered it an important issue for their contentment with life. Sexual difficulties were found to be unrelated with gender, formal education, alcohol and tobacco consumption, type of surgery (partial vs. total laryngectomy), radiotherapy, and tumor site. Psychological distress (F = 46.27, P < .001) was seen to have a strong independent impact on the occurrence of sexual difficulties and stage of disease (F = 4.50, P < .05) and age (F = 4.79, P < .05), a moderate independent impact. CONCLUSIONS: Reduced libido and sexual enjoyment is a common problem after laryngeal and hypopharyngeal cancer surgery. However, it is not caused by the oncological treatment but rather by the cancer itself. Depression is often associated with sexual problems. Both should be discussed in medical consultations with head and neck cancer patients when appropriate to provide adequate treatment.

Longitudinal analysis of psychiatric morbidity in cancer patients.

BACKGROUND: About one third of cancer patients suffers from a psychiatric disorder. However, only few studies feature long-term assessment of psychiatric disease in cancer patients, covering a broad range of diagnoses, and employing high-quality instruments. PATIENTS AND METHODS: A total of 62 patients underwent assessments during a 3-year follow-up period after initial cancer diagnosis. The Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was used to measure psychiatric morbidity at baseline (t1) and 2 follow-up assessments (t2 and t3). Follow-up assessments took place between 6 and 18 months (t2) and between 24 and 36 months (t3) after baseline measurement. RESULTS: At t1, at least one DSM-IV diagnosis was found in 29% of the patients. During follow-up, the frequency of psychiatric morbidity increased to 36% at t2 and 44% at t3. New occurrence of psychiatric disease during follow-up was 18% at t2 and 38% at t3. CONCLUSION: Persistence and number of newly diagnosed psychiatric disorders during the first 3 years after cancer treatment should be considered in the treatment of cancer patients, especially in individuals with according predictive factors.

The Course of Anxiety and Depression in Patients with Breast Cancer and Gynaecological Cancer.

BACKGROUND/AIMS: The aim of this study was to assess the course of anxiety and depression in cancer patients over time and to detect determinants of the changes in the scores. PATIENTS AND METHOD: Women with breast cancer and gynaecological cancer (n = 367) were tested at the beginning (T1) and at the end (T2) of treatment in the hospital, 6 months later (T3), and 12 months later (T4), using the Hospital Anxiety and Depression Scale (HADS). RESULTS: Anxiety and depression were highest at the start of the stay in the hospital. More than half of the women are at least doubtful cases in at least one of the two HADS dimensions. The mean scores declined from T1 to T4. After 1 year, depression scores are similar to those of the general population, while anxiety scores remain elevated. The decline of the HADS scores depends on treatment, time since diagnosis, and education. CONCLUSIONS: Women receiving radio- or chemotherapy (compared with surgery only), with a long time since diagnosis, and with a low educational level are at high risk of maintaining high anxiety and depression scores over time.

Long-term course of psychiatric disorders in cancer patients: a pilot study.

BACKGROUND: About one third of cancer patients suffer from a psychiatric disorder. However, only few studies feature long-term assessment of psychiatric disease in cancer patients, covering a broad range of diagnoses, and employing high-quality instruments. PATIENTS AND METHODS: A total of 62 patients underwent assessments during a 3-year follow-up period after initial cancer diagnosis. The Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders was administered to measure psychiatric morbidity at baseline (t1) and two follow-ups (t2 and t3). Follow-up assessments took place from 6 to 18 months (t2) and from 24 to 36 months (t3) after baseline. Biomedical and psychosocial factors were evaluated to identify predictors of psychiatric disorders using univariate and multivariate analyses. RESULTS: At t1, at least one DSM-IV diagnosis was found in 29% of the cases. At follow-ups, the frequency of psychiatric morbidity increased to 36% at t2 and 44% at t3, respectively. New occurrence of psychiatric disease at follow-ups was 18% at t2, and 38%, at t3. Predictors of psychiatric disorders were low social support, low physical functioning, metastases, complications of disease, and loss of sportive activity. CONCLUSION: Persistence and amount of newly diagnosed psychiatric disorders during three years after cancer treatment should be considered in the treatment of cancer patients, especially in individuals with accordant predictive factors.

Psychosocial determinants of successful voice rehabilitation after laryngectomy.

This study gives an overview of publications on factors that are associated with the outcome of voice rehabilitation after laryngectomy. A systematic literature review was conducted. Fifty-six manuscripts were analyzed regarding the parameters investigated, the number of participants included, the study designs used, the assessment instruments, and the results. A broad range of factors were considered to contribute to successful voice rehabilitation, whereby psychosocial attributes related to success are mentioned as often as medical and treatment-related characteristics. The results of the studies are mostly inconsistent. It can be concluded, however, that active communication behavior, employment status, type of alaryngeal speech and the general physical condition are associated with rehabilitation outcomes, whereas alcohol consumption is not. More comprehensive prospective studies are needed which analyze the impact of psychosocial factors with validated and standardized instruments. A large sample size would be necessary to calculate all possibly relevant factors and their interaction. Clinicians should be careful about considering their patients to be "unmotivated" if the rehabilitation fails; instead, they should encourage them to communicate actively and take part in social activities.

Quality of life correlates after surgery for laryngeal carcinoma.

OBJECTIVES: To assess the correlation of operation mode, postoperative radiotherapy, and disease stage factors with the health-related quality of life (HRQL) measures after surgery for laryngeal carcinoma. STUDY DESIGN: Reanalysis of data of two multi-institutional cross-sectional studies. PATIENTS AND METHODS: We interviewed 218 laryngectomees and 153 partial laryngectomy patients in and near Leipzig, Germany, in two cross-sectional studies, using the general and the head- and neck-specific quality of life questionnaires of the European Organization for the Research and Treatment of Cancer (EORTC QLQ-C30 and EORTC QLQ-H&N35). Multifactorial univariate and multivariate models were calculated, with laryngectomy vs. partial laryngectomy, radiotherapy (irradiated or not), and disease stage (International Union Against Cancer [UICC] stages I/II vs. III/IV) as influencing factors and the HRQL scales and items as dependent variables. Analyses were adjusted for the patient's age and the time elapsed since the operation. RESULTS: Laryngectomees were more affected in their sense of smell (P < or = .000). Among irradiated patients, functioning levels and many symptom scales showed worse results (P < or = .05). Both operation mode and postoperative radiotherapy were independently associated with head- and neck-specific HRQL in multivariate analysis. Differences between disease stage groups, however, were not significant. Patient's age was an influencing factor on HRQL, but time since operation was not. CONCLUSIONS: : Postoperative radiotherapy seems to have the greatest impact on patients' HRQL independent of other clinical factors following surgery for laryngeal carcinoma. Aftercare of irradiated laryngeal carcinoma patients should focus more on the patient's quality of life.

[Attitudes of medical students towards psychotherapeutic treatment and training]. / Einstellungen von Medizinstudierenden zu psychotherapeutischen Behandlungsverfahren und Weiterbildungen.

OBJECTIVES: Against the background of insufficient medical care for patients with psychiatric and psychosomatic disorders it is important to ascertain the interests and attitudes of medical students towards mental disorders, psychotherapeutic treatment and training. METHODS: Medical students (N = 366) in their clinical training were given half-standardized questionnaires about their attitudes towards psychotherapeutic treatments, their career plans, psychosocial distress and sociodemographic characteristics. RESULTS: There was an overall high interest in psychological distress of patients and in psychotherapeutic treatment methods. Contrary to these findings, however, only few medical students were willing to specialize in psychosomatic medicine, psychiatry or psychotherapy. Psychosomatic and psychotherapeutic career choices were more frequent in women as well as in students who had experienced psychological distress themselves, and who had undergone psychotherapy, and who were less oriented toward economic success and careers. CONCLUSIONS: Medical students regarded psychological characteristics as generally interesting and important for medical care, but rarely considered specializing in these medical fields after graduation. Potential remedies (e.g., improved teaching of psychosocial competences and psychotherapeutic knowledge, career counselling) are discussed.

[Perceived stigmatisation following laryngectomy]. / Stigmatisierungsgefühle nach Kehlkopfentfernung.

Patients who have had a cancer-related total laryngectomy (N = 217) were studied in order to investigate possible associations between perceived stigmatisation and such physical and social factors as: type and intelligibility of the replacement alaryngeal voice, mental health, and gender. The laryngectomees participated in structured interviews. The German questionnaire "Fragebogen zur pyschosozialen Anpassung nach Laryngectomie" (Questionnaire for Psychosocial Adjustment after Laryngectomy, FPAL) was used to measure patients' perceived stigmatisation. Speech intelligibility was measured both by using the Post-laryngectomy Telephone Intelligibility Test (PLTT) and by taking into account patients' own evaluation of how well they are able to speak. Patients' mental health was measured with the Hospital Anxiety and Depression Scale (HADS). Multi-factorial analysis of variance and covariance was used to test the effects of the parameters. Results show that stigmatisation is associated with anxiety (F = 5.992, p < 0.05 and F = 12.895, p < 0.001) but not with speech intelligibility, alaryngeal voice type, gender, or depression. There is a correspondence between the degree to which patients feel stigmatised because of their voice or tracheostomy and their sense of loneliness (F = 4.917, p < 0.05 and F = 6.271, p < 0.05). We can conclude that perceived stigmatisation is frequently accompanied by anxiety and loneliness. Men are apparently as often concerned as women. Stigmatisation is not increased when patients do use electronic devices for communication, and it is not lower in patients whose operation dates back several years.

[Predictors of mental disorders in patients with malignant diseases: empirical results]. / Prädiktoren psychischer Störungen bei Tumorpatienten: Empirische Befunde.

Between 2002 and 2004 485 cancer patients in oncological treatment were assessed for mental disorders using the Structured Clinical Interview for DSM-IV (SCID). Socio-demographic, psychosocial and medical data were taken as possible predictors into multivariate analysis. 32 % of the patients suffered from mental diseases. Significant risk factors for anxiety disorders were female sex, precedent mental trauma, children below 18 years; for affective disorders female sex, poor physical functioning; for stress disorders children below 18 years; for addictive disorders male sex, younger age, children from 18 years on, distant metastases. Additional psychosocial risk factors seem to be predominantly responsible for the development of a mental co-morbidity in inpatients with malignant diseases, which should be examined in doctor-patient-talks.

[The impact of parenthood on quality of life of cancer patients]. / Risiko oder Schutz? Der Einfluss der Elternschaft auf die Lebensqualität von Krebspatienten.

OBJECTIVES: The aim of this study was to examine the impact of parenthood on the quality of life of cancer patients. METHODS: A sample of 246 cancer patients (56% female) with different cancer locations were surveyed at the beginning of their inpatient medical treatment (t1) and 6 months afterward (t2) using the EORTC QLQ-C30 questionnaire. Three subgroups were compared in a cross-section and a longitudinal design. The variables sex, partnership, distant metastases and age were controlled. RESULTS: A negative impact of parenthood on certain sub-dimensions of quality of life was seen in contrast to patients without children at the time of the acute treatment (t1). After 6 months (t2) quality of life was increased, particularly in the subgroup of patients with younger children. However, there were no other statistically relevant differences between patients with or without children. Some variables such younger age, male sex and partnership have a positive impact on quality of life of patients. CONCLUSIONS: In conclusion, the present findings suggest that special psychosocial support during the acute treatment is necessary for cancer patients with children. The presence of younger children can possibly be interpreted as a protective factor in the process of illness. The development of suitable instruments for the measurement of psychosocial burden of parents with cancer and their children and the implementation and evaluation of specific intervention programs should be the goal of further investigations.

The acquiescence effect in responding to a questionnaire.

OBJECTIVE: Since the acquiescence effect can distort assessments, it is important to test techniques to quantify this effect. METHODS: The tendency of acquiescence is tested by means of a questionnaire. 2037 representatively selected subjects filled in the Multidimensional Fatigue Inventory (MFI-20), which consists of five subscales with positively and negatively formulated items. For each subject and for each subscale an acquiescence score was calculated based on the simple sum of the answers to the items of both orientations. RESULTS: Extreme acquiescence scores were rare (about 0.5%). All correlations between the acquiescence scores of the subscales were positive with mean values of 0.24, which indicates a certain degree of individual consistency in the acquiescence behavior. In the exploratory and confirmatory factorial analyses the polarity of the items was at least as meaningful as the contents of the subscales. Persons with high degrees of acquiescence were principally older and more depressed. By means of Rasch scaling procedures differences in threshold parameters for the response categories between positively and negatively oriented items were found. CONCLUSION: The acquiescence scores derived by simple addition of item values proved to be well suited to clarify amount and conditions of the acquiescence effect.