Predictors of cancer patients' utilization of psychooncological support: Examining patient´s attitude and physician´s recommendation.

PURPOSE: Patients with cancer suffer from a wide range of psychological distress. Nevertheless, in the literature low utilization rates of psychooncological services are reported. Various factors may influence the utilization of professional support during inpatient care. Up to now it is unclear to what extent patients' attitude towards psychooncological support and physicians' recommendation for psychooncological care may influence the utilization. METHODS: In a multicenter longitudinal observational study in Comprehensive Cancer Centers Germany, 1398 patients with mixed cancer diagnoses were assessed at baseline during their hospital stay with respect to psychooncological distress and the need for and use of psychooncological services. RESULTS: Psychooncological support was used by almost 28.4% of patients up to this time. A positive attitude towards psychooncological support was reported by 41.6%. A recommendation of psychooncological support by a physician was received by 16.2%. These patients reported a significant higher level of distress compared to patients who did not received a recommendation. Multivariable logistic regression detected that the utilization rate was 3.79 times higher among patients with positive attitude towards psychooncological support (OR, 3.79; 95% CI 2.51-5.73, p < 0.001). Utilization was 4.21 times more likely among patients who received a physician´s recommendation (OR, 4.21; 95% CI 2.98-5.95, p < 0.001). CONCLUSION: The results of the study provide evidence of the relevance of giving more attention to psychooncological distress and attitudes towards psychooncological care. To reduce reservations, patients need low-threshold information about the psychooncological services offered.

Caring for dependent children impacts practical and emotional problems and need for support, but not perceived distress among cancer patients.

OBJECTIVE: More than one in 10 cancer patients care for dependent children. It is unclear whether this status makes a difference in terms of the distress and associated problems they experience, or whether it is linked to differences in the need for or utilization of psychosocial support. METHODS: Secondary analysis of a cross-sectional German study in National Comprehensive Cancer Centers using self-report standardized questionnaires administered to inpatients. Patients living with dependent children (n = 161) were matched by age and sex with a subsample of 161 cancer patients not living with dependent children. The resulting sample was tested for between-group differences in Distress Thermometer (DT) scores and the corresponding DT Problem List. Additionally, between-group differences in measures of the need for and utilization of psychosocial support were examined. RESULTS: More than 50% of all patients suffered from clinically relevant distress. Patients living with dependent children reported significantly more practical (p < 0.001, η2 p = 0.04), family (p < 0.001, η2 p = 0.03), and emotional problems (p < 0.001, η2 p = 0.01). Although reporting a greater need for psychological support, parents with cancer were not found to more frequently utilize any type of psychosocial support. CONCLUSIONS: The specific problems and needs of parents with cancer who care for dependent children are currently not sufficiently addressed in the clinical care pathways. All families should be helped to establish open and honest communication as well as understand the available support systems and what they can provide. Tailored interventions should be implemented for highly distressed families.

Return to work after cancer: Improved mental health in working cancer survivors.

OBJECTIVE: Aim of the study was to compare working and non-working patients over a period of 12 months regarding socio-demographic, cancer-specific and mental health parameters. METHODS: This study was conducted as part of a Germany-wide longitudinal survey among 1398 patients in 13 national Comprehensive Cancer Centers. The sample used for analysis consisted of n = 430 cancer patients younger than 65 years (age M = 52.4 years, SD = 8.1; 67.0% females). Socio-demographic, cancer-specific and mental health parameters (Depression: Patient Health Questionnaire, Anxiety: Generalized Anxiety Disorder Scale, Distress: Distress Thermometer) were assessed at baseline during hospitalization and at 12 months follow-up. RESULTS: 73.7% of all patients (n = 317) have returned to work after one year. While working and non-working patients did not differ in socio-demographic parameters, there were significant differences in the presence of metastases, tumor and treatment status. Mixed analysis of variances revealed significant interactions between working status and time for depression (p = 0.009), anxiety (p = 0.003) and distress (p = 0.007). Non-working patients reported higher levels of depression, anxiety and distress than working patients over time. A logistic regression showed significant associations between lower depression (p = 0.019), lower distress (p = 0.033) and the absence of a tumor (p = 0.015) with working status. CONCLUSIONS: The majority of cancer survivors returned to work. Non-working patients had higher levels of depression, anxiety and distress than working patients. After controlling for cancer-specific factors, mental health parameters were still independently associated with working status. Return to work can thus be associated with an improved mental health in cancer survivors. In order to establish causality, further research is necessary.

Information needs in cancer patients across the disease trajectory. A prospective study.

OBJECTIVE: As satisfaction with information received is an important precondition of adherence to treatment in cancer patients, we aimed to examine the level of perceived information, information satisfaction and information needs, and examine the prospective association between information satisfaction and anxiety. METHODS: In a multicenter study in Germany, 1398 cancer patients were evaluated in terms of this at baseline, after 6 and 12 months. RESULTS: At baseline, the majority of patients reported to feel well-informed. Nevertheless, a considerable proportion reported to wish more information. The proportion of patients reporting unmet information needs declined over time (p < 0.001). Anxiety at baseline is negatively associated with information satisfaction after 6 months (ß = -0.10, p < 0.01). Conversely, information satisfaction at baseline is negatively associated with anxiety after 6 months (ß = -0.10, p < 0.01). At 12 months, only the negative path leading from anxiety to information satisfaction was significant (ß = -0.12, p < 0.01). CONCLUSION: We found high levels of information received and high information satisfaction. Nevertheless, there was a considerable quantity of unmet information needs. A bidirectional relationship between information satisfaction and anxiety symptoms emerged after 6 months. PRACTICE IMPLICATIONS: These results underline the priority of providing information and emotional support to cancer patients to improve satisfaction with information.

[Surveys as Quality Management Measures in Psychosocial Cancer Counselling Centers]. / Nutzerbefragung als Qualitätssicherungsmaßnahme in psychosozialen Krebsberatungsstellen.

AIM: The aim of the present survey was to describe and evaluate experiences of German psychosocial cancer counselling centers with user surveys as a quality management measure. METHODS: Representatives of various psychosocial cancer counselling centers were asked to prepare an experience report on user surveys. Nine field reports were presented and discussed in summary by the working group "Cancer Counselling Centers" of the Working Group Psychooncology of the German Cancer Society (PSO). Special attention was paid to the short questionnaire KBS-N (Cancer Counselling Centre Questionnaire) recommended by the working group. RESULTS: All psychosocial cancer counselling centers reported positive experiences with user surveys, which, however, represent an effort in terms of personnel and logistics. In addition to the KBS-N, more detailed questionnaires were also used. The surveys were conducted either continuously or on a random basis over a limited period of time. Those seeking advice were usually asked at a defined time directly after the initial interviews or after the end of the counselling sequence. The response rate was higher (85-95%) when the questionnaire was handed out personally after the initial consultation than for postal delivery and return (47-89%). All counselling centers reported positive feedback on the counselling services provided. Isolated points of criticism were related in particular to organizational framework conditions. CONCLUSION: After weighing up the costs and benefits, an active follow-up survey of those seeking advice using the short questionnaire KBS-N appears to be a practicable quality assurance measure, at least over a limited period of time. More detailed user surveys require more effort and are therefore more suitable for use in research that go beyond quality assurance.

The course of cancer-related insomnia: don't expect it to disappear after cancer treatment.

OBJECTIVE: The study aimed to examine the 12-month course of cancer-related insomnia (CRI) and to identify possible predictors for the prevalence and persistence of CRI. METHODS: This longitudinal multicenter study included N = 405 patients with cancer (56% females, mean age: 58.6 years). CRI was measured by the Insomnia Severity Index (ISI). Socio-demographic and clinical data, as well as psychological parameters (Distress Thermometer, PHQ-9, GAD-7, and EORTC-Fatigue), were assessed at baseline (T1) and 12 months later (T2). RESULTS: In our sample, a high prevalence of relevant insomnia symptoms (49.4%, ISI > 7) was found, while a clinical insomnia diagnosis was verified in 12.8% (ISI > 14). When insomnia was present at T1, this problem was persistent after one year in 64%. At T2, however, significantly more women suffered from insomnia symptoms (53.3% women vs. 39.3% men; p = 0.003). Insomnia was associated with many clinical and psychological parameters, especially with fatigue (r = 0.5). Multiple regression analysis revealed that, in women, only insomnia at T1 was a significant predictor for insomnia at T2 (R2 = 0.40; F(5) = 12.5; p < 0.001), whereas in men insomnia, depressive symptoms and the use of psychotropic drugs at T1 predicted the extent of insomnia at T2 (R2 = 0.28; F(7) = 9.5; p < 0.001). In all participants, levels of distress, depression, and anxiety decreased from T1 to T2 (p's < 0.016). CONCLUSION: Insomnia is a common disorder in cancer patients. Although medical and psychological parameters improved during the 12-month course of cancer treatment, our results show that insomnia is highly persistent, especially in women. This indicates that adequate support for those affected is needed. CLINICAL TRIAL REGISTRATION NUMBER: DRKS00004860.

Psychosocial distress and utilization of professional psychological care in cancer patients: An observational study in National Comprehensive Cancer Centers (CCCs) in Germany.

OBJECTIVE: The study aimed to assess cancer patients' use of psychological care and its correlates in a large sample of cancer patients in Comprehensive Cancer Centers (CCCs) in Germany. METHODS: In a multicenter study in Germany, cancer patients with various diagnoses were evaluated for self-reported use of psychological support. We measured psychological distress, depression and anxiety, quality of life, and social support with standardized questionnaires and analyzed its association with the utilization of psychological care using multivariable logistic regression. This paper focuses on a cross-sectional analysis of the data assessed during inpatient care. RESULTS: Three thousand fifty-four (50%) of hospitalized patients were asked for participation, and n = 1632 (53.6%) participated. We were able to analyze n = 1,398 (45.9%) patients. Three hundred ninety-seven (28.4%) of the sample utilized psychological support. Users of psychological care were significantly younger than nonusers (odds ratio [OR]: 0.967, P < 0.001) and were more often female (OR: 1.878, P < 0.001), whereas educational level was not associated with the use of psychological care. In the multivariable analysis, effects on the use of psychological care were observed for Hospital Anxiety and Depression Scale (HADS) anxiety (OR: 1.106, P = 0.001) and both subscales of the 12-item Short Form Health Survey (SF-12) quality of life measure (mental, OR: 0.97, P = 0.002; physical, OR: 0.97, P = 0.002). CONCLUSION: Psychological distress and anxiety are higher, and quality of life is lower in users of psychological care in comparison with nonusers during inpatient cancer treatment. Although psychooncological services should be provided to all patients who need them, special efforts should be made to reach populations that report low utilization.

[Patient's Autonomy and Information in Psycho-Oncology: Computer Based Distress Screening for an Interactive Treatment Planning (ePOS-react)]. / Patientenautonomie und -informiertheit in der Psychoonkologie: Computerbasiertes Belastungs-screening zur interaktiven Behandlungsplanung (ePOS-react).

To identify distressed patients in oncology using screening questionnaires is quite challenging in clinical routine. Up to now there is no evidence based recommendation which instrument is most suitable and how to put a screening to practice. Using computer based screening tools offers the possibility to automatically analyse patient's data, inform psycho-oncological and medical staff about the results, and use reactive questionnaires. Studies on how to empower patients in decision making in psycho-oncology are rare.Methods Women with breast and gynaecological cancer have been consecutively included in this study (n=103) at time of inpatient surgical treatment in a gynaecological clinic. They answered the computer based screening questionnaire (ePOS-react) for routine distress screening at time of admission. At the end of the tool an individual recommendation concerning psycho-oncological treatment is given ( i) psycho-oncological counselling, ii) brief psycho-oncological contact, iii) no treatment suggestion). The informed patients could choose autonomously either the recommended treatment or an individually more favoured alternative possibility. Additionally, a clinical interview (approx. 30 min) based on the "Psychoonkologische Basisdiagnostik (PO-Bado)" has been carried out for a third-party assessment of patients' need for treatment.Results 68.9% followed the treatment recommendation. 22.3% asked for a more "intense" (e. g. counselling instead of recommended brief contact) and 8,7% for a "less intense" intervention than recommended. The accordance of third-party assessment (clinical interview "PO-Bado") and treatment recommendation is about 72.8%. The accordance of third-party assessment and patient's choice (ePOS-react) is about 58.3%. The latter is smaller because 29.1% asked for a brief psycho-oncological contact for whom from the third-party assessment's perspective no indication for treatment has been existent.Discussion A direct response of the screening result (treatment recommendation) during the computer based screening and asking for a patient's choice leads to an increase of brief psycho-oncological contacts for personal information about psycho-oncological interventions. Compared with a third-party assessment (clinical interview) there is no improvement of the accuracy of the indications. But it improves the transparency for the access to psycho-oncological interventions which may strengthen patient's autonomy and adherence.