Comparison of patient-reported need of psycho-oncologic support and the doctor's perspective: how do they relate to disease severity in melanoma patients?

OBJECTIVE: Psycho-neuro-immune research suggests an association between cancer outcomes and psychosocial distress. Objective criteria to determine patients' levels of distress are important to establish potential links to disease outcomes. METHODS: We compared three patient-reported with one doctor-reported measures of psycho-oncologic distress frequently used in routine cancer care and investigated associations with standard disease severity parameters in melanoma patients. We enrolled n = 361 patients, successively seen at two outpatient university clinics in Germany. In the naturalistic study, n = 222 patients had been diagnosed <180 days and were seen for the first time (Group I); n = 139 had been diagnosed >180 days and were in after-care (Group II). RESULTS: Across groups, only moderate associations were seen between patient- reported and doctor-reported measures. Regarding clinical variables, disease severity and perceived need of psycho-oncologic support reported by patients or doctors showed hardly any association. After subgroup stratification, in patients of Group II, patient-reported and doctor-reported instruments showed some small associations with disease parameters commonly linked to more rapid cancer progression in patients who are in cancer after-care. CONCLUSIONS: Overall, the few and low associations suggest that need of psycho-oncologic support and clinical variables were largely independent of each other and doctors' perception may not reflect the patient's view. Therefore, the assessment of the patient perspective is indispensable to ensure that melanoma patients receive appropriate support, as such need cannot be derived from other disease parameters or proxy report. More research is needed applying psychometrically robust instruments that are ideally combined with sensitive biomarkers to disentangle psycho-neuro-immune implications in melanoma patients. Copyright © 2015 John Wiley & Sons, Ltd.

[Implementation of psychosocial care in pediatric cardiology. Results of a national survey]. / Etablierung psycho-sozialer Versorgung in der Pädiatrischen Kardiologie. Ergebnisse einer bundesweiten Befragung.

In the German health care system patient self-help groups assume growing importance. The aim of the umbrella organisation for self help groups in paediatric cardiology (Bundesverband Herzkranker Kinder e.V., BVHK) is to continuously improve comprehensive health care to children with heart diseases and their parents. One of the most important aims of the BVHK is to implement psychosocial services for inpatients. In some recent projects the BVHK has analysed the current structures of psychosocial care in German departments of paediatric cardiology. Existing structures are compared with the optimal standards of psychosocial care. Selected results of these projects are described in this article.