Estimating the prevalence of mental disorders in patients with newly diagnosed cancer in relation to socioeconomic status: a multicenter prospective observational study.

BACKGROUND: The purpose of this study was to provide the 4-week prevalence estimates of mental disorders in newly diagnosed cancer patients in relation to socioeconomic status (SES). PATIENTS AND METHODS: We enrolled newly diagnosed patients with a confirmed solid tumor within 2 months of diagnosis. We calculated patients' SES on the basis of their educational level, professional qualification, income and occupational status. We used the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-Clinical Version (SCID-5-CV) to assess the 4-week prevalence of mental disorders in addition to a comorbidity questionnaire to assess the level of physical impairment. RESULTS: We identified a total of 1702 patients with mixed cancers after reviewing their medical records and contacting them in person or by post due to coronavirus pandemic patient safety restrictions. 1030 patients (53.2% men, mean age 60.2 years) had completed SCID-5-CV. When weighted according to the SES distribution to account for over- and under-sampling of SES groups, 20.9% [95% confidence interval (CI) 18.1% to 23.6%] of patients were diagnosed with any mental disorder. The most prevalent were depressive disorders (9.9%, 95% CI 7.9% to 11.9%), trauma and stress-related disorders (6.3%, 95% CI 4.7% to 7.9%) and anxiety disorders (4.2%, 95% CI 2.9% to 5.6%). We found no difference in any mental disorder between patients with high, medium or low SES. Multivariate logistic regression analyses revealed higher proportion of patients with any mental disorder in patients younger than 60 years [odds ratio (OR) 0.42; P < 0.001], in patients without a partner (OR 1.84; P < 0.001), in women with tumor in female genital organs (OR 2.45; P < 0.002) and in those with a higher level of impairment (OR 1.05, 95% CI 1.03-1.07; P < 0.001). CONCLUSIONS: SES had no significant influence on mental comorbidity in early cancer survivorship.

[Pain-related stigma in patients with breast, colon, prostate or lung cancer : Results of a bicentric register-based cross-sectional study]. / Schmerzbedingte Stigmatisierung bei Patienten mit Brust­, Darm­, Prostata- oder Lungenkrebs : Ergebnisse einer bizentrischen registerbasierten Querschnittstudie.

BACKGROUND: Studies on cancer patients show a moderately high relevance of perceived stigmatization. However, no studies have explored the perceived stigmatization in relation to cancer-associated pain. In this work, we analysed the relationship between pain and perceived stigmatization across a large sample of four major cancer entities. METHODS: Quantitative data of 858 patients (45.6% women, mean age 60.7 years) with breast, bowel, lung and prostate cancer were evaluated in a register-based, bicentric study. Perceived stigmatization was measured using the social impact cale (SIS-D), including a total score and four subscales. Pain was assessed with the brief pain inventory (BPI). The data were analysed using correlation und multiple regression with various sociodemographic and medical predictors. RESULTS: Of all 858 cancer patients, those with lung and breast cancer were characterized by the greatest pain. The intensity of the pain was a predictor of the perceived stigma in patients with breast and colorectal cancer. In addition, younger age was also a predictor for perceived stigmatization. A good quality of life resulted as a protective factor. The final models showed a high goodness of the fit (corr. R2 > 0.35), except for the lung cancer patients. CONCLUSIONS: Our findings support the assumption that the experience of pain can have an impact on the perceived stigmatization of cancer patients. Depression might influence the perceived stigmatization. Therefore, this group of patients should receive special attention and psycho-oncological care in clinical practice. Further research on the course and mechanisms of action of pain-related perceived stigmatization is also required.

Finding meaning in suffering?-Meaning making and psychological adjustment over the course of a breast cancer disease.

This study aimed to explore individual meaning systems in the course of a breast cancer disease to test the assumed positive relation between meaning and well-being and to investigate the relationship between post-traumatic growth and well-being. A total of 65 patients with breast cancer were examined 1 year after initial treatment and another year follow-up. Questionnaires addressed meaning in life (MLQ), anxiety and depression (HADS), satisfaction with life (SWLS), health-related quality of life (EQ-5D, EORTC) and post-traumatic growth (PTGI). Personal meaning systems were assessed using a qualitative method. In the personal meaning systems with well-being and relationships as the most frequently named meaning categories, the experienced gains far outweigh the losses sustained as a result of the disease. A stronger sense of meaning was related to lower levels of anxiety and depression, a higher level of satisfaction with life and better health-related functioning. Well-being and post-traumatic growth were mostly independent. Reported losses were strongly related to a poorer well-being. Cancer can induce a process of personal growth, and a strong sense of purpose could facilitate psychological adjustment. The often claimed correlation of post-traumatic growth and a better psychological adjustment is still lacking clear evidence, whereas losses proofed to be crucial.

Perceived stigmatization and its impact on quality of life - results from a large register-based study including breast, colon, prostate and lung cancer patients.

BACKGROUND: To date, research on stigmatization among cancer patients and related psychosocial consequences has been scarce and mostly based on small and highly selected samples. We investigated stigmatization and its impact on quality of life among a large sample including four major tumor entities. METHODS: We assessed 858 patients with breast, colon, lung or prostate cancer from two cancer registries. Stigmatization and quality of life (QoL) was assessed with the Social Impact Scale (SIS-D) and the EORTC Quality of Life Questionnaire (European Organization for Research and Treatment of Cancer), respectively. Group effects were analyzed via analyses of variance, relationships were investigated via Pearson's r and stepwise regression analyses. RESULTS: The mean age was 60.7 years, 54% were male. Across cancer sites, the dimensions of stigmatization (isolation, social rejection, financial insecurity and internalized shame) were in the lower and middle range, with the highest values found for isolation. Stigmatization was lowest among prostate cancer patients. Stigmatization predicted all five areas of QoL among breast cancer patients (p < .05), but only affected emotional functioning (p < .01) among lung cancer patients. CONCLUSIONS: We found an inverse relationship between perceived cancer-related stigmatization and various dimensions of QoL, with variation between cancer sites. Breast cancer patients should be focused in individual therapies regarding the negative consequences accompanied by perceived stigmatization.

Feasibility of an exercise programme in elderly patients undergoing allogeneic stem cell transplantation - a pilot study.

It has been demonstrated that physical exercise benefits younger patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT). We designed a prospective pilot study investigating whether elderly patients (>60 years) would also be able to participate in such a programme. It consisted of physiotherapist-supervised alternating endurance and resistance workouts on 6 of 7 days a week. Sixteen consecutive patients undergoing allo-HSCT were enrolled into the study. The median age was 64.5 years. Twelve patients participated in the programme until the time of discharge (75%) from the transplant unit. Therefore, the predefined criteria regarding feasibility were met. The reason for drop out was transplantation associated mortality in all patients (n = 4). Adherence was very good with a median of 85% attended training sessions. No adverse events were recorded. The endurance capacity dropped by 7% and lower extremity strength improved by 2% over time. Quality of life decreased during the study period, with global health being significantly worse at the time of discharge. In conclusion, a combined and intensified strength and endurance exercise programme is feasible and safe in a population of elderly patients undergoing allo-HSCT. Further research should focus on exploring effect sizes of such an intervention by conducting randomised controlled trials.

[Feedback on service provision in cancer patients using the Ward Satisfaction Questionnaire (WSQ)--testing a new tool]. / Einschätzung von Visite und Stationsalltag bei Krebspatienten mit dem Stationsfragebogen (SFB)--Erprobung eines neuen Instrumentes.

BACKGROUND: Collecting information on patients' experiences and opinions is prerequisite to improving the quality of services at a ward. The Ward Satisfaction Questionnaire (WSQ) was developed for this purpose. We investigated its psychometric characteristics and percentage of missing values. METHODS: Over a period of 4 months, all patients at an interdisciplinary and an oncology ward were asked to complete the WSQ. Concordant validity was assessed using the Patient Involvement in Care Scales (PICS). RESULTS: 68 of 99 administered questionnaires were completed (response rate 69 %). The median of missing values per item was 6 % (0 -28 %). Internal consistency of the WSQ scales ranged from 0.68 ("Accessibility of Doctors") to 0.94 ("Doctor Consultations"). Cronbach's Alpha of the total score was 0.94. Scaling errors were 0 % ("Ward Rounds", "Doctor Consulations", "Accessibility Nurses") to 17 % ("Accessibility Doctors"). Variances of WSQ scales were relatively low. Correlation patterns of WSQ and PICS support the validity of WSQ. CONCLUSIONS: The WSQ facilitates systematic feedback on inpatient services. Psychometric characteristics are good and validation in a larger patient sample is warranted.

Passive tension of the ankle before and after stretching.

The passive tension resulting from dorsiflexion of the ankle was measured in relation to stretching in six handball players and six soccer players. Corresponding values of ankle angle and passive tension were measured by a strain gauge and a potentiometer connected to a pedal system. The passive tension versus ankle angle was measured before and 90 minutes after a single contract-relax stretching program of the plantar flexors. Stretching lowered the passive tension by up to 18%. Contract-relax stretching performed twice a day for 3 weeks lowered the passive tension in the plantar flexors by up to 36%. Before the last measurements, no stretching was performed for 20 hours or more. Stretching thus had both a short-term effect, matching the length of a training session, and a long-term effect, shown in a reduction of passive tension after 3 weeks. The relative decrease in passive tension after stretching exercises was constant from a neutral position of the ankle to maximal dorsiflexion. There was no correlation between 1) flexibility and the short-term effect of stretching, 2) flexibility and the long-term effect of stretching, or 3) the short-term and long-term effects of stretching. This indicates that passive tension was decreased in all subjects irrespective of their flexibility, and that subjects who had short-term effects after stretching did not necessarily demonstrate a long-term effect.

Muscle stiffness in human ankle dorsiflexors: intrinsic and reflex components.

1. The purpose of this study was to evaluate the mechanical response to stretch in normal human ankle dorsiflexors at different levels of voluntary contraction. In an active muscle, the total mechanical response is the sum of the intrinsic response from the contractile apparatus, the response from passive tissues, and the reflex mediated response. Each of these components was investigated. 2. The total incremental stiffness was defined as the ratio between the torque increment and the amplitude of the stretch. In 14 subjects the total stiffness increased from approximately 0.6 N.m/deg to approximately 2.5 N.m/deg at 50% of MVC and remained constant (+/- 10%) from 30 to 80% of MVC. 3. The contribution to incremental stiffness from intrinsic muscle properties was measured during electrical stimulation of the deep peroneal nerve at 7-50 Hz. Intrinsic stiffness increased linearly with torque from approximately 0.5 N.m/deg to approximately 2.5 N.m/deg at 80% of MVC. 4. The reflex component (total minus intrinsic stiffness) had a maximum of 0.5-1.5 N.m/deg at 30-50% of MVC and was approximately zero at no and maximal contraction. For intermediate levels of contraction the reflex increased the stiffness with 40-100% of the intrinsic stiffness in this flexor muscle. 5. The reflex contribution to total stiffness began approximately 50 ms after onset of stretch and peaked 150-300 ms after onset of stretch. 6. Total, intrinsic, and reflex mediated stiffness were all nearly independent of the amplitude of stretch in the range from 2 to 7 degrees. The higher stiffness observed for 1 degree stretches could be due to "short range stiffness" of the cross bridges. 7. Stretching of a contracting muscle generates large force increments even for moderate amplitudes of stretch. Approximately half of this force increment is due to the stretch reflex, which makes the muscle stiffer than predicted from the intrinsic stiffness. These findings in human flexor muscles are surprisingly similar to previous findings in extensor muscles of the decerebrate cat.