Difference in patient's acceptance of early versus late initiation of psychosocial support in breast cancer.

The present study was performed to assess the difference in acceptance of psychosocial counseling and resulting benefits between patients with breast cancer with early or late onset. In a prospective randomized controlled study conducted over 6 months, 41 women with a new diagnosis of early breast cancer (group 1) and 43 patients with advanced breast cancer (group 2) received individually tailored psychosocial support and were compared against controls. This therapy was free of charge, and the duration of support was determined by the patients' wishes and needs. Among the patients with new onset of disease acceptance of the psychosocial counseling was high, and these patients experienced significant improvements in their quality of life. In contrast, acceptance of psychosocial counseling was low in the advanced breast cancer group and the therapy did not improve quality of life over the observation period of 6 months. Early psychosocial support in patients with breast cancer meets with a high acceptance rate and improves quality of life.

Coping with amputation and phantom limb pain.

Phantom limb pain is a common, distressing phenomenon that can occur after the amputation or denervation of a part of the body. No conclusive etiological models or theories have emerged, although the problem was identified some time ago. This empirical-diagnostic study deals with correlations between coping with limb loss, body image, and the occurrence of phantom limb pain. It is based on Melzack's concept of a neuromatrix. Coping strategies were evaluated using semistructured interviews and analysis of patients' drawings of their body images. The results of the study, based on 43 amputees, show a significant association between coping strategies and pain. Patients who cope better with the loss suffer less from phantom limb pain. A difference can also be noted in subjective representation of the body image: patients suffering from phantom limb pain tend to have an image of their bodies as a complete and undamaged entity.

[Phase-specific function of denial in type 1 diabetic patients after disease onset]. / Zur phasenspezifischen Funktion der Verleugnung beim Typ 1 Diabetes Patienten nach Krankheitsausbruch.

In a longitudinal study we examined 43 patients with type 1 diabetes one week after onset as well as 8 and 24 month later in order to analyze the psychological role of denial processes in correlation to metabolic functions. Only depression decreased over the studied period while coping and denial remained stable. However, the adaptive function of denial after onset with low anxiety, good coping and few complaints became maladaptive over the first two years and the correlation of denial with a centripetal kinship behavior loosened. The destructive effect of denial was indicated only by delayed requests for assistance while no correlation could be shown for phase-specific internal restructuring of the psychological function of denial to compliance and metabolic control.

[Personality markers in patients with Sudeck's disease. A psychoanalytic study]. / Persönlichkeitsmerkmale bei Patienten mit M. Sudeck. Eine tiefenpsychologische Untersuchung.

We examined 22 patients suffering from reflex sympathetic dystrophy with psychoanalytic interviews. In all 22 patients we found a common psychological structure corresponding to Balint's basic fault (Balint, 1970). For people with this structure the accident that preceded the reflex sympathetic dystrophy and the following pain, immobilisation and need to help are promoting the patient's regression in a specific way ending in the developing of reflex sympathetic dystrophy. The dispair of the patients about their reflex sympathetic dystrophy expresses unsolved fears of early childhood.

[Effectiveness of psychosocial management of cancer patients--a critical review of empirical studies (status: December 1990)]. / Zur Effektivität psychosozialer Betreuung Krebskranker--Eine methodenkritische Literaturübersicht (Stand: Dezember 1990).

41 empirical studies evaluating psychosocial care of cancer patients, published between 1975 and 1990 are presented. Only those studies were selected that examined adult patients and controlled the effects of psychotherapeutic interventions. 35 studies reported significant effects on coping, mood states or quality of life. 6 articles were inquiries into the efficiency of intervention on time of survival, 3 measured the impact on the immune system.

[The disease coping of radiation cancer patients compared]. / Krankheitsbewältigung radioonkologischer Patienten im Vergleich.

Emotional well-being and physical complaints of 87 outpatients undergoing radiotherapy were compared with those of a variety of other patients. The emotional and physical status were assessed by a list of emotional symptoms (German: "Befindlichkeitsskala") [18] and a list of physical complaints (German: "Beschwerdeliste") [19]. Although they have to cope with a fair amount of physical strain, values of the "oncologic group" rank second lowest, outranked only by healthy controls. The results strengthen the hypothesis of an adaptive denial to cope with the strain of the treatment. In conclusion, concrete suggestions are made for the doctor-patient relationship.

[The psychosocial care of cancer radiology patients--the requirement, subjective need and acceptance]. / Psychosoziale Betreuung radioonkologischer Patienten--Bedarf, subjektives Bedürfnis und Akzeptanz.

The topic of the investigation was the discrepancy between the documented objective need for psychosocial support of cancer patients on the one hand, and of the patient's little subjective needs on the other, the latter resulting in only low acceptance of care offered. In an empiric study the attitude of 38 radio-oncological patients (29 female, nine male) toward psychosocial support was investigated. The study revealed a tendency, independent of sex, that may be described as a social retreat (e.g. emphasis on personal independence, desire not to burden anybody, to hold back own interests and feelings, to be of help rather to others). We interpret this attitude as a specific reaction of coping with the problem, attempting at self-stabilisation.

[The status of oncologic patients in radiotherapy--physical and psychological aspects]. / Die Situation des onkologischen Patienten in der Strahlentherapie--physische und psychische Aspekte.

UNLABELLED: This study examines the psychological strains experienced by patients undergoing radiotherapy, as well as their somatic complaints and the possible connection between these two aspects. The sample consisted of 87 cancer patients, 64 female, 23 male. We used two standardized clinical instruments, one Zerssen's list of somatic complaints ("Beschwerdeliste" in German) and Zerssen's questionnaire of wellbeing ("Befindlichkeitsskala" in German). These two research instruments were implemented four times: at the beginning, in the middle and at the end of radiation, and three months afterwards. RESULTS: Both the psychological state of well-being and somatic complaints remained at approximately the same level during the whole course of therapy. The state of well-being increased significantly after therapy, which is indicated by the decrease in the number of psychological impairments, whereas the score for somatic complaints remained the same. We observed a general tendency on the part of the patients to play down their situation. Sex differences were not observed. The discussion of the results includes their implication on the doctor-patient relationship.

[Psychosocial effects of plastic surgery reconstruction of the female breast following amputation for malignant/benign tumor]. / Psychosoziale Auswirkungen der plastisch-chirurgischen Rekonstruktion der weiblichen Brust nach der Amputation aufgrund eines malignen/benignen Tumors.

A total of 98 woman (malignant/benign tumors of the breast, mastectomy with/without subsequent reconstructive surgery as well as healthy controls) were examined in terms of subjective well-being, psychosomatic reaction patterns, subjective impairment due to mastectomy and satisfaction with the outcome of reconstructive surgery in this empiric retrospective study. In addition, numerous sociographic data were obtained. On the average, the examined women were satisfied with the outcome of reconstructive surgery and tended to be disappointed with regard to the desired psychosocial improvement. Objective tests demonstrate that subjective well-being was less favorable after reconstructive breast surgery than in women without reconstruction. In the group "benign tumor with subsequent reconstruction" the reaction to emotional strain was significantly more characterized by regressive behavior and withdrawal than in the group "benign tumor without reconstruction". In the group "malignant tumor with reconstruction" this difference was less pronounced. On the basis of these results we cannot confirm the assumption that reconstructive surgery of the breast has a supportive function.

[Effect of the stress coping mechanisms of oncologic patients on their physical and psychological state in radiotherapy]. / Der Einfluss von Stressverarabeitungsmechanismen onkologischer Patienten auf physisches und psychisches Befinden in der Strahlentherapie.

An empiric study was designed to investigate how patients cope with radiotherapy and its secondary effects. Subject of inquiry was the influence of variables such as age, sex and individual strategies of coping with stress on the extent of reported strain. 91 cancer patients (66 female, 25 male) undergoing radiotherapy with different diagnoses but comparable history and duration of disease were interviewed concerning physical complaints and impairment of psychic mood at four times: in the beginning, the middle and the end of a 6-week radiotherapy as well as 3 moths afterwards. Additionally general coping strategies were evaluated in the beginning. Results showed that reported impairment (only within the subgroup: women under 50) correlated significantly (p less than 0.01) with a coping behaviour that could be described as a "retreat and giving up".

[Coping with disease and management of therapy in patients with cancer with special reference to radiotherapy. An overview]. / Krankheitsverarbeitung und Therapiebewältigung bei Krebskranken unter besonderer Berücksichtigung der Radiotherapie. Ein Uberblick.

The actual state of research is reviewed, focussing on the psychosocial aspects of cancer. The argumentation is oriented at distinguishable stages during the course of disease. Further topics are doctor-patient-relationship, compliance, coping and the evaluation of psychosocial care.