Validation and practical implementation of a multidisciplinary cancer distress screening questionnaire.

BACKGROUND: In order to identify cancer patients with psychosocial needs during radiotherapy, a routine screening questionnaire is widely recommended in the literature. Several tools focusing mainly on psychological issues have been developed during the past decade. However, problems with their implementation into clinical routine have been repeatedly reported, due to a lack of practicability for clinicians and nurses. This study reports the compilation of a multidisciplinary screening questionnaire and an analysis of the effectiveness of its implementation into clinical routine at the Department of Radiotherapy, Medical University of Vienna. MATERIALS AND METHODS: The screening questionnaire is based on a compilation of several subscales from established and validated assessment tools. It focuses on comprehensive information with high a clinical relevance for all professions. In a pilot study, patients' acceptance was assessed qualitatively. Analysis of missing screening data in consecutively admitted patients reflects the effectiveness of implementation and representativity of the data. A validation analysis of the psychological subscales was performed using external criteria and its internal consistency was tested with Cronbachs' α. RESULTS: Qualitative patient acceptance of the screening questionnaire is good. The overall response rate in the screening procedure was 75 %. Missing patient screening data sets arose randomly-mainly due to organizational problems-and did not result in systematic errors. The psychological subscales identify highly distressed patients with a sensitivity of 89 and 78 %, and an internal consistency of 0.843 and 0.617. CONCLUSION: The multidisciplinary screening questionnaire compiled in this study has a high patient acceptance, provides reliable and representative data and identifies highly distressed patients with excellent sensitivity. Although requiring additional personnel resources, it can be implemented successfully in clinical routine with benefits for both the patient and the professional team.

Radiation of jejunal interposition in T3-T4 upper aerodigestive tumours.

30 patients with T3 and T4 tumours of the upper aerodigestive tract had their tumours resected by pharyngolaryngectomy. This was followed by reconstruction of a gullet or creation of a siphon as a tracheohypopharyngeal shunt for voice restoration with a free jejunal autograft. All patients were treated postoperatively with 60Co gamma radiation, 6 MeV photons or 7.5 to 10 MeV electrons of a beta-tron, with a dose of 50-65 Gy in the area of the primary tumour and 50-65 Gy to the neck. 4 patients refused further treatment after a depth dose of between 16 and 32 Gy. Local recurrence occurred in 40% of cases. The survival rate was 36.6% (11/30) after a mean follow-up time of 21.5 months, although 2 patients died of intercurrent diseases without recurrence of their tumours. The results obtained justify active surgical intervention with postoperative irradiation even at an advanced stage of the tumour.

Radiotherapy of Morbus Gorham-Stout: the biological value of low irradiation dose.

Morbus Gorham-Stout is a very rare disease. A patient with this disease was treated at the University Clinic of Radiobiology in Vienna. The clinical and radiological findings place special emphasis on the radiotherapeutic treatment, and the biological basis of the recommended dose is discussed.

[Mammographic and sonographic appearances of traumatic changes in the female breast]. / Mammographisches und sonographisches Erscheinungsbild traumatischer Veränderungen der weiblichen Brust.

As a result of trauma, or surgery, haematomas develop which are visible and can be demonstrated by sonography; they either regress completely or leave circular foci after a period of days or weeks. Both the new and older lesions can usually be well shown by sonography. During these stages the sonogram may be valuable. Long-standing changes, such as fat necrosis, are best shown by mammography. There are three types of fat necrosis; oily cysts, mixed types or scarring leading to an appearance resembling a carcinoma. Oily cysts may undergo mural calcification leading to liponecrosis macrocystica or liponecrosis microcystica, depending on size.

[A contribution to the differential diagnosis of odnotogeneous cysts]. / Differentialdiagnostischer Beitrag zur Problematik der odnotogenen Zysten

Problems concernint the diagnosis and differential diagnosis of odontogenic cystic lesions of the jaw are discussed with reference to a series of patients and some specially selected cases. The use of isotope examination is often of particular significance in coming to a decision. The position and value of scintigraphy has been demonstrated by referring to the literature and to our own investigations. The often difficult differentiation from certain types of odontogenic tumours is also discussed.

[Indications and methods of megavolt therapy in prostatic cancer--evaluation of 98 cases]. / Zur Indikation und Methodik der Megavolttherapie des Prostatakarzinoms--Auswertung von 98 Fällen.

A report is given on 98 unselected cases of carcinoma of the prostate, treated at the University Department of Radiotherapy and Radiobiology of Vienna from January 1974 till December 1979. 85% of the patients were over 60 years old. More than the half of them had been subjected to surgery or had undergone hormone therapy before starting radiotherapy. Moreover, more than 50% of the patients showed advanced disease (stages C or D). Local control was achieved in about 95% of cases. Long-term side effects such as irradiation damage to bladder or gut occurred in about 5% patients only. Survival rate was 75.5% after 3 years, 66.7% after 5 years and 46.7% after 7 years. Recommendations as to the management of such an unselected patient group are given. Our modified radiation technique is presented.

[Percutaneous radiotherapy of thyroid malignancies. Analysis of 54 cases]. / Zur perkutanen Strahlentherapie des Schilddrüsenmalignoms. Analyse von 54 Fällen.

A report is given on 54 cases of thyroid malignancy treated at the University Department of Radiotherapy and Radiobiology of Vienna from January 1970 till September 1977. These cases are analysed according to local control of disease and survival time. The 5-year disease-free survival rate for all histological types was found to be 48%. Local recurrence occurred in 13% of cases. Combined external irradiation and radioiodine therapy is critically discussed.

[Patho-anatomy of lymph vessels of the liver from a roentgenologic viewpoint]. / Zur Pathoanatomie der Lymphgefässe der Leber aus röntgenologischer Sicht.

With increased formation of lymph the lymphatic vessels of the liver are detectable on X-ray and can be assessed. Lymphatic vessels of the portal areas and Glisson's capsule and the pathways of the efferent extrahepatic lymphatics are described. Examples of pathological hepatograms in cirrhosis are presented.

[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.

Teleradiotherapy of joints in rheumatoid arthritis: lack of efficacy.

BACKGROUND: Low dose radiotherapy is commonly used for painful rheumatic conditions in clinical practice. Teleradiotherapy may be a cheap, painless procedure which is applicable to many joints at a time. OBJECTIVE: To determine if the local application of x rays to inflamed joints in rheumatoid arthritis (RA) affects the signs and symptoms of inflammation. METHODS: In a randomised, controlled, double blind study, roentgen irradiation was administered in a total dose of 20 Gy during 2 weeks to single joints in six patients with RA who were receiving constant and stable pharmacological treatment with DMARDs and NSAIDs. Single inflamed joints on the contralateral side of the body were used as controls and received sham irradiation. Swelling and tenderness was assessed by blinded investigators before and until 3 months after the irradiation; general disease activity and pain scales were included in the assessment. RESULTS: No change in the scores for tenderness, swelling, pain, or disease activity was seen. The trial was stopped for ethical reasons. CONCLUSION: Local roentgen treatment of RA at a substantial dose of 20 Gy was ineffective in this pilot trial.

[Radiotherapy in nasopharyngeal cancer. Evaluation of 37 cases]. / Strahlentherapie beim Nasopharynxmalignom. Auswertung von 37 Fällen.

37 cases of nasopharyngeal tumors were studied which have been treated from January 1971 through December 1976 at the University Clinic for Radiotherapy and Radiobiology Vienna. These cases were analysed according to local and regional control and survival time. The 5-year-disease-free survival rate for all patients studied is 46%. Local and regional recurrences are discussed.

[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.

[Suction-radiography in mammography (author's transl)]. / Die Saugaufnahme im Rahmen der Mammographie

The value of the suction apparatus used in over 500 examinations as a simple addition to mammography has been convincing in our hands. Suction of 30 mm Hg, produced with a test-rubber bulb, achieves distension or stretching of the mamma. This leads to changes of position, shape and density of normal and pathologic structures and gives further information, compared with routine mammography. It is often possible to distinguish between spaces filled with fluid (cysts, hematomata) and solid tumours, pseudotumours and genuine growths, and between benign and malignant tumours. One essential indication is the "small" breast of various types (constitutional, post-operative and in men), because often suction will enable us to do a mammography. Suction radiographs are added in every 10th patient to previously taken compression radiographs with, of course, large and coned radiographs, which will yield a safe diagnosis in one half of the cases or confirm suspected findings.

[Mammographic changes in the partially resected and irradiated breast]. / Mammographisch fassbare Veränderungen bei der teiloperierten und nachbestrahlten Brust.

Thirtyseven patients with breast cancer stage T1 have been treated by tumorectomy or quadrantectomy and radiation therapy. Mammographic changes as skin thickening and parenchyme reaction were described and put in correlation between the end of treatment and mammography controls. Differential diagnostic problems are discussed.

[Optimization of dose distribution by use of lead wedge filters in combined electron and photon therapy]. / Optimierung der Dosisverteilung bei kombinierter Elektronen- und Photonentherapie durch Anwendung von Blei-Keilfiltern.

A significantly improved isodose distribution has been reached by the combined application of high-energy photons and electrons, however, there are still problems with respect to the critical organs. It was demonstrated that a considerable progress is possible by the use of lead wedge filters within the frame of this irradiation technique. Recommendations for clinical application are given on the basis of the authors' own practical experiences.