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IntroductionHaving a better understanding of predictors of cancer-related fatigue makes it easier to early identify patients at risk of suffering from long-term fatigue. The aim of this longitudinal study was to identify factors that predict long-term fatigue 6 months after discharge from a rehabilitation clinic using a multidimensional conceptualization.MethodA mixed sample of cancer survivors (N = 948) were recruited while in-patient at a rehabilitation clinic. The follow-up survey was administered 6 months after they were discharged from the clinic. Fatigue was assessed with the EORTC QLQ-FA12. Predictive values were estimated using hierarchical multiple linear regression analyses.ResultsMean fatigue scores were 20.7 (cognitive fatigue), 30.9 (emotional fatigue), and 53.2 (physical fatigue) at baseline and significantly lower at follow-up (Cohen’s d 0.12–0.31). Baseline levels of fatigue and depression were identified as important predictors of all dimensions of fatigue. Partnership and time since diagnosis predicted only the levels of physical fatigue. The regression models explained between 36% and 45% of variance in fatigue.ConclusionLevels of fatigue in early stages as well as psychosocial issues could enable clinicians to identify patients with elevated long-term fatigue and thus to provide optimal care for improving patients’ quality of life. Findings of different associates of individual dimensions of fatigue support the multidimensional concept of fatigue.

Background: Psychological problems are common in cancer patients. For the purpose of planning psycho-oncological interventions and services tailored to the specific needs of different cancer patient populations, it is necessary to know to what extent psychological problems meet the criteria of mental disorders. The purpose of this study was to estimate the 12-month and lifetime prevalence rates of mental disorders in cancer patients. Methods: A representative sample of patients with different tumour entities and tumour stages (n = 2,141) in outpatient, inpatient and rehabilitation settings underwent the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for cancer patients (CIDI-O). Results: The overall 12-month prevalence for any mental disorder was 39.4% (95% CI: 37.3-41.5), that for anxiety disorders was 15.8% (95% CI: 14.4-17.4), 12.5% (95% CI: 11.3-14.0) for mood disorders, 9.5% (95% CI: 8.3-10.9) for somatoform disorders, 7.3% (95% CI: 6.2-8.5) for nicotine dependence, 3.7% (95% CI: 3.0-4.6) for disorders due to general medical condition, and 1.1% (95% CI: 0.7-1.6) for alcohol abuse or dependence. Lifetime prevalence for any mental disorder was 56.3% (95% CI 54.1-58.6), that for anxiety disorders was 24.1% (95% CI: 22.3-25.9), 20.5% (95% CI: 18.9-22.3) for mood disorders, 19.9% (95% CI: 18.3-21.7) for somatoform disorders, 18.2% (95% CI: 16.6-20.0) for nicotine dependence, 6.4% (95% CI: 5.4-7.6) for alcohol abuse or dependence, 4.6% (95% CI: 3.8-5.6) for disorders due to general medical condition, and 0.2% (95% CI: 0.1-0.6) for eating disorders. Conclusions: Mental disorders are highly prevalent in cancer patients, indicating the need for provision of continuous psycho-oncological support from inpatient to outpatient care, leading to an appropriate allocation of direct personnel and other resources.

Background Young adult patients with cancer have to deal with their disease in an eventful phase of life. A common side effect of cancer and its treatment is cancer-related fatigue (CRF), a phenomenon which can thwart successful coping with developmental tasks. The aims of this study were to assess the psychometric properties of the EORTC QLQ-FA12, a new instrument for assessing physical, emotional and cognitive fatigue, in young adults with cancer, and to propose a cut-off value that indicates a need for further more specific diagnostics. Methods In a sample of young adults who were first diagnosed with cancer between the ages of 18 and 39 years old, we assess the composite and item reliabilities as well as discriminant validity of the subscales for the EORTC QLQ-FA12. We also discuss two possible ways to calculate a summarizing score when conducting a receiver operating characteristic (ROC) analysis to find the cut-off value. Results The EORTC QLQ-FA12 fit the sample (CFI = 0.96, SRMR = 0.04), had discriminant validity regarding its subscales and every subscale showed convergent validity (composite reliabilities were 0.92 for physical, 0.89 for emotional and 0.74 for cognitive fatigue). The sum of the first ten items with a range of 0 to 30 revealed a cut-off value of twelve or more with 91% sensitivity and 77% specificity. Conclusion The new instrument EORTC QLQ-FA12 is able to distinguish between physical, emotional, and cognitive fatigue in young adult patients. It enables us to study different concepts of general fatigue without the need for additional items, and can be used as a screening instrument for young adults. Future research should investigate the multidimensional character of CRF.

Background There is a lack of psychotherapeutic trials of treatments of comorbid depression in cancer patients. Our study determines the efficacy of a manualized short-term psychodynamic psychotherapy and predictors of outcome by personality and quality of the therapeutic relationship. Methods/design Eligible breast cancer patients with comorbid depression are assigned to short-term psychodynamic psychotherapy (up to 20 + 5 sessions) or to treatment as usual (augmented by recommendation for counseling center and physician information). We plan to recruit a total of 180 patients (90 per arm) in two centers. Assessments are conducted pretreatment, after 6 (treatment termination) and 12 months (follow-up). The primary outcome measures are reduction of the depression score in the Hospital Anxiety and Depression Scale and remission of depression as assessed by means of the Structured Clinical Interview for DSM IV Disorders by independent, blinded assessors at treatment termination. Secondary outcomes refer to quality of life. Discussion We investigate the efficacy of short-term psychodynamic psychotherapy in acute care and we aim to identify predictors for acceptance and success of treatment. Trial registration ISRCTN96793588

Purpose Fatigue is one of the most disabling symptoms in cancer patients. Many instruments exist to measure fatigue. This variety impedes the comparison of data across studies or to the general population. We aimed to estimate a common metric based on six different fatigue instruments (EORTC QLQ-C30 subscale fatigue, EORTC QLQ-FA12, MFI subscale General Fatigue, BFI, Fatigue Scale, and Fatigue Diagnostic Interview Guide) to convert the patients’ scores from one of the instruments to another. Additionally, we linked the common metric to the general population. Methods For n  = 1225 cancer patients, the common metric was estimated using the Item Response Theory framework. The linking between the common metric of the patients and the general population was estimated using linear regression. Results The common metric was based on a model with acceptable fit (CFI = 0.94, SRMR = 0.06). Based on the standard error of measurement the reliability coefficients of the questionnaires ranged from 0.80 to 0.95. The common metric of the six questionnaires, also linked to the general population, is reported graphically and in supplementary crosswalk tables. Conclusions Our study enables researchers and clinicians to directly compare results across studies using different fatigue questionnaires and to assess the degree of fatigue with respect to the general population.

Head and neck cancer patients suffer from high levels of psychological comorbidity and often do not receive adequate psychological assistance. Therefore, speech therapists are frequently confronted with specific psychosocial challenges beyond the scope of their standard professional education. The following aspects were examined via a mixed-methods approach to explore their own perceptions of these challenges and their skills to deal with them: 1) The experiences and problems of speech therapists working with head and neck cancer patients; 2) the self-assessment of speech therapists' skills in cancer patient care; 3) the experiences and observations of psychologists supervising case discussions in oncology with speech therapists; 4) the communication skills of speech therapists working with emotionally distressed patients in oncology Our results show that therapists are acutely aware of their patients' distress. They agree that there is a need for patients to receive psychosocial counseling and that a significant portion of their speech therapy sessions is often dedicated to talking about personal problems. This difficult situation leads to: 1) deficiencies in speech therapists' ability to address patients' demands and deficiencies in distancing themselves from their patients; 2) speech therapists feeling overwhelmed with excessive demands and experiencing mental distress themselves. The psycho-oncological knowledge and communication skills among speech therapists were often deficient in light of such demands. There is a need for further training in psychological and social skills for speech therapists working with head and neck cancer patients.

Purpose Providing sufficient information about diagnosis and treatment is an important feature of high-quality patient care in oncology. To measure patient satisfaction with information received, the European Organisation for Research and Treatment of Cancer Quality of Life Group has recently developed a new tool, the information module (INFO25). The aim of this study was to evaluate the scale structure of the INFO25. Methods A total of n = 423 patients completed the INFO25 after finishing cancer therapy. The internal consistency of multi-item subscales was calculated using Cronbach's Alpha. The scale structure was evaluated using multi-trait methods and confirmatory factor analysis. Results Cronbach's Alpha of the multi-item scales ranged from 0.79 to 0.88. Only two items correlated somewhat higher with another scale than with their own, indicating a good scale structure. Construct validity with latent variable models, including a general information factor and four multi-item scales, resulted in the following fit indices CFI = 0.96, RMSEA = 0.08, TLI = 0.99 and WRMR = 1.03. Conclusion The suggested construct of the INFO25 with a total score (general factor) in addition to the subscales is valid.

Zusammenfassung Hintergrund Die ambulanten psychosozialen Krebsberatungsstellen (KBS) stellen eine wichtige Säule der psychoonkologischen Versorgung in Deutschland dar. Sie bieten Patient:innen in allen Krankheitsphasen sowie deren Angehörigen eine kostenlose, bedarfsorientierte sozialrechtliche und psychologische Beratung an und gewinnen mit der wachsenden Anzahl an Krebsüberlebenden weiter an Bedeutung. Fragestellung Der Beitrag thematisiert den Versorgungsauftrag der KBS in Deutschland und beleuchtet Strukturmerkmale, Leistungsangebote und Finanzierung. Material und Methoden Es handelt sich um eine Übersichtsarbeit auf der Basis einer Literaturrecherche zum aktuellen Stand der ambulanten Krebsberatung. Ergebnisse Das Leistungsspektrum der KBS ist vielschichtig und umfasst bestimmte Kernleistungen sowie ein standortspezifisch erweitertes Leistungsangebot. Zu den Kernleistungen gehört vor allem psychosoziale Beratung mit psychologischer und sozialer Schwerpunktsetzung. Rund jede/-r dritte Patient:in nutzt die Angebote der KBS. Unter den Nutzer:innen sind etwa 70 % Krebspatient:innen, der übrige Teil sind mitbetroffene Personen. Die Inanspruchnahme erfolgt in Abhängigkeit von individuellen Merkmalen der Ratsuchenden (z. B. Alter, Geschlecht, Bildung, Informationsstatus) sowie von strukturellen Faktoren (z. B. Erreichbarkeit der KBS). Mit der Refinanzierung von bis zu 80 % der Leistungen der KBS durch die gesetzlichen und privaten Krankenkassen hat sich die Finanzierungssituation in vielen KBS entspannt. Diskussion Die ambulante psychoonkologische Versorgung steht vor einer Reihe von Herausforderungen. Hierzu gehören der steigende Anteil an Cancer Survivors und damit verbunden die Integration der ambulanten Krebsberatung in neue Versorgungsstrukturen (z. B. Survivorship-Care-Programme). Die Sicherstellung einer flächendeckenden Versorgung und der Abbau von Zugangsbarrieren sind weitere wichtige Handlungsfelder. Für die Finanzierung der KBS ist mit der Krankenkassenfinanzierung eine wegweisende Entscheidung getroffen worden. Inwieweit diese strukturelle Innovation die Versorgungslage und -qualität der ambulanten Krebsversorgung beeinflusst, sollte mit zukünftigen Analysen verfolgt werden.

The purpose of this study was to determine (a) the course of fatigue in depressed breast cancer patients, (b) the effect of a depression-focused individual psychodynamic psychotherapy on fatigue, and (c) the associations of fatigue with depression, quality of life and treatment-related variables. In a German multicentre randomized controlled trial in Leipzig and Mainz, depressed early breast cancer patients (UICC stage 0–III, age 18–70 years) were randomly assigned to a short-term psychodynamic psychotherapy (STPP, an adaptation of the Supportive-Expressive psychotherapy by Luborsky for cancer patients) or treatment as usual (TAU) and completed data assessment pre- and post-treatment. Fatigue was assessed with the Multidimensional Fatigue Inventory (MFI-20). All analyses were conducted as complete case analyses including 52 STPP and 54 TAU completers ( n  = 106). The trial is registered at http://www.controlled-trials.com , number ISRCTN96793588. Fatigue declined significantly from a high level pre-treatment to post-treatment, but remained significantly higher than among population-based controls and a mixed sample of cancer patients. Significant time by group interactions favoured STPP for the subscales reduced activity and physical fatigue and the total scale. The strength of the associations between total fatigue and depression increased from 0.49 pre-treatment to 0.63 (Quality of life −0.52 to −0.63) at follow-up. STPP is beneficial for reducing dimensions of fatigue (particularly reduced activity and physical fatigue) in depressed breast cancer patients. Chronic fatigue needs more clinical attention in this vulnerable group.

HintergrundIn Deutschland ist Gebärmutterhalskrebs der dritthäufigste Genitaltumor der Frau. Dank der Früherkennung sowie den verbesserten medizinischen Therapien überleben mehr als zwei Drittel die Erkrankung. Der Frage nach der Lebensqualität kommt somit eine wichtige Bedeutung zu. Ziel dieser Arbeit ist es, die Folgen einer Zervixkarzinomerkrankung darzustellen und Unterstützungsbedürfnisse aufzuzeigen.MethodeDieser Beitrag gibt einen narrativen Überblick über die entsprechenden aktuellen Forschungsbefunde.ErgebnisseKörperlich haben die Patientinnen langfristig insbesondere mit einer trockenen bzw. verkürzten Scheide, Blasen- und Enddarmdysfunktionen sowie Hitzewallungen zu kämpfen. Die Angst vor dem Wiederauftreten der Erkrankung wird als psychisch belastend erlebt. Ebenso waren Depressionen und Fatigue in einigen Studien gegenüber den jeweiligen Vergleichsgruppen höher ausgeprägt. Ein wesentliches Problem stellen Veränderungen in der Weiblichkeit und damit auch der Sexualität dar. Die Frauen berichten ein vermindertes sexuelles Verlangen und leiden oftmals unter Schmerzen beim Geschlechtsverkehr. Die Behandlungsart hat einen Einfluss auf die Lebensqualität. Eine nervenschonende Operation ist mit weniger Belastungen assoziiert als radikale Chirurgie. Ferner geben radiotherapierte Frauen stärkere Beeinträchtigungen an als Frauen ohne Strahlentherapie. Psychosoziale Unterstützung wünschen sich die Frauen verstärkt für den sexuellen Bereich. Außerdem wurde ein erhöhter Informationsbedarf über die Erkrankung deutlich.SchlussfolgerungDamit Zervixkarzinompatientinnen mit den oftmals auftretenden körperlichen und psychosozialen Folgen besser umgehen können, ist es notwendig, die Frauen adäquat aufzuklären. Auf diese Weise können zum einen Unsicherheiten ausgeräumt werden. Andererseits wird der Weg geebnet, auch in der Nachsorge weiter mit den Frauen gut im Gespräch über ihre körperliche, sexuelle und seelische Befindlichkeit zu bleiben.