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Background Methods Results Conclusions One third of adults with cancer suffer from common mental disorders in addition to their malignant disease. However, it is unknown whether this proportion is the same in patients who have brain tumors and which factors modulate the risk for psychiatric comorbidity.In a multicenter study, patients with high‐grade glioma at 13 neurooncology clinics were enrolled consecutively and interviewed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID) to diagnose common mental disorders. Predictors of psychiatric comorbidity were investigated using binary logistic regression.Six hundred ninety‐one patients were interviewed. The proportion of patients who had mental disorders was 31% (95% confidence interval [CI], 28%–35%). There was evidence for an association of psychiatric comorbidity with the following factors: younger age (odds ratio [OR], 1.9; 95% CI, 1.1–3.4; p = .04), stable disease versus complete remission (OR, 1.7; 95% CI, 1.1–2.8; p = .04), lower income (OR, 1.7; 95% CI, 1.0–2.8; p = .04), living alone (OR, 1.6; 95% CI, 1.0–2.6; p = .05), fatigue (OR, 1.6; 95% CI, 1.1–2.4; p = .03), and impaired cognitive functioning (OR, 2.3; 95% CI, 1.5–3.6; p < .01). There was no evidence for independent effects of gender, histology, affected lobe, time since diagnosis, or employment status.Approximately one third of adult patients with high‐grade glioma may suffer from a clinically relevant common mental disorder, without notable disparity between the genders. In particular, clinicians should pay attention to possible comorbidities for cases in which patients exhibit compromised subjective cognitive function, are younger than 50 years, maintain a state of stable disease, or live alone. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to validate the new European Organisation for Research and Treatment of Cancer Quality of Life Thyroid Cancer Module (EORTC QLQ-THY34). Methods: We enrolled 437 thyroid cancer patients from 17 countries. One group (n = 303), undergoing treatment or best supportive care, completed the questionnaires at three time points (before therapy [t1], 6 weeks later [t2], and 6 months after t2 [t3]). A second group (survivors ≥2 years after diagnosis, n = 134) completed it at a random baseline time point and a second time 1 week later. We determined internal consistency (using Cronbach's alpha), the scale structure (with confirmatory factor analysis), and discriminant validity (using known-group comparisons). Group 1 data were used to assess responsiveness and group 2 data to determine test-retest reliability using intra-class correlations (ICC). Results: All 34 items fulfilled the criteria to be kept in the questionnaire. Cronbach's alpha was >0.70 in 8 of the 9 multi-item scales. All standardized factor loadings exceeded 0.40, confirming the proposed scale structure. The ICC was >0.70 in all scales expressing good test-retest reliability. Differences in scale scores between patients with different histology were >5 points in all scales. In all but one of the pre-specified scales (Dry Mouth), changes over time were ≥|4| points between at least two time points. Conclusion: The EORTC QLQ-THY34 with its 9 multi-item and 8 single-item scales is a reliable and valid tool to measure quality of life in thyroid cancer patients and can be used in future trials and studies. [ABSTRACT FROM AUTHOR]

At the end of the last century, there was a debate about whether cognitive psychology had superseded behavioral psychology and psychoanalysis, and the question was raised of whether the latter two might even be dead. The aim of this study was to investigate how these sub-disciplines have developed since then. The citation count, Journal Impact Factor (JIF), and Immediacy Index of four leading journals from each sub-discipline were abstracted for the years 1998, 2008, and 2018. Trends were analyzed using joinpoint regression analysis. The average number of times each sub-discipline's journals were cited increased between 1988 and 2018. The cognitive journals' JIF increased slightly, the behavioral journals' doubled, and the psychoanalytic journals' remained at the same level. The average annual percentage change for citations to the International Journal of Psychoanalysis showed that the number of citations statistically significantly increased over the years. This was also the case for the Journal of Applied Behavior Analysis. Its JIF trend changed at one point: it decreased up through 2006, after which it increased. Citations to Cognitive Psychology also increased over time, while there was no evidence that its JIF changed. This shows that all three sub-disciplines are still alive and relevant. [ABSTRACT FROM AUTHOR]

Purpose: We examined how migration background is associated with awareness and usage of psycho-oncology services. Methods: Oncologists in community-based practices and outpatient clinics asked their patients and their relatives to complete a questionnaire. Migrants were purposely over-sampled. The questionnaire was provided in Arabic, English, Farsi, French, German, Hindi, Kurdish, Pashto, Russian, Somali, Turkish, Urdu, and Vietnamese. Results: From 9 collaborators, 177 participants were enrolled (130 with and 47 without migration background). The existence of outpatient cancer counselling centres was known to 38% of the participants without and 32% with migration background, self-help groups to 32 vs. 12%, and psychotherapy to 43 vs. 25%. Respondents from the Near and Middle East were less likely to know about psychotherapy (odds ratio (OR) 0.1, p = 0.01); those from the Commonwealth of the Independent States or former Yugoslavia were less often informed about self-help groups (OR 0.1, p = 0.06). Migrants retrieved information less frequently from the internet than non-migrants (10 vs. 25%). At least one service had been used by 27% of migrants and 42% of non-migrants (OR 0.5, p = 0.06). After adjusting for gender, age, education, and patient-relative status, there was no evidence for an association between migration background and service use. Conclusions: Migrants should be better informed about psychotherapy and self-help groups, in particular the ones coming from the Near or Middle East and the Commonwealth of the Independent States or former Yugoslavia. The under-use of psychosocial services can largely be explained by confounding factors. Therefore, these factors must always be taken into account when analysing the use of psychosocial services in the aforementioned populations. [ABSTRACT FROM AUTHOR]

This study examined the demographic characteristics of patients using outpatient psychodynamic psychotherapy and compared them to the general population. A second aim was to explore clinical and biographical features of the users. We extracted data from a random sample of 983 applications for reimbursement of psychodynamic psychotherapy in community-based practices in Germany. These applications contain information for the health insurer but also additional written reports for an expert reviewer. Census data for comparison were obtained from the Federal Statistical Office of Germany. Men, older people, and migrants were underrepresented, while the unemployed were overrepresented compared to the general population. A third of the reports described a patient's experience of physical and/or sexual violence. Twenty-six percent of the reports mentioned that the parents had separated, and a third of these patients were younger than 5 years at that time. Suicidal ideation was reported for a fifth of the patients. About 5% were reported to present with self-harming behaviour and 14% with violence towards others. It was mentioned that the patients were consuming dangerous amounts of alcohol in 9%. The most frequent diagnosis group was affective disorders, followed by neurotic disorders, whereas only few had a substance use diagnosis or a psychotic disorder. In summary, men, migrants, older people, and patients with substance abuse and psychotic disorders are likely underrepresented in outpatient psychotherapy in Germany, indicating unequal access to mental health care despite the universal coverage of its costs. Patients in outpatient psychodynamic psychotherapy often present with severe clinical problems. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the pattern of psychosocial care in breast cancer survivors. Methods: In a prospective study with measurements before surgery, 1 month, 8 months, and 5 years thereafter, we examined the proportion of breast cancer survivors who were aware about, had been offered and received various types of psychosocial services from psychologists, social workers, doctors, self-help groups etc. The degree of helpfulness per service among users was ascertained with Likert scales. Determinants of awareness, offer and use were investigated using binary logistic regression analyses. How the services are inter-related was tested with principal component analyses. Results: Among 456 breast cancer survivors who participated until 5 years, psychological services were known by 91%, offered to 68%, and used by 55% of patients. Social services were known by 86%, offered to 65%, and used by 51%. Women ≥ 65 years were less likely to be informed about (odds ratio (OR) 0.2) and get offers for psychosocial services (OR 0.4 for social and 0.5 for psychological services) than women < 65 years. The services rated most helpful were social services in the hospital, psychological counselling by a consultant and psychotherapy in private practices. Conclusion: These findings underline the importance of psychosocial support by physicians in addition to the "professional" mental health and social care providers. They also show that elderly women in need for support might be in danger of not being well-informed about the services available. [ABSTRACT FROM AUTHOR]

Suicide is an important cause of death in patients with mental health disorders, but little is known about the occurrence of suicidal ideation and attempts in outpatient psychotherapy patients. The aim of this study was to identify the proportion of patients with and correlates of suicidal ideation and attempts in community‐based psychotherapy practices. Using 983 applications for reimbursement of psychotherapy from individual patients, reports about suicidal thoughts and suicide attempts were extracted along with demographic, biographic and clinical data. Multivariate logistic regression analysis was used to identify correlates of suicidal ideation and attempts by calculating odds ratios (ORs). Among the patients, 19% presented with suicidal thoughts (11% currently and 8% in the past) and 6% with suicide attempts. Important correlates of suicidal thoughts were male gender (OR 1.7), lower education (OR 1.8), early retirement (OR 2.9), death of a parent when younger than 5 years old (OR 3.3), violence experienced from various people (OR 2.1), self‐harm behaviour (OR 7.9) and alcohol misuse (OR 1.7). Suicide attempts were associated with male gender (OR 5.6), lower education (OR 4.2), violence experienced from partner (OR 2.5) or from various people (OR 9.5) and self‐harm behaviour (OR 15.0). These results show that the proportion of suicidal patients seeking outpatient psychotherapy is high. It should therefore be a central topic in clinical training. Biographic data such as the loss of a parent at an early age or experiencing violence are associated with who is at increased risk and should be explored in detail. [ABSTRACT FROM AUTHOR]

How do psychoanalysts perceive their male and female patients? We analyzed texts from reports to the experts from applications for reimbursement of psychotherapy to find out if there were gender-specific differences. The reports for 20 male patients and 20 female patients were qualitatively analyzed, resulting in 399 coded text segments. It was found that for women their appearances (hairstyle, body shape, eyes, clothing style, etc.) were described much more frequently than for men. Differences in the assessment of their appearance were also found: female patients were more often described as being pretty/attractive or childlike/younger looking, whereas these attributes were rarely used for men. By contrast, they were more often described as being aboveaverage intelligent. In the countertransference women more frequently induced feelings of having to be careful but also compassion and sympathy, whereas men more frequently induced the wish to help and to support them, the wish to limit them as well as anger and rage. These findings indicate that gender stereotypes play an important role in the perception (and description) of patients. [ABSTRACT FROM AUTHOR]

Aims: Social inequality in access to mental health care is a current concern across the world. The authors determined whether differences in waiting times for outpatient psychotherapy changed after a statutory reform of the German psychotherapy law. Methods: The dates of first contact, first visit and treatment start, along with socio‐demographic and clinical data, were extracted from patient records in community‐based psychotherapy practices. Predictors of waiting times for first visit and treatment start were investigated using multilevel Cox regression models to estimate adjusted hazard ratios (HRadj). Results: Data from 1548 patient records from nine practices were extracted. Before the reform, the time span between first contact and first visit was longer for patients with compulsory education than for patients with a college degree (HRadj 0.8, 95% CI 0.6–1.0), whereas this was no longer the case after the law changed (HRadj 1.0, 95% CI 0.8–1.3). Patients whose treatment was covered by the state were at higher risk of a long waiting time from last visit to treatment start compared with patients with statutory health insurance after the law changed (HRadj 0.4, 95% CI 0.3–0.7), which had not been the case before the law changed (HRadj 1.3, 95% CI 0.8–2.2). Conclusions: Social inequality in access to psychotherapy was reduced in part by the updated psychotherapy law in terms of educational groups; however, it increased in other aspects. This shows how political decisions can powerfully impact clinical practice, ultimately helping one group of patients while disadvantaging another. [ABSTRACT FROM AUTHOR]

Minimal important change estimates (MIC) are useful for interpreting results of clinical research with quality of life (QoL) as an endpoint. For the European Organisation for Research and Treatment of Cancer head and neck cancer module, the EORTC QLQ-HN43, no such thresholds are established. Head and neck cancer patients under active treatment (n = 503) from 15 countries completed the EORTC QLQ-HN43 three times (t1: before treatment, t2: three months after t1, t3: six months after t1). A subgroup completed a Subjective Significance Questionnaire (SSQ), indicating experienced change from the previous time point in four QoL domains. QoL was assumed to deteriorate after t1 and improve again until t3. The MIC was established using the average of mean differences in SSQ groups (MIC mean) and estimates based on logistic regressions (MIC predict). Additionally, minimal detectable changes (MDC) were computed using 0.5 standard deviation and standard error of the mean. For swallowing , speech , dry mouth, and global QoL , the MIC for deterioration were 13, 14, 26, and 10 respectively. The MIC for improvement were 8 (swallowing), 6 (dry mouth), and 5 (global QoL); no MIC for speech improvement can be presented because of insufficient correlation between change score and anchor. The MDC estimates for deterioration were 15, 14, 15, and 11. For improvement, the MDC estimates were 13, 14, 14, and 11. Our results underline that no single MIC or MDC can be applied to all EORTC QLQ-HN43 scales, and that the MIC for deterioration seems larger than those for improvement. • Important changes and differences for interpreting EORTC QLQ-HN43 scores examined. • Thresholds are based on a rigorous methodology. • Large multinational sample of head and neck cancer patients and prospective design. [ABSTRACT FROM AUTHOR]

Objective: This study investigated how the number of sessions for outpatient psychodynamic psychotherapy among patients with depressive disorders is associated with the severity of the disease. Methods: From a random sample of 1000 applications for reimbursement of outpatient psychodynamic psychotherapy, we selected those in which a diagnosis of depression with a severity rating (ICD-10 F32 or F33) was coded. The association of levels of depression severity (mild, moderate, and severe) with the number of sessions requested and the number of sessions endorsed by the reviewer was investigated using Spearman's rank correlation. If the application was for a continuation of an ongoing therapy, the previous sessions were taken into account too. Results: A total of 521 (52%) applications contained a diagnosis of F32 and/or F33. Out of these, 63 (12%) were coded as mild, 349 (67%) as moderate, and 50 (10%) as severe. There were 75 sessions applied for in patients with mild depression (median), 50 in patients with moderate depression, and 50 in patients with severe depression, whereby the range within each severity group was considerable (10 to 327 sessions) and the correlation was low (Rho −0.10). The median number of endorsed sessions was 74 in patients with mild depression, 50 in patients with moderate, and 50 in patients with severe depression. Here, too, the range was high (0 sessions to 327 sessions) and the association weak (Rho −0.11). Discussion: There is no evidence that psychotherapists determine the necessary number of sessions solely based on the severity of the diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to identify at what time patients with cancer and their relatives want to be informed about and receive psychosocial counselling. Methods: In a multi‐centre prospective study, both users and non‐users of psychosocial cancer counselling were asked to participate in a qualitative interview about their preferences for psychosocial counselling. A second interview was scheduled 3–6 months thereafter. Interviews were transcribed verbatim and coded according to content analysis. Results: Altogether, 61 patients and 42 relatives participated, resulting in 183 interviews (103 at t1, 80 at t2). Most often, the optimal time‐point for cancer counselling was defined by the participants according to the treatment trajectory, and the most frequently mentioned preferred time‐point was 'as early as possible': at the time of cancer diagnosis (mentioned in 22% of interviews with men and 10% of interviews with women). In particular, men also said that they wanted psychosocial counselling while waiting for test results (5%), at the point of returning to work and/or when under the threat of unemployment (3%). Women especially preferred this support during therapy (4%) and 'when one has the capacity for it' (4%), in terms of time and emotional capacity. Conclusions: Healthcare providers should inform their cancer patients and the relatives about the possibilities of professional psychosocial support early on in the disease trajectory (i.e. at the time of diagnosis) and repeatedly thereafter, especially in times of uncertainty, while ensuring the patients' capacity to process information at each time‐point is taken into consideration. [ABSTRACT FROM AUTHOR]

Background: Sarcomas are rare cancers of high heterogeneity. Health-Related Quality of Life (HRQoL) has been shown to be a prognostic factor for survival in other cancer entities but it is unclear whether this applies to sarcoma patients.Patients and Methods: HRQoL was prospectively assessed in adult sarcoma patients from 2017 to 2020 in 39 German recruiting sites using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Vital status was ascertained over the course of 1 year. HRQoL domains were analysed by multivariable cox-regressions including clinical and socio-economic risk factors.Results: Of 1102 patients, 126 (11.4%) died during follow-up. The hazard ratio (HR) for global health was 0.73 per 10-point increase (95% confidence interval (CI) 0.64-0.85). HR for the HRQoL-summary score was 0.74 (CI 0.64-0.85) and for physical functioning 0.82 (CI 0.74-0.89). There was also evidence that fatigue (HR 1.17, CI 1.10-1.25), appetite loss (HR 1.15, CI 1.09-1.21) and pain (HR 1.14, CI 1.08-1.20) are prognostic factors for survival.Conclusion: Our study adds sarcoma-specific evidence to the existing data about cancer survival in general. Clinicians and care-givers should be aware of the relations between HRQoL and survival probability and include HRQoL in routine assessment. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to explore what methods should be used to determine the minimal important difference (MID) and minimal important change (MIC) in scores for the European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module, the EORTC QLQ-HN43. Methods: In an international multi-centre study, patients with head and neck cancer completed the EORTC QLQ-HN43 before the onset of treatment (t1), three months after baseline (t2), and six months after baseline (t3). The methods explored for determining the MID were: (1) group comparisons based on performance status; (2) 0.5 and 0.3 standard deviation and standard error of the mean. The methods examined for the MIC were patients' subjective change ratings and receiver-operating characteristics (ROC) curves, predictive modelling, standard deviation, and standard error of the mean. The EORTC QLQ-HN43 Swallowing scale was used to investigate these methods. Results: From 28 hospitals in 18 countries, 503 patients participated. Correlations with the performance status were |r|< 0.4 in 17 out of 19 scales; hence, performance status was regarded as an unsuitable anchor. The ROC approach yielded an implausible MIC and was also discarded. The remaining approaches worked well and delivered MID values ranging from 10 to 14; the MIC for deterioration ranged from 8 to 16 and the MIC for improvement from − 3 to − 14. Conclusions: For determining MIDs of the remaining scales of the EORTC QLQ-HN43, we will omit comparisons of groups based on the Karnofsky Performance Score. Other external anchors are needed instead. Distribution-based methods worked well and will be applied as a starting strategy for analyses. For the calculation of MICs, subjective change ratings, predictive modelling, and standard-deviation based approaches are suitable methods whereas ROC analyses seem to be inappropriate. [ABSTRACT FROM AUTHOR]

Purpose: Cancer patients have been shown to frequently suffer from financial burden before, during, and after treatment. However, the financial toxicity of patients with sarcoma has seldom been assessed. Therefore, the aim of this study was to evaluate whether financial toxicity is a problem for sarcoma patients in Germany and identify associated risk factors. Methods: Patients for this analysis were obtained from a multicenter prospective cohort study conducted in Germany. Using the financial difficulties scale of the EORTC QLQ-C30, financial toxicity was considered to be present if the score exceeded a pre-defined threshold for clinical importance. Comparisons to an age- and sex-matched norm population were performed. A multivariate logistic regression using stepwise backward selection was used to identify factors associated with financial toxicity. Results: We included 1103 sarcoma patients treated in 39 centers and clinics; 498 (44.7%) patients reported financial toxicity. Sarcoma patients had 2.5 times the odds of reporting financial difficulties compared to an age- and sex-matched norm population. Patient age < 40 and > 52.5 years, higher education status, higher income, and disease progression (compared to patients with complete remission) were associated with lower odds of reporting financial toxicity. Receiving a disability pension, being currently on sick leave, and having a disability pass were statistically significantly associated with higher odds of reporting financial toxicity. Conclusion: Financial toxicity is present in about half of German sarcoma patients, making it a relevant quality of life topic for patients and decision-makers. [ABSTRACT FROM AUTHOR]

Background: Health economic appraisals often rely on the assessment of health utilities using preference-based measures (PBM). The cancer-specific PBM, European Organisation for Research and Treatment of Cancer Quality of Life Utility — Core 10 Dimensions (EORTC QLU-C10D), was developed recently, and now needs to be validated in various clinical populations. Methods: In a multicenter, multinational prospective cohort study, we longitudinally collected EORTC QLQ-C30 and EQ-5D-5L data from patients with thyroid cancer. We applied seven country-specific value sets to the QLQ-C30 data to derive country-specific utility values and used the EQ-5D-5L as a comparator PBM. Criterion validity was assessed by correlating index scores and Bland–Altman plots. Construct validity was investigated by correlating domain scores. Known-group comparisons and responsiveness were assessed using external clinical criteria. Results: A total of 181 patients with thyroid cancer from nine countries (three continents) provided analyzable data. Patients were included if they had differentiated, medullary, or anaplastic thyroid cancer. Mean utility values of both instruments were generally lower compared to general population norms. No floor or ceiling effects were present for the QLU-C10D. The intra-class correlation for EQ-5D-5L and QLU-C10D index values ranged from 0.761 to 0.901 across the measurement timepoints, supporting criterion validity. Spearman's correlation coefficients ranged from 0.289 to 0.716 for theoretically corresponding domain pairs. The QLU-C10D detected differences in 9 of 15 known-group comparisons, supporting sensitivity. Clinically important changes were detected by all QLU-C10D country specific value sets, supporting responsiveness. Further, the QLU-C10D had higher statistical efficiency than the EQ-5D-5L in 74.7% of comparisons. Conclusions: The QLU-C10D is a valid PBM for health economic evaluations in thyroid cancer studies. We recommend its use to estimate health utilities in economic evaluations of thyroid cancer therapies. [ABSTRACT FROM AUTHOR]

Purpose: This study examined what aspects of life in Eastern and Western Germany are considered by patients, therapists and society to cause (or indicate) emotional suffering so that outpatient psychotherapy is sought and warranted. Methods: In Germany, psychotherapy is covered by health insurance after patients submit an application accompanied by a written report from the therapist. We took a random sample of such applications and performed a qualitative text analysis of the reports, identifying all text units where some form of emotional suffering, distress or handicap was described. A coding system was developed based on the units, and all units were subsequently coded. The proportion of units per category was compared between reports from Western and Eastern Germany using chi‐square tests. Results: Out of 500 randomly selected reports, 25 were from Eastern Germany. An age‐ and sex‐matched sample from Western Germany was added. From these 50 reports, a total of 716 text units describing some form of emotional suffering were extracted (359 units from reports from Eastern Germany and 357 from Western Germany). Thirteen categories of emotional suffering emerged. In Eastern Germany, emotional suffering was considerably more frequently described in terms of somatic symptoms and in feeling nervous and tense. Patients from Western Germany were more often described as feeling depressed and hopeless, helpless, anxious and without drive (ϕ = 0.19, p =.02). Conclusion: There is evidence that there are differences between Eastern and Western Germany in how emotional suffering is expressed and/or described. [ABSTRACT FROM AUTHOR]

Background: Uncorrected refractive error (URE) is a major cause of vision impairment among children that impacts negatively on their lives including distresses. We aim to understand the disability-related distress among vision-impaired children due to URE in rural and semi-rural South Africa using qualitative techniques. Methods: Structured focus groups of children (aged 5–12 years old) with normal vision and vision impairment due to URE from four schools in Pinetown, KwaZulu Natal, South Africa, were performed (four mixed-gender group discussions and eight single gender group discussions). We recruited the study participants after the children underwent standardised vision screening. Criterion sampling was used when selecting study participants. The interviews were transcribed to identify meaning units and broken down to condensed meaning units, which were then grouped into megathemes. Themes were then generated. Results: Thirteen children with normal vision and 63 children with vision impairment due to URE participated in the twelve focus group discussions with 36 boys (47%) and 40 girls (53%). Twelve themes were generated. The megathemes were Loss of Self Confidence (number of themes (n) = 3), Loss of self-worth (n = 3), Loss of interconnection/ interaction with community (n = 2), Humiliation (n = 2) and Discrimination (n = 2). Conclusions: We found that vision impairment due to URE can cause distress in different domains in children's life and further grouped them into different themes. The themes will be used for the development of a tool to assess disability-related distress among children with vision impairment due to URE. We also recommend that distresses caused by URE should be taken into consideration when designing eye care programmes for children. [ABSTRACT FROM AUTHOR]

Summary: „These have all been innovations that have made it much easier" - Provision of Outpatient Group Psychotherapy After Reforming the German Psychotherapy Directive. Results of a Mixed-Methods Study One objective of reforming the German psychotherapy directive in 2017 was to promote group psychotherapy. The present study examined the provision of group psychotherapy and the reasons for psychotherapists not providing group psychotherapy after the reform. Data from the Associations of Statutory Health Insurance Physicians were used to determine the number of psychotherapists with group license and the number of group psychotherapy sessions provided one year before (2016) and after the reform (2018). Differences were tested with Wilcoxon signed-rank tests. We conducted semi-structured interviews with outpatient psychotherapists about their opinions on the new features for group psychotherapy and analyzed them using qualitative text analysis. The number of psychotherapists with group license increased from 10,432 before to 11,376 after the reform (p = 0.005). However, the number of provided group psychotherapy sessions did not change statistically significant (p = 0.464). Interviews with 41 psychotherapists revealed that group psychotherapy can be provided more flexibly, with less effort, and more financially reliable due to the reform. Reasons for not providing group psychotherapy included missing group license, limited time resources, organizational factors, personal preferences, and low demand from patients. In short, there was not significantly more group psychotherapy provided after the reform than before. Psychotherapists consider the reform to have led to improvements for group psychotherapy, but relevant barriers to providing group psychotherapy remained. [ABSTRACT FROM AUTHOR]

• In a nationwide study, real-world data on the quality of life of patients with soft tissue sarcoma were collected and evaluated by adjusting for tumor-specific factors according to whether radiotherapy took place pre- or postoperatively. • Most subdomains and overall quality of life did not differ between neoadjuvant and adjuvant radiotherapy. Pain and role functioning were better in patients with adjuvant radiotherapy whereas sleep was worse compared to patients with neoadjuvant radiotherapy. • Both groups had poorer quality of life compared to the general population in all domains investigated. • In preoperatively irradiated patients, the quality of life was better after 2 years. • These findings are essentially concordant with the only randomised trial of radiotherapy timing and thus provide real-world data relevant to patients. The sequence of radiotherapy and resection in patients with soft tissue sarcomas is usually discussed on an individual basis. Better understanding of potential differences of health-related quality of life (QoL) between patients undergoing adjuvant (ART) versus neoadjuvant radiotherapy (NART) is therefore helpful for clinical decision making. Adult sarcoma patients from 39 hospitals completed the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). Differences in global QoL, physical functioning, role functioning, fatigue, pain, and insomnia between ART versus NART were investigated with multivariate regression, adjusting for age, gender, chemotherapy, grading, stage, tumor location, recurrence/distant metastasis, sarcoma type, time since last treatment, and treatment status using validated thresholds. A total of 1110 patients participated. Of them, 340 had received radiotherapy (NART: n = 95, 28%; ART: n = 245, 72%). Global QoL was 59.3 on average after NART and 60.5 after ART (B adj = 1.0, p = 0.74). Physical functioning was 65.9 compared to 70.5 (B adj = 4.2; p = 0.16), role function 48.8 vs. 56.7 (B adj = 7.0, p = 0.08), fatigue 47.5 vs. 45.4 (B adj = -1.2; p = 0.71), pain 40.2 vs. 34.1 (B adj = -6.8; p = 0.08), and insomnia 33.7 vs. 41.6 (B adj = 5.5, p = 0.16). Among patients with NART, clinically relevant QoL impairments were less frequent 2 years after treatment compared to < 2 years thereafter (n = 6 vs. n = 4 on average). There is little evidence for QoL differences in most domains and overall QoL between the two irradiation groups. However, patients after NART might experience worse role functioning and pain but fewer problems with insomnia compared to patients after ART. [ABSTRACT FROM AUTHOR]

Purpose: We examined whether multi-disciplinary stepped psychosocial care for cancer patients improves quality of care from the patient perspective. Methods: In a university hospital, wards were randomly allocated to either stepped or standard care. Stepped care comprised screening for distress, consultation between doctor and patient, and the provision of psychosocial services. Quality of care was measured with the Quality of Care from the Patient Perspective questionnaire. The analysis employed mixed-effects multivariate regression, adjusting for age and gender. Results: Thirteen wards were randomized, and 1012 patients participated (n = 570 in stepped care and n = 442 in standard care). Patients who were highly distressed at baseline had 2.3 times the odds of saying they had had the possibility to converse in private with doctors and/or psychologists/social workers when they were in stepped care compared to standard care, 1.3 times the odds of reporting having experienced shared decision-making, 1.1 times the odds of experiencing their doctors as empathic and personal, and 0.6 times the odds of experiencing the care at the ward to be patient oriented. There was no evidence for an effect of stepped care on perceived quality of care in patients with moderate or low distress. Conclusions: Stepped care can improve some aspects of perceived quality of care in highly distressed patients. Trial registration: http://www.clinicaltrials.gov. NCT01859429. [ABSTRACT FROM AUTHOR]

To date, instruments to measure quality of life (QoL) specifically for patients with acquired aplastic anaemia (AA) and paroxysmal nocturnal haemoglobinuria (PNH) are lacking altogether. As a consequence, this issue is either underevaluated or alternatively, instruments originally designed for cancer patients are being used. We therefore started to systematically develop a AA/PNH-specific QoL (QLQ-AA/PNH) instrument in these ultra-rare diseases according to European Organisation for Research and Treatment of Cancer (EORTC) guidelines. While phases I and II of the process have previously been published, we now report on the resulting instrument (phase III of this process). As part of the phase III of the evaluation process, we approached patients through physicians, patient support groups, and patient conferences. After participants completed the preliminary questionnaire and reported socio-demographic data, they were interviewed in person or via phone with a debriefing interview to find out whether the items were relevant, easy to understand, and acceptable to patients and whether there was anything missing in the questionnaire. We hypothesised what items could be combined into a scale and calculated Cronbach's alpha to define its preliminary internal consistency. After definition of a priori criteria to keep or delete items, a group of six experts met in person, discussed the results, and decided on in- or exclusion. A total of 48 patients were enrolled, 21 of those suffered from AA (44%), 13 from PNH (27%), and 14 from AA/PNH syndrome (29%). The median time to complete the 69 items was 10 min (range 5-20), mean time 11 min. The compliance criterion (> 95% completion) was fulfilled by 57 items. Twenty-three items were mentioned as especially relevant by ≥ 2% of the patients. Cronbach's alpha of the hypothesised scales ranged from 0.63 (social support) to 0.92 (fear of progression and illness intrusiveness). Finally, 47 items were kept; 16 were deleted, and 5 were changed, while 1 item expanded. This resulted in 54 items in total. As no issues were mentioned to lacking by a minimum of five patients, no items were added to the questionnaire. After completion, the AA/PNH-QoL tool (QLQ-AA/PNH) was translated according to EORTC guidelines into English, French, and Italian. For patients with PNH and AA until now, the standard assessment for QoL was to use the EORTC Quality of Life Questionnaire (QLQ-C30) or the Functional Assessment of Chronic Illness Therapy Fatigue Instrument (FACIT-Fatigue). We herewith present a new instrument aimed to be better tailored to the needs of PNH and AA patients. The anticipated fourth development phase will be performed for psychometric validation; however, we already explored the internal consistency of the hypothesised scales and found the results to be very good. Hence, the new QLQ-AA/PNH with 54 items can be used in trials and clinical studies from now on, according to EORTC strategy even if the scoring algorithm at this point is preliminary and the QLQ-AA/PNH might change slightly after phase IV. This is important, as there are no other disease-specific instruments available for AA/PNH patients right now. [ABSTRACT FROM AUTHOR]

Purpose: Cancer patients in Germany often face payments related to their disease or treatment which are not covered by their health insurance. The aim of this study was to analyze the amount of out-of-pocket payments (OOPPs) among cancer patients in Germany, to explore potential socioeconomic determinants of OOPPs, and to identify how cancer patients are burdened by these payments.Methods: Cancer ptients were consecutively enrolled in 16 clinics in Leipzig, Germany. Data on OOPPs for the past 3 months and on socioeconomic status were obtained at the end of their hospital stay (t0) and 3 (t1) and 15 months (t2) after t0. Financial burden was calculated by dividing the monthly OOPPs by the midpoint of the income category, and the perceived burden was assessed by using the financial difficulties scale of the EORTC QLQ-C30. A two-part regression model was used to estimate the determinants of OOPPs.Results: At baseline (t0), 502 cancer patients participated in the study and provided data on OOPPs and socioeconomic status. The mean 3-month OOPPs were the following: €205.8 at baseline, €179.2 at t1, and €148.1 at t2. Compared to the lowest income group (< €500 monthly), all other income groups (€500-999, €1000-1499, and ≥ €1500) had higher 3-month OOPPs of €52.3 (p = 0.241), €90.2 (p = 0.059), or €62.2 (p = 0.176). Financial burden at t0 was 6.4% (SD 9.2%) on average, 5.4% (SD 9.9%) at t1, and to 3.9% (SD 7.0%) of monthly income at t2.Conclusion: German cancer patients face relatively high OOPPs during their cancer journey. These payments may burden cancer patients, especially certain subgroups like low-income groups. [ABSTRACT FROM AUTHOR]

Background: Distress impacts the daily life of glioma patients. This study explored its course over time and the usage of psychosocial care.Methods: A consecutive sample of glioma patients completed the Hospital Anxiety and Depression Scale to assess distress levels at admission to the hospital (t1), before discharge (t2), after 3 months (t3), and after 6 months (t4). They were interviewed with the Structured Clinical Interview for DSM-IV to ascertain psychiatric disorders at t2. Psycho-oncological care in the hospital was determined with the Hospital Information System, and the use of outpatient treatment was evaluated with the Health Care Usage Questionnaire at t4. We compared the percentages of elevated distress, psychiatric co-morbidity, and care usage between men and women.Results: During the study period, 37 patients were enrolled. Nineteen percent of the patients were diagnosed with a psychiatric disorder. The percentages of patients with elevated distress were 56, 59, 39, and 40% at t1, t2, t3, and t4, respectively. Participants who did not survive the 6 months presented with higher levels of distress. In the hospital, 14% of those with elevated distress were visited by a psycho-oncologist. In the outpatient setting, 43% of those with elevated distress visited a neuro-psychiatrist, and 14% went to a psychotherapist. There was no evidence for an effect of gender on psychiatric co-morbidity, distress, or care use.Conclusions: A significant proportion of glioma patients report elevated distress during the hospital stay and thereafter. Only a fraction of them receive mental health care. [ABSTRACT FROM AUTHOR]

Purpose: We examined whether multi-disciplinary stepped psycho-social care decreases financial problems and improves return-to-work in cancer patients.Methods: In a university hospital, wards were randomly allocated to either stepped or standard care. Stepped care comprised screening for financial problems, consultation between doctor and patient, and the provision of social service. Outcomes were financial problems at the time of discharge and return-to-work in patients < 65 years old half a year after baseline. The analysis employed mixed-effect multivariate regression modeling.Results: Thirteen wards were randomized and 1012 patients participated (n = 570 in stepped care and n = 442 in standard care). Those who reported financial problems at baseline were less likely to have financial problems at discharge when they had received stepped care (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.1, 0.7; p = 0.01). There was no evidence for an effect of stepped care on financial problems in patients without such problems at baseline (OR 1.1, CI 0.5, 2.6; p = 0.82). There were 399 patients < 65 years old who were not retired at baseline. In this group, there was no evidence for an effect of stepped care on being employed half a year after baseline (OR 0.7, CI 0.3, 2.0; p = 0.52).Trial Registration: NCT01859429 CONCLUSIONS: Financial problems can be avoided more effectively with multi-disciplinary stepped psycho-social care than with standard care in patients who have such problems. [ABSTRACT FROM AUTHOR]

Objective: Emotional distress in cancer patients often goes unnoticed in daily routine; therefore, distress screening is now recommended in many national guidelines. However, screening alone does not necessarily translate into better well-being. We examined whether stepped psychooncological care improves referral to consultation-liaison (CL) services and improves well-being.Methods: In a cluster-randomized trial, wards were randomly allocated to stepped versus standard care. Stepped care comprised screening for distress, consultation between doctor and patient about the patient's need for CL services, and provision of CL service. Primary outcomes were referral to psychosocial services and emotional well-being half a year after baseline, measured with the Hospital Anxiety and Depression Scale. A secondary endpoint was uptake of outpatient health care. Analysis employed mixed-effects multivariate regression modeling.Results: Thirteen wards were randomized; 1012 patients participated. With stepped care (N = 570; 7 wards), 22% of the patients were referred to CL services and 3% with standard care (N = 442; 6 wards; odds ratio [OR] 10.0; P < .001). Well-being 6 months after baseline was 9.5 after stepped care (N = 341) and 9.4 after standard care (N = 234, β -0.3; P = .71). After stepped care, patients with psychiatric comorbidity went more often to psychotherapists (OR 4.0, P = .05) and to psychiatrists (OR 2.3, P = .12), whereas patients without comorbidity used psychiatrists less often (OR 0.4, P = .04) than in standard care.Conclusions: Stepped care resulted in better referral to CL services. The patients' emotional well-being was not improved, but uptake of outpatient psychiatric help was increased in patients with psychiatric comorbidity and decreased in patients without. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to analyse the incidence of lip malignancies in Germany.Methods: Data from population-based cancer registries covering a population of 39 million inhabitants from 14 federal states were pooled. Lip malignancies were classified according to the International Classification of Diseases (ICD-10). Age-standardised incidence rates and annual percentage changes in the incidence trends of lip cancer (C00), melanoma of the lip (C43.0), and non-melanoma skin cancer of the lip (C44.0) were calculated.Results: Lip cancer (C00) incidence rate was 0.57/0.15 per 100 000 (men/women) in 2003 and 0.52/0.18 in 2012. In women, the change was statistically significant. Melanoma lip cancer (C43.0) incidence rates both in men and women were 0.02 in 2003 and 0.01 in 2012. Incidence rates of non-melanoma skin cancer of the lip (C44.0) significantly increased from 1.6 in 2003 to 2.1 in 2012 in men and from 1.5 in 2003 to 2.4 in 2012 in women. In lip cancer (C00), the vast majority (98% in men/93% in women) were squamous cell carcinomas and 2%/7% were basal cell carcinoma. In men, 56% of non-melanoma skin cancers (C44.0) were squamous cell carcinoma, whereas these were only 27% in women.Conclusions: The incidences of non-melanoma skin cancer of the lip increased over time in Germany in both sexes. Lip cancer incidence increased in women, while it stayed stable in men. Melanoma of the lip did not change in incidence. The distribution of histology in non-melanoma skin cancer of the lip differed by sex. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to delineate the challenges that psychotherapists encounter when they treat cancer patients and how they organise their practices to be able to treat them.Methods: A random sample of certified psychotherapists, licensed by the health authorities, with training in psycho-oncology, was asked to complete a questionnaire covering the following issues: therapists' qualifications, organisation of the practice, dealing with appointment cancellations, financing, and networking. Practices with ≥50% cancer patients in their patient load were defined as "practices specialising in cancer" (PSC) and were compared to practices with a smaller proportion of cancer patients (non-PSC).Results: Of 120 contacted therapists, 83 replied and 77 were eligible. The median waiting time for a first consultation was 10 days in PSC and 14 days in non-PSC (P = .05). Seventy-five of PSC and 56% of non-PSC can offer psychotherapy within 4 weeks. Time spent on dealing with the social problems of the patients was higher in PSC than in non-PSC (P = .04). They spent also more time communicating with other health care professionals such as private practice oncologists (P = .001). Cancer patients need to cancel appointments more frequently than noncancer patients (58% vs 48% cancel ≥1× per quarter). Sixty-six percent of the psychotherapists do not ask for financial reimbursement of these sessions.Conclusion: Psychotherapy for cancer patients in the outpatient setting requires different organisation of the practice. Sessions are cancelled more frequently, waiting time is considerably shorter, and psychotherapists communicate more often with other health care providers than in general psychotherapy. [ABSTRACT FROM AUTHOR]

Purpose: Reasons for the social gradient in cancer survival are not fully understood yet. Previous studies were often only able to determine the socio-economic status of the patients from the area they live in, not from their individual socio-economic characteristics.Methods: In a multi-centre cohort study with 1633 cancer patients and 10-year follow-up, individual socio-economic position was measured using the indicators: education, job grade, job type, and equivalence income. The effect on survival was measured for each indicator individually, adjusting for age, gender, and medical characteristics. The mediating effect of health behaviour (alcohol and tobacco consumption) was analysed in separate models.Results: Patients without vocational training were at increased risk of dying (rate ratio (RR) 1.5, 95% confidence interval (CI) 1.1-2.2) compared to patients with the highest vocational training; patients with blue collar jobs were at increased risk (RR 1.2; 95% CI 1.0-1.5) compared to patients with white collar jobs; income had a gradual effect (RR for the lowest income compared to highest was 2.7, 95% CI 1.9-3.8). Adding health behaviour to the models did not change the effect estimates considerably. There was no evidence for an effect of school education and job grade on cancer survival.Conclusions: Patients with higher income, better vocational training, and white collar jobs survived longer, regardless of disease stage at baseline and of tobacco and alcohol consumption. [ABSTRACT FROM AUTHOR]

The purpose of the study was to pilot-test a questionnaire measuring healthrelated quality of life (QoL) in thyroid cancer patients to be used with the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire EORTC QLQ-C30. A provisional questionnaire with 47 items was administered to patients treated for thyroid cancer within the last 2 years. Patients were interviewed about time and help needed to complete the questionnaire, and whether they found the items understandable, confusing or annoying. Items were kept in the questionnaire if they fulfilled pre-defined criteria: relevant to the patients, easy to understand, not confusing, few missing values, neither floor nor ceiling effects, and high variance. A total of 182 thyroid cancer patients in 15 countries participated (n = 115 with papillary, n = 31 with follicular, n = 22 with medullary, n = 6 with anaplastic, and n = 8 with other types of thyroid cancer). Sixty-six percent of the patients needed 15 min or less to complete the questionnaire. Of the 47 items, 31 fulfilled the predefined criteria and were kept unchanged, 14 were removed, and 2 were changed. Shoulder dysfunction was mentioned by 5 patients as missing and an item covering this issue was added. To conclude, the EORTC quality of life module for thyroid cancer (EORTC QLQ-THY34) is ready for the final validation phase IV. [ABSTRACT FROM AUTHOR]

Background: The objectives of this study were to determine quality of life (QoL) issues that are relevant to thyroid cancer patients cross-culturally, and to identify those with highest relevance to them in addition to the more general issues covered by the core European Organisation for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30). Methods: A systematic literature search provided a list of potentially relevant QoL issues to supplement the core questionnaire EORTC QLQ-C30, which is widely used in research and in care and addresses QoL issues relevant to all groups of cancer patients. A panel of experts revised this list, and thyroid cancer patients rated the issues regarding their relevance for QoL by selecting the 25 issues that they would include in a thyroid cancer- specific QoL module. Results: The literature search and expert discussion provided a list of 71 QoL issues that was rated by thyroid cancer patients (n = 110) from seven countries. All issues were of high priority to at least some of the patients. The most frequently selected issues were sudden attacks of tiredness, exhaustion, quality of sleep, employment, social support, fear of cancer progression, fear of second operation, difficulties swallowing, and globus sensation. Conclusions: Thyroid cancer patients cross-culturally rate fatigue-related issues as highly important for their QoL, calling for increased efforts to find successful treatments for this problem. Vocational rehabilitation is also highly relevant for them and should therefore be an important aim of multidisciplinary care. The third important area of concern is psychological issues, especially fear of progression and of additional treatments. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the frequency of psychiatric co-morbidity in patients with breast cancer, its changes over time and predictors for these changes.Methods: In a prospective study with measurements before surgery (t1, baseline), 1 month (t2) and 8 months thereafter (t3) using the Patient Health Questionnaire, we examined the course of psychiatric co-morbidity in breast cancer patients. The co-morbidity courses were grouped into healthy (no co-morbidity during the study), acute (co-morbidity at t1 and/or t2, but not at t3), emerging (no co-morbidity at t1, but at t3) and chronic (co-morbidity at t1 and t3).Results: Of the 598 participants, 19% had acute, 10% emerging and 9% chronic psychiatric co-morbidity. Acute co-morbidity was more common in patients with poor quality of life (odds ratio (OR) 9.6, 95% confidence interval (CI) 4.4-20.8) and somatic co-morbidity (OR 3.8, CI 1.1-12.4). Patients who perceived support from their doctors had acute co-morbidity less frequently (OR 0.7, CI 0.5-1.0). Emerging co-morbidity occurred more often in younger patients (OR 2.4, CI 1.2-4.7) and in patients with another cancer in their own (OR 2.0, CI 1.1-3.9) or family (OR 2.1, CI 1.1-4.3) histories, less often in patients with support from doctors (OR 0.6, CI 0.4-1.0). Chronic co-morbidity was related to poor quality of life (OR 12.1, CI 3.6-39.9).Conclusion: We found acute and emerging psychiatric co-morbidities less often in patients who reported having a supportive doctor-patient relationship. Patients that require psycho-oncological support often have poor quality of life and have experienced cancer before. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective We examined psychosocial and informational services used by long-term survivors of breast, colon and prostate cancer in immigrants versus non-immigrants. Methods Patients were sampled from population-based cancer registries in Germany. They completed a questionnaire assessing immigration biography, service use and socio-demographic characteristics. Results Data of 6143 cancer survivors were collected of whom 383 (6%) were immigrants. There was no evidence of an association between immigration status and service use. However, immigration biography played a role when patients' and their parents' birthplace were taken into account. When parents were born outside Europe, survivors less frequently used information from the Internet (ORadj 0.4, 95% CI 0.2; 0.8). Web-based information (ORadj 0.7, 95% CI 0.5; 0.9) was less frequently used when the participant was born outside Germany. Conclusion The differences in the use of psychosocial and informational services between immigrants and non-immigrants seem to be generally small. Acculturation may play a role in service uptake. In survey-based health services research, investigators should not stratify by census-defined immigration status, but rather by cultural background. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background High levels of emotional distress in cancer patients often goes unnoticed in daily clinical routine, resulting in severe undertreatment of mental health problems in this patient group. Screening tools can be used to increase case identification, however, screening alone does not necessarily translate into better mental health for the patient. Doctors play a key role in providing basic emotional support and transferring the patients in need of such specific support to mental health professionals. This study investigates whether a stepped care model, combining screening, doctor consultation and professional psycho-oncological service in a structured way, improves the emotional wellbeing of cancer patients. Methods/Design This study is a cluster randomized trial with two parallel groups (intervention vs. care as usual), set in an academic hospital. Participants are cancer patients, a total of 1,000 at baseline. The intervention consists of stepped psychosocial care. Step one: screening for distress, step two: feedback of screening results to the doctor in charge of the patient and consultation with the patient, and step three: based on a shared patient-doctor decision, either transferal to the consultation liaison (CL) service or not. The outcome will be emotional well-being half a year after baseline, ascertained with the Hospital Anxiety and Depression Scale. Randomization will be done by the cluster randomization of wards. Discussion Mental health problems not only cause emotional suffering but also direct and indirect costs. This calls for timely and adequate psychosocial support, especially as we know that such support is effective. However, not every cancer patient can and must be treated by a mental health professional. Allocating limited resources most sensibly and economically is of crucial importance for our healthcare system to ensure the best quality of care to as many patients as possible. It is the hope of the STEPPED CARE trial that this model is both effective and efficient, and that it can be implemented in other hospitals as well, if proven to be effective. [ABSTRACT FROM AUTHOR]

Purpose: We investigated predictors of limitations in work performance, odds of drop out of work, and odds of receiving disability pension in sarcoma patients. Methods: We measured clinical and sociodemographic data in adult sarcoma patients and recorded if the patients received a (1) disability pension at baseline or (2) had dropped out of work 1 year after initial assessment. (3) Work limitations were assessed using the Work-limitations questionnaire (WLQ©). We analyzed exploratively. Results: (1) Amongst 364 analyzed patients, odds to receive a disability pension were higher in patients with abdominal tumors, older patients, high grade patients and with increasing time since diagnosis. (2) Of 356 patients employed at baseline, 21% (n = 76) had dropped out of work after 1 year. The odds of dropping out of work were higher in bone sarcoma patients and in patients who received additive radiotherapy ± systemic therapy compared with patients who received surgery alone. Odds of dropping out of work were less amongst self-employed patients and dropped with increasing time since diagnosis. (3) Work limitations were higher in woman and increased with age. Patients with bone and fibrous sarcomas were more affected than liposarcoma patients. Patients with abdominal tumors reported highest restrictions. Sarcoma treatment in the last 6 months increased work limitations. Conclusion: Work limitations, drop out of work and dependence on a disability pension occurs frequently in patients with sarcoma adding to the burden of this condition. We were able to identify vulnerable groups in both the socioeconomic and disease categories. [ABSTRACT FROM AUTHOR]

Treatment bottlenecks in outpatient psychotherapy have led to various legislative initiatives in recent years. One of these ideas was the implementation of diagnosis-specific treatment quotas. Based on this healthcare policy proposal, the question arose to what extent empirical data support or refute such a practice, i.e., how "homogeneous" are patients with the same ICD-10 diagnosis from a psychodynamic perspective. Using qualitative content analysis 13 reports on patients with an initial diagnosis of major depressive disorder, recurrent, moderate (F33.1) were evaluated, who were then examined within the German assessment procedure for outpatient treatment. In addition, the general level of functioning was assessed and the maturity of defence mechanisms was compared with the presence of comorbid mental diagnoses. A total of 56 pages of text material were analyzed. Based on this, 4 different types of conflict (self-esteem, closeness-distance, submission, guilt) were identified as well as structural impairments in 4 areas (self-perception and object perception, self-regulation, attachment, and identity), in the presence of diverse treatment goals and forms of interaction. The defence mechanisms ranged from immature to neurotic levels, which were not related to the presence of other comorbid diagnoses. The level of functioning suggested a broad spectrum of general impairment. The results indicate that unipolar depression has multiple manifestations and psychodynamic backgrounds. This is in contradiction to the idea of an assignment of ICD-10 diagnosis and treatment quotas. [ABSTRACT FROM AUTHOR]

BACKGROUND The authors investigated whether cancer patients who have comorbid mental health disorders (MD) are at greater risk of early retirement compared with those who do not have MD. METHODS Individuals ages 18 to 55 years from a consecutive sample of patients who were admitted for inpatient oncologic treatment were interviewed using structured clinical interviews to ascertain MD. The patients were followed for 15 months, and the date of early retirement was documented. Rates of early retirement per 100 person-years (py) in patients with and without MD were compared using multivariate Poisson regression models. RESULTS At baseline, 491 patients were interviewed, and 150 of those patients (30.6%) were diagnosed with MD. Forty-one patients began full early retirement during follow-up. In patients with MD, the incidence of early retirement was 9.3 per 100 py compared with 6.1 per 100 py in mentally healthy patients. The crude rate ratio (RR) was 1.5 (95% confidence interval [CI], 0.8-2.8). The effect of MD on early retirement was modified in part by income: in patients with low income, the adjusted RR was 11.7, whereas no effect was observed in higher income groups. Patients with depression were at greater risk of retirement when they had higher income (RR, 3.4; P = .05). The effects of anxiety (RR, 2.4; P = .05), adjustment disorders (RR, 1.7; P = .21), and alcohol dependence (RR, 1.8; P = .40) on early retirement were equal across income groups. CONCLUSIONS Mental health conditions are risk factors for early retirement in cancer patients, although this effect differs according to the type of disorder and the patient's income level. Cancer 2014;120:2199-2206. © 2014 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background. The aims of this study are to present the results of a new general population normative study of the quality of life questionnaire EORTC QLQ-C30 and to give European reference values averaged across six studies. Methods. The empirical study was based on a representative sample of the German adult population (N = 2448). The subjects were asked to fill in several questionnaires, one of them being the EORTC QLQ-C30. Results. EORTC QLQ-C30 mean scores of this sample indicated slightly better quality of life (QoL) than in previous European studies. QoL decreased with age, but there were only small gender differences. The mean scores were compared with the age and gender adjusted scores of five other European normative studies from Sweden, the Netherlands, Norway, and Germany (N between 1731 and 4910). Finally, the data of these five studies and the new study were combined to arrive at averaged European normative values for the scales and the symptom items of the questionnaire. Conclusion. The reference values of the scales pooled across six European studies (N = 16 151) can be used as general population references for QoL scores of cancer patients. [ABSTRACT FROM AUTHOR]

Purpose: The EORTC QLQ-H&N35 (H&N35) is widely used to measure quality of life in head and neck cancer patients. The aims of this study were to obtain insight into a) the languages in which the H&N35 has been used and the psychometric properties in those languages, b) the study designs, and c) its acceptance by patients and investigators. Methods: A systematic literature review was performed searching for all original papers that had used at least one item of the H&N35. Identified papers were read and the information about methodological issues abstracted statistically analysed. Results: A total of 136 papers were identified. The H&N35 was administered in 19 different languages in 27 countries. The study design was cross-sectional in the majority of studies (53 %), prospective cohort studies (31 %), phase-II-trials (7 %), phase-III-trials (6 %) and case–control studies (1 %). The scales with the highest percentages of missing values were Sexuality (11.5 %) and Speech (7 %). The median Cronbach’s alpha of the multi-item scales ranged from 0.61 (Senses) to 0.93 (Sexuality). Construct validity was rarely investigated. On average, 12 scales (range 0-18) of the instrument were used by the investigators. The scale most often used was swallowing (in 85 % of studies) and least often used was Weight Gain (39 %). Conclusion: The H&N35 is widely used throughout the world, mainly in observational studies, and has demonstrated robust psychometric features in different languages. However, some methodological problems reported imply that the instrument can be improved in some areas. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Since patients with thyroid cancer have a very good prognosis overall, clinicians may often assume that their quality of life is comparable to the general population. We hypothesized that quality of life of thyroid cancer patients is lower compared with the general population while controlling the effect of age and gender. Methods: At the beginning of their stay at an inpatient rehabilitation clinic, a cohort of n=121 patients with thyroid cancer were assessed using the quality of life core questionnaire of the European Organisation for Research and Treatment of Cancer (QLQ-C30). Data for comparison were derived from a representative German community sample with n=2037. Results: The patients reported significantly more problems than the community sample participants independent of gender and age effects in all but two domains, namely constipation and diarrhea. The strongest effects of the group (patients vs. general population) were found in the following domains: insomnia ( B=−43.7, p<0.001), fatigue ( B=−38.0, p=<0.001), and role functioning ( B=29.7, p=<0.001). Significant interactions between age and group occurred in the social functioning, role functioning, fatigue, nausea/vomiting, and financial difficulties domains. Quality of life was unrelated to the stage of the disease, except in the physical function and global health status domains. Conclusions: At the beginning of inpatient rehabilitation, patients with thyroid cancer often experience more problems than controls from community samples, independent of their age and gender. Clinicians should be aware of the fact that quality of life is not directly related to the severity of the cancer prognosis. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to develop an art education program for ambulatory patients with cancer and to assess its feasibility and possible effects. We conducted the workshops in groups of 4–8 participants. A total of 23 participants completed the entire art education program. Six patients dropped out, but neither of them dropped out because of program length. Some changes to the program were made after receiving feedback from the participants and the program length was augmented from 20 to 22 sessions. Anxiety and self-confidence improved during the course of the program, whereas coping and depression did not change. Results suggest that art education workshops with outpatients are feasible, but recruitment may be difficult, especially at the beginning. Based on the characteristics of the patients, special attention should be paid to establish a high-level of structure to the sessions, in order to provide the participants with enough safety for self-exploration and expression. The creation of an object, e.g. a book, may help in this prospect as well. [ABSTRACT FROM AUTHOR]

Abstract: Objective : The aim of this study was to evaluate patients'' acceptance and the reliability and validity of a recently developed instrument to assess quality of life among cervical cancer patients, the European Organization for Research and Treatment of Cancer Cervical Cancer Module (EORTC QLQ-CX24), in surgically treated patients after primary surgery. Methods : The EORTC QLQ-CX24 was administered to 134 cervical cancer patients who had undergone pelvic surgery. Additional questionnaires completed were the EORTC QLQ-C30, and the Hospital Anxiety and Depression Scale. Sociodemographic and medical data were recorded. Results : Missing values occurred in 4.5% of all non-optional items. Internal consistencies (Cronbach''s alpha coefficients) for the three multi-item scales ranged from 0.70 to 0.87 (Symptom Experience 0.70, Body Image 0.87, Sexual/Vaginal Functioning 0.76), whereas scaling errors occurred in 6.8%, 0.0%, and 6.3% of the cases. In all domains, the entire range of the scale was used by patients. The scales were able to discriminate between different subgroups of patients. Conclusion : These psychometric analyses confirm that the EORTC QLQ-CX24 is a useful tool for the assessment of quality of life in cervical cancer patients after surgery. [Copyright &y& Elsevier]

Objectives: The aim of this study was to determine how accurate mental distress screening instruments are in identifying psychological sequelae in ambulatory laryngeal cancer patients who have undergone surgery. Methods: Two-hundred and fifty subjects were tested for mental disorders according to the guidelines defined in the Diagnostic Statistical Manual of Psychological Illnesses, Version 4. Screening instruments tested were: the ‘Hospital Anxiety and Depression Scale’ (HADS), the subscale ‘Emotional Functioning’ of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), the ‘Hornheider Fragebogen’ (HFB), and a single-item visual analogues scale (VAS). Accuracy was assessed by calculating the sensitivity rates, specificity rates, and areas under the curve from the receiver operating characteristic curves. Results: The relative frequency of mental disorders was 19.8%. All of the screening instruments tested were found to be highly accurate. The best levels of sensitivity and specificity were associated with the total score of the HADS. Conclusions: These results confirm that a significant minority of laryngeal cancer patients suffer from severe mental distress, and that accurate screening for clinically significant mental disorders is possible using any of the instruments evaluated here. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: About one third of cancer patients suffer from a psychiatric disorder. However, only few studies feature long-term assessment of psychiatric disease in cancer patients, covering a broad range of diagnoses, and employing high-quality instruments. Patients and methods: A total of 62 patients underwent assessments during a 3-year follow-up period after initial cancer diagnosis. The Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders was administered to measure psychiatric morbidity at baseline (t1) and two follow-ups (t2 and t3). Follow-up assessments took place from 6 to 18 months (t2) and from 24 to 36 months (t3) after baseline. Biomedical and psychosocial factors were evaluated to identify predictors of psychiatric disorders using univariate and multivariate analyses. Results: At t1 at least one DSM-IV diagnosis was found in 29% of the cases. At follow-ups, the frequency of psychiatric morbidity increased to 36% at t2 and 44% at t3, respectively. New occurrence of psychiatric disease at follow-ups was 18% at t2, and 38%, at t3. Predictors of psychiatric disorders were low social support, low physical functioning, metastases, complications of disease, and loss of sportive activity. Conclusion: Persistence and amount of newly diagnosed psychiatric disorders during three years after cancer treatment should be considered in the treatment of cancer patients, especially in individuals with accordant predictive factors. [ABSTRACT FROM AUTHOR]

Background: This study examined the relationship between social service counseling (SSC) and financial and role functioning problems in primary breast cancer (BC) patients over a 5-year observation period. Methods: In the multicenter prospective study, patients were approached before surgery (t1), before initiation of adjuvant treatment (t2), after therapy completion (t3), and 5 years after surgery (t4). We examined the proportion of BC survivors who had financial and role functioning problems and the proportion who were employed at t4. We examined how frequently patients were informed about, offered, or used SSC, and we used multivariate logistic regression analyses to examine the relationship between this and financial and role functioning problem prevalence. Results: Of the 456 BC survivors, 33% had financial problems and 22% reported role functioning problems at t4. There was no evidence that women with increased financial problems were informed about SSC more often than those without (OR 1.1, p = 0.84) or that they used SSC more often (OR 1.3, p = 0.25). However, women with role functioning problems were informed about SSC significantly more often (OR 1.7, p = 0.02) and attended counseling significantly more often (OR 1.6, p = 0.03). Among participants aged < 65 years at t4 (n = 255), 70% were employed. Patients who had received SSC were more likely to be employed at t4 than patients who did not (OR 1.9, p = 0.04). Conclusion: These findings underline the importance of SSC for BC patients with role functioning issues. They indicate that individuals who use SSC are more likely to be employed later on than individuals who do not. [ABSTRACT FROM AUTHOR]

Purpose: To develop and validate a health-related quality of life (HRQoL) questionnaire for patients with current or previous coronavirus disease (COVID-19) in an international setting. Methods: This multicenter international methodology study followed standardized guidelines for a four-phase questionnaire development. Here, we report on the pretesting and validation of our international questionnaire. Adults with current or previous COVID-19, in institutions or at home were eligible. In the pretesting, 54 participants completed the questionnaire followed by interviews to identify administration problems and evaluate content validity. Thereafter, 371 participants completed the revised questionnaire and a debriefing form to allow preliminary psychometric analysis. Validity and reliability were assessed (correlation-based methods, Cronbach's α, and intra-class correlation coefficient). Results: Eleven countries within and outside Europe enrolled patients. From the pretesting, 71 of the 80 original items fulfilled the criteria for item-retention. Most participants (80%) completed the revised 71-item questionnaire within 15 min, on paper (n = 175) or digitally (n = 196). The final questionnaire included 61 items that fulfilled criteria for item retention or were important to subgroups. Item-scale correlations were > 0.7 for all but nine items. Internal consistency (range 0.68–0.92) and test–retest results (all but one scale > 0.7) were acceptable. The instrument consists of 15 multi-item scales and six single items. Conclusion: The Oslo COVID-19 QLQ-W61© is an international, stand-alone, multidimensional HRQoL questionnaire that can assess the symptoms, functioning, and overall quality of life in COVID-19 patients. It is available for use in research and clinical practice. Further psychometric validation in larger patient samples will be performed. [ABSTRACT FROM AUTHOR]

Zusammenfassung: Gewalterfahrungen in der Kindheit und Jugend werden möglicherweise psychisch so verarbeitet, dass das Gegenüber später in einer spezifischen Weise auf die Betroffenen reagiert. Wir untersuchten dies anhand der Frage, ob sich Reaktionen (Assoziationen) auf Berichte an den Gutachter dahingehend unterscheiden, ob der Patient Gewalterfahrungen in der Kindheit oder Jugend in der Herkunftsfamilie gemacht hat oder nicht. Es wurden 22 pseudonymisierte Berichte an den Gutachter im Rahmen des Antragsverfahrens auf Kostenübernahme von Psychotherapie von zwei Untersucherinnen qualitativ analysiert. Die Analyse erfolgte über die Qualitative Inhaltsanalyse nach Mühlfeld.Beim Vergleich der deduktiv entwickelten Kategoriensysteme konnten im Hinblick auf die Reaktionsmuster Parallelen, aber auch mehrere Differenzen zwischen den beiden Patientengruppen festgestellt werden. Als Reaktionsmuster auf Patienten mit Gewalterfahrung zeigten sich Sprachlosigkeit, Tod oder Sich-verstecken-Wollen, was sich so bei der anderen Gruppe nicht fand. Parallelen ergaben sich unter anderem bei Reaktionsmustern von Zartheit, Ekel oder Relativierung von Leid. Bei Berichten über Patienten ohne Gewalterfahrung kam es zu einer größeren emotionalen Varianz in den Reaktionsmustern.Die gefundenen Reaktionsmuster stimmen nur teilweise mit Angaben der Literatur zu „typischen“ Gegenübertragungsreaktionen auf traumatisierte Patienten überein. Die geringere emotionale Varianz gegenüber Berichten von Patienten mit Gewalterfahrungen könnte ein empirischer Beleg für deren geringere Symbolisierungsfähigkeiten sein. [ABSTRACT FROM AUTHOR]

Objective: Soft tissue sarcomas (STS) and gastrointestinal stromal tumours (GIST) are a group of rare malignant tumours with a high and heterogenous disease burden. As evidence is scarce, we analysed the prevalence of increased emotional distress and identified distress-associated factors in these patients.Methods: The PROSa-study (Burden and medical care of sarcoma) was conducted between 2017 and 2020 in 39 study centres. Cross-sectional data from adult STS and GIST patients were analysed. Distress was measured with the Patient Health Questionnaire (PHQ-4). The relation of socioeconomic and clinical factors with distress was explored in adjusted logistic regression models.Results: Among 897 patients, 17% reported elevated anxiety and 19% reported depression. Unemployed patients (odds ratio [OR] 6.6; 95% CI 2.9-15.0), and those with a disability pension (OR 3.1; 95% CI 1.9-5.0) were more likely to experience distress compared to employed patients. Also, patients with a disability pass had higher odds of increased distress than those without (OR 1.8; 95% CI 1.2-2.7). Lowest distress was observed in patients 2 to <5 years and ≥5 years after diagnosis (comparison: <6 months) (OR 0.4; 95% CI 0.2-0.6) and (0.3; 95% CI 0.2-0.6). Patients with thoracic STS (vs. lower limbs) had twice the odds to experience distress (OR 2.0; 95% CI 1.1-3.6). Distress was seen almost twice as often in patients with progressive disease (vs. complete remission) (OR 1.7; 95% CI 1.1-2.8).Conclusion: The prevalence of elevated distress in STS and GIST patients is high. In unemployed patients, in those with a disability pension and in newly diagnosed patients a noticeable increase was observed. Clinicians should be aware of these factors and consider the social aspects of the disease. [ABSTRACT FROM AUTHOR]