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Standardized Screening and Psycho-oncological Treatment of Orthopedic Cancer Patients.

ABSTRACT: BACKGROUND/AIM:Psycho-oncological distress is a relevant clinical problem. The aim of this study was to administer a standardized psycho-oncological distress screening for early identification and indication-based treatment of highly distressed orthopedic cancer patients as well as the evaluation of distress patterns. PATIENTS AND METHODS:In total, 35 patients with cancer were psycho-oncologically screened using a cancer-specific expert rating scale (Basic Documentation for Psycho-Oncology Short Form) at three different time points (day of admission, day before discharge, 3 months postoperatively). Psycho-oncological support was offered to all patients whose distress exceeded a defined cut-off value. RESULTS:Levels of distress in approximately 51% of patients exceeded the cut-off value at the time of admission and these patients received psycho-oncological support. The high distress levels decreased significantly over time. Patients whose distress did not exceed the cut-off value at the first assessment showed low distress levels at all time points. CONCLUSION:A relevant number of orthopedic tumor patients suffer from psychosocial distress. Standardized screening might help to identify and adequately treat those patients.

SUBMITTER: Lenze F

PROVIDER: S-EPMC6199587 | biostudies-literature | 2018 Sep-Oct

REPOSITORIES: biostudies-literature

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Standardized Screening and Psycho-oncological Treatment of Orthopedic Cancer Patients.

Lenze Florian F Kirchhoff Chlodwig C Pohlig Florian F Knebel Carolin C Rechl Hans H Marten-Mittag Birgit B Herschbach Peter P Eisenhart-Rothe Rüdiger V RV Lenze Ulrich U

In vivo (Athens, Greece) 20180901 5

<h4>Background/aim</h4>Psycho-oncological distress is a relevant clinical problem. The aim of this study was to administer a standardized psycho-oncological distress screening for early identification and indication-based treatment of highly distressed orthopedic cancer patients as well as the evaluation of distress patterns.<h4>Patients and methods</h4>In total, 35 patients with cancer were psycho-oncologically screened using a cancer-specific expert rating scale (Basic Documentation for Psycho ...[more]

PMID: 30150439

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Project description:BackgroundCancer patients often suffer from psychological distress. Psycho-oncological services (POS) have been established in some health care systems in order to address such issues. This study aims to identify patient and center characteristics that elucidate the use of POS by patients in prostate cancer centers (PCCs).MethodsCenter-reported certification and patient survey data from 3094 patients in 44 certified PCCs in Germany were gathered in the observational study (Prostate Cancer Outcomes). A multilevel analysis was conducted.ResultsModel 1 showed that utilization of POS in PCCs is associated with patients' age (OR = 0.98; 95%-CI = 0.96-0.99; P < .001), number of comorbidities (1-2 vs 0, OR = 1.27; 95%-CI = 1.00-1.60; P=.048), disease staging (localized high-risk vs localized intermediate risk, OR = 1.41; 95%-CI = 1.14-1.74; P < .001), receiving androgen deprivation therapy before study inclusion (OR = 0.19; 95%-CI = 0.10-0.34; P < .001), and hospital teaching status (university vs academic, OR = 0.09; 95%-CI = 0.02-0.55; P = .009). Model 2 additionally includes information on treatment after study inclusion and shows that after inclusion, patients who receive primary radiotherapy (OR = 0.05; 95%-CI = 0.03-0.10; P < .001) or undergo active surveillance/watchful waiting (OR = 0.06; 95%-CI = 0.02-0.15; P < .001) are less likely to utilize POS than patients who undergo radical prostatectomy. Disease staging (localized high-risk vs localized intermediate risk, OR = 1.31; 95%-CI = 1.05-1.62; P = .02) and teaching status (university vs academic, OR = 0.08; 95%-CI = 0.01-0.65; P = .02) are also significant predictors for POS use. The second model did not identify any other significant patient characteristics.ConclusionsFuture research should explore the role of institutional teaching status and whether associations with therapy after study inclusion are due to treatment effects - for example, less need following radiotherapy - or because access to POS is more difficult for those receiving radiotherapy.

Project description: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.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.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.Clinical Trials Register (Clinicaltrials.gov) identifier: NCT01859429 registration date 17 May 2013.

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Dataset Information

Standardized Screening and Psycho-oncological Treatment of Orthopedic Cancer Patients.

Publications

Standardized Screening and Psycho-oncological Treatment of Orthopedic Cancer Patients.

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