Factors associated with non-participation and dropout among cancer patients in a cluster-randomised controlled trial.

We investigated the impact of demographic and disease related factors on non-participation and dropout in a cluster-randomised behavioural trial in cancer patients with measurements taken between hospitalisation and 6 months thereafter. The percentages of non-participation and dropout were documented at each time point. Factors considered to be potentially related with non-participation and dropout were as follows: age, sex, marital status, education, income, employment status, tumour site and stage of disease. Of 1,338 eligible patients, 24% declined participation at baseline. Non-participation was higher in older patients (Odds Ratio [OR] 2.1, CI: 0.6-0.9) and those with advanced disease (OR 2.0, CI: 0.1-1.3). Dropout by 6 months was 25%. Dropout was more frequent with increased age (OR 2.8, CI: 0.8-1.2), advanced disease (OR 3.0, CI: 1.0-1.2), being married (OR 2.4, CI 0.7-1.1) and less frequent with university education (OR 0.4, CI -1.3 to -0.8) and middle income (OR 0.4, CI -0.9 to -0.7). When planning clinical trials, it is important to be aware of patient groups at high risk of non-participation or dropout, for example older patients or those with advanced disease. Trial designs should consider their special needs to increase their rate of participation.

Course of psychiatric comorbidity and utilization of mental health care after laryngeal cancer: a prospective cohort study.

In a German multi-center prospective cohort study, we wanted to assess the course of psychiatric comorbidity, utilization of mental health care and psychosocial care needs in laryngeal cancer patients during the first year after partial laryngectomy (PRL). Structured interviews with patients were conducted before surgery, 1 week (1 w), 3 months (3 m) and 1 year (12 m) after PRL. Psychiatric comorbidity was assessed using the Structured Clinical Interview for DSM-IV (SCID). Psychosocial care needs and utilization of mental health care were evaluated with standardized face-to-face interviews. In 176 patients, psychiatric disorders were prevalent in 11 % (1 w), 15 % (3 m) and 14 % (12 m), respectively, of which 4 % (12 m) underwent psychiatric treatment or psychotherapy. Two percent had acute, 15 % emerging and 6 % chronic psychiatric comorbidity. Chronically mental ill patients were more frequently younger than 65 years (p = 0.026), female (p = 0.045) and experienced more often a need for psychological counseling (p ≤ 0.001). One year after surgery, 27 % of the comorbid psychiatric patients expressed a need for additional psychological counseling. Alcohol-related disorders were diagnosed in 3 % (1 w), 3 % (3 m) and 8 % (12 m), respectively. Only one of these patients received psychological treatment, while 14 % expressed a need for psychological counseling and 7 % for additional medical consultations. The non-treatment of alcohol-related disorders measured in our sample indicates a major problem since continued alcohol consumption in laryngeal cancer patients is associated with reduced global quality of life, increased functional impairments and reduced overall survival. Screening instruments integrated into acute care are necessary to detect harmful drinking behavior.

[Social integration and its relevance for quality of life after laryngectomy]. / Soziale Integration und deren Bedeutung für die Lebensqualität nach Laryngektomie.

BACKGROUND: Social networks and social participation generally have positive effects on health. Yet, little is known about how patients after total laryngectomy (TLE) are integrated into the society. Aim of this study was to investigate how patients are socially integrated after a TLE and if social integration is associated with certain areas of quality of life. PATIENTS AND METHODS: In a longitudinal multi-centred study 161 laryngectomees were interviewed 1 year after the total laryngectomy. Social integration was measured on the basis of an index formed by the questionnaire "Psychosocial Adjustment after Laryngectomy" and questions about social support. To assess quality of life, we used the questionnaire from the European Organisation for Research and Treatment of Cancer EORTC QLQ-C30. RESULTS: 58% of all patients are well integrated 1 year after surgery. Well integrated persons have less problems in different components of quality of life. They report higher levels of social (OR 4.07; CI: 1.96-8.47) and role functioning (OR 3.59; CI: 1.61-8.02). Successful social integration is also associated with higher emotional well-being (OR 8.57; CI: 3.59-20.46). CONCLUSIONS: There is evidence that 1 year after TLE only about half of the patients feel socially integrated. Because of the negative association of poor social integration with social, emotional and role functioning, patients should be supported in their attempts to take actively part in social life.

[Psycho-oncology for speech therapists: establishment and conception of the course PSYKOL]. / Psychoonkologie für Logopäden und Sprechwissenschaftler : Begründung und Konzeption des Kurses PSYKOL.

OBJECTIVE: Head and neck cancer patients show a high psychiatric comorbidity, yet receive only little psychosocial support. Therefore, a specific psychosocial qualification for speech therapists working with head and neck cancer patients seems necessary. MATERIAL AND METHODS: A course was developed based on a process model. Questionnaires were completed by speech therapists (self-evaluation of working situation; n = 15) as well as therapists interested in further training (collection of issues in the work with head and neck patients who are under psychological pressure assessed as problematic by the therapists; n = 27), whose competence in communication was also evaluated. In addition, a literature research was conducted and a focus group was formed. RESULTS: High psychosocial demands within the therapists' work with tumor patients and difficulties in communication became obvious. Nearly all interviewees frequently used nonconducive communication patterns, yet implicit knowledge existed (usage of a favorable conversational style in multiple choice test: 68 %). The content and concept of the curriculum were discussed within the focus group and led to the final version of the training. CONCLUSION: A customised psycho-social training curriculum for speech therapists has been developed.

Mental disorders and psychosocial support during the first year after total laryngectomy: a prospective cohort study.

OBJECTIVES: To assess the frequency of mental disorders and the use of psychosocial services in laryngectomised patients during the first year after surgery. DESIGN: Multicentre prospective study including six interviews. Data regarding psychiatric comorbidity 3 months (3 m) and 1 year (12 m) after total laryngectomy (TLE) are reported in this study. SETTING: Structured interviews were conducted at nine hospitals and three rehabilitation centres in Germany. PARTICIPANTS: One hundred and seventy-one patients were interviewed at both time-points. MAIN OUTCOME MEASURES: Structured clinical interview for DSM-IV (SCID). RESULTS: Mental disorders were diagnosed in 25% of the patients (3 m) and in 22% of the patients (12 m), respectively. Six per cent of the patients developed a mental disorder during the first year after total laryngectomy. In general, male and female patients suffered from mental disorders with equal frequency (3 m: 23% versus 37%; P = 0.26; 12 m: 22% versus 21%; P = 1.00). Women suffered more often than men from post-traumatic stress disorder (3 m) (P = 0.01) and generalised anxiety disorder (12 m) (P = 0.01).Of the patients who had acquired no voice, 20% suffered from alcohol dependence (P = 0.01) [corrected]. There were no differences between men and women in receiving any kind of counselling (P = 0.79) or psychotherapy/psychiatric treatment (P = 0.47). Of those patients diagnosed with any mental disorder 3 months after total laryngectomy, 7% had received psychotherapy 1 year after total laryngectomy. None of the patients diagnosed with alcohol dependence received psychotherapy or psychiatric treatment. CONCLUSIONS: Mental disorders occur in laryngectomees as frequently in men as they do in women. Total laryngectomised patients who were mentally ill did not receive enough psychotherapeutic or psychiatric support. As mental health seems to be related to successful voice restoration, future research should develop and evaluate special psychosocial supportive programmes for patients with laryngeal cancer, especially regarding alcohol dependence treatment.

[Swallowing disorders after partial laryngectomy. Prevalence and predictors]. / Schluckstörungen nach Kehlkopfteilresektion. Auftrittshäufigkeit und Prädiktoren.

BACKGROUND: Improvements in surgical techniques have led to a higher percentage of larynx preservations. These do not always include preservation of the swallowing function. This study investigates the prevalence of swallowing disorders after partial laryngectomy and their predictors. PATIENTS AND METHODS: In a multicenter cross-sectional study with patients who received a partial laryngectomy (n=154) the prevalences of problems related to swallowing and eating were gathered. Additionally, medical and sociodemographic data were obtained as well as information about alcohol and tobacco consumption. RESULTS: Twenty percent of the patients had problems related to swallowing and eating; more specifically, eating solid foods and eating in public. Chances of having swallowing disorders were significantly lower for patients who received laser therapy (OR=0.12; 95% CI: 0.04-0.37; p<0.01), when time since the last laryngeal surgery was longer (OR=0.89; 95% CI: 0.75-0.99; p<0.03) and when patients were non-smokers (OR=3.39; 95% CI: 1.29-8.94; p<0.02). CONCLUSION: Swallowing disorders correlate with post-surgery smoking. Physicians and therapists should focus more on the negative side effects of smoking on swallowing during patient consultations.

Alcohol consumption after laryngectomy.

OBJECTIVE: The aim of the study was the analysis of drinking behaviour in laryngectomised patients and its concomitants in quality of life and mental health. STUDY DESIGN: Multi-centered cross-sectional study. PARTICIPANTS AND SETTING: Two hundred and twenty-five laryngectomised patients were asked to participate in the study. One hundred and seventy nine patients (80%) were interviewed after laryngectomy at six different ENT clinics in Germany. MAIN OUTCOME MEASURES: 'Questionnaire of Health Behaviour' (FEG), 'Short Questionnaire of Alcohol Risk', Hospital Anxiety and Depression Scale (HADS), Hornheider Questionnaire (HFB), Visual Analogue Scales (VAS) and the Quality of Life Questionnaires of the European Organization of Research and Treatment of Cancer (EORTC) (EORTC QLQ-C30, EORTC QLQ-H & N35). RESULTS: Alcohol dependence was found in 7% of the patients. Half of the respondents showed a constant consumption of alcohol with 6% of the patients who wanted to change their consumption. Patients with alcohol dependence indicated in comparison with non-dependent persons increased anxiety (p = 0.03), problems in coping with illness (p = 0.03), increased psychosocial care needs (p = 0.02), fatigue (p = 0.04), shortness of breath (p = 0.04), diarrhoea (p = 0.02) and a worse emotional functioning level (p = 0.03). Alcohol intake was independent of tumour stage (p = 0.48), employment status (p = 0.54), social class (p = 0.82), the time interval since laryngectomy (p = 0.64) and type of voice substitute (p = 0.76). The quality of life and mental state were independent of the amount of alcohol consumed. CONCLUSIONS: The results show that alcohol dependence is associated with adverse psychosocial and medical consequences, which require treatment. Socio-demographic and medical parameters do not allow any conclusions to alcoholism risk. Therefore, an individual exploration of the patients' drinking behaviour is needed, which could prepare the ground to specific treatment.

[Smoking behaviour after laryngectomy]. / Rauchverhalten nach Laryngektomie.

BACKGROUND: Tobacco smoking is an important risk factor for laryngeal cancer. Aim of this study was to investigate the prevalence of smoking and to identify factors that can promote tobacco abstinence. PATIENTS AND METHODS: In a multi-centre cross-sectional study, 187 patients after laryngectomy were surveyed regarding their smoking behaviour. Instruments used were the questionnaire "Quality of Life after Laryngectomy" (Ackerstaff & Hilgers) and the "Questionnaire of Health Behaviour" ("Fragebogen zur Erfassung des Gesundheitsverhaltens", Dlugosch & Krieger). RESULTS: Life time prevalence of tobacco smoking was 89%, whereas current prevalence was only 6%. None of the laryngectomies believed tobacco consumption to be safe. 24% thought that their tumour was caused mainly by smoking, although the current prevalence of smoking was not related to that number. 74% of all ex-smokers had stopped smoking at the time of the laryngectomy. CONCLUSIONS: Only a small fraction of laryngectomized patients do smoke several years after the operation. Anti-tobacco interventions should therefore be focused on high risk persons, not on the entire patient population.

[Methodologic problems in the measurement of somatometric characteristics]. / Methodologisch Uberlegungen zur Erfassung somatometrischer Merkmale.

With respect to difficult research conditions the problems of taking biologically relevant somatometric measurements for the determination of habitus variants are discussed. Under consideration of these difficulties several somatometric characters are selected by comparing the correlations based on the data of two series measured by the authors and three series taken from literature. However, attention is drawn to the fact that no complete characterization of habitus variants will result by means of these few measurements but yet some important relevant criteria.

[Population biology of North Germany. Comparative growth study of school children in Bremen and the rural surroundings]. / Untersuchungen zur Bevölkerungsbiologie Norddeutschlands. 2.. Vergleichende Wachstumsuntersuchungen an Schulkindern in Bremen und der ländlichen Umgebung.

Body weight and body height measurements have been carried out on two samples of n = 1236 pupils between 8 and 16 years of age from schools in Bremen and of n = 1401 pupils of the same age group from the rural surroundings of Bremen. From this information the values of the Rohrer-index and body surface have been calculated for each individual. The differences in these four anthropometric parameters between the rural and urban children were analysed by sex and age.

Investigations on the changes of sex ratio in Germany from 1826 up to 1978.

The changes of the secondary sex ratio in Bremen (North Germany) from 1826 up to 1978 are compared with those of Germany in the period from 1872 to 1978. To some extent there are marked differences. The oscillation of the secondary sex ratio in Bremen is more extended in Germany. On the average in Bremen the values are lower in the 19th century than in the 20th. For Germany higher values are observed in the years between 1915 and 1959. The changes of reproductive performance, indicated by birth rate. Supposing that the primary sex ratio is dependent on the time of insemination within the intermenstruum, the same figures of monthly distribution of secondary sex ratio and birth frequency can be expected. In fact, the seasonal variations proved to be not significant and do not show the expected parallel figures.