[Fatigue and its determinants in radio-oncology]. / Fatigue und deren Determinanten in der Radioonkologie.

BACKGROUND: Fatigue is a common symptom among cancer patients, influencing their quality of life. The primary goal of his study was to identify parameters influencing fatigue, both prior to radiotherapy (RT) and changes in fatigue during RT. METHODS: 239 patients could be assessed prior to RT, 208 patients were reassessed at the end of RT. Measures comprised the Multidimensional Fatigue Inventory (MFI-20), the Resilience Scale (RS) and the SF-12 as a measure of health related Quality of Life (QoL). RESULTS: The sample revealed higher scores in the MFI and in the RS as well as lower scores in the SF-12 than normative samples. Fatigue increased significantly during RT. Fatigue at the beginning of RT was best predicted by the patients' resilience scores, changes of fatigue scores during RT depended on the patients' initial fatigue scores, the decrease in haemoglobin and the patients' experience with RT. CONCLUSIONS: Fatigue appears to be an important problem among cancer patients receiving RT. Resilience proved to powerfully predict the patients' fatigue at the beginning of RT. This result confirms other studies showing resilience to be an important psychological predictor of QoL and coping in cancer patients. The change of fatigue during RT is mainly related to disease- and treatment-related factors.

The need for psychosocial support and its determinants in a sample of patients undergoing radiooncological treatment of cancer.

OBJECTIVE: The primary goal of this study was to examine the need for psychosocial support in a consecutive sample of cancer patients undergoing radiotherapy (RT). Out of an initial sample of 250 patients, 239 patients could be assessed at the beginning of their RT. Two hundred eight patients were reassessed at the end of RT 4-8 weeks later. METHODS: Measures comprised the Hornheide Screening Instrument, the Multidimensional Fatigue Inventory, the Resilience Scale, and the Short Form 12 as a measure of health-related quality of life (QoL). Medical and radiological data were continuously registered. RESULTS: Within the sample, the need for psychosocial support as reflected in the screening instrument was high (>70%). Patients with the need for psychosocial support revealed significantly higher fatigue scores than patients who where not identified as needing psychosocial support. Furthermore, a negative correlation of the need for psychosocial support and QoL as well as resilience could be observed. QoL turned out to be the strongest predictor for the need of psychosocial support. CONCLUSION: The study confirmed that the need for psychosocial support is an important aspect in the treatment of cancer patients undergoing RT, which appeared to be powerfully predicted by the patients' health-related QoL. Fatigue turned out to be an important illness- and treatment-related factor that affects QoL. Psychological interventions for cancer patients should explicitly focus on decreasing patients' fatigue and increasing their resilience, thus improving their QoL.

The influence of resilience on fatigue in cancer patients undergoing radiation therapy (RT).

PURPOSE: The primary goal of the study was to determine if resilience influences fatigue in a consecutive sample of cancer patients treated with radiotherapy (RT) at the beginning and at the end of the treatment. METHODS: Out of an initial sample of 250 patients, 239 could be assessed at the beginning of their RT. Two hundred and eight patients were reassessed at the end of RT 4-8 weeks later. Measures comprised the Resilience Scale (RS), the Multidimensional Fatigue Inventory (MFI), and the SF-12 as a measure of health related Quality of Life (QoL). Medical data were continuously registered. RESULTS: As hypothesized, the sample revealed higher scores in the MFI and lower scores in the SF-12 than normative samples. Resilience scores were higher than in the norm population. Fatigue increased during RT. Using multiple regression analyses, fatigue scores at the beginning of treatment were shown to be higher in inpatients and patients undergoing palliative treatment. Initial fatigue was best predicted by the patients' initial resilience scores. Changes of fatigue scores during RT depended on initial scores, decrease in Hb and the patients' experience with RT. Resilience could not be determined as a predictor of changes in fatigue during RT. CONCLUSIONS: The study confirmed that fatigue is an important problem among RT patients. Resilience turned out to powerfully predict the patients' fatigue at least early in RT. This result is in line with other studies, showing resilience to be an important psychological predictor of QoL and coping in cancer patients. On the other hand, resilience seems to have little influence on treatment related fatigue during RT.

[The Resilience Scale (RS): a statistical comparison of the short and long version based on a patient population]. / Die Resilienzskala (RS): Ein statistischer Vergleich der Kurz- und Langform anhand einer onkologischen Patientenstichprobe.

The use of short and reliable questionnaires in psychological and medical studies is increasingly demanded due to economic, but also ethical reasons. The expectation of low dropout rates within longitudinal studies is an important issue with respect to the validity and quality of clinical studies. In this article, differences of the Resilience Scale (RS) in a short (11 items) and a long version (25 items) are described related to 212 patients treated in a radiooncological unit before receiving radiotherapy. It can be demonstrated that the long and the short version of the Resilience Scale did not appear to differ clinically relevant (differences of means = - 0.080, median = - 0.042, effect size = 0.11). Effect sizes and correlations of the resilience of the patients and other illness- and treatment-related variables such as the need for psychosocial support and fatigue did not change depending on the use of the short or long version of the questionnaire. Therefore, it can be concluded that the short version of the Resilience Scale turns out to be a useful and valid instrument that can be recommended for its use in psychological and medical research.

[Comprehensive evaluation of medical teaching -- a task for the psychosocial disciplines?]. / Umfassende Lehrevaluation in der Medizin -- eine Aufgabe für die psychosozialen Fächer?

The paper describes the experiences with a comprehensive evaluation of medical teaching at the medical faculty of the Friedrich-Schiller-University Jena. Based upon evaluations of courses initiated by the students, the evaluation of teaching is organized scientifically and extended as a comprehensive evaluation of several relevant issues (e. g. surveys of teachers and alumni) by the staff of the Department of Medical Psychology since 1998. Originally supported by a grant of the state of Thuringia, the evaluation is now financed by the medical faculty. The paper describes the requested resources for staff and material to establish a systematic evaluation of medical teaching. In addition, a detailed concept of the allocation of financial means considering evaluations, examinations, and other indicators of teaching quality is demonstrated. Based upon the results of studies related to the evaluation data base, the question of the establishment of an external evaluation in view of the coming changes of the medical curriculum in Germany is critically discussed.