Quality of life of breast cancer patients in the course of adjuvant radiotherapy.

GOALS OF THE WORK: In cancer patients, there is an ongoing interest in evaluating the impact of therapeutic interventions on health-related quality of life (hrqol). However, only a few longitudinal studies are published being able to measure the influence of therapy for the patients' quality of life. Based on these data, our aim was to evaluate changes of hrqol during the course of adjuvant radiotherapy in breast cancer patients with special focus on subgroup analysis. MATERIALS AND METHODS: Sixty-one women undergoing radiotherapy after breast conserving surgery were asked to answer the EORTC Quality of life questionnaire (EORTC-QOL-C30) three times: at the beginning of radiotherapy, in the forth week and 6 weeks after the end of treatment. To identify patients with changes of their qol during the observation time, the function scale "Global health status/Quality of life" was used enabling us to classify three subgroups: (1) unchanged hrqol (NC), (2) increasing hrqol (INC), (3) decreasing of hrqol (DEC). MAIN RESULTS: Patients with an increasing hrqol (N = 25) demonstrated a significant increase in the role as well as in the emotional functioning scales. In patients with a decreasing hrqol (N = 15), no changes in any of the function scales were found, while a significant decrease in their cognitive functioning was observed in patients with no change in hrqol (N = 21). CONCLUSIONS: Although the interpretation of these data is difficult because only a few data are available to compare our results, it could be demonstrated that emotional support and the ability to maintain a daily routine in additionally irradiated breast cancer patients is important to optimise hrqol. If hrqol decreases during the course of radiotherapy, the function scales of the EORTC-QOL-C30 seem to be insensitive to reflect this decrease.

[Pain in patients with breast-conserving cancer treatment and radiotherapy]. / Schmerz bei brusterhaltend operierten und bestrahlten Brustkrebspatientinnen--Status und Verlauf.

In patients with breast-conserving surgery of carcinoma and radiotherapy pain rarely is an issue between patient and physician because the operation is considered to be well tolerable and radiotherapy to have few side- effects. There are very few data about frequency and management of pain in these patients. Therefore we evaluated a group of 180 patients after breast-conserving surgery during radiotherapy using a new Likert-scaled questionnaire. Data on the following items were collected: number of patients experiencing pain, pain attribution, frequency and intensity of pain, subjective evaluation and restriction in daily routine. Furthermore, we evaluated the side effects of radiation in an RTOG scale. 85% of patients had pain during radiation which by most was attributed to cancer treatment (surgery and radiation). More than 50% reported light to moderate pain during the entire six-week treatment. Thus pain is a more common symptom in breast cancer patients during radiation therapy than normally assumed and therefore should receive more attention by gynecologists and radiotherapists.

Influence of irradiation on therapy-associated psychological distress in breast carcinoma patients.

PURPOSE: To confirm our assumptions regarding factors that apparently cause psychological distress related to adjuvant radiotherapy in breast cancer patients and to evaluate variables that can predict therapy-associated distress. METHODS AND MATERIALS: Between January 1997 and April 1998, 111 women (33-84 years) with early-stage breast cancer were irradiated (56 Gy) after breast-conserving surgery. Patients were given self-assessment questionnaires on the first and last day of radiotherapy. Statistical analysis was performed using the structural equation model LISREL, variance analysis, and regression analysis. RESULTS: The internal subject-related factors (coping, radiation-related anxiety, physical distress, psychological distress) reciprocally influenced each other, whereas external radiotherapy-specific factors (environmental influence, confidence in the medical staff) were causally related to coping, anxiety, and distress. Fifty-three percent of the women felt distressed because cancer affected the breast; 48% were initially afraid of radiotherapy. For 36%, anxiety was not reduced during treatment. Highly distressed women were identified by the following parameters: < or =58 years; initial anxiety; they were affected by having breast cancer, were negatively affected by environmental factors, and did not find distraction helpful. CONCLUSION: Despite considerable individual variability in breast cancer patients, it seems possible to identify women who run a high risk of therapy-associated distress. In these patients, psychosocial support is necessary to reduce treatment-related anxiety and to stabilize confidence in the medical staff.

[Self concept and object relations of patients with affective disorders--individual centered diagnosis with the repertory-grid technique]. / Selbstkonzept und Objektbeziehungen bei Patientlnnen mit affektiven Störungen. Individuumzentrierte Diagnostik mit der Repertory-Grid-Technik.

Significant dimensions of the self concept and the object relations of 127 depressive patients and 34 orthopaedic patients were investigated with the repertory-grid-technique. Self concept and object relations were compared by means of nomothethically used idiographic results after recovery from manifest depression. The object relations of the depressive sample were characterised by the dimension "symbiotic near"; "ambivalent" and "indifferent" partnership relationships were found much more frequently in the controls. The idiographic results contribute to a differentiation of the spectrum of affective disorders. They underline the importance of the interpersonal dimension of depression and may be used as a basis of a therapeutic orientation.

Personality and object relations in patients with affective disorders: idiographic research by means of the repertory grid technique.

BACKGROUND: This paper presents an idiographic approach to evaluate the self concept and the self-object-relationship of patients suffering from affective disorders. METHODS: Significant dimensions of the personality and the object relations of 127 depressive patients and 34 orthopaedic patients were investigated with the repertory grid-technique. The self concept and the object relations were compared by means of nomothetically used idiographic results after recovery from manifest depression. RESULTS: 'Low self esteem' was frequently found in patients with a long lasting course of illness and the ICD-10-diagnoses of 'bipolar affective disorder' and 'dysthymia'. The object relations of the depressive sample were characterised by the dimension 'symbiotic near'; 'ambivalent' and 'indifferent' partnership relationships were found much more frequently in the controls. CONCLUSIONS: The idiographic results help to differentiate the spectrum of affective disorders. They underline the importance of the interpersonal dimension of depression and may be used as a basis of a therapeutic appraisal. LIMITATIONS: The repertory grid-technique may not be used as a diagnostic instrument. However, the combination of idiographic results with further clinical informations enables the multidimensional assessment of the self concept and psychosocial coping mechanisms.

[Self concept and parental images in patients with affective disorders--a clinical study with the Giessen Test]. / Selbstkonzept und Elternbilder bei PatientInnen mit affektiven Störungen. Eine klinische Studie mit dem Giessen-Test.

The relationship between self, ideal self and normative self was studied in a sample of 139 patients with affective disorders and 73 patients with orthopaedic complaints. The depressive patients showed significant-asymmetric relationships between self and ideal self even after recovery from the clinical depression. Neurotic depressive patients could be distinguished from unipolar depressive patients in this regard. The self-concept of the depressive patients was characterised by means of the bipolar Giessen-test dimensions "insufficiency of performance", "lack of social adjustment" and "lack of social contact" and by means of the GT-dimensions "negative social resonance" and "depressive mood". There were no specific relationships between self-image and parental images in the depressive sample. The results underline the necessity of therapeutic interventions in depressive patients during the so-called symptom-free interval.

[The effect of adjuvant radiotherapy on the mental health of female patients with a breast-conserving operated breast carcinoma]. / Einfluss der adjuvanten Radiotherapie auf das psychische Befinden von Patientinnen mit einem brusterhaltend operierten Mammakarzinom.

BACKGROUND: In literature there are only few informations about the influence of postoperative irradiation on the psychological health of breast cancer patients treated by breast-conserving surgery. However, psychological distress and anxiety related to irradiation are often observed. Purpose of our study was the evaluation of the influence of radiotherapy-induced distress in these patients. PATIENTS AND METHODS: Between October 1995 and June 1996 in 48 breast cancer patients (31 to 76 years old) treated by breast-conserving surgery adjuvant irradiation with or without systemic therapy was applied. On the first and the last day of radiotherapy they were given a questionnaire (Table 1) which was designed together with psychologists. Covering different situations related to radiotherapy the construction of items are determined by factors with possible influence on psychological distress and perception with regard to irradiation. RESULTS: Most of the women (92%) stated to be well informed about the irradiation and tried to obtain further information about this treatment (83%). 56% tried not to think about radiotherapy and/or to distract themselves (81%). 40% were anxious about the fact to undergo irradiation. In the end of treatment 77% reported to have been anxious only initially or never; only 19% were anxious almost or most of the time. 35% were worried about the expected cosmetic alterations of their breast; only 30% observed acute cosmetic changes. With regard to situation-related distress all patients (100%) stated that the communication with the medical staff made it easier to stand the irradiation treatment. CONCLUSIONS: In spite of theoretical considerations our results are explorative in character. However, following statements seem to be important: 1. A large requirement exists to get information about radiotherapy. 2. The patients experience irradiation treatment more positive than initially expected by themselves. 3. With regard to radiotherapy anxiety is reduced during the course of treatment. Here the psychosocial care of the medical staff is an important support for reduction of anxiety.

Influence of radiotherapy on psychological health in breast cancer patients after breast conserving surgery.

BACKGROUND: The purpose of this study was the evaluation of the radiotherapy-induced psychological distress of patients and changes in psychological health during radiotherapy (RT). PATIENTS AND METHODS: 53 breast cancer patients undergoing irradiation after breast conserving surgery participated in this study. In the beginning and at the end of radiotherapy they answered a questionnaire asking for coping strategies, psychological distress with regard to irradiation and influence of surroundings. RESULTS: 92% stated to be well informed about radiotherapy. Coping strategies in order of importance: Talking to physician (94%) or partner (84%), 81% try to distract themselves, 56% repress thoughts about radiotherapy. 40% were anxious about RT and expected side effects (54%). At the end of therapy anxiety was reduced: 77% were anxious only initially or never. CONCLUSIONS: Patients are very interested in information about RT. Their experience of radiotherapy was more positive than initially expected. The relation to medical staff plays an important part in the reduction of irradiation-related psychological distress.

[Power, status and valency in relationship to affective psychoses, schizoaffective and neurotic depression of patients]. / Macht, Status und Valenz in den Partnerschaften affektpsychotischer, schizoaffektiver und depressiv neurotischer Patienten.

The interrelationships of patients with affective psychoses and depressive neuroses were analysed by means of the Giessentest. They were categorised using Beckmanns approach to power, status and valency. The different frequency of these scores in the depressive subgroups underlined the interactional dimension of depression and the influence of gender variables as well. In particular neurotic depressive male patients tended to have asymmetric structures of relationships. The couple relationships of female patients suffering from depression or physical illness were characterised by a negative valency in the self-concept and a positive valency in the self as perceived by others.