Anxiety, depression and quality of life in family caregivers of palliative cancer patients during home care and after the patient's death.

We examined psychological parameters in family caregivers of palliative cancer patients before and after the death of the patients. Caregivers' data about depression and anxiety (Hospital Anxiety and Depression Scale), quality-of-life (Short Form-8 Health Survey), and social support (Oslo Social Support Scale) were collected at the beginning of home care (t1) and 2 months after the patient had died (t2). Regression models were employed to examine factors related to depression and anxiety in the bereaved caregivers. We interviewed 72 relatives, who were the primary caregiver of a patient. One-third (31.9%) of caregivers had high anxiety levels and 29.2% had high depression levels (t1, cut-off = 10). At t2, anxiety and depression had decreased significantly. There were no changes in quality-of-life over time. At both points of assessments, quality-of-life was lower than in the general population. Relevant factors for higher anxiety and depression in the bereaved caregivers were high levels of distress at t1, insufficient social support and low physical function. Bereaved caregivers were particularly depressed when they had been the spouse of the patient. Healthcare professionals should consider social isolation of caring relatives both during homecare and afterwards. Thus, it seems to be important to routinely offer support to spouses.

Depression and anxiety following hematopoietic stem cell transplantation: a prospective population-based study in Germany.

In this prospective multicenter study, we investigated the course of depression and anxiety during hematopoietic stem cell transplantation (HSCT) until 5 years after transplantation adjusting for medical information. Patients were consulted before HSCT (n=239), at 3 months (n=150), 12 months (n=102) and 5 years (n=45) after HSCT. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS). Detailed medical and demographic information was collected. Prevalence rates were compared with an age- and gender-matched control group drawn from a large representative sample (n=4110). The risk of depression before HSCT was lower for patients than for the control group (risk ratio (RR), 0.56; 95% confidence interval (CI), 0.39/0.81). Prevalence rates of depression increased from 12 to 30% until 5 years post HSCT. Anxiety rates were most frequently increased before HSCT (29%, RR, 1.31; 95% CI, 1.02/1.68) and then reached a stable level comparable to the background population (RR 0.83, 95% CI, 0.56/1.22). This study confirms the low levels of depression in the short term after HSCT and identifies depression as a long-term effect. Furthermore, it confirms previous results of heightened anxiety before HSCT. Surveillance of symptoms of anxiety during the short-term phase of HSCT and of depression during the following years is crucial.

Investigating the temporal course, relevance and risk factors of fatigue over 5 years: a prospective study among patients receiving allogeneic HSCT.

Although allogeneic hematopoietic stem cell transplantation (HSCT) features severe physical and psychological strain, no previous study has prospectively investigated fatigue beyond 3 years after transplantation. We investigated the temporal course of fatigue over 5 years, compared patients with the general population (GP) and tested for treatment- and complication-related risk factors. Patients were assessed before conditioning (T0, N=239) and at 100-day (T1, N=150), 1-year (T2, N=102) and 5-year (T3, N=45) follow-up. We measured fatigue with the Multidimensional Fatigue Inventory-20. Patients were compared with the GP at T0 and at T3. Global fatigue increased from T0 to T1 (t=3.85, P<0.001), decreased from T1 to T2 (t=-2. 92, P=0.004) and then remained stable (t=0.45, P=0.656). No difference in global fatigue was found between T0 and T3 (t=0.68, P=0.497). Compared with the GP, patients showed higher global fatigue at T0 (t=-6.02, P<0.001) and T3 (t=-2.50, P=0.014). These differences reached meaningful effect sizes (d⩾0.5). Acute and chronic GvHD predicted global fatigue at T1 (γ=0.34, P=0.006) and T2 (γ=0.38, P=0.010), respectively. To conclude, fatigue among allogeneic HSCT patients improves with time, finally returning to pretransplantation levels. However, even after 5 years, the difference from the GP remains relevant. Patients with GvHD are at risk for increased fatigue.

[Coping and depression in underage children of cancer patients: Data on the course]. / Coping und depressive Belastungen minderjähriger Kinder von Krebspatienten : Verlaufsdaten.

BACKGROUND: There is increasing consideration of a family-focused perspective of the psychosocial consequences of cancer. OBJECTIVES: This study examined the psychosocial situation of children and adolescents (11 to 17 years old) of cancer patients assessing their psychological distress and coping over time. METHODS: A total of 110 children and adolescents were assessed post-treatment of parents with cancer (t1), 6 (t2) and 12 months (t3) after t1. Participants completed validated questionnaires assessing coping (KidCope) and depressive symptoms (CES). These data were compared with a matched sample from the general population. RESULTS: The children reported using a combination of coping measures. In particular, active coping was perceived as being helpful. In terms of coping, there were only small gender differences and 6 months after completion of treatment of the parents (t2), depressive symptoms of the children were still elevated. Depression diminished over time and was near the level of the comparison group at t3. CONCLUSION: Children and adolescents are particularly psychologically distressed after cancer treatment of parents. This distress was connected with not helpful coping strategies. The extended adjustment of children/adolescents of cancer patients has to be considered in the clinical and psychosocial care of the families.

["One cannot just look at the clock" - interviews with family doctors on ambulatory palliative care of tumour patients]. / "Da kann man nicht auf die Uhr gucken" - Interviews mit Hausärzten zur ambulanten Palliativversorgung von Tumorpatienten.

GOAL OF THE STUDY: In the study "possibilities and limits of ambulatory palliative care" there was a survey with family doctors about their own subjective views of ambulatory palliative care. The different parameters of home care, the role of caring relatives as well as burdening and supporting factors for family doctors occupied the focus in these interviews. METHODS: With the help of the results from 9 qualitative interviews, a questionnaire was compiled and sent by post to all family doctors within 50 km (N=427). For analysis questionnaires were available from N=89 family doctors. Statements about various areas of outpatient palliative work were collected with Likert scales and open questions. RESULTS: The personal overloads of the care-giving relatives, the inadequate payment and their own time pressures for the family doctors were the main obstacles in home care of palliative patients. On the other hand the family doctors considered as supporting factors for an ambulatory care: a good pain and symptom management, a high satisfaction of the patients and a good teamwork between the caring service and other people taking part in the care. CONCLUSION: In order to minimise the time overload of family doctors and to focus the psycho-social distress of the caring relatives the expansion of non-medical offers should be supported, e. g., ambulatory hospice services and consultative forms of care by psychologists and religious personnel.

Quality of life in patients with muscle invasive and non-muscle invasive bladder cancer.

PURPOSE: Compared to the literature on other malignancies, data on quality of life (QoL) in bladder cancer are sparse. This study sought answers to the following questions: In what QoL domains do patients with bladder cancer differ from the general population? Do patients with radical cystectomy differ in QoL compared to those who received conservative treatment? Do patients with neobladder generally have better QoL compared to patients with other diversion methods? METHODS: At the beginning of inpatient rehabilitation, N = 823 patients with bladder cancer were assessed. Data of a representative community sample (N = 2037) were used for comparison. The questionnaire EORTC QLQ-C30 was used to measure QoL. Multivariate linear regression models were computed to investigate differences between groups. RESULTS: Patients with both non-muscle invasive and muscle invasive bladder cancer reported significantly more problems and worse functioning than the general population. Radiotherapy is associated with clinically relevant more pain, dyspnoea, constipation, appetite loss and decreased social functioning while chemotherapy is associated more with dyspnoea. Cystectomy patients reported more fatigue, appetite loss and decreased role functioning. Male patients ≥70 years with conduit experienced more sleep and emotional problems. These effects of urinary diversion were not observed in women and younger patients. CONCLUSIONS: Patients with bladder cancer experience various QoL concerns at the beginning of inpatient rehabilitation. These problems can partly be explained by the type of treatment the patients receive. Type of urinary diversion is relevant for QoL in subgroups of patients.

Quality of life of parents diagnosed with cancer: change over time and influencing factors.

Suffering from cancer while having parental responsibilities can amplify the psychosocial strain that the disease puts on the individual as well as on the whole family system. Our longitudinal study examines changes in the quality of life of cancer patients in relation to parenthood. The quality of life of cancer patients is assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item version during the initial treatment period (T1) and compared to the quality of life 2 years later (T2). Two groups of patients are compared: those who have children below the age of 18 years (n= 41) and those who do not have children (n= 28). Shortly after being diagnosed with cancer (T1), both groups report a similarly low quality of life. Two years later (T2), individuals with children below the age of 18 report better quality of life on the majority of the dimensions assessed. However, variance analysis did not show that this is an independent effect of parenthood. In fact, having a partner and being female proved to impact the quality of life. These findings support the existing body of research on the influence of social support and gender on quality of life. The resulting limitations and suggestions on how to overcome them in further research are discussed.

["About me and my disease" - the making of an individual book within an art therapy course for cancer patients]. / "Über mich und meine Krankheit" - die Gestaltung eines individuellen Buches im Rahmen einer kunstpädagogischen Intervention für Krebspatienten.

AIMS: Art therapy is increasingly gaining in importance in psychooncological care. At the university of Leipzig an art therapy intervention was developed for cancer patients in ambulant aftercare and was tested in retrospect. The aim of the course was making an individual book-object, in which the cancer could be a central topic. METHODS: Before and after the intervention the participants were questioned using semi-structured interviews. Beside the qualitative analysis of the interviews the process of the course and the making of the book were demonstrated using the example of a breast cancer patient. RESULTS: The participants reported various effects of the intervention. In all, 17 of 23 participants have created her own book. More than 75 % of the books created pick out their own cancer disease as a central theme. The participants deal with the subject in different ways. All participants placed themselves at the center and the majority created the book for themselves. CONCLUSION: The results show that the making of an individual book permits a constructive analysis with the cancer disease in a protected framework and can have a supportive effect on the participants in dealing with their disease.

[Mutual communication is often lacking--interviews with professional care givers on ambulatory palliative care]. / "Die Kommunikation untereinander ist häufig nicht vorhanden"--Interviews mit Pflegedienstmitarbeitern zur ambulanten Palliativversorgung.

GOAL OF THE STUDY: Within the study "possibilities and borders of ambulatory palliative care" interviews with employees of the outpatient care service were carried out. Thereby the subjective view of the professional care givers was the maintaining of interest. The focus was on problems in palliative home care, co-operation with other professionals and family caregivers as well as the conditions of their work. METHODS: With the help of qualitative manual interviews, the questioning took place with nine cooperating ambulatory care services. The interviews were recorded, transliterated, analysed and evaluated following the qualitative content analysis of Mayring. RESULTS: From the ambulant caregivers' point of view the causes for a failure of home care are particularly the poor cooperation with other professionals and the large distress of the family caregivers. In contrast, they estimate that a good cooperation with the family doctor and other participants of the care, a sufficient qualification and networking as well as committed family caregivers and pleased patients are beneficial factors for ambulatory palliative care. CONCLUSION: An efficient implementation of specialised ambulatory care models (SAPV) is imperative in order to ensure an interdisciplinary and cooperative care for palliative patients and to afford an effective working field for professional care givers.

[Palliative home care of cancer patients in the Leipzig region]. / Ambulante Palliativversorgung von Tumorpatienten im Raum Leipzig.

BACKGROUND: In many model regions of Germany, palliative home care can be improved for cancer patients over longer periods so that most of these patients could die at home. However, there is a shortage of ambulatory care for dying patients in regions without special agreements for this type of care. METHODS: The aim of the study was to identify beneficial as well as impedimentary factors of outpatient palliative care. Therefore we interviewed 91 tumour patients and collected medical, psychosocial and sociodemographic data with standardized questionnaires. RESULTS: Nearly half of the patients (43%) had moderate to strong pain during domestic care and felt depressed (44%) and anxious (26%). Home hospice services, social workers, and psychologists were rarely involved in home care. Ambulatory home care was often interrupted because of hospital stays. CONCLUSION: Palliative symptom control in outpatients should be performed by qualified and interdisciplinary palliative-care teams, so that patients can receive more psychosocial support and hospital stays can be prevented.

Quality of care and emotional support from the inpatient cancer patient's perspective.

BACKGROUND: Patient satisfaction and emotional support are crucial elements of cancer care. Little is known, however, about which areas of care are important from the patient's perspective and the roles emotional distress and support play in this context. METHODS: Multicenter prospective study was conducted (n = 396 cancer patients; t1 = after admission to hospital, t2 = before discharge). Quality of care was measured with the quality of care from the patient's perspective questionnaire, and emotional distress was measured with the hospital anxiety and depression scale. Additional questions regarding emotional support wished (at t1) and provided (at t2) were administered. RESULTS: The patients reported that the domains of care most important to them were as follows: respect and commitment of the physicians, information before procedures, care equipment, and medical care. The areas where improvements are most obviously needed were nutrition, participation, clarity about who is responsible for personal care, and having the possibility of speaking in private with nurses and psycho-oncologists. Fifty-six percent of the patients were highly emotionally distressed, 84% wanted support from physicians, 76% from nurses, 33% from psychologists, and 7% from a pastor. CONCLUSION: Emotional support is a crucial part of patient satisfaction and should be provided by several members of the oncological team, especially the patients' physicians. In turn, it is crucial that medical professionals be equipped with good communication skills.

Use of Penning ionization electron spectroscopy in plasma for measurements of environmental gas constituents.

A breadboard GC detector based on Penning ionization electron spectroscopy in plasma (PIES) was investigated. The PIES detector was set up in series with a gas chromatograph and a thermal conductivity detector. Two-dimensional PIES chromatograms were recorded for carbon monoxide, carbon dioxide, and methane. The analytes were identified independently of the GC retention time, and their concentrations were measured in a range between 1 and 100 ppm. PIES spectra for methane were observed for the first time and displayed two characteristic peaks with electron energies of 7.1 and 5.4 eV. Rate coefficients for Penning ionization due to collisions between 2(3)S helium metastable atoms and analyte molecules under study were found to be k*(CO) = (0.7 +/- 0.2) x 10(-10), k*(CO2) = (1.8 +/- 0.7) x 10(-10), k*(7.1 CH4) = (4.7 +/- 0.6) x 10(-10), and k*(5.4 CH4) = (8 +/- 2) x 10(-10) cm(3)/s. The work provides the basis for the development of a portable and robust analytical platform capable of in situ real-time monitoring of greenhouse gases, with a perspective toward laboratory-on-chip realization.

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care.

The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of > or =13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of > or =6 (specificity 0.21). With scores of > or =16 and > or =22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.

[Medical decision making in hospital--results of an exploratory study on the value of shared decision making from the physicians point of view]. / Medizinische Entscheidungsfindung im Krankenhaus--Ergebnisse einer explorativen Studie zum Stellenwert des shared decision making aus der Sicht der Arzte.

The changes in the relationship between doctors and patients and the transfer of shared decision making into medical treatment has often been discussed. The role and the perspective of the patients are primarily described. The aim of our study is to examine the attitudes of physicians regarding the shared decision making concept, based on 15 interviews with clinical doctors. Our findings show that most doctors know the content of the concept and mostly agree with it. Practical barriers for the realisation of shared decision making are often stressed. The meaning of the concept of shared decision making for the physicians is in some respects different from the meaning of this concept for the patients. It is important to examine this concept more particularly with standardised instruments. It will be necessary to explore not only the role of patients and physicians in the medical decision making process but also the position of other relevant persons like the relatives of the patients or the nursing staff.

[Long-term influence of the spongiosa metal surface prosthesis on the periprosthetic bone. A radiological and osteodensitometric analysis of implantation of the S& G (ESKA) hip prosthesis]. / Langfristiger Einfluss der anatomisch angepassten spongiösen Endoprothese auf den periprothetischen Knochen.

INTRODUCTION: The anatomically shaped, cementless total hip replacement (THR) (S and G, ESKA Lübeck) has a fully porous coating for secondary osseointegration. The aim of the present study was to analyse the long-term effect of the prosthesis on periprosthetic bone remodelling. METHODS: 137 THR in 117 patients were analysed clinically and radiographically 12.8 years (10-14.9 years) postoperatively. The average age at the last follow-up was 71.8 years (range: 34-87 years). Osteodensitometric DEXA measurements of the periprosthetic bone in comparison to the contralateral non-operated femora were performed. RESULTS: Cumulative survival rates of all implanted THR (n = 231) at 14.9 years were 86.2 % (+/-5.3 %) for the fully porous coated stem and 90.1 % (+/- 8 %) for the cup. Five stem fractures (3.6 %) at the middle part were recorded. The Harris hip score of the non-revised THR at the last follow-up averaged 88.3 (34-100) points. Bony atrophy in the proximal periprosthetic femora in Gruen zones I (16.8 %) and VII (34.6 %) confirmed a proximal stress-shielding. Osteodensitometric analyses demonstrated in comparison to the contralateral femora (BMD 1.3 g/cm (2)) a significantly reduced bone density at the calcar femoris (BMD 0.9 g/cm (2)) (p < 0.001). CONCLUSION: The original goal of a physiological load transfer has not been realised with this fully porous, cementless THR. The anatomic S & G stem will mainly be osseointegrated by distal load transfer.

Long-term results of the metal-cancellous cementless Lübeck total hip arthroplasty: a critical review at 12.8 years.

INTRODUCTION: The influence of a spongy metal surface total hip arthroplasty (THA) (S&G, ESKA, Lübeck, Germany) on the clinical, psychometric, and radiograhic long-term results were examined. MATERIAL AND METHODS: An amount of 137 THA with the cementless spongy metal Lübeck hip prosthesis were evaluated long-term, radiographically and clinically, with a mean follow-up time of 12.8 years (range 10.1-14.9 years). The MOS SF-36 was used to assess the health-related quality of life (HRQL). RESULTS: Cumulative survival rates were 90% (+/-8%) for the cups and 86% (+/-5%) for the stems at 14.9 years. Four stems fractured at the middle part (3%) without major trauma. In the remaining patients the clinical results expressed as Harris Hip Score (HHS) averaged 88 (range 34-100). Patients above 60 years undergoing THA had no significant difference in HRQL (MOS SF-36) in comparison to the age-matched healthy population (P>0.05). Patients younger than 60 years had scores lower than normal in the physical function domains (P<0.01), but were comparable in the mental health domains (P>0.05). Radiolucent lines and bone atrophy related to stress shielding by distal fixation were found in the periprosthetic Gruen Zone I (19.8, 16.8%) and VII (10.3, 27.1%) of the proximal femur. DISCUSSION: Whereas the rate of aseptic cup failures of the cementless spongy metal Lübeck hip prosthesis is among the best, the failure rate of the stems is attributable to osteolysis of the proximal femur. The fractures of the stem may be attributed to the combination of the lack of proximal support, the fully porous stem made of a cast cobalt-chrome-molybdenum alloy, and the narrow dimension of the stem core. The long-term results of the spongy metal cup are good, whereas the high loosening and fracture rate of fully coated stem are a source of concern especially with regard to the difficult revision scenario with frequent massive bone loss.

[Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence]. / Langzeitergebnisse der Lebensqualität nach Harrington Distraktionsspondylodese bei idiopathischen Thorakalskoliosen und deren gutachterliche Relevanz.

AIM: The expert evidence of operated patients with idiopathic scoliosis is determined by functional and pulmonary restriction. The degree of deformity and the extent of fusion is crucial for grading disability. In a retrospective study on the quality of life (SF-36) and low back pain (Roland-Morris Score) of 82 patients (22 - 40 years) with idiopathic scoliosis treated with Harrington instrumentation the grading was registered. METHOD: An average of 16.7 years after the surgery, these data were correlated with the type and size of curve and to the extension of fusion. RESULTS: Compared to the age-matched healthy population, there was no significant difference in the physical SF-36 scale (P = 0.98). Surgically treated patients showed significantly lower scores than at baseline in the psychological SF-36 scale (P = 0.005). Sixty-five (79.3 %) of the eighty-two patients reported no or occasional back pain in the Roland Index. Five patients (6.1 %) complained of chronic back pain. 33 patients (40 %) were legally defined in their rate of disability as severely handicapped patients. The grading disability was associated with the physical SF-36 scale (P < 0.001) and the low back pain (P = 0.02). A significant correlation between the grading disability and the extent of fusion (P = 0.53) or the size of curve (p = 0.4) could not be proven. CONCLUSION: Despite good long-term outcomes, 40 % of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons. The additional measurements of quality of life and low-back pain can improve legal assessment in orthopaedics.

Separation of selected anticancer drugs using superheated water as the mobile phase.

Six anticancer drugs have been eluted on a polystyrene-divinylbenzene (PS-DVB) column with buffered superheated water as the mobile phase. The temperature range studied was from ambient temperature up to 160 degrees C, and the pH of the water was adjusted to 11.5 and 3.5 with phosphate buffer. It was possible to separate the substances 5-fluorouracil (5-FU), methotrexate (MTX), 7-hydroxymethotrexate (7-OH-MTX), and etoposide (VP-16) in one chromatographic run. The separation of these substances was optimized when adjusting the pH from 11.5 to 3.5, resulting in a total elution time of less than 13 min. Furthermore, retention factors of all of the investigated substances were measured at different temperatures and pH values.

[Spondylothoracic dysplasia--a case report of 2 affected sisters with 20 year follow-up]. / Spondylothorakale Dysplasie--Eine Fallbeschreibung zweier betroffener Schwestern mit einem Nachbeobachtungszeitraum von 20 Jahren.

This is a case report and review of the literature in spondylothoracic dysplasia. Spondylothoracic dysplasia is a genetically transmitted, rare entity characterized by multiple vertebral abnormalities and rib anomalies. Two siblings from one family of normal parents who have four other normal children were affected. There is no history of congenital anomalies in the family. Due to progressing deformity of the spine, a convex epiphyseodesis had to be performed in the oldest girl. The second girl, who has a healthy twin sister, was borne with an inperforated anus and a recto-vaginal fistula. An operation was performed at an early stage. Today, the mature patients are painfree and fully integrated in social life. Spondylothoracic dysplasia is discussed with regard to the hereditary nature, course, and prognosis on the basis of the pertinent literature.

Fourier transform Raman and infrared spectra and normal coordinate analysis of organo-arsenic(III), -antimony(III) and -bismuth(III) thiolates.

The FT-Raman and infrared spectra of (PhS)BiPh2, (PhS)2BiPh, (PhS)3Sb, (PhS)3Sb, (PhS)3As and (PhSe)BiPh2 were measured in the range 3600-100 cm(-1). A normal coordinate analysis was performed for all substances in terms of the calculation and discussion of the force constants which are dependent on the element-sulphur and element-selenium group using a modified valence force field. Furthermore, for all compounds 1H-NMR, 13C-NMR and MS data were also given. The investigation of the microbiological activity of some substances against Escherichia coli was an additional aspect because of their strong bactericidal and fungicidal effects.