[The Development of Quality Standards for the Psychosocial Outpatient Care of Cancer Patients - Results of a Delphi Survey]. / Die Entwicklung von Qualitätsstandards für die ambulante psychosoziale Krebsberatung ­ Ergebnisse einer Delphibefragung.

BACKGROUND: The psychosocial outpatient care of cancer patients and their families is a central element of oncological care. To date, the provision of care to this group is very heterogeneous in terms of the spectrum of services offered and quality of care. The aim of this study was to develop a multidimensional classification of quality standards for psychosocial outpatient cancer counseling. METHOD: We conducted a study using the Delphi method. 97 experts from more than 10 different fields of action or institutional contexts (e. g. mental health care professionals, cancer societies, self-help groups) were included in 3 rounds of Delphi assessment. Finally, 134 single criteria within 9 quality areas (e. g. staff, range of services, documentation) were generated and evaluated for their relevance, clarity, comprehensiveness and level of obligation. RESULT: A total of 119 individual criteria (88.8%) achieved consensus within the 3 Delphi rounds. Hereof, 94 were basic criteria (79%) and 25 optional criteria (21%). The highest number of individual criteria referred to the service spectrum (26 individual criteria), documentation (21) as well as staff and accessibility (16 each). Fifteen criteria (11.2%) achieved no consensus and were removed. CONCLUSION: For the first time, criteria for assessing the quality of psychosocial outpatient cancer counseling with expert consensus are available, facilitating the evaluation of psychosocial outpatient cancer counseling.

[Structural and process quality in outpatient psychosocial cancer counselling centres. evaluating a major funding programme of the "Deutsche Krebshilfe e.V."]. / Struktur- und Prozessqualität in ambulanten psychosozialen Krebsberatungsstellen des Förderschwerpunktes "Psychosoziale Krebsberatung" der Deutschen Krebshilfe.

BACKGROUND: In 2007, the German Cancer Aid ("Deutsche Krebshilfe e.V.") initiated and funded a programme in 28 selected cancer counselling centres in Germany attempting to both promote and strengthen quality assured psychosocial cancer counselling as well as to ensure long-term financing. The accompanying evaluation programme aims to collect structural data of the institutions and to evaluate processes of quality assurance within the sample of cancer counselling centres. METHODS: On the basis of structured research within scientific databases and internet, as well as with the support of experts, characteristics of structural quality of cancer counselling centres were identified. Structural data were collected using a self-developed questionnaire and a semi-structured interview during the on-site visitations of the institutions. RESULTS: The results show homogeneity in some fields of structural quality such as individual psycho-oncological and social counselling, human resources, room facilities, quality assurance, diagnostics, documentation and public relations. Structural quality of the investigated centres appears more heterogeneous with regard to aspects such as availability and accessibility, barrier-free access, group support offers (counselling, sports, arts, etc.) as well as cooperation, financing and written mission statements. CONCLUSION: The investigated cancer counselling centres ensure mainly good minimum standards according to structural quality of cancer counselling. There is potential for further optimisation including cooperation, quality assurance, room facilities and being differentiated in terms of conceptual content and working concepts. Further achievements on quality assured cancer counselling can use the presented data as a basis for describing minimum standards and obligatory quality criteria.

Postoperative Health-Related Quality of Life of Cervical Cancer Patients - A Comparison between the Wertheim-Meigs Operation and Total Mesometrial Resection (TMMR).

Introduction: The present study compares for the first time the standard therapy for cervical cancer in FIGO-stages IB-IIB, radical hysterectomy according to the Wertheim-Meigs operation, with the newly developed, nerve-sparing surgical technique, total mesometrial resection (TMMR) with regard to postoperative, health-related quality of life. Method: In the framework of a multicentre, retrospective cohort study a total of 110 cervical cancer patients were interviewed once by means of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the cervical cancer module (EORTC QLQ-CX24). The influence of the surgical method was investigated by analysis of covariance under control of age and the time elapsed between treatment and interview. Results: An influence of the therapeutic method was demonstrated in the EORTC scales physical function (p = 0.047), role function (p = 0.016), fatigue (p = 0.028), pain (p = 0.018), shortness of breath (p = 0.034), lack of appetite (p = 0.006) and diarrhoea (p = 0.012) in favour of the 74 women treated by TMMR. With regard to cognitive, emotional and social functioning as well as cervical cancer-specific symptoms, no significant differences between the therapy groups were found. Conclusion: The findings presented in this study suggest a superiority of TMMR in comparison to the previously employed radical hysterectomy according to Wertheim-Meigs with regard to the postoperative quality of life, especially in the fields of physical activity and fatigue. This needs to be validated in the course of prospective, multicentre studies. In addition, it must be clarified as to what extent the found effects are, in particular, due to the omission of an additional radiotherapy.

Efficacy of short-term psychodynamic psychotherapy (STPP) with depressed breast cancer patients: results of a randomized controlled multicenter trial.

BACKGROUND: There is a lack of trials of psychodynamic treatments of depression in breast cancer patients. The purpose of this trial was to determine the efficacy of short-term psychodynamic psychotherapy (STPP) in non-metastatic breast cancer patients diagnosed with depression, one of the most frequent mental comorbidities of breast cancer. PATIENTS AND METHODS: In a multicenter prospective trial, 157 breast cancer patients with comorbid depression were randomized to either individual STPP (intervention group, N=78) or 'treatment as usual' (control group, TAU, N=79). As our primary outcome measure, we hypothesized a higher rate of remission defined as no diagnosis of depression (Structured Clinical Interview for DSM-IV) and reduction in depression score by at least 2 points (Hospital Anxiety and Depression Scale, HADS-D) in STPP versus TAU at treatment termination. Secondary outcomes mainly refer to quality of life (QoL). RESULTS: In the intention to treat (ITT) analysis, 44% of the STPP group achieved highly significantly more remission than TAU (23%). STPP treatment (OR=7.64; P<0.001) was the strongest predictor for remission post-treatment; time was also significant (OR=0.96; P<0.05). A high effect favoring STPP (d=0.82) was observed for the HADS-D score post-treatment (secondary outcome). Regarding further secondary outcomes (QoL), analyses of covariance yielded main effects for group (favoring STPP with an effect size of at least d=0.5) for global QoL, role, emotional and social functioning, pain, treatment side-effects, breast symptoms and upset by hair loss. CONCLUSIONS: STPP is an effective treatment of a broad range of depressive conditions in breast cancer patients improving depression and functional QoL. Findings are limited by the drop-out rate (∼1/3) and delayed post-treatment assessments. Future trials may consider stepped-care approaches, tailored to patients' needs and requirements in the acute treatment phase.

Age- and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients.

BACKGROUND: The aim of this longitudinal study was to determine age- and sex-standardised prevalence rates of cancer-related fatigue in different groups of patients. METHODS: This was a prospective study in a cohort of N=1494 cancer patients investigating fatigue at three time points t1-t3 (t1: admission to hospital, t2: discharge, t3: half a year after t1). Fatigue was measured with the Multidimensional Fatigue Inventory. Age- and sex-adjusted norms were derived from a representative community sample of N=2037, using a cutoff at the 75th percentile. RESULTS: At admission to the hospital, 32% of the patients were classified as fatigued. At discharge, the overall prevalence rate was 40%, and at half a year after t1, prevalence was 34%. Fatigue prevalence rates differed according to tumour stage, site, age, and sex of the patients. CONCLUSION: The prevalence rates provided by this study can be used for the planning of research and clinical routine.

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.

Annoyance from multiple transportation noise: statistical models and outlier detection.

OBJECTIVE: Statistical models for the annoyance from multiple transportation noise are needed to understand and predict the annoyance resulting from specific noise exposures. METHODS: Models from the class of generalized linear models are suggested and discussed. Observations which are not well explained by the considered model are regarded as outliers. Outlier detection methods are applied to the data modelled by robust estimates using different link functions. RESULTS: The discussed methods are applied to data from a laboratory experiment using generalized linear models. While considering outliers, a generalized linear model with a complementary log-log link is found to be a good choice in modelling the exposure-response relationship between noise levels and annoyance.