Psychosocial distress and need for psychotherapeutic treatment in cancer patients undergoing radiotherapy
Introduction
The frequency and extent of psychosocial distress experienced by cancer patients undergoing radiation therapy are similar to those experienced by cancer patients undergoing other forms of treatment [1], [2], [17], [18], [21], [23]. Much of this distress is caused by limitations in the physical capacity and social performance of patients [1], [30], but only 30–50% of patients undergoing radiation therapy are motivated to accept an offer of psychotherapeutic treatment for their psychosocial distress [11], [13], [29], [30]. However, patients undergoing radiation therapy have a tendency to become withdrawn, and their difficulties in coping with their disease frequently cause them to minimize their distress and help others rather than accepting help themselves [13], [30]. Women have been found to accept offers of psychotherapeutic treatment more readily than men [13], and patients with a higher level of psychosocial distress have increased motivation to accept psychotherapeutic treatment [11], [28], [30]. To date, however, there have been no studies in which psychosocial distress and the resultant need for treatment from the patient's point of view has been compared with results from structured psychodiagnostic interviews and standardized psychometric self-rating instruments.
As defined by the WHO, the indication for psychotherapeutic treatment is based on a ‘subjective needs assessment’ voiced by the persons involved and an ‘objective needs assessment’, as determined by expert evaluation, psychodiagnostic interviews or psychometric questionnaires [4]. Accordingly, the present study had two objectives. The first was to assess the prevalence of psychosocial distress and mental disorders in inpatients in two radiooncology wards. The second objective was to compare the need for psychotherapeutic treatment as determined by self- and expert evaluation.
Section snippets
Patients and study design
All patients (n=102) consecutively treated in the two wards of the Department of Radiooncology within a period of 3 months were included. Those who had an inadequate knowledge of the German language (n=3), overly severe disease (n=9) or who refused to participate (n=3) were excluded, resulting in a sample size of 87 patients. The 15 excluded patients did not differ significantly from the 87 participating patients in age, gender, oncological diagnosis, or severity or duration of the disease. The
Statistical procedures
The data were prepared and assessed using SPSS 10.0. The most important statistical analytical procedures on the bivariate level are contingency tables, χ2-tests and Fisher's exact test, if necessary, and the comparison of means by single and multiple analyses of variance. Significance levels used were P<0.05, P<0.01, and P<0.001, and all significance tests were 2-sided. Multiple linear regression, multiple logistical regression and factor analyses were used for multivariate analyses. There are
Sociodemographic and clinical description of the patient population
Of the 87 patients, 56 (64.4%) were male and 31 (35.6%) were female. Their mean age was 63.6 years (SD±12.92 years). Other sociodemographic data for these patients are shown in Table 1. These patients did not differ significantly in age and sex from the annual average in the Department of Radiooncology.
Most of the patients had been diagnosed with carcinomas of the rectum, esophagus, lung, or female breast, or with brain tumors (Table 2). Of the 87 tumors, eight (9%) were stage T1, 16 (18%) were
Discussion
The present results confirm the high rate of psychosocial distress among oncology inpatients receiving radiotherapy. We observed patterns of mental disorders similar to those in previous studies, including high rates of adjustment disorder [10], [12], anxiety and depression [11], [23]. Compared with the general population and with the primary care setting, the prevalences for psychosocial stress in the self-rating instruments and of mental disorders in the psychodiagnostic interview were only
References (31)
- et al.
Prevalence of anxiety and depression in cancer patients seen at the Norwegian radium hospital
Eur J Cancer
(1997) - et al.
Anxiety and cancer treatment: response to stressful radiotherapy
Health Psychol
(1984) - et al.
Bedarf und Motivation zu psychosozialen Interventionen bei Patienten mit malignen Hauttumoren [The need and motivation for psychosocial support in patients with malignant skin tumors]
Zt f Hautkrankheiten
(1997) - et al.
Emotional and functional impact of radiotherapy and chemotherapy on patients with primary breast cancer
J Psychosoc Oncol
(2000) - et al.
Der Fragebogen Alltagsleben—ein Verfahren zur Erfassung der gesundheitsbezogenen Lebensqualität [Everyday life questionnaire—an instrument for the assessment of health-related qualify of life]
Zt f Med Psychol
(1993) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Analysis of non-response in a prospective study of depression in Los Angeles county
Int J Epidemol
(1983) Probleme der Falldefinition und der Fallfindung [Problems of case definition and case finding]
Nervenarzt
(1978)- et al.
The prevalence of psychiatric disorder among cancer patients
J Am Med Assoc
(1983)
Emotionale Belastung und Unterstützungsbedürfnis bei Mammakarzinompatientinnen zu Beginn der Strahlentherapie. [Emotional distress and needs for psychosocial support among breast cancer patients at start of radiotherapy]
Psychother Psychosom Med Psychol
Psychiatric aspects of radiotherapy
Am J Psychiatry
Psychosoziale Betreuung von radioonkologischen Patienten—Bedarf, subjektives Bedürfnis und Akzeptanz [The psychosocial care of cancer radiology patients—the requirement, subjective need and acceptance]
Strahlenther Onkol
Psychosomatic liaison service in hematological oncology: need for psychotherapeutic interventions and their realization
Hematol Oncol
HADS-D: hospital anxiety and depression scale. Deutsche version [German version]
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