Angehörige und Patienten in der ambulanten psychoonkologischen Versorgung: Zugangswege, psychische Belastungen und Unterstützungsbedürfnisse

Zusammenfassung

Die Unterstützungsbedürfnisse der Angehörigen von Krebspatienten werden in der psychosozialen Versorgung zu wenig beachtet. In der Spezialambulanz für Psychoonkologie am Universitätsklinikum Hamburg-Eppendorf wurde 132 Angehörigen und 362 Krebspatienten (Teilnahmequote > 95 %) bei telefonischer Anmeldung postalisch ein Screeningfragebogen zugesandt. Die Mehrzahl der Studienteilnehmer kommt auf Empfehlung Dritter in die Ambulanz. Mehr als 90 % der Angehörigen und Krebspatienten weisen hohe Disstresswerte auf; 49 % der Angehörigen, 59 % der Patienten haben eine moderate bis hohe Depressivität; 58 % der Angehörigen, 61 % der Patienten zeigen eine moderate bis hohe Ängstlichkeit; Geschlechtsunterschiede bestehen in beiden Gruppen nicht. Die häufigsten Unterstützungsbedürfnisse bei beiden Gruppen beziehen sich auf Progredienzangst, Ungewissheit, Traurigkeit und den Erhalt einer positiven Sichtweise. Die Ergebnisse unterstreichen den Bedarf an spezifischen psychoonkologischen Interventionen.

Abstract

Supportive care needs of family members of cancer patients are often overlooked within psychosocial care. A screening measure was sent to 132 family members and 362 cancer patients (response rate > 95 %) after telephone registration at a specialized outpatient clinic for psycho-oncology at the University Medical Center Hamburg-Eppendorf. The majority of participants was informed about the outpatient clinic for psycho-oncology through advice by third parties. More than 90 % of family members and cancer patients show high levels of distress; 49 % of family members and 59 % of patients had moderate to high levels of depression; 58 % of family members and 61 % of patients had moderate to high levels of anxiety. No gender differences were observed in both groups. Most frequent supportive care needs in both groups refer to fear of recurrence, dealing with uncertainty, sadness and keeping a positive outlook. Our findings emphasize the need for specific psycho-oncological interventions.

Schlüsselwörter

Disstress - Psychoonkologie - Krebs - ambulante Versorgung

Keywords

distress - psycho-oncology - cancer - outpatient care

• Literatur

• 1 Weis J, Schumacher A, Blettner G et al. Psychoonkologie: Konzepte und Aufgaben einer jungen Fachdisziplin. Der Onkologe 2007; 13: 185-194
• 2 Heckl U, Singer S, Wickert M et al. Aktuelle Versorgungsstrukturen in der Psychoonkologie. Nervenheilkunde 2011; 3: 124-130
• 3 Singer S, Hohlfeld S, Müller-Briel D et al. Psychosoziale Versorgung von Krebspatienten. Psychotherapeut 2011; 56: 386-393
• 4 Faller H, Schilling S, Otteni M et al. Soziale Unterstützung und soziale Belastung bei Tumorkranken und ihren Partnern. Z Psychosom Med Psychoanal 1995; 41: 141-157
• 5 Adams E, Boulton M, Watson E. The information needs of partners and family members of cancer patients: A systematic literature review. Patient Education and Counseling 2009; 77: 179-186
• 6 Adams E, Boulton M, Rose PW et al. A qualitative study exploring the experience of the partners of cancer survivors and their views on the role of primary care. Support Care Cancer 2012; Feb 22 (Epub ahead of print), doi:
• 7 Hodges L, Humphris G, Macfarlane G. A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Soc Sci Med 2005; 60: 1-12
• 8 Kotkamp-Mothes N, Slawinsky D, Hindermann S et al. Coping and psychological well being in families of elderly cancer patients. Crit Rev Oncol Hematol 2005; 55: 213-229
• 9 Molassiotis A, Wilson B, Blair S et al. Unmet supportive care needs, psychological well-being and quality of life in patients living with multiple myeloma and their partners. Psychooncology 2011; 20: 88-97
• 10 Pitceathly C, Maguire P. The psychological impact of cancer on patientsʼ partners and other key relatives a review. Eur J Cancer 2003; 39: 1517-1524
• 11 Ellis J. The impact of lung cancer on patients and carers. Chron Respir Dis 2012; 9: 39-47
• 12 Friethriksdottir N, Saevarsdottir T, Halfdanardottir S et al. Family members of cancer patients: Needs, quality of life and symptoms of anxiety and depression. Acta Oncol 2011; 50: 252-258
• 13 Hodgkinson K, Butow P, Hobbs KM et al. Assessing unmet supportive care needs in partners of cancer survivors: the development and evaluation of the Cancer Survivorsʼ Partners Unmet Needs measure (CaSPUN). Psychooncology 2007; 16: 805-813
• 14 Frick E, Tyroller M, Panzer M. Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre. Eur J Cancer Care (Engl) 2007; 16: 130-136
• 15 Bergelt C, Koch U, Petersen C. Quality of life in partners of patients with cancer. Qual Life Res 2008; 17: 653-663
• 16 Röder T, Joraschky P, Köllner V. Die Rolle der Partner bei der Bewältigung einer Tumorerkrankung. PiD – Psychotherapie im Dialog 2010; 11: 175-178
• 17 Löwe B, Spitzer RL, Zipfel S, Herzog W. Gesundheitsfragebogen für Patienten (PHQ-D). Zweite Auflage. [PRIME MD Patient Health Questionnaire (PHQ) – German version, 2nd Edition]. Karlsruhe: 2002
• 18 Löwe B, Kroenke K, Herzog W et al. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord 2004; 81: 61-66
• 19 Spitzer RL, Kroenke K, Williams JB et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166: 1092-1097
• 20 Löwe B, Decker O, Muller S et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care 2008; 46: 266-274
• 21 Mehnert A, Müller D, Lehmann C et al. Die deutsche Version des NCCN Distress-Thermometers – Empirische Prüfung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 2006; 54: 213-223
• 22 Lehmann C, Koch U, Mehnert A. Psychometric properties of the German version of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34-G). Support Care Cancer 2012; Jan 3 (Epub ahead of print) doi:
• 23 Bonevski B, Sanson-Fisher R, Girgis A et al. Evaluation of an instrument to assess the needs of patients with cancer. Supportive Care Review Group. Cancer 2000; 88: 217-225
• 24 Sanson-Fisher R, Girgis A, Boyes A et al. The unmet supportive care needs of patients with cancer. Supportive Care Review Group. Cancer 2000; 88: 226-237
• 25 Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum; 1988
• 26 Northouse LL, Mood D, Templin T et al. Couplesʼ patterns of adjustment to colon cancer. Soc Sci Med 2000; 50: 271-284
• 27 Hodgkinson K, Butow P, Hunt GE et al. Life after cancer: couples’ and partners’ psychological adjustment and supportive care needs. Support Care Cancer 2007; 15: 405-415
• 28 Stafford L, Judd F. Partners of long-term gynaecologic cancer survivors: psychiatric morbidity, psychosexual outcomes and supportive care needs. Gynecol Oncol 2010; 118: 268-273
• 29 Turner D, Adams E, Boulton M et al. Partners and close family members of long-term cancer survivors: health status, psychosocial well-being and unmet supportive care needs. Psychooncology 2011; Sep 9 (Epub ahead of print) doi:
• 30 Holland J, Reznik I. Pathways for psychosocial care of cancer survivors. Cancer 2005; 104 (11) 2624-2637
• 31 Holland J, Weiss T. The new standard of quality cancer care: integrating the psychosocial aspects in routine cancer from diagnosis through survivorship. Cancer J 2008; 14: 425-428
• 32 Mitchell AJ, Chan M, Bhatti H et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 2011; 12: 160-174
• 33 Herschbach P, Berg P, Waadt S et al. Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychother Psychosom 2010; 79: 31-38
• 34 Gaudio FD, Zaider TI, Brier M et al. Challenges in providing family-centered support to families in palliative care. Palliat Med 2011; Nov 10 (Epub ahead of print) doi:
• 35 Kacel E, Gao X, Prigerson HG. Understanding bereavement: what every oncology practitioner should know. J Support Oncol 2011; 9: 172-180
• 36 Dinkel A, Herschbach P, Berg P et al. Determinants of Long-term Response to Group Therapy for Dysfunctional Fear of Progression in Chronic Diseases. Behav Med 2012; 38: 1-5
• 37 Northouse LL, Mood DW, Schafenacker A et al. Randomized clinical trial of a brief and extensive dyadic intervention for advanced cancer patients and their family caregivers. Psychooncology 2012; doi:
• 38 Vehling S, Koch U, Ladehoff N et al. Prävalenz affektiver und Angststörungen bei Krebs: systematischer Literaturreview und Metaanalyse. Psychother Psych Med 2012; doi: