Psychosomatic liaison service in hematological oncology: need for psychotherapeutic interventions and their realization

Health-related quality of life in hemato-oncology patients: role of informativeness and doctor-patient communication

Background

The patient's information about the disease and doctor-patient communication are both constructs whose importance is emphasized in the theory, but much less frequently researched and used in the practice.

Objective

This study aimed to determine whether certain facets of health-related quality of life of hemato-oncology patients in Croatia could be predicted based on patients' sociodemographic data, the disease's determinants, the patients' information about their disease and the quality of doctor-patient communication.

Methods

60 women and 54 men with diagnoses of both leukemia and lymphoma have participated in filling out questionnaires. The survey consisted of a sociodemographic questionnaire, EORTC QLQ-C30(version 3), EORTC QLQ-INFO25 and the Doctor-Patient Communication Questionnaire.

Results

Patients' sociodemographic data, the disease's determinants, the patients' information about their disease and the quality of doctor-patient communication predicted 26.8 % variance of global health status (F = 2.756, p \< .01), 35.7% variance of physical functioning (F = 4.196, p \< .01), 23.3% variance of role functioning (F = 2.291, p \< .05), 29.9% variance of emotional functioning (F = 3.215, p \< .01) and 27.9% of social functioning (F = 2.881, p \< .01). Predictors that significantly contributed to the change in variance of health-related quality of life were age, duration of diagnosis, the existence of comorbidity, frequency of hospitalization, talking with the psychologist after getting the diagnosis and information.

Conclusion

The study offers valuable insights into an under-researched patient population and a better understanding of their health-related quality of life. The results indicate the importance of information that can be implemented in everyday clinical practice, and pave the way for further research on doctor-patient communication.

The prevalence of depression in general hospital inpatients: a systematic review and meta-analysis of interview-based studies

BACKGROUND

Comorbid depression in the medically ill is clinically important. Admission to a general hospital offers an opportunity to identify and initiate treatment for depression. However, we first need to know how common depression is in general hospital inpatients. We aimed to address this question by systematically reviewing the relevant literature.

METHODS

We reviewed published prevalence studies in any language which had used diagnostic interviews of general hospital inpatients and met basic methodological quality criteria. We focussed on interview-based studies in order to estimate the proportion of patients with a diagnosis of depressive illness.

RESULTS

Of 158 relevant articles, 65 (41%) describing 60 separate studies met our inclusion criteria. The 31 studies that focussed on general medical and surgical inpatients reported prevalence estimates ranging from 5% to 34%. There was substantial, highly statistically significant, heterogeneity between studies which was not materially explained by the covariates we were able to consider. The average of the reported prevalences was 12% (95% CI 10-15), with a 95% prediction interval of 4-32%. The remaining 29 studies, of a variety of specific clinical populations, are described.

CONCLUSIONS

The available evidence suggests a likely prevalence high enough to make it worthwhile screening hospital inpatients for depression and initiating treatment where appropriate. Further, higher quality, research is needed to clarify the prevalence of depression in specific settings and to further explore the reasons for the observed heterogeneity in estimates.

Improving Provision of Care for Long-term Survivors of Lymphoma

The progressive improvement of lymphoma therapies has led to a significant prolongation of patient survival and life expectancy. However, lymphoma survivors are at high risk of experiencing a range of early and late adverse effects associated with the extent of treatment exposure. Among these, second malignancies and cardiopulmonary diseases can be fatal, and neurocognitive dysfunction, endocrinopathy, muscle atrophy, and persistent fatigue can affect patients' quality of life for decades after treatment. Early recognition and reduction of risk factors and proper monitoring and treatment of these complications require well-defined follow-up criteria, close coordination among specialists of different disciplines, and a tailored model of survivorship care. We have summarized the major aspects of therapy-related effects in lymphoma patients, reviewed the current recommendations for follow-up protocols, and described a new hospital-based model of survivorship care provision from a recent multicenter Italian experience.

Psychological Screening of Onco-Hematologic Inpatients: Distress Thermometer Administration

Purpose

The screening of psychological distress is a milestone in psycho-oncology. The National Comprehensive Cancer Network has established clinical guidelines for detecting and managing it and the Distress Thermometer (DT) was the recommended tool for the screening. Although its utility for oncologic patients has been reported frequently in the literature, less is known about hematologic patients. The present study involves a sample of onco-hematologic adult patients.

Methods

In the current study, we proposed the Distress Thermometer and the Problem List in a sample of hematologic inpatients at Ca’ Foncello Hospital, Treviso, Italy. We evaluated 102 patients, 61% male and 39% female, median age 59 years (range 18-78). Enrolled patients had acute leukemia (31%), multiple myeloma (31%), or lymphoma (31%).

Results

A total of 41.6% of the patients presented psychological distress, and the DT score was associated with neither sex nor diagnosis. The psychological distress was mild in 21.8%, moderate in 13.8%, and severe in 12.9% of the patients.

Conclusions

Our results were consistent with previous results regarding the validation process of DT in a large sample of Italian cancer patients.

Psychosomatic services for melanoma patients in tertiary care

BACKGROUND

Individuals diagnosed with malignant melanoma face significant practical and psychological challenges, including existential fears and pain and discomfort associated with treatment. To enhance psychological adjustment, patients receive psychosomatic-psychotherapeutic consultation-liaison services (CLS) within the general medical hospital. However, little is known about the use of these services in routine clinical care.

METHODS

This study includes all patients referred to the CLS of a large German tertiary care hospital between 2005 and 2008 (n=3658). Data were recorded using the CL-BaDo form - a multicenter documentation form for the assessment of clinical characteristics of patients and CLS delivery. Descriptive and inferential statistics were employed to compare patients with melanomas and patients with other dermatological diseases.

RESULTS

Dermatologists requested CLS more often for other dermatology patients than for patients with melanoma. These two groups also differed in the reasons for referral: patients with melanoma were referred more often for acute coping issues; other dermatology patients were referred more often for unexplained physical symptoms. Additionally, the latter group was diagnosed with more and different mental and behavioral disorders. Patients with melanomas received more psychotherapeutic interventions while admitted to hospital but fewer recommendations for further psychosocial treatment after their hospital stay.

CONCLUSION

These findings highlight the need for professional psychosocial support in individuals diagnosed with melanoma - especially when first diagnosed or experiencing a recurrence. Dermatologists play a crucial role in identifying their patients' needs and in navigating them toward available support services.

Revisão da literatura sobre a eficácia da intervenção psicológica no tratamento do lúpus eritematoso sistêmico

Manifestações neuropsiquiátricas são comuns no lúpus eritematoso sistêmico (LES), especialmente depressão, ansiedade e psicose. O estresse psicológico e o uso de corticóide têm sido responsabilizados pelas manifestações psicopatológicas. Objetivou-se realizar revisão de literatura sobre a eficácia da intervenção psicológica no tratamento do LES, utilizando-se pesquisas em bases de dados, através dos descritores "psychotherapy" and "lupus", incluindo-se os ensaios clínicos randomizados e os estudos prospectivos. Foram encontrados seis artigos, sendo quatro ensaios clínicos randomizados e dois estudos prospectivos. Cinco artigos encontraram evidências de acentuada melhora nos pacientes que tinham acompanhamento psicológico e apenas um não encontrou tal evidência. Concluiu-se que a intervenção psicológica pode ser uma ferramenta importante no tratamento do LES.

Psychological issues of stem cell transplant

OBJECTIVES

To address the psychological impact of transplant on quality of life, including physical, psychological, social, and spiritual, for the patient and caregiver, and to discuss the nurse's "emotional labor of caring" and "compassion fatigue" for such an intense vulnerable population.

DATA SOURCES

Psychological transplant studies, peer review journals, and textbooks.

CONCLUSION

The psychological impact after the experience of transplant can leave an indelible impression on the patient, caregiver, and nurse.

IMPLICATIONS FOR NURSING PRACTICE

Suggestions are made for assessment and management of various potential psychological issues for the three mentioned populations. With these issues being better understood, nurses can actively lessen psychological morbidity.

Haemato-oncology and burnout: an Italian survey

This cross-sectional survey aimed to evaluate the prevalence of burnout and estimated psychiatric disorders among haemato-oncology healthcare professionals in Italy. The aspects of work that respondents perceive as stressful and satisfying have also been examined. The assessments were made using the Maslach Burnout Inventory (MBI), General Health Questionnaire and a study-specific questionnaire. Logistic regression models were applied to show associations between different sources of work-related stress and burnout. Three hundred and eighty-seven out of 440 (87.95%) returned their questionnaires. The scores on MBI subscales indicate a high level of emotional exhaustion in 32.2% of the physicians and 31.9% of the nurses; a high level of Depersonalisation in 29.8 and 23.6%, respectively; and a low level of personal accomplishment in 12.4 and 15.3% respectively. The estimated prevalence of psychiatric disorders was 36.4% in physicians and 28.8% in nurses. Statistical analysis confirmed age, sex, personal dissatisfaction, physical tiredness and working with demanding patients to be associated with burnout. In conclusion, haemato-oncology healthcare professionals report a level of burnout and estimated psychiatric morbidity comparable to other oncological areas. Knowledge of the mechanisms of burnout and preventing and dealing with them is therefore a fundamental requirement for the improvement of quality in health services and job satisfaction.

Psychosomatischer Liaisondienst am Universitätsklinikum

BACKGROUND

Little is known about the complex decision-making process involving recognition of psychosocial stress, its diagnosis, and psychotherapeutic intervention within the framework of a psychosomatic consulting and liaison service.

PATIENTS AND METHODS

Psychosocial stress was recorded using a psychometric questionnaire for 392 patients on admission to hospital, the estimated need of psychotherapeutic treatment, and the application of a psychosomatic liaison service.

RESULTS

Of the examined patients, 44% presented with at least one mental disorder requiring treatment according to ICD-10 criteria. According to the expert opinions, a need for psychotherapeutic treatment was present in 41%, while 54% were themselves motivated for at least one of the psychotherapeutic treatments offered. Psychotherapy was actually received by 35% of the patients. While mental disorders and emotional distress were significant predictors of the need for treatment as rated by experts, they played no genuine role in determining indication or whether a patient accepts the use of psychotherapy

CONCLUSION

Psychotherapeutic interventions in the liaison service are not always effective or related to the indication.

Nurses’ perception of adequacy of care for leukemia patients with distress during the incurable phase and related factors

Leukemia patients experience distress during the incurable phase of illness. Adequacy of care (i.e., extent to which care relieves the patients' suffering) was described from the nurses' viewpoint, and institutional factors related to adequacy of care were explored. A self-administered questionnaire was completed by 425 nurses working in 26 hematology wards. Nurses tended to rate the care as inadequate. In particular, care for social distress needs to be improved. Our findings suggest that communication among health professionals, utilization of hospital resources, and palliative care education for staff were important in palliative care for leukemia patients during the incurable phase.

Psychosocial distress and need for psychotherapeutic treatment in cancer patients undergoing radiotherapy

BACKGROUND AND PURPOSE

Empirical investigations examining the need for psychotherapeutic treatment of inpatients in radio-oncology departments are rare. We, therefore, assessed the degree of psychosocial distress of radio-oncology inpatients and their need for psychotherapeutic interventions.

PATIENTS AND METHODS

Eighty-seven patients from two radio-oncology wards underwent psychodiagnostic interviews and completed self-rating instruments to determine mental disorders, psychosocial distress, coping strategies and quality of life. Need for psychotherapeutic interventions and treatment motivation were estimated by patients and by a professional.

RESULTS

Using ICD-10 criteria, mental and behavioral disorders were diagnosed in 51% of the patients, most of them adjustment disorders. The professional regarded 32.2% of patients as needing psychotherapeutic treatment, compared with 43% of the patients who were motivated to accept at least one of the psychotherapeutic treatments offered. There was a marked discrepancy between the points of view of the patient and the professional, in that, while the professional regarded anxiety as a highly significant predictor of the need for treatment, psychosocial distress played no role in the patients' estimation.

CONCLUSIONS

In determining the indication for psychotherapeutic treatment, both objectified psychosocial distress and a patients' subjective treatment expectations should be considered. There is a need to develop screening instruments that integrate both aspects.

Quality of life of patients with chronic lymphocytic leukemia: results of a longitudinal investigation over 1 yr

OBJECTIVES

The aim of this longitudinal study was to determine the long-term quality of life (QoL) of patients with chronic lymphocytic leukemia (CLL) and to investigate the relationship between QoL and sociodemographic and clinical parameters.

METHODS

Ninety-seven patients suffering from CLL were asked to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) four times over a period of 1 yr. Clinical data on disease and treatment characteristics were collected from medical records. For the purpose of comparison, EORTC QLQ-C30 scores were collected from 152 age- and gender-matched healthy controls.

RESULTS

Seventy-six patients (age: median 68 yr, range 41-89) returned one or more questionnaires and were included in the statistical analysis. Compared with healthy controls CLL patients reported a lower QoL in almost all domains. No differences regarding QoL could be observed between CLL patients who had already received chemotherapy and those who had not. Moreover, female CLL patients were found to have remarkably lower QoL scores in the areas of emotional and social functioning than male patients.

CONCLUSION

Patients suffering from CLL could have their QoL improved by more effective symptom management and psycho-oncological support. This could focus on specific symptoms such as fatigue and might have particular benefits for female patients with respect to their emotional and social well-being.