[Psycho-oncology - psychosocial oncology: integration in a concept of oncological treatment]

Does the distance to the cancer center affect psycho-oncological care and emergency visits of patients with IDH wild-type gliomas? A retrospective study

Background

Malignant isocitrate dehydrogenase wild-type (IDHwt) gliomas impose a high symptomatic and psychological burden. Wide distances from patients' homes to cancer centers may affect the delivery of psycho-oncological care. Here, we investigated, in a large brain tumor center with a rural outreach, the initiation of psycho-oncological care depending on spatial distance and impact of psycho-oncological care on emergency visits.

Methods

Electronic patient charts, the regional tumor registry, and interviews with the primary care physicians were used to investigate clinical data, psycho-oncological care, and emergency unit visits. Interrelations with socio-demographic, clinical, and treatment aspects were investigated using univariable and multivariable binary logistic regression analysis and the Pearson's Chi-square test.

Results

Of 491, 229 adult patients of this retrospective cohort fulfilled the inclusion criteria for analysis. During the last three months of their lives, 48.9% received at least one psycho-oncological consultation, and 37.1% visited the emergency unit at least once. The distance from the cancer center did neither affect the initiation of psycho-oncological care nor the rate of emergency unit visits. Receiving psycho-oncological care did not correlate with the frequency of emergency unit visits in the last three months of life.

Conclusion

We conclude that the distance of IDHwt glioma patients' homes from their cancer center, even in a rural area, does not significantly influence the rate of psycho-oncological care.

Spinal meningiomas, from biology to management - A literature review

Meningiomas arise from arachnoidal cap cells of the meninges, constituting the most common type of central nervous system tumors, and are considered benign tumors in most cases. Their incidence increases with age, and they mainly affect females, constituting 25-46% of primary spinal tumors. Spinal meningiomas could be detected incidentally or be unraveled by various neurological symptoms (e.g., back pain, sphincter dysfunction, sensorimotor deficits). The gold standard diagnostic modality for spinal meningiomas is Magnetic resonance imaging (MRI) which permits their classification into four categories based on their radiological appearance. According to the World Health Organization (WHO) classification, the majority of spinal meningiomas are grade 1. Nevertheless, they can be of higher grade (grades 2 and 3) with atypical or malignant histology and a more aggressive course. To date, surgery is the best treatment where the big majority of meningiomas can be cured. Advances in surgical techniques (ultrasonic dissection, microsurgery, intraoperative monitoring) increase the complete resection rate. Operated patients have a satisfactory prognosis, even in those with poor preoperative neurological status. Adjuvant therapy has a growing role in treating spinal meningiomas, mainly in the case of subtotal resection and tumor recurrence. The current paper reviews the fundamental epidemiological and clinical aspects of spinal meningiomas, their histological and genetic characteristics, and their management, including the various surgical novelties and techniques.

Supporting Medical Staff from Psycho-Oncology with Smart Mobile Devices: Insights into the Development Process and First Results

Cancer is a very distressing disease, not only for the patients themselves, but also for their family members and relatives. Therefore, patients are regularly monitored to decide whether psychological treatment is necessary and applicable. However, such monitoring processes are costly in terms of required staff and time. Mobile data collection is an emerging trend in various domains. The medical and psychological field benefits from such an approach, which enables experts to quickly collect a large amount of individual health data. Mobile data collection applications enable a more holistic view of patients and assist psychologists in taking proper actions. We developed a mobile application, FeelBack, which is designed to support data collection that is based on well-known and approved psychological instruments. A controlled pilot evaluation with 60 participants provides insights into the feasibility of the developed platform and it shows the initial results. 31 of these participants received paper-based questionnaire and 29 followed the digital approach. The results reveal an increase of the overall acceptance by 58.5% in the mean when using a digital screening as compared to the paper-based. We believe that such a platform may significantly improve cancer patients’ and relatives’ psychological treatment, as available data can be used to optimize treatment.

[Psychiatric psychotherapeutic interventions in breast cancer inpatients: a contribution to liaison-consultation psychiatry]

BACKGROUND

Psychosocial stress and psychopathological abnormalities are expected in cancer patients at a frequency of 30-60%. Apart from decreased quality of life psychological factors may cause a negative impact on treatment compliance and on the subsequent biological course of tumor development.

MATERIALS AND METHODS

This study examined the association of different psychiatric and psychotherapeutic interventions in liaison-consultation psychiatry with the four psychopathological dimensions derived by factor analysis based on the items of psycho-oncological basic documentation in a group of 141 breast cancer patients without pre-existing mental disorders who were inpatients of a gynecologic cancer centre. In addition information concerning subjective stress experience was collected with the distress thermometer.

RESULTS

The plausible fit of the various psychiatric and psychotherapeutic interventions due to the psychopathological dimensions and due to the subjective experience of stress could be demonstrated. Those intervention variables that were associated with an improvement of the psychological state could be described as well. The findings showed that improvement or at least stability of the psychological state was regularly associated with completion of oncological treatment in the relevant index inpatient stay. In addition it was found that the interventions offered could contribute to improved psychological well-being in the subgroup of patients without mental disorders particularly in normal grief reactions.

CONCLUSION

Despite methodological limitations this investigation contributes to describing relevant psychopathological syndromes in a group of breast cancer patients without pre-existing mental disorders and the goodness of fit of the different psychiatric and psychotherapeutic interventions. Finally the study confirmed the assumption that stabilization of the mental state may help to avoid treatment interruptions in an oncological inpatient setting and therefore decrease the likelihood that reduced psychological well-being can negatively impact the biological course of tumor development.