Social service counseling in cancer centers certified by the German Cancer Society

Caring for dependent children impacts practical and emotional problems and need for support, but not perceived distress among cancer patients

OBJECTIVE

More than one in 10 cancer patients care for dependent children. It is unclear whether this status makes a difference in terms of the distress and associated problems they experience, or whether it is linked to differences in the need for or utilization of psychosocial support.

METHODS

Secondary analysis of a cross-sectional German study in National Comprehensive Cancer Centers using self-report standardized questionnaires administered to inpatients. Patients living with dependent children (n = 161) were matched by age and sex with a subsample of 161 cancer patients not living with dependent children. The resulting sample was tested for between-group differences in Distress Thermometer (DT) scores and the corresponding DT Problem List. Additionally, between-group differences in measures of the need for and utilization of psychosocial support were examined.

RESULTS

More than 50% of all patients suffered from clinically relevant distress. Patients living with dependent children reported significantly more practical (p < 0.001, η2 p = 0.04), family (p < 0.001, η2 p = 0.03), and emotional problems (p < 0.001, η2 p = 0.01). Although reporting a greater need for psychological support, parents with cancer were not found to more frequently utilize any type of psychosocial support.

CONCLUSIONS

The specific problems and needs of parents with cancer who care for dependent children are currently not sufficiently addressed in the clinical care pathways. All families should be helped to establish open and honest communication as well as understand the available support systems and what they can provide. Tailored interventions should be implemented for highly distressed families.

Incorporating psychosocial care into routine oncological care: insights into challenges and strategies from certified cancer centers' audit data

PURPOSE

Provision of psychosocial care is obligatory in cancer centers certified in accordance with the criteria of the German Cancer Society, but the extent to which it is utilized differs greatly between centers. Anomalous utilization percentages are discussed during certification audits. This analysis aims to describe (1) how certified centers explain psychosocial care utilization percentages during audits and (2) the measures they then plan for improving psychosocial care utilization. The aim of the analysis is to help understand patterns of psychosocial care utilization in oncology and reduce potential disparities by describing the challenges that cancer centers face and their strategies for integrating psychosocial care into routine oncological care.

METHODS

The content of free-text comments regarding psychosocial utilization percentages by certified centers during certification audits in 2019 was analyzed. In total, 178 comments were analyzed from 116 prostate, colorectal, and breast cancer centers in Germany, Switzerland, Austria, Italy, and Luxembourg.

RESULTS

The explanations for utilization percentages most often mentioned involved patients' levels of interest and need, outpatient care, staff shortages, inclusion of psychosocial care in other processes in the center, documentation issues, and factors regarding different legal regulations in countries outside Germany. The measures most often planned for improving psychosocial care utilization involved adjusting work processes, increasing staff resources, optimizing documentation, and establishing quality-assurance groups/task forces.

CONCLUSION

This exploratory analysis shows that the challenges and strategies involved in incorporating psychosocial care into routine oncological care are diverse. Further research should identify process-level strategies that can promote the integration of psychosocial care. This article is protected by copyright. All rights reserved.

Predictors for the utilization of social service counseling by prostate cancer patients

PURPOSE

Social service counseling (SSC) is an important instrument to support cancer patients, for example, regarding legal support, or rehabilitation. Several countries have established on-site SSC in routine care. Previous analyses have shown that SSC utilization varies across cancer centers. This analysis investigates patient and center-level predictors that explain variations in SSC utilization between centers.

METHODS

Logistic multilevel analysis was performed with data from 19,865 prostate cancer patients from 102 prostate cancer centers in Germany and Switzerland. Data was collected within an observational study between July 2016 and June 2020 using survey (online and paper) and tumor documentation.

RESULTS

The intraclass correlation coefficient for the null model implies that 51% of variance in SSC utilization is attributable to the center a patient is treated in. Patients aged 80 years and older, with higher education, private insurance, without comorbidities, localized intermediate risk, and undergoing androgen deprivation therapy before study inclusion were less likely to utilize SSC. Undergoing primary radiotherapy, active surveillance, or watchful waiting as compared to prostatectomy was associated with a lower likelihood of SSC utilization. Significant negative predictors at the center level were university hospital, center's location in Switzerland, and a short period of certification.

CONCLUSION

The results show that patient and center characteristics contribute to explaining the variance in SSC utilization in prostate cancer centers to a large extent. The findings may indicate different organizational processes in the countries included and barriers in the sectoral structure of the healthcare system. In-depth analyses of processes within cancer centers may provide further insights into the reasons for variance in SSC utilization.

Use of social service counseling by cancer patients: an analysis of quality assurance data of 6339 breast cancer patients from 13 certified centers in Germany treated between 2015 and 2017

Background

Integrated social care may help to mitigate social risk factors in order to achieve more equitable health outcomes. In cancer centers certified according to the criteria set out by the German Cancer Society, every patient must be given low-threshold access to qualified social workers at the center for in-house social service counseling (SSC). Previous analyses have demonstrated large variation in the utilization of these services across individual centers. Therefore, this research aims at investigating whether SSC utilization varies regarding breast cancer patient characteristics and center characteristics presenting a unique approach of using routine data.

Methods

Multilevel modeling was performed using quality assurance data based on 6339 patients treated in 13 certified breast cancer centers in Germany in order to investigate whether SSC utilization varies with patient sex, age, and disease characteristics as well as over time and across centers.

Results

In the sample, 80.3% of the patients used SSC. SSC use varies substantially between centers for the unadjusted model (ICC = 0.24). Use was statistically significantly (P < .001) more likely in women, patients with invasive (in comparison to tumor in situ/ductal carcinoma in situ) diseases (P < .001), patients with both breasts affected (P = .03), patients who received a surgery (P < .001), patients who were diagnosed in 2015 or 2017 compared to 2016 (P < .001) and patients older than 84 years as compared to patients between 55 and 64 years old (P = .002).

Conclusion

The analysis approach allows a unique insight into the reality of cancer care. Sociodemographic and disease-related patient characteristics were identified to explain SSC use to some extent.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08396-1.

Returning to work in lung cancer survivors-a multi-center cross-sectional study in Germany

Purpose

To investigate the work situation of lung cancer survivors and to identify the factors associated with their returning to work.

Methods

Descriptive analysis and logistic regression were used to evaluate study population characteristics and independent factors of subsequently returning to work. To analyze time to return to work, Cox regression was used.

Results

The study sample included 232 lung cancer survivors of working age from 717 enrolled participants in the multi-center cross-sectional LARIS (Quality of Life and Psychosocial Rehabilitation in Lung Cancer Survivors) study. About 67% of the survivors were not employed during the survey. More than 51% of the survivors who were employed before their illness did not return to their work. The survivors who had returned to their careers were younger, associated with higher household income, lower fatigue score, and stable relationship and vocational training. Patients who received social service counseling showed a higher chance of regaining their career.

Conclusions

Lung cancer survivors were found to be associated with a high risk of unemployment and very low professional reintegration after interruption due to illness. More comprehensive studies are needed to support lung cancer survivors and targeting of patients in need of special attention in rehabilitation that would benefit from the findings in the present study.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-020-05886-z.

Implementing quality metrics in European Cancer Centers (ECCs)

PURPOSE

Since 2014, prostate cancer centers outside Germany (PCCoG) are eligible for certification according to the criteria set out by the German Cancer Society (DKG). These centers must fulfill the same requirements as their German counterparts. The article reports on the experiences of the first nine certified PCCoG, with a focus on their indicator results.

METHOD

Following a descriptive analysis about primary case distribution, indicator definitions, and patient numbers, we compared indicator results for all 114 German PCC with all 9 PCCoG that have been certified for at least 3 years. Median centers' proportion was calculated and overall proportion for every indicator. Two-sided Cochran-Armitage tests were applied to detect trends over time.

RESULTS

The number of primary cases increased for both groups steadily from 2015 to 2017 as did fulfillment of most other indicators including PCa guideline-derived indicators. Requirements that proved to be hard to fulfill for PCCoG initially included psycho-oncological services (POS) and social service counselling (SCC). Fulfillment of POS requirements improved in the following years after initial certification in PCCoG. SCC rates remain low in PCCoG due to the different health system structures.

CONCLUSION

Acquiring a certificate by the DKG is achievable for PCCoG. Candidate centers need to be aware that substantial effort is required to fulfill the criteria, but once this is done, typically an improvement of indicators and an increase in patient numbers can be observed. Different health-care systems need to be taken into consideration and the certification requirements adapted in different areas to allow country-specific implementation.

What does an oncology social worker deal with in patient consultations? - An empirical study

The oncology social worker is a core profession in the psychosocial care of cancer patients, and has been scrutinised according to its role, function, and delivery of care, primarily from an Anglo-Saxon perspective. There is, however, a lack of studies outside this context, and empirical studies based on individual data. This study is a contribution by exploring the variability in clinical practice from a Swedish perspective. It is based on documentation from one oncology social worker's (OSW's) patient contacts over the course of one year. The essence of the majority of contacts was counseling and the patients displayed a wide variety of motives for seeing an OSW. The function of the OSW is thus multifaceted, and the findings suggest that the OSW, in addition to guiding patients in social legislation issues, also should be prepared to act as an anchor in an acute crisis, contain despair in different phases of the trajectory, and facilitate the 'carrying on as before' or finding a 'new normal'. The paper discusses the importance of the OSW being acquainted with different counseling/psychotherapy perspectives in the illness context, but primarily the importance of having the ability to establish a 'working alliance' with their patients.

Unmet information needs and limited health literacy in newly diagnosed breast cancer patients over the course of cancer treatment

OBJECTIVE

To investigate unmet information needs in newly diagnosed breast cancer patients over the course of cancer treatment and its association with health literacy.

METHODS

We present results from a prospective, multicenter cohort study (PIAT). Newly diagnosed breast cancer patients (N=1060) were surveyed directly after breast cancer surgery, 10 and 40 weeks later. Pooled linear regression modeling was employed analyzing changes in unmet information needs over time and its association with health literacy.

RESULTS

Unmet information needs on side effects and medication and medical examination results and treatment options were high and increased during the first 10 weeks after breast cancer surgery. Considering health promotion and social issues, unmet information needs started high and decreased during post-treatment. Patients with limited health literacy had higher unmet information needs.

CONCLUSION

Our results indicate a mismatch in information provision and breast cancer patients' information needs. Patients with limited health literacy may be at a distinct disadvantage in having their information needs met over the course of breast cancer treatment.

PRACTICE IMPLICATIONS

Strategies are needed to reduce unmet information needs in breast cancer patients considering treatment-phase and health literacy and thereby enable them to better cope with their diseases.

Frequency of psycho-oncologic and social service counseling in cancer centers relative to center site and hospital characteristics: Findings from 879 center sites in Germany, Austria, Switzerland, and Italy

BACKGROUND

There is extensive evidence that patients with cancer and cancer survivors have a strong need for expert support in relation to the psychological and social consequences of the disease. The requirements set out in the German Cancer Society's cancer center certification system include the routine provision of psycho-oncologic care (POC) and social service counseling for every patient. The current study investigated which organizational and structural characteristics in hospitals account for variations in psychosocial care provision in these centers.

METHODS

Data routinely collected during the certification process regarding the percentages of psychosocial care provision and characteristics of center sites and hospitals were matched with data with regard to size of the municipality, teaching hospital status, and institutional ownership. Linear multilevel regression analyses were performed to identify the characteristics of hospitals and center sites that were related to psychosocial care provision.

RESULTS

Substantial differences were found for different types of cancer (eg, a greater provision of psychosocial care in centers specializing in breast rather than prostate cancer). There was more POC provision in longer-certified centers and less in rural areas and university hospitals. Much of the variation between hospitals remains unexplained.

CONCLUSIONS

Although the implementation of mandatory psychosocial services generally provides patients with access to POC and social service counseling, the wide differences in the provision of counseling indicate that additional measures are needed to avoid inequalities resulting from the center at which a patient receives cancer treatment. Cancer 2016;122:3538-3545. © 2016 American Cancer Society.