Psychoonkologische Versorgung von Melanompatienten in zertifizierten Hautkrebszentren

Psychosocial stress of dermatology inpatients and their relatives - Comparison of patients with and without cancer

BACKGROUND

In the clinical treatment pathways of certified oncological centers, psychotherapeutic services are mandatory. Although patients with somatic, non-oncological illnesses show an equally high prevalence of psychosocial stress, these guidelines do not exist for the general hospital sector. Are these patients really less burdened and is psychological support only needed in individual cases? The example of dermatological patients will be used to show whether the need for psychosocial care and the desire for support vary between individuals with and without malignant disease.

PATIENTS AND METHODS

Using the Hornheider screening instrument and distress thermometer, 216 dermatological inpatients assessed their psychosocial stress and that of a close relative. In addition, they were asked about their desire for support and preferred support provider.

RESULTS

i) Patients without skin cancer were more frequently and more severely distressed than cancer patients. ii) Patients of both groups assessed their relatives to be approximately equally distressed. Compared with their own distress, cancer patients assessed their relatives as more frequently and on average more severely distressed. More than 50 % of all patients regarded their own disease as the cause of their relatives' distress. iii) The desire for support in both groups was about 18 %. iv) Doctors and psychologists were usually named as potential contact persons.

CONCLUSIONS

The expansion of psychosocial support services for non-tumor patients and their relatives seems necessary. The establishment of appropriate screening methods should be considered. Further studies in other clinical areas are required.

[Supportive therapy and management of side effects in dermato-oncology]

In the context of supportive therapy, possible complaints which may be caused by the cancer itself, by the antitumoral therapy or by psychosocial concerns are considered. Due to the introduction of new anticancer drugs in dermato-oncology, clinicians are confronted with a novel spectrum of adverse events. There are a number of inflammatory, immune-mediated side effects caused by immunotherapies, which can affect virtually any organ. Targeted therapies also have specific side effects. Basically, the management of adverse events depends on their severity. Besides treatment breaks and dosage modifications, immunotherapy-related adverse events are treated with systemic immunosuppressants. Supportive symptomatic therapy is offered. The additional consideration of psychosocial problems can improve quality of life of cancer patients.

[Psycho-oncology in dermatological practice : Evaluation of need and care structures]

BACKGROUND

Psycho-oncological care is a main component of comprehensive oncological care as stated in the National Cancer Plan of the German Federal Government. Correspondingly this goal has been adopted in the strategy of the German Skin Cancer Council. In certified skin cancer centers structural requirements for psycho-oncological care are established. Nevertheless, a large proportion of skin cancer patients are treated in dermatological practices. Up to now data on psycho-oncological care in dermatological practices are missing.

MATERIALS UND METHODS

We conducted a descriptive cross-sectional written survey on psycho-oncological care in dermatological practices from October 2016 to February 2017.

RESULTS

In all, 171 practices completed the questionnaire; 19.4% of these practices have an oncological focus. The mean number of treated skin cancer patients was 554.3 ± 659.1 and 62.4 ± 73.6 for melanoma patients. Dermatologists estimated a low proportion (≤5%) of patients with need for psycho-oncological care; however, 21.9% of practices actively offer information on psycho-oncological programs and 26.1% cooperate with psycho-oncological care providers. Interest in psycho-oncological care concepts was stated by 29.3%.

CONCLUSIONS

Psycho-oncological care is only occasionally and partly deficiently provided in dermatological practices including referral to psycho-oncological care professionals. The results emphasize the necessity to raise awareness regarding psycho-oncological needs of skin cancer patients and to integrate psycho-oncological counselling into clinical routine in dermatological practices.