Original articlesThe need for psychosocial support and its determinants in a sample of patients undergoing radiooncological treatment of cancer
Introduction
Patients suffering from cancer are known to be highly distressed due to their disease as well as their sometimes invasive and aggressive therapies [1], [2]. A variety of stressors (e.g., fear of relapse, pain, problems in partnership) as well as acute side effects and sequelae of treatment may extensively reduce the patients' quality of life (QoL), which, in turn, can affect the course and success of treatment. Psychosocial support of cancer patients and help in coping with the disease is an important part of any comprehensive oncological therapy [3].
Radiooncological therapy (RT) is an effective treatment for malign tumors. Up to 80% of cancer patients experience fatigue during their treatment, which is known to be a very common side effect in cancer patients undergoing RT (e.g., Refs. [4], [5]). The etiology of cancer-related fatigue still remains unclear. The symptom is either associated with characteristics of the tumor, but also a consequence of the cancer (e.g., sleep disturbances or pain) [6], [7]. Furthermore, fatigue in cancer patients is often attributed to specific RT-related factors (e.g., the localization and the dosage of irradiated volume) [5], [8], and a relationship to anemia has been reported [9]. Fatigue in general comprises extreme tiredness and exhaustion resulting in poor physical (e.g., exhaustion), psychological (e.g., cognitive deficits, lack of motivation), and social functioning (e.g., isolation) [10], which, in turn, strongly affects correspondent dimensions of QoL.
Since fatigue dramatically affects QoL [11], one can assume that these constructs are reflected in the patients' need for psychosocial support. Health-related QoL describes a multidimensional psychological concept being characterized by psychological well-being, physical state, social relationships, and functional competence [12]. QoL is influenced not only by the individuals' lifestyle experiences and expectations but also by the side effects of RT, personality-related factors, ways of coping, and the availability of resources [13], [14]. Thus, it is assumed that patients suffering more strongly from side effects of RT such as fatigue report poorer health-related QoL than patients being less affected. An association between fatigue and QoL has been shown by several authors [14], [15].
Among the psychological factors, resilience as a personality-related factor might be of influence for the development/intensity of fatigue and reduced health-related QoL. The resilience construct refers to a psychological resistance enabling a person to manage critical life events such as a cancer disease (e.g., Ref. [16]). A resilient person is successful in activating latent resources that are necessary to manage such exceptional challenges. Based upon the assumption that resilience also includes emotional resistance relating to self-regulatory competence and adaptation [17], it is reasonable to expect that patients with low resilience would be less successful in mobilizing their inner resources for psychological coping (consequently suffer more from the side effects of RT) [18] and, thus, need more psychosocial support. Previous studies dealing with cancer patients revealed that resilience is positively related to quality of life [19] but still provides a different construct than optimism [20].
Furthermore, aspects of the patients' coping behavior (e.g., information about disease and treatment, optimism, the subjective desire for psychosocial support) have been tested as predictors of the need for psychosocial support. According to Fritzsche et al. [21], a discrepancy between the patients' distress and the wish for psychosocial support can be observed. Moreover, optimism turned out to be a salient predictor for the participation in supporting group [22].
In summary, this study aims to (a) determine the need for psychosocial support in a sample of patients undergoing RT and (b) test whether the patients' fatigue, health-related QoL, resilience, and aspects of coping behaviour would be related to this need. It is hypothesized that the need for psychosocial support is determined by the patients' QoL which, in turn, is influenced by their fatigue and resilience.
Section snippets
Sample
Out of 250 consecutive patients diagnosed with cancer, a total of 239 agreed to participate in the baseline assessment; 208 patients could be repeatedly assessed at the end of their treatment 4–8 weeks later (depending on the site and/or size of tumor). The remaining 31 patients were either lost to follow-up or withdrew from the study due to organizational reasons (e.g., not reachable at the end of RT, problems with time). Due to potential cognitive impairments, patients with tumors of the
Need for psychosocial support
Using the cut-off criterion described above, the need for psychosocial support of cancer patients receiving RT was more than 70% considering both assessments. Most of the patients (119 patients, 61.0%) turned out to be in need for psychosocial support at the beginning and at the end of RT. In contrast, only 36 patients (19%) did not show a need for psychosocial support at both phases of RT. Table 2 presents an HSI-item description including the results for the nine items.
According to the
Discussion
The results of this study undoubtedly confirm that cancer-related distress is a relevant problem among radiooncologically treated patients. This is one of the reasons why psychosocial support of cancer patients should be integrated into any oncological treatment.
The need for psychosocial support appeared to be high within the investigated sample (more than 70% at the beginning and at the end of RT). No effects of age and gender on the need for psychosocial support could be found, indicating
Conclusions
Regarding the importance of QoL in predicting the need for psychosocial support and the strong correlation of fatigue and resilience with the need for psychosocial support in this study, it appears necessary to focus on these factors within psychosocial interventions. Psychosocial support, therefore, should aim at providing strategies that relieve emotional disturbance, fear of tumor progression, and lack of self-confidence (within psychological sessions). Furthermore, physical discomfort and
Acknowledgments
This work was supported by the Wilhelm-Sander-Foundation (FKZ 2002.071.1).
References (35)
- et al.
Radiotherapy related fatigue
Crit Rev Oncol Hematol
(2002) - et al.
Review: fatigue in patients with cancer
Eur J Cancer
(1998) - et al.
The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue
J Psychosom Res
(1995) - et al.
Resilience factors associated with adaptation to HIV disease
Psychosomatics
(2000) - et al.
Cognitive functioning and quality of life in malignant glioma patients: a review of literature
Psychooncology
(1998) - et al.
Coping with disease and management of therapy in patients with cancer with special reference to radiotherapy: an overview
Strahlenther Onkol
(1989) Clinical practice guidelines for the psychosocial care of adults with cancer. National Breast Cancer Centre, Camperdown, NSW
(2003)Management of cancer symptoms: Pain, depression, and fatigue. Evidence report number 61
(2002)- et al.
A qualitative study to explore the concept of fatigue/ tiredness in cancer patients and in healthy individuals
Support Care Cancer
(1996) - et al.
Cancer-related fatigue: evolving concepts in evaluation and treatment
Cancer
(2003)
Anemia in cancer patients
Semin Oncol
Fatigue in advanced cancer: a study on the different dimensions and their correlates
J Clin Oncol
Factors influencing quality of life in cancer patients: anemia and fatigue
Semin Oncol
SF-36 Fragebogen zum Gesundheitszustand. Handanweisung
Critical review of psychosocial interventions in cancer care
Arch Gen Psychiatry
Fatigue mediates the effects of exercise on quality of life
Qual Life Res
The extent of tiredness and fatigue in the age group over 60 years in a healthy German population sample
Psychotherapeut
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