The need for psychosocial support and its determinants in a sample of patients undergoing radiooncological treatment of cancer

Abstract

Objective

The primary goal of this study was to examine the need for psychosocial support in a consecutive sample of cancer patients undergoing radiotherapy (RT). Out of an initial sample of 250 patients, 239 patients could be assessed at the beginning of their RT. Two hundred eight patients were reassessed at the end of RT 4–8 weeks later.

Methods

Measures comprised the Hornheide Screening Instrument, the Multidimensional Fatigue Inventory, the Resilience Scale, and the Short Form 12 as a measure of health-related quality of life (QoL). Medical and radiological data were continuously registered.

Results

Within the sample, the need for psychosocial support as reflected in the screening instrument was high (>70%). Patients with the need for psychosocial support revealed significantly higher fatigue scores than patients who where not identified as needing psychosocial support. Furthermore, a negative correlation of the need for psychosocial support and QoL as well as resilience could be observed. QoL turned out to be the strongest predictor for the need of psychosocial support.

Conclusion

The study confirmed that the need for psychosocial support is an important aspect in the treatment of cancer patients undergoing RT, which appeared to be powerfully predicted by the patients' health-related QoL. Fatigue turned out to be an important illness- and treatment-related factor that affects QoL. Psychological interventions for cancer patients should explicitly focus on decreasing patients' fatigue and increasing their resilience, thus improving their QoL.

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.