Determinants of illness-specific social support and its relation to distress in long-term melanoma survivors

Background Social support is considered to be one of the most important resources for coping with cancer. However, social interactions may also be detrimental, e. g. disappointing or discouraging. The present study explored: 1. the extent of illness-specific positive aspects of social support and detrimental interactions in melanoma survivors, 2. their relationships to mental health characteristics (e. g. distress, quality of life, fatigue, coping processes, and dispositional optimism) and 3. Combinations of positive social support and detrimental interactions in relation to depression and anxiety. Methods Based on the cancer registry of Rhineland-Palatinate, Germany, melanoma patients diagnosed at least 5 years before the survey were contacted by their physicians. N = 689 melanoma patients filled out the Illness-specific Social Support Scale ISSS (German version) and standardised instruments measuring potential psychosocial determinants of social support. Results Using principal component analysis, the two factor structure of the ISSS could be reproduced with acceptable reliability; subscales were “Positive Support” (PS) and “Detrimental Interactions” (DI); Cronbach’s α = .95/.72. PS was rated higher than DI. Multivariable linear regressions identified different associations with psychosocial determinants. Survivors living in a partnership and those actively seeking out support had a higher probability of receiving PS, but not DI. PS and DI interacted regarding their association with distress: Survivors reporting high DI but low PS were the most depressed and anxious. High DI was partly buffered by PS. When DI was low, high or low PS made no difference regarding distress. Conclusion Psycho-oncologic interventions should take into account both positive and negative aspects of support in order to promote coping with the disease

Psychosocial Care Needs of Melanoma Survivors: Are They Being Met?

Patients who have survived malignant melanoma for more than five years may lack the opportunity to talk about their burden. As a consequence their psychosocial care needs remain undetected and available supportive interventions may not be utilised. Therefore, the psychosocial burden of this patient group needs to be assessed using specific screening instruments. The aim of this study was to investigate the psychosocial burden of long-term melanoma survivors, their psychosocial care needs and the determinants of these needs. We wanted to find out if the use of professional support corresponds to the care needs defined by experts. Using the cancer registry of Rhineland-Palatinate, melanoma patients diagnosed at least 5 years before the survey were contacted by physicians. N = 689 former patients completed the Hornheide Questionnaire (short form HQ-S) to identify psychosocial support need (scale cut off ≥ 16 or item-based cut-off score) and the potential psychosocial determinants of these needs. Additionally, they were asked about their utilisation of the professional support system. More than one third (36%) of them was in need for professional psychosocial support. The highest burden scores concerned worry about tumour progression. Younger age (< 50), higher general fatigue, higher symptom burden, lower general health, negative social interactions and unfulfilled information needs were significant predictors of the need for psychosocial intervention. Related to the percentage of survivors identified as 'in need', the professional support system was underused. Further studies should investigate whether using the HQ-S to routinely identify burdened melanoma patients could lead to better fulfilment of their intervention needs, ultimately enhancing health-related quality of life

Demographic and medical characteristics of the sample (n = 689).

<p>¹UICC-stage: till 2003 (year of diagnosis) according to TNM 5. ed., Springer publisher 1997, from 2004 (year of diagnosis) TNM 6. ed., Springer publisher 2002; classification according to TNM 6 in A and B were subsumed to the particular stage; missing data: marital status (1), partnership (23), educational level (1), melanoma surgery (9)</p><p>Demographic and medical characteristics of the sample (n = 689).</p

Predictors of the need for psychosocial care: Multivariable logistic regression based on multiple imputation (10 imputation data sets, Nagelkerkes R² .41-.44).

<p>* Multiple Imputation for a set of covariates selected by forward and backward selection (level of selection 5%) in single imputation data</p><p>Predictors of the need for psychosocial care: Multivariable logistic regression based on multiple imputation (10 imputation data sets, Nagelkerkes R² .41-.44).</p

Item and scale analysis of the Hornheide Questionnaire short form (HQ-S).

<p>¹6-point Likert Scale from 0 = “does not apply" to 5 = “applies and troubles me extremely”, Cronbach´s α = .87”;r_it = discrimination power; item cut-off scores (care need prevalent) underlined</p><p>²a care need prevalent, if the sum of the anxiety measuring items (3, 6) is <u>7</u>, <u>8</u>, <u>9</u> or <u>10</u></p><p>³Care need index: sum score ≥ 16: 14% of the sample, M = 6.78, SD = 7.85; need for psychosocial intervention (HQ-S ≥ 16 or underlined item cut-off scores), prevalent 36% (n = 239), not prevalent 64% (n = 433)</p><p>Item and scale analysis of the Hornheide Questionnaire short form (HQ-S).</p

Quality of life (EORTC QLQ30) in male and female survivors of malignant melanoma across the age range.

<p>¹⁾Survivors below 30 years excluded due to small sample sizes (male: N = 2, female: N = 4);</p><p>²⁾ Means/SD are presented</p><p>Quality of life (EORTC QLQ30) in male and female survivors of malignant melanoma across the age range.</p

Depression (PHQ-9) and anxiety (GAD-7) in male and female malignant melanoma survivors and in the general population.

<p>¹⁾Multiple regression, separately for men and women with group (melanoma vs. general population) as predictor: men: beta = 1.05 (95% CI: .59 to 1.51); p<.0001; women: beta = 1.87 (95% CI: 1.42 to 2.32); p<.0001</p><p>²⁾Multiple regression, separately for men and women with group (melanoma vs. general population) as predictor: men: beta = .13 (95% CI-.28 to .54); n.s.; women: beta = .59 (95% CI .17 1.02); p = .006</p><p>Depression (PHQ-9) and anxiety (GAD-7) in male and female malignant melanoma survivors and in the general population.</p

Efficacy of psychodynamic short-term psychotherapy for depressed breast cancer patients: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>There is a lack of psychotherapeutic trials of treatments of comorbid depression in cancer patients. Our study determines the efficacy of a manualized short-term psychodynamic psychotherapy and predictors of outcome by personality and quality of the therapeutic relationship.</p> <p>Methods/design</p> <p>Eligible breast cancer patients with comorbid depression are assigned to short-term psychodynamic psychotherapy (up to 20 + 5 sessions) or to treatment as usual (augmented by recommendation for counseling center and physician information). We plan to recruit a total of 180 patients (90 per arm) in two centers. Assessments are conducted pretreatment, after 6 (treatment termination) and 12 months (follow-up). The primary outcome measures are reduction of the depression score in the Hospital Anxiety and Depression Scale and remission of depression as assessed by means of the Structured Clinical Interview for DSM IV Disorders by independent, blinded assessors at treatment termination. Secondary outcomes refer to quality of life.</p> <p>Discussion</p> <p>We investigate the efficacy of short-term psychodynamic psychotherapy in acute care and we aim to identify predictors for acceptance and success of treatment.</p> <p>Trial registration</p> <p>ISRCTN96793588</p