gms | German Medical Science

Objective: Development of Cancer Centers is increasing and emphasis on patient and caregiver's expectations regarding treatment is crucial [1].

The aims of study were to evaluate

1) the effect of treatment and infrastructure of a cancer center on quality of life

2) effect of firsthand compared to indirect referral to psycho-oncological therapy after primary screening

3) if the initially expressed patient's wish for psychooncological therapy results in an objective need for psychological help over the course of the disease.

Method: After histopathological diagnosis was confirmed, 140 recruited patients were evaluated during their hospital stay using three screening instruments (PHQ-4, Distress Thermometer (DT) as well as Hornheide Screening Instrument (HSI)) as bedside tests.

Positively screened patients in study center 1 (certificated Cancer Center) received information material/addresses of psychologists only, in study center 2 identified patients were referred directly to psychologists. 3 and 6 months re-evaluation using all screening instruments was performed.

Results: Mean scores of initial postoperative DT did not differ between both study centers (4.49 ± 2.4 and 5.52 ± 2.5, respectively, p>0.05), and remained stable at 3 months follow-up. 6 months follow-up revealed higher, though not significantly different DT scores for center 1 (4.75 and 3.44, respectively, p>0.05). Similarly, HSI identified comparable percentages of patients in need of psychosocial help at 0, 3 and 6 months evaluation (center 1: 28.75%, 36.2% and 27.1%; center 2: 26.4%, 24.1 and 33.3%). However, 31 (23.3%) patients initially expressed their wish for psychological support after diagnosis was confirmed, only 12 of these were identified by screening instruments. Surprisingly, follow-up screening after 3 (and 6 months) revealed that 88% (and 100%) of these patients were indeed positively identified as in need for psychosocial help according to HSI.

Conclusions: Establishing comprehensive care centers is important in care of patients with malignant gliomas, but equally important is establishing psychosocial health care structures with direct referral to psycho-oncologists to improve of psychosocial well-being in the early postoperative phase. During the further course of the disease the patients' expressed demands for psychological support unerringly predicts necessity for psychooncological care.