Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Strahlenther Onkol. 2013 May;189(5):424-9. doi: 10.1007/s00066-013-0329-y. Epub 2013 Mar 29.
The need for psychosocial support in cancer patients is estimated in the literature at 14-50 %. At the Department of Radiation Oncology, Medical University of Vienna, approximately 3,000 patients are seen annually. Due to limited staff resources, highly distressed patients need to be selected for focused support. A multidisciplinary screening questionnaire covering physical, social and psychological problems and needs was successfully implemented in clinical routine. We present the results of a representative sample of 1,500 heterogeneous cancer patients before beginning radiotherapy.
The prevalence rates of physical, social and psychological problems and needs were evaluated. Independent risk factors for critical psychological distress were analyzed in a multivariate logistic regression model, in order to identify vulnerable subgroups for focused psychosocial support.
Critical psychological distress was found in 22 % of the overall cohort, of whom only 26 % reported a need for psychological information. Clinically relevant pain was suffered by 31 %. Patients' most frequent complaints were weakness, sleeping difficulties and exhaustion. Consequently, 40 % were impaired in activities and 35 % reported a requirement for support in daily life. A need for further information was expressed by 37 % of patients. Significant risk factors for critical psychological distress included pain, functional status, support requirements and patient-reported symptoms. Differences in tumor type, metastases and sociodemographic variables had no impact on critical psychological distress.
Approximately one third of all patients beginning radiotherapy have physical, social and psychological problems and should receive focused psychosocial support. Multivariate analysis reveals that patients with impaired "physical integrity" are at a significantly higher risk of experiencing critical psychological distress.
文献中估计癌症患者对心理社会支持的需求为 14-50%。在维也纳医科大学放射肿瘤学系，每年大约有 3000 名患者就诊。由于人力资源有限，需要对高度困扰的患者进行有针对性的支持。一个涵盖身体、社会和心理问题和需求的多学科筛选问卷已成功在临床常规中实施。我们展示了在开始放射治疗前对 1500 名不同癌症患者的代表性样本的结果。
评估了身体、社会和心理问题及需求的患病率。在多变量逻辑回归模型中分析了临界心理困扰的独立风险因素，以确定需要有针对性的心理社会支持的脆弱亚组。
整体队列中有 22%的患者存在临界心理困扰，其中只有 26%的患者报告需要心理信息。有 31%的患者出现临床相关疼痛。患者最常见的抱怨是虚弱、睡眠困难和疲惫。因此，40%的患者活动能力受损，35%的患者报告日常生活需要支持。37%的患者表示需要进一步的信息。临界心理困扰的显著风险因素包括疼痛、功能状态、支持需求和患者报告的症状。肿瘤类型、转移和社会人口统计学变量的差异对临界心理困扰没有影响。
大约三分之一开始接受放射治疗的患者存在身体、社会和心理问题，应接受有针对性的心理社会支持。多变量分析显示，“身体完整性”受损的患者经历临界心理困扰的风险显著增加。
