Greek researchers undertook a study to assess the rates and clinical course of anxiety and depression in Greek patients with cancer scheduled to commence chemotherapy, and to investigate the factors which determined sufferers' overall quality of life. As the ECCO 13 audience was reminded, the onset of cancer is often accompanied by severe emotional distress, yet actual estimates of anxiety and depression vary considerably across different studies, ranging from a low of 1% to a high of almost 50%.
In total, 80 Greek patients completed questionnaires before and after chemotherapy treatment. Fatigue and sleep disturbances were significantly increased after the treatment period, but no changes emerged in the rates of anxiety or depression throughout chemotherapy. Nevertheless a significant proportion of the cancer patients studied (almost a third), were found to be experiencing severe emotional distress before, throughout and after chemotherapy. The presence of depression proved to be a strong predictor of overall quality of life. This study concluded that routine screening of emotional distress across all phases of cancer should be mandatory because it will contribute to identifying those patients in need of psychological or pharmaceutical intervention.
"The implication for practice relates to the proper screening and management of cancer patients with psychological distress", reported Dr Gregoris Iconomou study author from the University of Patras Medical School, Greece at ECCO 13. "Almost a third of our patients experienced levels of anxiety and depression sufficient to warrant further evaluation and management. High levels of depression, beyond their detrimental effects on global quality of life, may also hamper treatment decision-making and have been found to impede recovery and increase mortality. Despite worldwide recognition of the problem, little currently is being done to treat patients effectively and in consequence many patients are denied proper management. Therefore, routine screening for emotional distress throughout the course of cancer is mandatory, because it will contribute to identifying those patients for whom pharmaceutical management and/or psychological intervention may be most warranted and salutary."
The second ECCO study to look at patient management issues addressed the question of apparent gender bias in meeting cancer sufferers' preferences for male or female healthcare providers. It is well known that women show a strong preference for female physicians, especially during pelvic exams, yet the attitudes and preferences of male cancer sufferers have thus far been overlooked. To redress this balance, UK investigators assessed the attitude of male urological cancer patients towards female physicians, nurses and chaperones.
The results revealed that a minority of male patients (11% with prostate cancer and 11% with testicular cancer) preferred to consult a male doctor, yet none of the men expressed a preference for a female doctor. 10% of patients did not feel comfortable discussing personal/sexual issues with a female doctor and 56% did not like the presence of a nurse during consultation with the doctor. In particular, 12% of men did not feel comfortable discussing personal/sexual issues with a male doctor in the presence of a female chaperone.
These study findings suggest that, whenever feasible, male patients, like their female counterparts, should be offered the option of seeing a male health professional. Since an increasing proportion of physicians are likely to be females in the near future, these gender preferences may have implications for service delivery.
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Abstract: 1320
1701 Patient management (to include cancer in the elderly, palliative care, symptom management, psychosocial aspects, quality of life management)
Anxiety, depression and quality of life in cancer patients treated with chemotherapy: a prospective examination
G. Iconomou, A.K. Koutras, K. Assimakopoulos, V. Mega, A. Viha, A.V. Iconomou, H.P. Kalofonos
University of Patras Medical School, Department of Medicine, Division of Oncology, Rion, Patras, Greece
Background:
The onset of cancer is often accompanied by severe emotional distress. However, estimates of anxiety and depression vary across studies and range from a low of 1% to a high of almost 50%. In consequence, psychological distress often goes undetected along the disease continuum and patients are denied proper management with adverse effects on QOL, not to mention the negative impact on the family and the institutional systems. The aim of this study was to assess the rates and clinical course of anxiety and depression in Greek patients with cancer scheduled to commence chemotherapy, and to investigate the determinants of global quality of life (QOL).
Material and methods:
Chemotherapy-naive outpatients with solid tumors who consented to participate were administered the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ C-30) Questionnaire and the Hospital Anxiety and Depression Scale (HADS) prior to (Time 1) and again at the end of treatment (Time 2).
Results:
Of the 102 patients initially assessed, 80 (78.4%) completed the study. Most aspects of QOL did not change considerably over time. At Time 2, patients reported only significant increases in fatigue (P < 0.01) and significant decreases in sleep disturbance (P < 0.01). Although no significant changes emerged in the rates of anxiety or depression throughout chemotherapy, still almost a third of our patients experienced severe emotional distress (HADS score ¡Ý 11) at both points in time. Finally, multiple regression analyses revealed that HADS depression proved to be the leading predictor of global QOL at Time 1 and at Time 2.
Conclusions:
Our results indicate that a significant proportion of Greek cancer patients experience intense anxiety and depression throughout chemotherapy, and confirm the importance of depression as a strong predictor of global QOL. Routine screening of emotional distress across all phases of cancer is mandatory, because it will contribute to identifying those patients who are in need of pharmaceutical and/or psychological intervention.
Abstract: 1327
1701 Patient management (to include cancer in the elderly, palliative care, symptom management, psychosocial aspects, quality of life management)
Male Cancer Patients' attitudes towards female physicians, female nurses and chaperones during urological consultations
S. Sundar, A. Wade, D. Lakshmanan, A. Dhadda, M. Sokal
Nottingham City Hospital, Dept of Oncology, Nottingham, United Kingdom
Objective:
There is considerable literature regarding female patients attitudes towards male physicians and chaperones. It is well known that some women have a strong preference for female physicians particularly during pelvic exams (Rifkin. Acad Med. 2002; 77:1034-8). On the other hand, even though a significant proportion of the health professionals are females, male cancer patients' attitudes and preferences have not been well studied (Gupta. Hum Resour Health. 2003 22; 1:5)(Chur-Hansen. J Adv Nurs. 2002; 37:192-8). Hence, as part of a service development audit, we assessed male urological cancer patients' attitudes towards female physicians, female nurses and chaperones.
Patient and Methods:
A random sample of 89 patients completed a self-administered anonymised questionnaire during their routine follow-up clinic visits. The median age group of the patients was 51-70yrs (Age group 18 to 30yrs - 8%; 31 to 50 yrs - 30%; 51 to 70 yrs - 39%; above 71yrs- 23%). 40% of the patients had testicular cancer and 60% had prostate cancer.
Results:
Overall, 96% of patients surveyed felt that their privacy has been respected in the clinic and 93% of the patients mentioned that they and their partners have been given the opportunity to discuss any personal problems or worries. A minority of male patients (prostate - 11%; testis -11%) preferred to consult a male doctor. None of the patients expressed a preference for a female doctor. 10% of patients did not feel comfortable discussing personal/sexual issues with a female doctor. 56% of patients did not like the presence of a nurse during the consultation with the doctor. In particular, 12% patients did not feel comfortable discussing personal/sexual issues with a male doctor in the presence of a female chaperone.
Conculsion:
Whenever feasible, male patients, like their female counterparts, should be offered the option of seeing a male health professional. Since an increasing proportion of physicians are likely to be females in the near future, these gender preferences of some males have implications for service delivery.