Date: September 18, 2009 (Friday)
12:30 – 14:00 (sandwich lunch from 12:30 –12:45; seminar begins at 12:45)
Venue: Seminar Room 6, LG/1-F, Laboratory Block, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong

Abstract:

Progress in multimodal cancer treatments has markedly improved prognosis for many patients during recent years, though cancer is still one of the leading causes of morbidity and mortality worldwide. An estimated 3 191 600 cancer cases were diagnosed in Europe in 2006 (Ferlay et al., 2007). The most common form of cancers was breast cancer (13.5% of all cancer cases), followed by colorectal cancers (12.9%) and lung cancer (12.1%). In Germany, the latest cancer incidence statistics show 436.500 new cancer cases per year and an enhanced 5-year survival rate of 60% for women and 53% for men, including all cancer stages. Over the past decades a considerable amount of research has shown the significant emotional and social impact of cancer and its treatment on patients and their families. Cancer patients experience distress caused by a number of problems that arise during the course of the illness and effect different areas of a patient’s life. In addition, specific problems which existed prior to the cancer diagnosis as well as the initial level of distress may play a role in coping and psychological adjustment to the disease. In distinction to mental disorders according to the ICD or DSM, distress has been defined as “an unpleasant emotional experience of a psychological, social and/or spiritual nature which extends on a continuum from normal feelings of vulnerability, sadness and fears to disabling problems such as depression, anxiety, panic, social isolation and spiritual crisis” (HOLLAND & REZNIK, 2004; NCCN, 2004). Psychosocial distress can differ in severity, and occur in different phases of the illness. In addition to physical symptoms and subsequent problems such as pain, fatigue, and various disabilities, sources of distress also include strain on the family such as uncertainty regarding social roles and tasks, separation from partner and children; and existential and spiritual problems through the confrontation with mortality, the search for meaning and consolation. Furthermore, various social, financial and occupational stressors can occur, as well as problems whose origin can be seen in the health care system such as problems in communication, impersonal treatment, lack of time and lack of intimacy. As particularly distressing phases during the several stages of cancer, MCCORMICK & CONLEY (1995) specified the cancer diagnosis, the initial treatment, the time of treatment completion and hope for treatment success, the recurrence of cancer, the palliative treatment as well as the terminal stage as existential crises in cancer. Previous studies using self-report screening measures have reported distress, anxiety and depression in on average one quarter to one third of cancer survivors with levels up to 50% following diagnosis and treatment (ZABORA ET AL., 2001; BURGESS ET AL., 2005; KNOBF, 2007). However, lower prevalence rates were reported in studies using structured clinical interviews for DSM or ICD. While high levels of psychosocial distress have been found within the first year post diagnosis, there is evidence for an improvement in distress, psychosocial well being and quality of life (QoL) in long-term survivors, even though research has shown no improvement or even a decline in physical and/or mental health, specifically in older patients (GANZ ET AL., 2003; HELGESON ET AL., 2004). Overall risk factors for psychosocial distress include fewer personal resources and maladaptive coping strategies, poorly controlled physical symptoms, lack of social support, psychiatric medical history, poor doctor-patient communication, lower educational level as well as younger or intermediate age. Overall, only a small percentage of patients with severe psychosocial distress and mental disorders in the present oncological practice is accurately identified, diagnosed, and appropriately treated. Therefore, sufficient knowledge about psychosocial distress and mental disorders as well as screening procedures is urgent concerns to improve psychosocial care for cancer patients.

Bio-sketch:

Dr Mehnert is a research associate at the Department of Medical Psychology at the University Medical Center Hamburg-Eppendorf, Germany, since 1999. In 2005, she completed her PhD and worked at the Department of Psychiatry & Behavioral Sciences at Memorial Sloan-Kettering Cancer Center, New York, as a postdoctoral research fellow (2007-2008). She is currently completing her Habilitation thesis at the University of Hamburg on work and employment in cancer survivorship. She was principal investigator and co-investigator in several funded psycho-oncological research projects. Research topics included psychological aspects of predictive genetic testing and counseling for hereditary breast and ovarian cancer susceptibility; neuropsychological functioning and quality of life in the course of cancer treatment; prevalence of psychosocial distress, psychiatric disorders, need and utilization of psychosocial support in cancer patients; and doctor-patient communication.

Presentation file