Der Verlauf der Lebensqualität von Brustkrebspatientinnen in Abhängigkeit von Patientinnenmerkmalen und psychoonkologischem Angebot

Abstract

The psycho-oncological treatment of patients with breast cancer plays a prominent role in the multimodal care of breast cancer. Important aims are the improvement of quality of life and the decrease of anxiety and depression. The aim of the present study was to test the efficacy of a new psycho-oncological clinical pathway including a screening for psychological distress. The development of quality of life was evaluated and parameters that influence quality of life were identified. A total of 213 women with breast cancer aged 26 to 88 years were included into the present study. Standardized measurements of quality of life (EORTC-QLQ-C30), anxiety and depression (HADS), mental adjustment to cancer (MAC) and a checklist to survey psycho-social burdens were determined at three points of time: 0, six and 12 months after diagnosis. The intervention cohort (110 patients) attended a new screening based psycho-oncological pathway. The control group (103 patients) received an unstructured psycho-oncological support. Contrary to our expectations no significant differences concerning quality of life were found between the cohorts six months after diagnosis. Noninferiority of the new psycho-oncological pathway could be proven. Due to the lack of efficacy of the new psycho-oncological clinical pathway it was not shown that patients with a higher initial mental burden and women with a low fighting spirit especially benefit from the psycho-oncological pathway. An initially high level of psychological distress was negatively related to quality of life six months after diagnosis. Contrary to our expectations a strong fighting spirit did not predict a higher quality of life. We observed a stronger improvement of quality of life in patients with higher psychological distress and more fighting spirit in the beginning in both groups. Several facts may have influenced these results. On the one hand the psycho-oncological interventions may have affected the development of quality of life. On the other hand the phenomenon of spontaneous remission due to a successful coping with the illness may have played a role. Additionally, in the course of time, patients may have recovered from potential side effects of the surgical intervention and the adjuvant therapy, which may also explain the improvement of quality of life over time. Age, presence of a mental disorder, psychosocial burdens, type of coping with the illness, the individual therapy and personal resources were identified as parameters which influence the quality of life. We found that the initial value of quality of life was the most important influence factor. Furthermore, younger patients were more burdened than older patients. The analyzed cohort of breast cancer patients reached lower scores of quality of life compared to a healthy German female population. We concluded that a standardized offer of a psycho-oncological support including a screening for psychical distress is useful and reasonable to improve quality of life and to reduce psychical distress in breast cancer patients. However, further investigations on the efficacy of psycho-oncological interventions over time and their effects on quality of life and psychological health compared to control groups are preferable.