The purpose of this study was to assess the psychological distress of cancer patients in a disease-specific manner as well as the demographic and medical variables that have an impact on the distress. Psychological distress was assessed with the Questionnaire on Stress in Cancer Patients revised version, which has been developed and psychometrically evaluated in Germany. It consists of items about 23 cancer-specific stress situations, which have to be answered in terms of relevance and amount of distress. A heterogeneous sample of 1721 cancer in-and outpatients was assessed. For the total group, the most important distress is the fear of disease progression. We consider between 23.4% (ca. of the upper gastrointestinal tract) and 40.9% (breast cancer patients) as highly distressed. The most distressed diagnostic subgroups are patients with soft tissue tumours and breast cancer patients. There are no global (general) stress factors, as the relevant demographic and medical 'risk factors' varied between the diagnostic subgroups. Cancer-specific distress questionnaires give a more precise insight into patients' experience than general or psychiatric questionnaires. They are not only used in large screening studies but also in routine medicine, particularly when the objective is to identify patients to whom psycho-oncological support is to be given.

The purpose of this study was to investigate psychosocial stress in a large sample of cancer patients using an expert rating scale. Specific aims were to analyse the relevance of setting variables (type of clinic, contact initiative, therapy) and gender. A total of 6365 patients were assessed in 105 institutions. Univariate and multivariate statistical analysis of setting variables indicated that patients treated in palliative care settings showed highest distress scores compared to patients recruited from hospitals and outpatient clinics (Po0.001). Significant differences were also found for contact initiative (Po0.001); lowest distress was found in patients who were recruited by routine contact. Patients who asked for psychosocial support or who were recruited by the medical staff showed the highest distress scores. The analysis of therapy groups showed that patients receiving radiotherapy or surgery were not more distressed than patients without therapy. The most distressing treatment was chemotherapy. Gender had differential effects on clinic type (Po0.001) and contact initiative (Po0.001) but not on treatment and diagnosis. Expert rating scales are an important complement for self-assessment questionnaires to evaluate psychological distress of cancer patients in psychosocial studies as well as in routine medical care.

Background: The integration of psycho-oncology into the medical care of cancer patients requires a transparent, reliable, and valid assessment of psychosocial stress. The Basic Documentation for Psycho-Oncology (PO-Bado), including a short version and a breast cancerspecific version, is such an instrument. The purpose of this article is to present the current stage of development of the 3 versions. Patients and Methods: All versions of the PO-Bado were developed and psychometrically evaluated based on the empirical analysis of multiple oncological samples. External criteria for the validation and determination of cut-off scores were the Hospital Anxiety and Depression Scale, the Questionnaire on Stress in Cancer Patients, and the EORTC Quality of Life Questionnaire. Inter-rater reliability was examined by different psycho-oncologists who independently rated PO-Bado interviews. Results: Three versions of the PO-Bado are presented: the standard version (PO-Bado, 17 items), the short form (PO-Bado SF, 7 items), and the breast cancerspecific version (PO-Bado BC, 21 items). A manual and interview guideline are provided for all versions. By now, the standard version has been implemented throughout Germany and includes data of 6,365 patients. Conclusion: A consistent nationwide implementation of the PO-Bado for the assessment of psychosocial stress in cancer patients would contribute to the improvement of medical care.

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The Scales of Psychological Capacities (SPC) are introduced as a new measure of structural change as the mode-specific effect of psychoanalytic psychotherapy. The design and results of an interrater reliability study, a convergent and discriminant validity study with well-established construct-near and construct-distant measures, and a discriminant validity study with different diagnostic groups are presented. The results indicate substantial evidence that the SPC are a reliable and valid measure of psychic structure and, if their sensitivity to change is proven, are a suitable instrument for psychoanalytic process-outcome research.