Psychosocial distress in cancer patients undergoing radiotherapy: a prospective national cohort of 1042 patients in Germany

Abstract

Purpose Psychosocial distress is common among cancer patients in general, but those undergoing radiotherapy may face specific challenges. Therefore, we investigated the prevalence and risk factors for distress in a large national cohort. Methods We performed a secondary analysis of a multicenter prospective cross-sectional study which surveyed cancer patients at the end of a course of radiotherapy using a patient-reported questionnaire. Distress was measured with the distress thermometer (DT), using a cut-off of ≥ 5 points for clinically significant distress. Univariate analyses and multivariate multiple regression were used to assess associations of distress with patient characteristics. A two-sided p-value < 0.05 was considered statistically significant. Results Out of 2341 potentially eligible patients, 1075 participated in the study, of which 1042 completed the DT. The median age was 65 years and 49% (511/1042) of patients were female. The mean DT score was 5.2 (SD = 2.6). Clinically significant distress was reported by 63% (766/1042) of patients. Of the patient characteristics that were significantly associated with distress in the univariate analysis, a lower level of education, a higher degree of income loss, lower global quality of life, and a longer duration of radiotherapy in days remained significantly associated with higher distress in the multivariate analysis. Yet effect sizes of these associations were small. Conclusion Nearly two in three cancer patients undergoing radiotherapy reported clinically significant distress in a large multicenter cohort. While screening and interventions to reduce distress should be maintained and promoted, the identified risk factors may help to raise awareness in clinical practice. Trial Registry identifier DRKS: German Clinical Trial Registry identifier: DRKS00028784.

Patient-Relevant Costs for Organ Preservation versus Radical Resection in Locally Advanced Rectal Cancer

“…Total treatment costs were computed for both treatment options (I, TNT and NOM, vs. II, CRT and resection) for all patients as well as for a subgroup of patients, who were in employment, and patients, who were already retired (Table 6). Treatment costs were higher for patients in the resection group (II) in all cases (1017 EUR-1985 EUR), whereas [15,18]. The mean income was found to be 1701-2600 EUR.…”

“…This approach allowed for more representative results, but was prone to be biased by differences in the simulated rectal cancer population from socioeconomic factors. To limit this bias, a subgroup analysis of the "FinTox" trial [15,16,18,51] was performed and enabled a comparison with a multicenter real-world rectal cancer population in Germany. Epidemiologic results and income data of this group were in a similar order.…”

“…Table 5. Results of the reference cohort derived from the "FinTox" trial and its precursor trial by Fabian et al [15,16,18]. The number of patients [N] and corresponding percentage [%] are described for each subgroup.…”

“…For example, co-payments for medication or health care measures are usually required, driving expenses for consultations might not be refunded in any case or loss of income due to absence from work is limited in time. Additional expenses were thus often seen to occur during cancer treatment in a German multicenter study, although the resulting financial toxicity was rarely not compensable by the patients [15,16,18].…”

“…Figure 2. Net household income per month of rectal cancer patients insured with a German statutory health insurance (N = 38) from the reference cohort by Fabian et al[15,18]. The mean income was found to be 1701-2600 EUR.…”