Clinical Oncology

[Psychooncology in the everyday practice]

ROHÁNSZKY Magda, PUSZTAFALVI Henriette

FEBRUARY 10, 2015

Clinical Oncology - 2015;2(01)

[In the past 40 years the progressively growing fi eld of psychooncology has played an increasing role in the multidisciplinary practice of oncology. In this review methods for identifying and treating cancer patients’ psychological challenges will be summarized. Effective psychological interventiones will be discussed, and two methods especially devised for supporting cancer patients (Simonton Training and Mindfulness Based Cancer Recovery) will be introduced. We also deal with the communication traits that affect the doctor-patient relationship, the mental challenges that affect doctors dealing with terminally ill patients, burnout and its prophylaxis.]

COMMENTS

0 comments

Further articles in this publication

Clinical Oncology

[Neoadjuvant treatment of rectal cancer]

PINTÉR Tamás

[Rectal cancer due to its frequent local invasion, high recurrence rate and metastatic potential is a serious health problem, leading to decreased life quality, severe complaints and death. Treatment for locally advanced, resectable rectal cancer improved over the years. Various chemotherapy protocols and combinations with radiation therapy and radical surgery - total mesorectal excision (TMA) - are the main elements of current therapy. Preoperative combined chemoradiation followed by surgery is the preferred treatment sequence. Radiation treatment in combination with fl uoropyrimidines (infusional 5-fl uorouracil [5-FU] or oral capecitabine) is recommended. Clinical trials with oxaliplatin-based neoadjuvant chemoradiation did not improve the pathologic complete response rate (pCR). Oxaliplatin-based treatment was more toxic as compared with 5-FU. The data concerning local recurrence rate and survival are controversial. Adjuvant chemotherapy in some studies improved survival, so - based on positive results in colon cancer - adjuvant FOLFOX chemotherapy may be recommended.]

Clinical Oncology

[Treatments of brain tumors in adults – an up-date]

BAGÓ Attila György

[Maximal safe resection is the fi rst step in the complex neurooncological therapy of adult brain tumors. Surgical management of brain tumors, including the surgical innovations (neuronavigation, intraoperative imaging, awake craniotomy, intraoperative electrophysiology) providing more radical resection with the safe preservation of neurological functions will be presented. In case of malignancy the surgery is followed by radiation and chemotherapy. In this review we describe the postoperative adjuvant therapeutical modatilites available for primary and metastatic tumors, emphasizing the modern chemotherapy of high grade gliomas and stereotactic radiosurgery of brain metastases. As a conclusion we summerize the guidelines and modalities for the most common adult brain tumors, according to histological type and grade.]

Clinical Oncology

[Treatments of brain tumors in adults – an up-date]

BAGÓ Attila György

[The prognosis of brain metastases is very poor. Surgery and radiotherapy provides the fi rst line treatment, while systemic therapy has limited value. Nevertheless, our knowledge is increasing: normal cells contribute signifi cantly to the homing and growth of tumor cells; the molecular profi le of the primary tumor and its metastases could be different, which infl uences the therapeutic strategies; the type of blood supply can change during the tumor growth. It would be very important to optimize the cooperation of the different therapeutic modalities, and to fi nd markers which could predict the risk of metastatization.]

Clinical Oncology

[Oncological management of gastro-entero-pancreatic neuroendocrine neoplasias]

PETRÁNYI Ágota, UHLYARIK Andrea, RÁCZ Károly, BODOKY György

[Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are unusual and relatively rare neoplasms. They characteristically synthetize, store and secrete a variety of peptides and neuroamines, which can lead to development of disctinct clinical syndromes. Clinical symptoms and presentations vary depending on the location and hormones produced by the tumor. The diagnosis of NETs is established by histological examination and the immunohistochemical detection of general neuroendocrine markers, such as chromogranin A (CgA) and synaptophysin. An update of the WHO classifi cation has resulted in a new classifi cation dividing neuroendocrine neoplasms into neuroendocrine tumors (NETs) including G1 (Ki67 index ≤2%) and G2 (Ki67 index 3-20%) tumors and neuroendocrine carcinomas (NECs) with Ki67 index >20%, G3. The different available therapeutic approaches, including surgery, liver-directed ablative therapies, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, are discussed in this overview.]

Clinical Oncology

[Development in the treatment of non-operable, metastatic colorectal cancer]

GRAMONT de Aimery

[Today, due to the steady improvement, the survival of patients with non-operable, metastasic colorectal cancer is about 30 months. This review discusses the results of recent clinical trials, the new drugs, the treatment protocols as well as the tumor response after surgery. A suggestion will be made not only on an optimal treament strategy, but also how to increase the survival, and the feasibility of a secunder resection.]

All articles in the issue

Related contents

Clinical Neuroscience

[Comparative analysis of the full and shortened versions of the Oldenburg Burnout Inventory]

ÁDÁM Szilvia, DOMBRÁDI Viktor, MÉSZÁROS Veronika, BÁNYAI Gábor, NISTOR Anikó, BÍRÓ Klára

[Background – The two free-to-use versions of the Oldenburg Burnout Inventory (OLBI) have been increasingly utilised to assess the prevalence of burnout among human service workers. The OLBI has been developed to overcome some of the psychometric and conceptual limitations of the Maslach Burnout Inventory, the gold standard of burnout measures. There is a lack of data on the structural validity of the Mini Oldenburg Burnout Inventory and the Oldenburg Burnout Inventory in Hungary. Purpose – To assess the structural validity of the Hungarian versions of the Oldenburg Burnout Inventory and the Mini-Oldenburg Burnout Inventory. Methods – We enrolled 564 participants (196 healthcare workers, 104 nurses and 264 clinicians) in three cross-sectional surveys. In our analysis we assessed the construct validity of the instruments using confirmatory factor analysis and internal consistency using coefficient Cronbach’s α. Results – We confirmed the two-dimensional structure (exhaustion and disengagement) of the Mini-Oldenburg Inventory and a shortened version of the Oldenburg Burnout Inventory Internal consistency coefficient confirmed the reliability of the instruments. The burnout appeared more than a 50 percent of the participants in every subsample. The prevalence of exhaustion was above 54.5% in each of the subsamples and the proportion of disengaged clinicians was particularly high (92%). Conclusions – Our findings provide support for the construct validity and reliability of the Hungarian versions of the Mini-Oldenburg Burnout Inventory and a shortened version of the Oldenburg Burnout Inventory in the assessment of burnout among clinicians and nurses in Hungary.]

Clinical Neuroscience

[The examination of burnout among healthcare workers]

FEJES Éva, MÁK Kornél, POHL Marietta, BANK Gyula, FEHÉR Gergely, TIBOLD Antal

[Health reforms in recent decades have been largely based on economic considerations and have led to a significant problem in the sector today, with the issue of human resources being pushed back, which is exacerbated by burnout syndrome. The aim of this questionnaire-based study was to examine the complex background of burnout among health care workers in the cities of Komló, Pécs and Kecskemét. Baseline demographic data were recorded. Burnout was assessed by the Maslach Burnout Inventory (MBI), and the intensity of dysfunctional attitudes were also studied. Depression was detected by the Beck Scale and social supports, and effort-reward dysbalance were also examined. Overall 411 employees participated in our study. Age group distribution was middle aged access, vast majority of the workers was between 36 and 55 years. Mean burnout scale was 58.6 (SD = 16.3), 63 workers had mild (14.2%), 356 had moderate (80.7%) and 22 had severe (5.1%) burnout. In a multivariate analysis the type of work (OR = 1.018), age (OR = 2.514), marital status (OR = 1.148), job type (OR = 1.246) the lack of social support (OR = 1.189) and allowance (OR = 9.719) were independently associated with burnout (p < 0.05 in all cases). There was a significant association among burnout, depression and dysfunctional attitudes. The vast majority of our social workers suffered from moderate and a small, but significant proportion suffered from severe burnout. Our work draws attention to the modifiable and unmodifiable risk factors of burnout in this population, which may help in the development of preventive strategies.]

Clinical Neuroscience

[High prevalence of burnout and depression may increase the incidence of comorbidities among Hungarian nurses]

ÁDÁM Szilvia, CSERHÁTI Zoltán, MÉSZÁROS Veronika

[Background and purpose - Poor mental health among health care professionals may have a significant impact on public health. There is limited information about the prevalence and potential consequences of burnout and depression among nurses in Hungary. The objective of this study is to explore the relationship between burnout as well as depression and somatic symptoms as well as comorbidities among nurses in Hungary. Methods - Cross-sectional study with self-administered questionnaires among 1,713 nurses. Burnout and depression were assessed by the Maslach Burnout Inventory (MBIHSS) and the Shortened Beck Depression Questionnaire, respectively. Somatisation was measured by the Patient Health Questionnaire (PHQ-15). Correlates of burnout and depression were assessed by logistic and linear regression analyses. Results - The prevalence of depressive symptom and clinical depression was 35% and 13%, respectively. The prevalence of moderate and high level emotional exhaustion, depersonalisation, and decreased personal accomplishment was 44%, 36% and 74%, respectively. We identified burnout and depression as a predictor of high prevalence of subjective somatisation. Whilst burnout showed a strong association with increased prevalence of hypertension, depression predicted almost all examined diseases, in particular, cardiac and cerebrovascular diseases, as well as neoplasms. Conclusion - We found high prevalence of burnout and depression among nurses in Hungary. As depression has been shown to be associated with higher prevalence of comorbidities than burnout, its consequences may be more significant. Appropriate prevention, diagnosis, and adequate treatment of burnout and depression may decrease the prevalence of ensuing comorbidities.]

Lege Artis Medicinae

[The real cost of caring for seriously ill patients - compassion fatigue or satisfaction]

KEGYE Adrienne, ZANA Ágnes, RÉVAY Edit, HEGEDÛS Katalin

[The improvement of the Hungarian hospice network and the increasing number of people dealing with the seriously ill are reflected by the annual hospice reports (2001-2013). However these reports also draw the attention to the cumulating mental and spiritual burdens of carers which can lead to fatigue and burnout. On the base of practical experience we surveyed the mental and spiritual condition of the caregivers of seriously ill patients and also reviewed research findings and the professional literature on the exposure to imperilment. The grounds of professional literature’s research were the Hungarian and international databases. We favoured studies published in Hungarian or English between 2000 and 2014 primarily on carers working in palliative and hospice service. One of the main profits of reviewing the professional literature is getting more detailed information on the mental state of professional caregivers. Relatively new element in researches is studying the relation between burnout and compassion satisfaction and compassion fatigue. It includes studying of symptoms and coping strategies. These all enable a better understanding of causes and help us to support hospice carers with more effective methods to protect them from mental and spiritual exhaustion.]

Clinical Oncology

[Actual place and role of communication in Hungarian oncology]

MUSZBEK Katalin, GAAL Ilona

[The move to shared decision model from the patriarchal model of doctor-patient relationship is a communication challenge for doctors and patients as well. Communication is extremely important in Oncology, because the suggestive effect of every action of doctors and nurses is outstanding in this fi eld of healthcare. This burden has to urge professionals to self-improvement. One of the most important success of the Doctor-Patient Relationship program of the Hungarian Hospice Foundation since its launch in 2014 is the statement of two clinical centres on the importance of communication skills in everyday praxis, and engaging themselves in self-improvement. The successful cooperation also depends on patients and their care-givers not just on professionals. To gain all the necessary information is a learning process for them; even as to fi nd out the depth of information and decision level they wish. The patient who is satisfied with his or her own communication in healthcare is less distressed than the one who feels like adrifting. That gives the sense of achievement to professionals as well.]