Issues faced by cancer patients - assessement - impact - implications

Nov 3 2005

New study findings showcased at the 13th European Cancer Conference (ECCO) have shed further light on the manifold factors which must be considered when managing patients with cancer. Studies from around Europe looked at a number of the issues faced by cancer patients and assessed their impact and associated implications.

Greek researchers undertook a study to assess the rates and clinical course of anxiety and depression in Greek patients with cancer scheduled to commence chemotherapy, and to investigate the factors which determined sufferers' overall quality of life. As the ECCO 13 audience was reminded, the onset of cancer is often accompanied by severe emotional distress, yet actual estimates of anxiety and depression vary considerably across different studies, ranging from a low of 1% to a high of almost 50%.

In total, 80 Greek patients completed questionnaires before and after chemotherapy treatment. Fatigue and sleep disturbances were significantly increased after the treatment period, but no changes emerged in the rates of anxiety or depression throughout chemotherapy. Nevertheless a significant proportion of the cancer patients studied (almost a third), were found to be experiencing severe emotional distress before, throughout and after chemotherapy. The presence of depression proved to be a strong predictor of overall quality of life. This study concluded that routine screening of emotional distress across all phases of cancer should be mandatory because it will contribute to identifying those patients in need of psychological or pharmaceutical intervention.

"The implication for practice relates to the proper screening and management of cancer patients with psychological distress", reported Dr Gregoris Iconomou study author from the University of Patras Medical School, Greece at ECCO 13. "Almost a third of our patients experienced levels of anxiety and depression sufficient to warrant further evaluation and management. High levels of depression, beyond their detrimental effects on global quality of life, may also hamper treatment decision-making and have been found to impede recovery and increase mortality. Despite worldwide recognition of the problem, little currently is being done to treat patients effectively and in consequence many patients are denied proper management. Therefore, routine screening for emotional distress throughout the course of cancer is mandatory, because it will contribute to identifying those patients for whom pharmaceutical management and/or psychological intervention may be most warranted and salutary."

The second ECCO study to look at patient management issues addressed the question of apparent gender bias in meeting cancer sufferers' preferences for male or female healthcare providers. It is well known that women show a strong preference for female physicians, especially during pelvic exams, yet the attitudes and preferences of male cancer sufferers have thus far been overlooked. To redress this balance, UK investigators assessed the attitude of male urological cancer patients towards female physicians, nurses and chaperones.

The results revealed that a minority of male patients (11% with prostate cancer and 11% with testicular cancer) preferred to consult a male doctor, yet none of the men expressed a preference for a female doctor. 10% of patients did not feel comfortable discussing personal/sexual issues with a female doctor and 56% did not like the presence of a nurse during consultation with the doctor. In particular, 12% of men did not feel comfortable discussing personal/sexual issues with a male doctor in the presence of a female chaperone.

These study findings suggest that, whenever feasible, male patients, like their female counterparts, should be offered the option of seeing a male health professional. Since an increasing proportion of physicians are likely to be females in the near future, these gender preferences may have implications for service delivery.