Background There is a significant number of long-term breast cancer survivors in Germany. However, research on the psychological challenges of cancer survivors is limited. This analysis describes prevalence, development and determinants of depression and anxiety 5 to 6 years after diagnosis and identifies predictors for an increase of anxiety and depression over time. Methods Data from 164 women was collected by survey and tumour documentation during post-operative hospital stay, 40 weeks and 5 to 6 years after diagnosis. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale. Sankey-diagrams were created for visual presentation of prevalence over time. Logistic and linear regression models were calculated to identify determinants of anxiety and depression. Results Respondents had higher levels of depression and anxiety 5 to 6 years than 40 weeks after the diagnosis. Lower vocational status and having children were associated with depression, surgery type was correlated with anxiety, and age, as well as comorbidities, were predictors for both anxiety and depression 5 to 6 years after diagnosis. An increase of depression over time was more likely when having children and comorbidities. An increase in anxiety was less likely after cancer recurrence. Conclusions Findings highlight that anxiety and depression are relevant burdens for breast cancer survivors in Germany. Several sociodemographic and clinical predictors are identified. There is need for psychosocial support after acute treatment and in the long-term. Research on psychological burdens of long-term breast cancer survivors in the identified vulnerable groups is needed.

While breast cancer is the most common cancer among women (Bray et al., 2018), it is considered a rare disease among men as only 1% of patients are male (Giordano, 2018). This inequality in prevalence exposes male breast cancer patients (MBCPs) to particular disadvantages such as diagnosis delays, treatment deficits, and stigmatisation due to the perception of breast cancer as a 'women's disease' (

IntroductionPatient–provider communication is an important factor influencing the quality of care in oncology. The study examines the comparative effectiveness of a 10-hour interprofessional communication skills training (CST) programme for physicians and nurses in cancer centres.Methods and analysisKommRhein Interpro is a cluster-randomised trial sponsored by the German Cancer Aid (Deutsche Krebshilfe, DKH) and conducted at the cancer centres of the university hospitals of Aachen, Bonn, Cologne and Düsseldorf. Thirty oncology teams of four cancer centres are randomly assigned to three study arms, providing healthcare professionals with either (a) only written information on patient-centred communication or (b) written information plus CST for physicians or (c) written information plus interprofessional CST for physicians and nurses. For summative evaluation, standardised surveys from three measurement points for patients (T0pat: study enrollment; T1pat: after discharge; T2pat: 3 months’ follow-up) and two measurement points for physicians and nurses (T0hcp: before the intervention; T1hcp: after the intervention) are used. N=1320 valid patient cases are needed for data evaluation. The primary endpoint is fear of progression in patients with cancer after discharge. Data will be analysed according to the intention-to-treat principle using a mixed model for repeated measurement. Secondary outcome is the providers’ self-efficacy in patient centeredness. Individual confounders and possible moderating effects of organisational factors will be considered. Secondary analysis will be performed by means of multilevel analysis and structural equation modelling.Ethics and disseminationA vote of approval has been obtained from the ethics committees of the medical faculties of RWTH Aachen University (EK325/20), University of Bonn (391/20), University of Cologne (20–1332) and Heinrich Heine University Düsseldorf (2019–796). Data protection regulations are adhered to for all processed data. The conduct of the study will be monitored. Dissemination strategies include a transfer workshop with cancer teams and distribution of the final study report to participants.Trial registration numberDRKS00022563; DRKS (German Clinical Trials Register).

Objective This study explores rehabilitation processes in long‐term cancer survivors (CSs) and explains the causes, contexts, and consequences under which decisions related to rehabilitation are made. Methods Within the mixed‐methods Breast Cancer Patients' Return to Work (B‐CARE) project, conducted from 2018–2020, data were collected through a written survey and semi‐structured interviews with CSs 5–6 years after their diagnosis. In total, 184 female CSs participated in the survey, and 26 were interviewed. A qualitative grounded theory approach was applied. Results The 26 interviewees were 57 years old on average, 70% were married, and 65% had children. The participants experienced incompatibilities caused by the cancer disease in their areas of life and the demands that arose from it. To reconcile demands from the areas family, work, leisure time, household, and disease, the interviewed CSs used different coping mechanisms and adjusted their lives by prioritizing certain areas as a consequence. This prioritizing was often to the detriment of work and rehabilitation. Furthermore, it worked as a barrier for participation in rehabilitation programs and explains why CSs experienced job changes after their return to work. Conclusions Physical and mental long‐term effects were observed in the interviewees' lives 5–6 years into survival. The study results stress the importance of individualized and needs‐oriented survivorship care.