Reading Wishes from the Lips: Cancer Patients’ Need for Psycho-Oncological Support during Inpatient and Outpatient Treatment

Abstract

Background: Psycho-oncological support (PO) is an effective measure to reduce distress and improve the quality of life in patients with cancer. Currently, there are only a few studies investigating the (expressed) wish for PO. The aim of this study was to evaluate the number of patients who request PO and to identify predictors for the wish for PO. Methods: Data from 3063 cancer patients who had been diagnosed and treated at a Comprehensive Cancer Center between 2011 and 2019 were analyzed retrospectively. Potential predictors for the wish for PO were identified using logistic regression. As a novelty, a Back Propagation Neural Network (BPNN) was applied to establish a prediction model for the wish for PO. Results: In total, 1752 patients (57.19%) had a distress score above the cut-off and 14.59% expressed the wish for PO. Patients’ requests for pastoral care (OR = 13.1) and social services support (OR = 5.4) were the strongest predictors of the wish for PO. Patients of the female sex or who had a current psychiatric diagnosis, opioid treatment and malignant neoplasms of the skin and the hematopoietic system also predicted the wish for PO, while malignant neoplasms of digestive organs and older age negatively predicted the wish for PO. These nine significant predictors were used as input variables for the BPNN model. BPNN computations indicated that a three-layer network with eight neurons in the hidden layer is the most precise prediction model. Discussion: Our results suggest that the identification of predictors for the wish for PO might foster PO referrals and help cancer patients reduce barriers to expressing their wish for PO. Furthermore, the final BPNN prediction model demonstrates a high level of discrimination and might be easily implemented in the hospital information system.

Disparities and barriers in the assessment of psychological distress, access to and use of psycho-oncological support in Europe: current perspectives

“…As a matter of fact, patients had the lowest median score on the Distress Thermometer ( National Comprehensive Cancer Network, 2019 ) with respect to the Asian patients and Hispanic patients population which showed the highest scores. The latter results can be of multiple nature such as religious, cultural or social; indeed, scientific literature often reports on the impact of culture and religion on the stigmatisation of mental health problems and the notion of “normality” regarding emotional distress and unpleasant feelings, which frequently tie back to specific racial/ethnic groups ( Andrykowski et al, 2014 ; Schulze et al, 2022a ). Other notable socio-demographic barriers refer to older age, male gender, lower educational level, lower income and ruralness of residence.…”

“…Other notable socio-demographic barriers refer to older age, male gender, lower educational level, lower income and ruralness of residence. Rural cancer patients may avoid self-reporting mental distress because of negative attitudes or stigma associated with mental health issues and services that are often recurrent in more isolated geographic areas, where, in addition, the mean income and educational level are generally lower when compared to urban sites ( Schulze et al, 2022a ). Furthermore, current literature underlines the presence of severe mental illness and/or a comorbid pre-existent mental health disorder as a barrier to being screened for emotional distress and informed about psycho-oncological support services ( Günther et al, 2022 ).…”

“…Lastly, having a rare cancer type diagnosis could be considered as a barrier. Lung, gynaecological, breast, and gastrointestinal cancer patients are more likely to be screened for distress compared to other types of tumours ( Bergerot et al, 2021 ); however, previous studies in the literature are discordant as they found breast and skin cancer diagnoses as barriers to the assessment of psychological distress ( Schulze et al, 2022a ).…”

“…Indeed, there appear to be personal characteristics and perspectives of the patient that can affect their willingness to engage with psycho-oncological support. Aside from socio-demographic aspects ( Schulze et al, 2022a ), there are recurrent psychosocial aspects, some influenced by socio-demographic ones (such as cultural beliefs and stigma regarding mental health services and problems), that need to be addressed; several patients, for example, report thinking psychological support is not necessary or useful for their perceived level of distress, or that their level of distress is not severe enough to warrant intervention, hence preferring self-help ( Clover et al, 2015 ). In addition, Schulze et al (2022b) found that high emotional distress (but not physical) acts as a barrier to the utilisation of psycho-oncological support, yet, it appears that only suffering from both emotional and physical distress leads to the wish for support ( Schulze et al, 2022b ).…”