Cancer Research in Switzerland - Krebsliga Schweiz

Use of the medical/public health system
Only a minority (about 20 %) of the survivors of paediatric
cancer were involved in a systematic follow-up for their
former disease, and the numbers decreased with time.
The same was true of the availability of medical files summarizing
their former disease and therapy and describing
the needed follow-up examinations and schedule. Many
survivors found that regular follow-up was unnecessary.
Patient benefit
This prospective cohort study is very important for both
patients and paediatric oncologists. It shows the spectrum
of potential late effects and their dynamics and will be
able to identify what risk factors are associated with what
late toxicities. In the same way, we think that it will be
possible also to demonstrate the beneficial effects of
more recent therapies, which are much more adapted to
the biological behaviour of the disease, sparing unnecessary
toxicity in good risk patients (“tailored therapy”, individualized
oncology). In the last 50 years, paediatric
cancer moved from an almost always fatal to a usually
curable disease. It is therefore compulsory to early detect,
prevent, treat or at least reduce late toxicities in the majority
of survivors. Another crucial topic is the transition
from paediatric to adult medical care. This point will be
the focus of a new study based on the same data and also
supported by the Foundation Cancer Research Switzerland
and the Swiss Cancer League.
Project coordinator
PD Dr Nicolas von der Weid
Service de pédiatrie
Centre hospitalier universitaire vaudois (CHUV)
Rue du Bugnon 46
CH-1011 Lausanne
Phone +41 (0)21 314 13 34
Fax +41 (0)21 314 33 32
nicolas.von-der-weid@chuv.ch
Znoj Hansjörg | Posttraumatic personal growth and
posttraumatic stress in patients and their partners
adapting to cancer (OCS 01741-08-2005)
In this longitudinal study, a representative sample of patients
with a new primary cancer diagnosis was assessed
within eight weeks of diagnosis, six months after diagnosis
and 12 months thereafter. Measures included symptoms
of emotional distress, psychosocial parameters, pain, aim
of medical treatment and the Posttraumatic Growth Inventory
(Tedeschi & Calhoun, 1996). In addition, partners
were also investigated, because gender and role differences
of couples challenged with cancer have been investigated
with different results.
Aim of the study
We intended to describe the longitudinal course of posttraumatic
personal growth and posttraumatic stress in the
first year post-diagnosis. Second, we intended to identify
predictors of perceiving posttraumatic personal growth
vs. posttraumatic stress from cancer at the individual and
dyadic level for patients and their partners.
Method
A total of 346 patient names were provided by their doctors.
After exclusion based on time since diagnosis and
other criteria, 296 of the remaining patients were deemed
eligible, 287 consented to receive the assessment by mail,
and 218 patients returned a completed questionnaire
(74 % response rate). No significant differences were
found between responders and non-responders regarding
age, stage of disease, ECOG performance status, tumour
site, curative versus palliative treatment or partners’
study participation.
During the initial phone call, participating patients were
asked whether they had been living with an intimate partner,
married or not, for at least six months. If yes and
where available, spouses were given full study information
on the phone; 166 spouses were deemed eligible and
were sent the assessment package together with the
patient’s and along with full written study information;
137 spouses returned the completed questionnaire (83 %
response rate).
Measures assessed multiple quality of life (QoL) dimensions
including health-related and dyadic QoL as well as
symptoms of distress: anxiety, depression, intrusion,
avoidance and hyperarousal. The main intention of this
study was to understand in more detail how patients and
their partners adapt to cancer diagnosis. In order to optimally
utilize all gathered data, we decided to analyze t1
and t2 measurements separately and additionally to the
longitudinal analysis.
Results of the study
Multivariate analyses revealed, eight weeks after diagnosis,
marked symptoms of distress for 25 % of the respondents.
Twelve months after diagnosis 15 % would still need
professional help. Most of the patients reported posttraumatic
growth (PTG) at least in some respect. PTG appeared
together with emotional and cognitive coping, but
it was not associated with emotional distress or more progressed
disease. These results support the findings that
PTG is not a strategy aimed to deny the seriousness of a
cancer diagnosis. Moreover, these results indicate that patients
reporting PTG realize and accept the bad and the
good of a cancer diagnosis. One-third of the variance of
PTG is explained by active and target oriented coping,
seeking social support and emotion regulation. This result
has important clinical significance, in that these strategies
can be fostered through psychological interventions.
Among couples coping with cancer diagnosis, the effects
of gender, role (patient vs. spouse) and patient relationship
status (single vs. partnered) on quality of life (QoL)
have been investigated with inconsistent results. The present
study examined the impact of gender, role and relationship
status on male and female patients, their spouses
and non-partnered patients. Multivariate analyses of covariance
revealed lower QoL for women versus men, and
for spouses versus patients on a number of measures
(health-related QoL, satisfaction with dyadic coping, anxiety
and intrusions).
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