Psychological stress in geriatric patients with genito-urinary cancers

Abstract

Background

Two-thirds of all cancer cases affect patients who are older than 65 years, yet the specific conditions of the treatment and supportive care in this age group are poorly studied. There are limited data on the specific psycho-oncological problems in elderly patients with genito-urinary cancers. The aim of this study was to investigate the psychosocial needs of elderly patients with genito-urinary tumors using screening questionnaires and to use such screening questionnaires for an in-patient psychosocial treatment program.

Methods

Patients (≥ 65 years, n = 319) who underwent surgical (n = 295) or medical treatment (n = 24) for genito-urinary malignancies between 06/2014 and 11/2015 in our institution were included for prospective stress assessment. This was done with standardized questionnaires for stress screening and for the identification of need for care (NCCN Distress Thermometer and Hornheider Screening Instrument, HSI).

Results

The patients scored an average of 4.4 on the Distress Thermometer. According to the survey evaluation, 28% of patients had need for psychosocial care. However, only a minority of patients (4%) did actually communicate any need for psychosocial care. We also assessed the actual utilization of inpatient psychosocial support which is offered to all patients.

Conclusion

There is a significant number of elderly patients with genito-urinary cancer with increased psychological stress and a consecutive need of psychosocial care. This is underreported and underused by the patients. Therefore, an easy low-threshold access system with an interdisciplinary and inter-professional collaborative support system would be desirable. Measuring psychological distress systematically can be helpful in treating older patients with malignant diseases.

Introduction

Cancer is a life-threatening disease. Approximately 26% (n = 852,328) of overall mortality is attributed to cancer died of a malignancy in 2011. In Germany, approximately 70,000 people were diagnosed with a genito-urinary cancer in 2011 (Table 1). Thus, in Germany, cancer was in 2013 the most common cause of death second only to cardiovascular disease. This proportion has increased over the last 30 years by almost 25% [1].

Patients with cancer are threatened by the malignant disease itself and also by the potential side effects of treatment. They are exposed to numerous pressures and may be affected by variety disease- and treatment-related functional limitations. Psychological stress factors are the uncertainty of treatment outcome, the experience of a direct threat to life, the potential change in self-image, in their familiar and social roles. In addition to physical problems, mental stress can include anxiety and depression, but also more non-specific psychosocial stress (distress).

Geriatric patients have until recently not been considered as a specific group with different needs in medicine. Since the 1960s, gerontology or geriatrics has become established as a separate medical discipline looking at the special medical problems and needs of the elderly and very old. However, this age group is still underrepresented in clinical studies [2].

In clinical geriatrics, it is now recognized that this specific age group should be treated mandatory with an inclusive biopsychosocial medical concept. The interest in clinical oncology in this old age group has initially been low, although two-thirds of all patients with cancer are over 65 years of age. Since then, geriatric assessments have slowly been integrated into the treatment of older patients with cancer [2]. Concerning the specific psycho-oncological problems of elderly patients in urology, literature data is rare. In 2014, an interdisciplinary project was initiated by the Department of Urology of our institution aiming at accurate distress evaluation in patients with cancer with a view to identifying patients in need of psychosocial support. In this study, we investigated the stress situation of elderly patients with genito-urinary cancer using screening questionnaires and the usefulness of such screening for the inpatient psychosocial support program.