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Sinnbasierte Interventionen bei fortgeschritten erkrankten Patienten

Meaning-based interventions for patients with advanced cancer

  • Psychoonkologie
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Menschen mit fortgeschrittener Tumorerkrankung zeigen häufig schwere psychosoziale Beeinträchtigungen, die einem umfassenden existenziellen Leiden entsprechen können. Im besonderen Fall des CUP-Syndroms (CUP Cancer of Unknown Primary) sind entsprechende empirische Daten rar. Allerdings wurden in den letzten Jahren eine Reihe psychoonkologischer Interventionsansätze vorgestellt, die insbesondere für Patienten mit infauster Prognose und schwerer psychischer Belastung entwickelt wurden. Diese Ansätze zeichnen sich durch ihre Adaptivität im onkologischen und palliativmedizinischen Setting aus. Ferner sind sie in randomisierten kontrollierten Studien auf ihre Effektivität überprüft worden. Ein wirksamer einzeltherapeutischer Ansatz ist CALM (Managing Cancer and Living Meaningfully), der Belastungen im Umgang mit Unsicherheit und einer verkürzten Lebenserwartung reduziert. Die Autoren stellen ein kurzes Therapiebeispiel vor.

Abstract

Individuals living with advanced cancer often experience severe psychosocial distress. Such distress can reflect a state of existential suffering. Data on psychological and existential issues in patients with cancer of unknown primary (CUP) syndrome are limited; however, a number of psycho-oncological interventions have been recently developed which are specifically tailored to patients with incurable cancer and severe psychological distress. A distinct feature of these approaches is their applicability in oncological and palliative care settings. Their effectiveness has further been tested in randomized controlled trials. One effective individual therapeutic intervention is managing cancer and living meaningfully (CALM) which can reduce distress in coping with uncertainty and a foreshortened life expectancy. We briefly describe an example of therapeutic treatment.

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Literatur

  1. Bowlby J (1982) Attachment. Basic Books, New York

    Google Scholar 

  2. Boyland L, Davis C (2008) Patients’ experiences of carcinoma of unknown primary site: dealing with uncertainty. Palliat Med 22(2):177–183. doi:10.1177/0269216307085341

    Article  PubMed  Google Scholar 

  3. Breitbart W, Poppito SR (2014) Meaning-centered group psychotherapy for patients with advanced cancer. A treatment manual. Oxford University Press, Oxford

    Google Scholar 

  4. Breitbart W, Rosenfeld B, Pessin H, Applebaum A, Kulikowski J, Lichtenthal WG (2015) Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer. J Clin Oncol 33(7):749–754. doi:10.1200/jco.2014.57.2198

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chochinov HM, Hack T, McClement SE, Kristjanson LJ, Harlos M (2002) Dignity in the terminally ill: a developing empirical model. Soc Sci Med 54(3):433–443

    Article  PubMed  Google Scholar 

  6. Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement SE, Harlos M (2005) Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol 23(24):5520–5525. doi:10.1200/jco.2005.08.391

    Article  PubMed  Google Scholar 

  7. Chochinov HM, Kristjanson LJ, Breitbart W, McClement S, Hack TF, Hassard T, Harlos M (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol 12(8):753–762. doi:10.1016/s1470-2045(11)70153-x

    Article  PubMed  PubMed Central  Google Scholar 

  8. Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF (2014) Psychoonkologische Diagnostik, Beratung und Behandlung von erwachsenen Krebspatienten, Langversion 1.1. http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html. Zugegriffen: 6. Juli 2017

    Google Scholar 

  9. Faller H, Schuler M, Richard M, Heckl U, Weis J, Kuffner R (2013) Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol 31(6):782–793. doi:10.1200/jco.2011.40.8922

    Article  PubMed  Google Scholar 

  10. Garcia-Rueda N, Carvajal Valcarcel A, Saracibar-Razquin M, Arantzamendi Solabarrieta M (2016) The experience of living with advanced-stage cancer: a thematic synthesis of the literature. Eur J Cancer Care (Engl) 25(4):551–569. doi:10.1111/ecc.12523

    Article  CAS  Google Scholar 

  11. Hyphantis T, Papadimitriou I, Petrakis D, Fountzilas G, Repana D, Assimakopoulos K, Carvalho AF, Pavlidis N (2013) Psychiatric manifestations, personality traits and health-related quality of life in cancer of unknown primary site. Psychooncology 22(9):2009–2015. doi:10.1002/pon.3244

    Article  PubMed  Google Scholar 

  12. Kissane DW (2012) The relief of existential suffering. Arch Intern Med 172(19):1501–1505. doi:10.1001/archinternmed.2012.3633

    Article  PubMed  Google Scholar 

  13. Mitchell SA (1995) Relational concepts in psychoanalysis. An integration. Harvard University Press, Cambridge

    Google Scholar 

  14. Nissim R, Freeman E, Lo C, Zimmermann C, Gagliese L, Rydall A, Hales S, Rodin G (2012) Managing cancer and living meaningfully (CALM): a qualitative study of a brief individual psychotherapy for individuals with advanced cancer. Palliat Med 26(5):713–721. doi:10.1177/0269216311425096

    Article  PubMed  Google Scholar 

  15. Reuter K, Spiegel D (2016) Psychische Belastungen bei Krebserkrankungen. Gruppentherapie nach dem supportiv-expressiven Ansatz. Hogrefe, Göttingen

    Google Scholar 

  16. Richardson A, Wagland R, Foster R, Symons J, Davis C, Boyland L, Foster C, Addington-Hall J (2015) Uncertainty and anxiety in the cancer of unknown primary patient journey: a multiperspective qualitative study. BMJ Support Palliat Care 5(4):366–372. doi:10.1136/bmjspcare-2013-000482

    Article  CAS  PubMed  Google Scholar 

  17. Robinson S, Kissane DW, Brooker J, Burney S (2015) A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research. J Pain Symptom Manage 49(3):595–610. doi:10.1016/j.jpainsymman.2014.07.008

    Article  PubMed  Google Scholar 

  18. Rodin G, Zimmermann C (2008) Psychoanalytic reflections on mortality: a reconsideration. J Am Acad Psychoanal Dyn Psychiatry 36(1):181–196. doi:10.1521/jaap.2008.36.1.181

    Article  PubMed  Google Scholar 

  19. Rodin G, Lo C, Rydall A, Nissim R, Malfitano C, Shnall J, Zimmermann C, Hales S (2017) Managing cancer and living meaningfully (CALM). A randomized controlled trial of a psychological intervention for patients with advanced cancer. J Clin Oncol 35(18_suppl):LBA10001. doi:10.1200/jco.2017.35.18_suppl.lba10001

    Article  Google Scholar 

  20. Scheffold K, Philipp R, Engelmann D, Schulz-Kindermann F, Rosenberger C, Oechsle K, Härter M, Wegscheider K, Lordick F, Lo C, Hales S, Rodin G, Mehnert A (2015) Efficacy of a brief manualized intervention managing cancer and living meaningfully (CALM) adapted to German cancer care settings: study protocol for a randomized controlled trial. BMC Cancer 15:592. doi:10.1186/s12885-015-1589-y

    Article  PubMed  PubMed Central  Google Scholar 

  21. Scheffold K, Engelmann D, Schulz-Kindermann F, Rosenberger C, Krüger A, Rodin G, Härter M, Mehnert A (2017) „Managing cancer and living meaningfully“: qualitative Pilotergebnisse einer sinnbasierten Kurzzeittherapie für fortgeschritten erkrankte Krebspatienten (CALM). Psychotherapeut 62(3):243–248. doi:10.1007/s00278-017-0179-7

    Article  Google Scholar 

  22. Schulz-Kindermann F (2013) Psychoonkologie. Grundlagen und psychotherapeutische Praxis. Beltz, Weinheim

    Google Scholar 

  23. Sherman DW, Norman R, McSherry CB (2010) A comparison of death anxiety and quality of life of patients with advanced cancer or AIDS and their family caregivers. J Assoc Nurses AIDS Care 21(2):99–112. doi:10.1016/j.jana.2009.07.007

    Article  PubMed  Google Scholar 

  24. Spiegel D, Classen C (2000) Group therapy for cancer patients. A research-based handbook of psychosocial care. Basic behavioral siences. Basic Books, New York

    Google Scholar 

  25. Temel JS, Shaw AT, Greer JA (2016) Challenge of prognostic uncertainty in the modern era of cancer therapeutics. J Clin Oncol 34(30):3605–3608

    Article  Google Scholar 

  26. Vehling S (2016) Sinnorientierte Interventionen. In: Mehnert A, Koch U (Hrsg) Handbuch Psychoonkologie. Hogrefe, Göttingen, S 676–688

    Google Scholar 

  27. Vehling S, Kissane DW, Lo C, Glaesmer H, Hartung TJ, Rodin G, Mehnert A (2017) The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer. doi:10.1002/cncr.30749

    PubMed  Google Scholar 

  28. Vos J, Craig M, Cooper M (2015) Existential therapies: a meta-analysis of their effects on psychological outcomes. J Consult Clin Psychol 83(1):115–128. doi:10.1037/a0037167

    Article  PubMed  Google Scholar 

  29. Wilson KG, Chochinov HM, McPherson CJ, LeMay K, Allard P, Chary S, Gagnon PR, Macmillan K, De LM, O’Shea F, Kuhl D, Fainsinger RL (2007) Suffering with advanced cancer. J Clin Oncol 25(13):1691–1697. doi:10.1200/jco.2006.08.6801

    Article  PubMed  Google Scholar 

  30. Wilson KG, Dalgleish TL, Chochinov HM, Chary S, Gagnon PR, Macmillan K, de Luca M, O’Shea F, Kuhl D, Fainsinger RL (2016) Mental disorders and the desire for death in patients receiving palliative care for cancer. BMJ Support Palliat Care 6(2):170–177. doi:10.1136/bmjspcare-2013-000604

    Article  PubMed  Google Scholar 

  31. Yalom ID (1980) Existential psychotherapy. Basic Books, New York

    Google Scholar 

  32. Yalom ID, Greaves C (1977) Group therapy with the terminally ill. Am J Psychiatry 134:396–400

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Frank Schulz-Kindermann &  Sigrun Vehling

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  1. Frank Schulz-Kindermann
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  2. Sigrun Vehling
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Correspondence to Frank Schulz-Kindermann or Sigrun Vehling.

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Interessenkonflikt

F. Schulz-Kindermann und S. Vehling geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schulz-Kindermann, F., Vehling, S. Sinnbasierte Interventionen bei fortgeschritten erkrankten Patienten. Onkologe 23, 1011–1015 (2017). https://doi.org/10.1007/s00761-017-0281-z

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  • DOI: https://doi.org/10.1007/s00761-017-0281-z

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