[Psycho-Oncologic Care by a Consultation-Liaison Service - Differences between Oncologic Patients with and without Psychiatric Comorbidity].

Background: Psycho-oncologic consultation and liaison services (CLS) are mainly psychosomatic oriented teams in acute care hospitals. Their interventions are electively, setting-related or universal like in accredited centers. Objectives: We investigated whether clinical and care-related differences between cancer patients with and without psychiatric comorbidity exist as well as between patients treated in oncologic centers and aside thereof. We also investigated possible differences according to psychiatric as well as to oncologic diagnoses. Method: A 4-year study (2012-15, for center-related comparisons: 2013-15) in a regional hospital (520 beds, 18 wards, 6 oncologic centers) based on data from a basic documentation covering selected clinical as well as care variables. Data was been collected on occasion of each consultation (N=3441 corresponding to 2257 patients). Associations between clinical and care-related variables were identified by means of chi-square, ANOVA, Scheffé post hoc tests as well as by means of multivariate linear and logistic regression models. Results: The sample was on average 64 years old, about 68% women, and they showed a distress about 4.63. Affective disorders were found for 4.4% and adjustment disorders for 7.8% of the sample. Bivariate tests show that patients with psychiatric comorbidity (19%) and patients aside the centers (24%) were highly significant (p<0.001) clinically more impaired and received more intensive care by CLS. Within the centers the psychiatric comorbidity amounted on average 9% (range:4-16%), that was lower than aside the centers (33,5%). Multivariate regression models largely confirm the differences found in bivariate tests; no gender differences were found, but a negative association between age and care density. Discussion: This study supports that psychooncologic CLS follow a good practice, because patients with a higher clinical burden related to psychiatric comorbidity receive more intensive care. Comorbidity quotas found were lower than in other similar German investigations. Conclusions: Oncologic patients with psychiatric comorbidity should be identified by CLS because they have a larger clinical burden and more distress. The fact that older patients receive less face to face interventions may have to be balanced with systemic interventions. Care needs - and not only received care - have to be assessed in further research.