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Psychological distress in cancer patients


Cancer patients and their spouses often suffer from psychological distress. A recent meta-analysis was performed based on a literature search in 4 databases (PubMed, PsychINFO, EMBASE and CINAHL) including epidemiological studies on the prevalence of depression among adult cancer patients during or after treatment. We included studies that assessed depression using validated questionnaires CES-D, HADS-D, BDI, BSI or (semi-) structured clinical interviews. 211 studies met the inclusion criteria. Pooled mean prevalence of depression in cancer patients ranged from 8% to 24% and differed by the type of instrument, type of cancer and treatment phase. Future prospective studies should disentangle whether differences in prevalence of depression are caused by differences in the type of instrument, type of cancer, or treatment phase.

In a study on 41 head and neck cancer (HNC) patient-spouse pairs a clinical level of distress was noted in 20% of the spouses and in 27% of the patients. Distress in spouses was related to the presence of a feeding tube in patients, a passive coping style, less vitality, and a disrupted daily life schedule due to caregiving. Distress in patients was related to the presence of a feeding tube, speech and swallowing problems, less social contacts, a passive style of coping, and non-expression of emotions.


In a prospective study, 55 consecutive newly diagnosed HNC patients were asked to complete the Hospital Anxiety and Depression Scale (HADS) and the EORTC QLQ-C30 and H&N35 quality of life questionnaires on a touch screen computer-assisted data collection system on their first visit and during follow-up visit. Sociodemographic, clinical, and quality of life parameters were compared to a high level of distress (HADS score >15). Number of patients with a high level of distress were compared to referral rates to psychosocial care as retrieved from patient hospital files. At time of diagnosis, 18% (10/55) of the patients had a high level of distress (related to tumor stage and site, and global quality of life and social eating) versus 25% (14/55) at follow-up (related to a variety of quality of life parameters). Low levels of distress at baseline or follow-up was noted in 64%; 18% had normal scores at baseline and developed distress at follow-up; 11% had high levels at baseline and returned to normal scores at follow-up, and 7% had persistent distress from baseline to follow-up. No patients were referred to psychosocial care at time of diagnosis. At follow-up visit 21% (3/14) were referred, all patients who developed a high level of distress after initial diagnosis.


It was concluded that a high level of emotional distress is common and few patients are referred to psychosocial care. Development of a stepped care model (including careful monitoring by using a touch screen computer system) may meet the potentially unmet needs of HNC patients and contribute improving cancer care (see also project Stepped care).


ZonMw, KWF Kankerbestrijding, and Fonds NutsOhra.


PhD student
A.M.H. Krebber, MD, Research-physician, dpt. of Otolaryngology-Head & Neck Surgery, VUmc.
Project leaders
Prof I.M. Verdonck-de Leeuw, PhD, Psychologist, Speech and Language Therapist, Linguist, Vdpt. of Otolaryngology-Head & Neck Surgery, VUmc and dpt. of Clinical Psychology, VU Faculty of Psychology and Education.
Prof  W.J.M.J. Cuijpers, PhD, Psychologist, dpt. of Clinical Psychology, VU Faculty of Psychology and Education.
A. van Straten, PhD, Psychologist, Epidemiologist, dpt. of Clinical Psychology, VU Faculty of Psychology and Education.

L. Buffart, PhD, human movement scientist, EMGO+

Prof C.R. Leemans, PhD MD, Head & Neck Surgeon, ENT-specialist, dpt. of Otolaryngology-Head & Neck Surgery, VUmc.

For questions, please contact:
Anne-Marie Krebber, MD, Physician
Email: a.krebber@vumc.nl
Phone: + 31( 0)20-4445395

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News flashes


Treatment of psychological distress in patients with head and neck or lung cancer cost-effective.
A recent study of PhD-student Femke Jansen and colleagues, recently published in the Journal of Clinical Oncology


PhD thesis Nadine Köhle

December 15, 2016 Nadine Köhle defended her PhD thesis "Hold on, for each other. Supporting partners of cancer patients via eHealth and positive psychology". 


PhD thesis Anne-Marie Krebber

December 2, 2016 Anne-Marie Krebber defended her PhD thesis "Stepped care targeting psychological distress in head and neck cancer and lung cancer patients".


PhD thesis Nadia van der Spek

September 7, 2016, Nadia van der Spek defended her PhD thesis "Meaning-centered group psychotherapy for cancer survivors: development, efficacy, and cost-utility". 


EORTC QLG Newsletter Spring 2016
The EORTC QLG  Spring Meeting took place on April 20th and 21th 2016 in Oslo. The Spring newsletter of the EORTC QLG is now available. 

PhD thesis Ingrid Cnossen

April 12, 2016, Ingrid Cnossen defended her PhD thesis entiteld “Self-management Supporting Rehabilitation in Head and Neck Cancer Patients”. 


VU/VUmc and Red-kite sign agreement for the provision of the Oncokompas in healthcare.

The VU University Amsterdam and VUmc Cancer Center Amsterdam work with Red-kite, distributor of software for hospitals in Netherlands. (November 3, 2015)


PhD thesis Christine van Gogh

December 4, 2015, Christine van Gogh defended her PhD thesis entiteld “Functional outcome of early glottic cancer”. 

Book presentation

On June 15th, 2015, Irma Verdonck presented the book "In Tune Without Cords" (in Dutch: VerderZonderStembanden) to Rob Burdorf, the president of the patient society for patients after laryngectomy.


PhD thesis Florien Boele

May 11 Florien Boele defended her PhD thesis, entitled "Towards improving health-related quality of life in glioma patients and their informal caregvers".


PhD thesis Trille Kristina Kjaer

May 8, Trille Kjaer will defend her PhD thesis entitled "Late effects after treatment of head and neck cancer and use of patient reported outcomes in clinical practice." Irma Verdonck is member of the committee.


Niels Stensen Fellowship
Florien Boele has received a Niels Stensen Fellowship. This is a scholarship that is awarded annually to a number of outstanding researchers who have recently obtained their PhD degree, to gain working experience abroad. Florien Boele will go to Pittsburgh (United States) and Edinburgh (Scotland) in 2015 and 2016.

Key paper

The publication “Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments” of A.M.H. Krebber et.al is chosen by the Editors as one of the key papers in Psycho-oncology, (issue June 2014).


On April 10th, 2014, the first edition of the Value Based Healthcare Prize took place. The prize for the most exceptional initiative in collaborations went to Jippa, a collaborative by VUmc, CZ, Radboud UMC and Tilburg University.


In November 2013 the NVPO organised the International Congress "Innovation in Psycho-Oncology". The researchgroup held several presentations and posters.


Interested in oncological care chain? Come 2 October 2013 to the 3rd MuON symposium in hospital Gelderse Vallei. Keynote speaker Michel van Schaik (Director Rabobank) about Innovation in the care!


12 april 2013: KWF Kankerbestrijding / Alpe d’HuZes has granted the research proposal Netherlands Quality of life and Biomedical Cohort Studies in Cancer (NET-QUBIC).

Marieke de Bruijn will defend her PhD thesis on 10 juni 2013 at 15.45 pm.

Support our bicycle team for Alpe d'HuZes 2013!

On 6 June 2013 our team living together with cancer will cycle the Alpe d'HuZes! This in the fight against cancer. At this moment there is already more than 1500 euro donated. Do you support us too?


The 15th World Congress of Psycho-Oncology and Psychosocial Academy will be held in Rotterdam, 4-8 November 2013. www.ipos-society.org/ipos2013/.


29 January 2013. Pink Ribbon has granted a project to develop and evaluate an online training for cancer patients with insomnia (Annemieke van Straten), and a project to develop and evaluate a breast cancer module for the OncoKompas (Nelly van Uden).


Charity Symposium "Living with cancer"

On December 19, 2012 there will be a Symposium ''Living with Cancer''. This is a charity symposium on meaning centered psychotherapy for cancer patients. Read more about it at the tab News at the left.


15 November 2012: Hoe?Zo! Radio interview with Irma Verdonck on stress and cancer.


October 2012: Interview with Irma Verdonck in Psychologie Magazine.


September 9, 2012. Interview Hans van Willigenburg with Irma Verdonck on Radio 5.


August 2012. Five students finish their MSc thesis and graduate as MSc in Clinical PSychology.


June 28-30, 2012: International symposium on Supportive Care in Cancer (MASCC ISOO) at New York. Kevin Yap and Irma Verdonck organise a workshop on e-health and supportive care.


Record for Alpe d'HuZes 2012. The sponsor action Alpe d'HuZes (6 and 7 June) 2012 has already yielded the record amount of 28.5 million euros.


June 6-8, 2012: Our research group contributes to Alpe d'HuZes as volunteers.


April 20, 2012: Nelly van Uden will give a presentation about OncoKompas at a conference about  ICT in health care in Barcelona.


March 16, 2012: NVPO congress in Utrecht, we contribute with 2 oral and 2 poster presentations and a workshop.


January 1, 2012: The project POLARIS project has officially started.


December 22, 2011: Radio program DeGids.fm, Felix Meurders interviews Corien Eeltink on sexuality and cancer. 


November 2, 2011: KWF / Alpe d'HuZes funds a grant for the development and evaluation of an online intervention for informal caregivers of cancer patients.


October 30, 2011 In the national television program "Gesprek op 2", Daphne Bunskoek interviewed Irma Verdonck on living with cancer.


October 28, 2011: www.oncokompas.nl is online!


October 23, 2011: Alpe d'HuZes hands over more than 20 million euros to the Dutch Cancer Society!



Team work

Our research projects are embedded in the two largest research institutes of VU University in Amsterdam: VUmc CCA-VICI (Cancer Center Amsterdam) www.vumc.nl/afdelingen/CCA-V-ICI/ and EMGO+ (Institute for Health and Care Research emgo.nl

We work closely with patients and their caregivers and with researchers and physicians at VU University and VU University Medical Center in Amsterdam and other research institutes and hospitals in the Netherlands and worldwide. Team work is crucial  improving research and translating results into clinical practice.

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