Klett-Cotta-Verlag Psychology
Wissenschaft

Traumatische Erfahrungen und Posttraumatische Belastungsstörungen im Rahmen von Krebserkrankungen

Eine kritische Übersicht


November 2017, 11. Jahrgang, Heft 4, pp 294-306

DOI 10.21706/tg-11-4-294



Zusammenfassung
Die Diagnose Krebs und viele der damit verbundenen Ereignisse stellen für die meisten onkologischen Patienten eine enorme psychische Belastung dar. Im DSM-IV wurden erstmals auch lebensbedrohliche Erkrankungen als potentielle Traumata eingeführt. Diese Änderung des Trauma-Kriteriums führte zu einem eigenen Forschungszweig der Psychoonkologie, der sich mit der traumatischen Wirkung bzw. Entstehung einer PTBS im Zuge einer Krebserkrankung beschäftigt. Wenngleich die negativen Auswirkungen von PTBS bei somatischen Patienten unbestritten sind, besteht nach wie vor große Uneinigkeit darüber, ob und inwiefern das allgemeine PTBS-Konzept auf das onkologische Setting übertragen werden kann und sollte. Der folgende Artikel will daher einen Überblick zum aktuellen Forschungsstand von krebsbezogener PTBS vermitteln. Dabei sollen auch die konzeptuellen Kontroversen, damit verbundene klinische und wissenschaftliche Herausforderungen sowie aktuelle Entwicklungen im Zuge der Einführung des DSM-5 sowie der bald erscheinenden ICD-11 vorgestellt und diskutiert werden.

Abstract
Traumatic events und Posttraumatic Stress Disorder in the course of cancer – a critical review
Cancer and many of the events going along with that constitute an enormous psychological strain for the majority of oncological patients. With the DSM-IV, life threatening illnesses were introduced as potentially traumatic events. This modification of the trauma criterium lead to a new branch of psycho-oncological research investigating severe stress responses including the development of PTSD in the course of cancer and its treatment. Even though research has demonstrated the detrimental impact of PTSD on somatic patients, the concept of cancer-related PTSD has always been controversially discussed. This article aims to provide a summary of previous research. It will also focus on the conceptual peculiarities of the concept in oncological settings, the clinical and scientific challenges, and the future developments which may arise from the introduction of the DSM-5 and the upcoming ICD-11.

mots-clés
mots-clés non définis
  1. Aaronson, N. K., Mattioli, V., Minton, O., Weis, J., Johansen, C., Dalton, S. O., Verdonck-de Leeuw, I. M., Stein, K. D. et al. (2014). Beyond treatment – Psychosocial and behavioural issues in cancer survivorship research and practice. EJC Suppl, 12(1), 54 – 64. DOI 10.1016/j.ejcsup.2014.03.005.
  2. Abbey, G., Thompson, S. B. N., Hickish, T. & Heathcote, D. (2015). A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder. Psychooncology, 24(4), 371 – 381.  DOI 10.1002/pon.3654 .
  3. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed, text revision). Washington, DC: Autor.
  4. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed). Washington, DC: Autor.  DOI 10.1176/appi.books.9780890425596 .
  5. Andersen, B. L., DeRubeis, R. J., Berman, B. S., Gruman, J., Champion, V. L., Massie, M. J., Holland, J. C., Partridge, A. H. et al. (2014). Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol, 32(15), 1605 – 1619.  DOI 10.1200/JCO.2013.52.4611 .
  6. Andersen, B. L., Shapiro, C. L., Farrar, W. B., Crespin, T. & Wells-Digregorio, S. (2005). Psychological responses to cancer recurrence. Cancer, 104(7), 1540 – 1547.  DOI 10.1002/cncr.21309 .
  7. Andrykowski, M. A., Cordova, M. J., Mcgrath, P. C., Sloan, D. A. & Kenady, D. E. (2000). Stability and change in posttraumatic stress disorder symptoms following breast cancer treatment: a 1-year follow-up. Psychooncology, 9(1), 69 – 78.  DOI 10.1002/(SICI)1099-1611(200001/02)9:1<69::AID-PON439>3.0.CO;2-R .
  8. Angelis, R. de, Sant, M., Coleman, M. P., Francisci, S., Baili, P., Pierannunzio, D., Trama, A., Visser, O. et al. (2014). Cancer survival in Europe 1999 – 2007 by country and age. Results of EUROCARE-5 – a population-based study. Lancet Oncol, 15(1), 23 – 34.  DOI 10.1016/S1470-2045(13)70546-1 .
  9. Antoni, M. (2006). Reduction of Cancer-Specific Thought Intrusions and Anxiety Symptoms With a Stress Management Intervention Among Women Undergoing Treatment for Breast Cancer. Am J Psychiatry, 163(10), 1791.  DOI 10.1176/ajp.2006.163.10.1791 .
  10. Beijnen, J. H. & Schellens, J. H. M. (2004). Drug interactions in oncology. Lancet Oncol, 5(8), 489 – 496.  DOI 10.1016/S1470-2045(04)01528-1 .
  11. Black, E. K. & White, C. A. (2005). Fear of recurrence, sense of coherence and posttraumatic stress disorder in haematological cancer survivors. Psychooncology, 14(6), 510 – 515.  DOI 10.1002/pon.894 .
  12. Breslau, N. (2009). The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Violence Abuse, 10(3), 198 – 210.  DOI 10.1177/1524838009334448 .
  13. Brewin, C. R. (2005). Systematic review of screening instruments for adults at risk of PTSD. J Trauma Stress, 18(1), 53 – 62.  DOI 10.1002/jts.20007 .
  14. Brewin, C. R., Andrews, B. & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol, 68(5), 748 – 766.  DOI 10.1037/0022-006X.68.5.748 .
  15. Bruce, M. (2006). A systematic and conceptual review of posttraumatic stress in childhood cancer survivors and their parents. Clin Psychol Rev, 26(3), 233 – 256.  DOI 10.1016/j.cpr.2005.10.002 .
  16. Bryant, R. A. (2011). Acute stress disorder as a predictor of posttraumatic stress disorder: a systematic review. J Clin Psychiatry, 72(2), 233 – 239.  DOI 10.4088/JCP.09r05072blu .
  17. Bultz, B. D. & Johansen, C. (2011). Screening for distress, the 6th vital sign: where are we, and where are we going? Psychooncology, 20(6), 569 – 571.  DOI 10.1002/pon.1986 .
  18. Classen, C., Butler, L. D., Koopman, C., Miller, E., DiMiceli, S., Giese-Davis, J., Fobair, P., Carlson, R. W. et al. (2001). Supportive-Expressive Group Therapy and Distress in Patients With Metastatic Breast Cancer. Arch Gen Psychiatry, 58(5), 494.  DOI 10.1001/archpsyc.58.5.494 .
  19. Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., Feltner, C., Brownley, K. A. et al. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clin Psychol Rev, 43, 128 – 141.  DOI 10.1016/j.cpr.2015.10.003 .
  20. Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF (2014). Psychoonkologische Diagnostik, Beratung und Behandlung von erwachsenen Krebspatienten, Langversion 1.1. AWMF-Registernummer: 032/051OL (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF [Leitlinienprogramm Onkologie], Hrsg.). Zugriff am 03. 07. 2017. Verfügbar unter http://www.awmf.org/leitlinien/detail/ll/032-051OL.html
  21. DuHamel, K. N., Mosher, C. E., Winkel, G., Labay, L. E., Rini, C., Meschian, Y. M., Austin, J., Greene, P. B. et al. (2010). Randomized clinical trial of telephone-administered cognitive-behavioral therapy to reduce post-traumatic stress disorder and distress symptoms after hematopoietic stem-cell transplantation. J Clin Oncol, 28(23), 3754 – 3761.  DOI 10.1200/JCO.2009.26.8722 .
  22. DuHamel, K. N., Ostroff, J. S., Bovbjerg, D. H., Pfeffer, M., Morasco, B. J., Papadopoulos, E. & Redd, W. H. (2001). Trauma-focused intervention after bone marrow transplantation: A case study. Behav Ther, 31(1), 175 – 186.  DOI 10.1016/S0005-7894(00)80010-6 .
  23. Ehlers, A. & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behav Res Ther, 38(4), 319 – 345.  DOI 10.1016/S0005-7967(99)00123-0 .
  24. Epping-Jordan, J. E., Compas, B. E., Osowiecki, D. M., Oppedisano, G., Gerhardt, C., Primo, K. & Krag, D. N. (1999). Psychological adjustment in breast cancer: Processes of emotional distress. Health Psychol, 18, 315 – 326.  DOI 10.1037/0278-6133.18.4.315 .
  25. Esser, P., Kuba, K., Scherwath, A., Schirmer, L., Schulz-Kindermann, F., Dinkel, A., Balck, F., Koch, U. et al. (2017). Posttraumatic stress disorder symptomatology in the course of allogeneic HSCT: a prospective study. J Cancer Surviv, 11(2), 203 – 210.  DOI 10.1007/s11764-016-0579-7 .
  26. Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D. M., Forman, D. et al. (2015). Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 136(5), E359 – 86.  DOI 10.1002/ijc.29210 .
  27. Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F. & Orsillo, S. M. (1999). The posttraumatic cognitions inventory (PTCI): Development and validation. Psychological assessment, 11(3), 303.  DOI 10.1037/1040-3590.11.3.303 .
  28. Friedman, M. J. (2013). PTSD in the DSM-5: reply to Brewin (2013), Kilpatrick (2013), and Maercker and Perkonigg (2013). J Trauma Stress, 26(5), 567 – 569.  DOI 10.1002/jts.21847 .
  29. Glaesmer, H., Romppel, M., Brähler, E., Hinz, A. & Maercker, A. (2015). Adjustment disorder as proposed for ICD-11: Dimensionality and symptom differentiation. Psychiatry Res, 229(3), 940 – 948.  DOI 10.1016/j.psychres.2015.07.010 .
  30. Gondos, A., Bray, F., Brewster, D. H., Coebergh, J. W. W., Hakulinen, T., Janssen-Heijnen, M. L. G., Kurtinaitis, J. & Brenner, H. (2008). Recent trends in cancer survival across Europe between 2000 and 2004: a model-based period analysis from 12 cancer registries. Eur J Cancer, 44(10), 1463 – 1475.  DOI 10.1016/j.ejca.2008.03.010 .
  31. Green, B. L., Rowland, J. H., Krupnick, J. L., Epstein, S. A., Stockton, P., Stern, N. M., Spertus, I. L. & Steakley, C. (1998). Prevalence of Posttraumatic Stress Disorder in Women With Breast Cancer. Psychosomatics, 39(2), 102 – 111.  DOI 10.1016/S0033-3182(98)71356-8 .
  32. Greimel, E., Dorfer, M., Lambauer, M., Bjelic-Radisic, V., Gramm, S., Lahousen, M. & Lang, U. (2013). Posttraumatic stress disorder in female cancer patients: an inappropriate diagnosis in oncology? Psychother Psychosom, 82(4), 271 – 272.  DOI 10.1159/000348610 .
  33. Gurevich, M., Devins, G. M. & Rodin, G. M. (2002). Stress response syndromes and cancer: conceptual and assessment issues. Psychosomatics, 43(4), 259 – 281.  DOI 10.1176/appi.psy.43.4.259 .
  34. Hantman, S. & Solomon, Z. (2007). Recurrent trauma: Holocaust survivors cope with aging and cancer. Soc Psychiatry Psychiatr Epidemiol, 42(5), 396 – 402.  DOI 10.1007/s00127-007-0177-0 .
  35. Härter, M., Reuter, K., Aschenbrenner, A., Schretzmann, B., Marschner, N., Hasenburg, A. & Weis, J. (2001). Psychiatric disorders and associated factors in cancer: results of an interview study with patients in inpatient, rehabilitation and outpatient treatment. Eur J Cancer, 37(11), 1385 – 1393.  DOI 10.1016/S0959-8049(01)00136-8 .
  36. Herschbach, P. & Dinkel, A. (2014). Fear of progression. In: Psycho-Oncology 2014 (S. 11 – 29). Heidelberg: Springer.  DOI 10.1007/978-3-642-40187-9_2 .
  37. Hund, B., Reuter, K., Jacobi, F., Siegert, J., Wittchen, H.-U., Harter, M. & Mehnert, A. (2014). Adaptation des Composite International Diagnostic Interview (CIDI) zur Erfassung komorbider psychischer Störungen in der Onkologie: das CIDI-O. Psychother Psychosom Med Psychol, 64(3 – 4), 101 – 107.
  38. Jim, H. S. L. & Jacobsen, P. B. (2008). Posttraumatic stress and posttraumatic growth in cancer survivorship: a review. Cancer J, 14(6), 414 – 419.  DOI 10.1097/PPO.0b013e31818d8963 .
  39. Kangas, M. (2013). DSM-5 Trauma and Stress-Related Disorders: Implications for Screening for Cancer-Related Stress. Frontiers in Psychiatry, 4, 122.  DOI 10.3389/fpsyt.2013.00122 .
  40. Kangas, M., Henry, J. L. & Bryant, R. A. (2002). Posttraumatic stress disorder following cancer: A conceptual and empirical review. Clin Psychol Rev, 22(4), 499 – 524.  DOI 10.1016/S0272-7358(01)00118-0 .
  41. Kangas, M., Henry, J. L. & Bryant, R. A. (2005). The relationship between acute stress disorder and posttraumatic stress disorder following cancer. J Consult Clin Psychol, 73(2), 360 – 364.  DOI 10.1037/0022-006X.73.2.360 .
  42. Kapfhammer, H. P. (2014). Trauma- und stressorbezogene Storungen. Diagnostische Konzeptualisierung im DSM-5. Nervenarzt, 85(5), 553 – 563.  DOI 10.1007/s00115-013-3988-0 .
  43. Köllner, V. (2009). Posttraumatische Belastungsstörungen bei körperlichen Erkrankungen und medizinischen Eingriffen. In: Posttraumatische Belastungsstörungen (S. 415 – 426). Heidelberg: Springer.  DOI 10.1007/978-3-540-88489-7_23 .
  44. Kuhnt, S., Brähler, E., Faller, H., Harter, M., Keller, M., Schulz, H., Wegscheider, K., Weis, J. et al. (2016). Twelve-Month and Lifetime Prevalence of Mental Disorders in Cancer Patients. Psychother Psychosom, 85(5), 289 – 296.  DOI 10.1159/000446991 .
  45. Lee-Jones, C., Humphris, G., Dixon, R. & Bebbington Hatcher, M. (1997). Fear of cancer recurrence – a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psychooncology, 6(2), 95 – 105.  DOI 10.1002/(SICI)1099-1611(199706)6:2<95::AID-PON250>3.0.CO;2-B .
  46. Levin, A. P., Kleinmann, S. B. & Adler, J. S. (2014). DSM-5 and Posttraumatic Stress Disorder. J Am Acad Psychiatry Law, 146 – 158.
  47. Lorenz, L., Bachem, R. C. & Maercker, A. (2016). The Adjustment Disorder – New Module 20 as a Screening Instrument: Cluster Analysis and Cut-off Values. Int J Occup Med Environ Health, 7(4. Oktober), 775 – 215.
  48. Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., Reed, G. M., van Ommeren, M., Humayun, A., Jones, L. M. et al. (2013). Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet, 381(9878), 1683 – 1685.  DOI 10.1016/S0140-6736(12)62191-6 .
  49. Maercker, A., Einsle, F. & Köllner, V. (2007). Adjustment disorders as stress response syndromes: a new diagnostic concept and its exploration in a medical sample. Psychopathology, 40(3), 135 – 146.  DOI 10.1159/000099290 .
  50. McDonald, S. D. & Calhoun, P. S. (2010). The diagnostic accuracy of the PTSD checklist: a critical review. Clin Psychol Rev, 30(8), 976 – 987.  DOI 10.1016/j.cpr.2010.06.012 .
  51. Mehnert, A., Berg, P., Henrich, G. & Herschbach, P. (2009). Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors. Psychooncology, 18(12), 1273 – 1280.  DOI 10.1002/pon.1481 .
  52. Mehnert, A., Brähler, E., Faller, H., Harter, M., Keller, M., Schulz, H., Wegscheider, K., Weis, J. et al. (2014). Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol, 32(31), 3540 – 3546.  DOI 10.1200/JCO.2014.56.0086 .
  53. Mehnert, A. & Koch, U. (2007). Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study. Psychooncology, 16(3), 181 – 188.  DOI 10.1002/pon.1057 .
  54. Mehnert, A., Lehmann, C., Graefen, M., Huland, H. & Koch, U. (2010). Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients. Eur J Cancer Care, 19(6), 736 – 745.  DOI 10.1111/j.1365-2354.2009.01117.x .
  55. Miovic, M. & Block, S. (2007). Psychiatric disorders in advanced cancer. Cancer, 110(8), 1665 – 1676.  DOI 10.1002/cncr.22980 .
  56. Mosher, C. E., Redd, W. H., Rini, C. M., Burkhalter, J. E. & DuHamel, K. N. (2009). Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psychooncology, 18(2), 113 – 127.  DOI 10.1002/pon.1399 .
  57. O’Connor, M., Christensen, S., Jensen, A. B., Moller, S. & Zachariae, R. (2011). How traumatic is breast cancer? Post-traumatic stress symptoms (PTSS) and risk factors for severe PTSS at 3 and 15 months after surgery in a nationwide cohort of Danish women treated for primary breast cancer. Br J Cancer, 104(3), 419 – 426.  DOI 10.1038/sj.bjc.6606073 .
  58. Ouimette, P., Wade, M., Prins, A. & Schohn, M. (2008). Identifying PTSD in primary care: comparison of the Primary Care-PTSD screen (PC-PTSD) and the General Health Questionnaire-12 (GHQ). J Anxiety Disord, 22(2), 337 – 343.  DOI 10.1016/j.janxdis.2007.02.010 .
  59. Riechelmann, R. P., Tannock, I. F., Wang, L., Saad, E. D., Taback, N. A. & Krzyzanowska, M. K. (2007). Potential drug interactions and duplicate prescriptions among cancer patients. J Natl Cancer Inst, 99(8), 592 – 600.  DOI 10.1093/jnci/djk130 .
  60. Robert Koch-Institut (2016). Bericht zum Krebsgeschehen in Deutschland 2016. Zugriff am 18. 05. 2017. Verfügbar unter http://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebsgeschehen/Krebsgeschehen_download.pdf?__blob= publicationFile
  61. Rothenhäusler, H.-B. & Kapfhammer, H.-P. (2006). Posttraumatische Belastungssymptome als Folge schwerer körperlicher Erkrankungen – eine zunehmend relevantere konsiliarpsychiatrische Herausforderung. Psychiatrie und Psychotherapie, 2(1), 15 – 22.  DOI 10.1007/s11326-006-0014-1 .
  62. Rustad, J. K., David, D. & Currier, M. B. (2012). Cancer and post-traumatic stress disorder: diagnosis, pathogenesis and treatment considerations. Palliat Support Care, 10(3), 213 – 223.  DOI 10.1017/S1478951511000897 .
  63. Shelby, R. A., Golden-Kreutz, D. M. & Andersen, B. L. (2008). PTSD diagnoses, subsyndromal symptoms, and comorbidities contribute to impairments for breast cancer survivors. J Trauma Stress, 21(2), 165 – 172.  DOI 10.1002/jts.20316 .
  64. Siegel, R., DeSantis, C., Virgo, K., Stein, K., Mariotto, A., Smith, T., Cooper, D., Gansler, T. et al. (2012). Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin, 62(4), 220 – 241.  DOI 10.3322/caac.21149 .
  65. Smith, M. Y., Redd, W. H., Peyser, C. & Vogl, D. (1999). Post-traumatic stress disorder in cancer: a review. Psychooncology, 8(6), 521 – 537.  DOI 10.1002/(SICI)1099-1611(199911/12)8:6<521::AID-PON423>3.0.CO;2-X .
  66. Stark, D., Kiely, M., Smith, A., Velikova, G., House, A. & Selby, P. (2002). Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol, 20(14), 3137 – 3148.  DOI 10.1200/JCO.2002.08.549 .
  67. Stein, K. D., Syrjala, K. L. & Andrykowski, M. A. (2008). Physical and psychological long-term and late effects of cancer. Cancer, 112(11 Suppl), 2577 – 2592.  DOI 10.1002/cncr.23448 .
  68. Tedeschi, R. G. & Calhoun, L. G. (2004). »Posttraumatic growth: Conceptual foundations and empirical evidence«. Psychol Inq, 15(1), 1 – 18.  DOI 10.1207/s15327965pli1501_01 .
  69. Tedstone, J. E. & Tarrier, N. (2003). Posttraumatic stress disorder following medical illness and treatment. Clin Psychol Rev, 23(3), 409 – 448.  DOI 10.1016/S0272-7358(03)00031-X .
  70. Tjemsland, L., Søreide, J. A. & Malt, U. F. (1998). Posttraumatic distress symptoms in operable breast cancer III. Breast Cancer Res Treat, 47(2), 141 – 151.  DOI 10.1023/A:1005957302990 .
  71. Ursano, R. J., Bell, C. C., Eth, S., Friedman, M. J., Norwood, A. E. & Pfefferbaum, B. (2004). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Am J Psychiatry, 161(11 Suppl), 3 – 31.
  72. Verdecchia, A., Francisci, S., Brenner, H., Gatta, G., Micheli, A., Mangone, L. & Kunkler, I. (2007). Recent cancer survival in Europe: a 2000 – 02 period analysis of EUROCARE-4 data. Lancet Oncol, 8(9), 784 – 796.  DOI 10.1016/S1470-2045(07)70246-2 .
  73. Voigt, V., Neufeld, F., Kaste, J., Buhner, M., Sckopke, P., Wuerstlein, R., Hellerhoff, K., Sztrokay-Gaul, A. et al. (2017). Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study. Psychooncology, 26(1), 74 – 80.  DOI 10.1002/pon.4102 .
  74. Wachen, J. S., Patidar, S. M., Mulligan, E. A., Naik, A. D. & Moye, J. (2014). Cancer-related PTSD symptoms in a veteran sample: association with age, combat PTSD, and quality of life. Psychooncology, 23(8), 921 – 927.  DOI 10.1002/pon.3494 .
  75. World Health Organization (2004). Global Burden of Disease: 2004 update. Genf: WHO Press.
  76. Yap, K. Y.-L., Tay, W. L., Chui, W. K. & Chan, A. (2011). Clinically relevant drug interactions between anticancer drugs and psychotropic agents. Eur J Cancer Care, 20(1), 6 – 32.  DOI 10.1111/j.1365-2354.2009.01113.x .


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