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In search of the sixth vital sign: cancer care in Romania



Romania still has to adapt and develop psychosocial assessment protocols which would allow standardized screening for the sixth vital sign in cancer patients, namely distress and quality of life. The present study screens for the psychosocial and communication needs of cancer outpatients in palliative care and in rehabilitation. These data are also compared with those obtained from a sample of cancer inpatients.


Subjects for this study were recruited from cancer care services from the Transylvania region in Romania. A total of 203 persons with cancer were included in the screening. Of this number, 68 were in the hospitalized group, 71 were from the rehabilitation group, and 64 were palliative care cases. FACT-G 4.0 and BDI screening instruments were used in these clinical samples. Statistical analysis performed was: associational and comparative statistics, one-way analysis of variance.


Statistically and clinically significant results were found in relation to symptoms of depression, physical and functional well-being, and overall quality of life. However, with regard to psychosocial well-being, there were no clinically relevant or significant differences among cancer patients under hospital treatment, or in rehabilitation and palliative care programs. More than 40 % of the cancer patients included in our pilot screening were not open to talk about their illness and their related needs.


Cancer is an unmet psychosocial challenge to patients and to the specialized services, regardless of care type. The urgency of psychosocial screening in the Romanian cancer care system is revealed. Based on these findings, there is a need for psychosocial screening and related supportive care services that need to be integrated into Romania’s cancer care programs. A recommendation is to pilot psychosocial and supportive care model within the four regional cancer care institutions.

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The author would like to express his greatest gratitude to Arthur Sárosi, Brigitte Mild, Stella Hanusz, and Júlia Vágási for their assistance in screening cancer patients. This work was supported by a grant of the Romanian National Authority for Scientific Research, CNCS – UEFISCDI, project number PN-II-RU-TE-2012-3-0011.

Conflict of interest

The author has no conflicts of interest to declare. The author has full control of all primary data and thereby he agrees to allow the journal to review data if requested.

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Correspondence to Csaba L. Dégi.

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Dégi, C.L. In search of the sixth vital sign: cancer care in Romania. Support Care Cancer 21, 1273–1280 (2013).

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  • Distress
  • Quality of life
  • Cancer care
  • Romania