Dr. Claudia Plenge is an experienced specialist in psychosomatic medicine and psychotherapy with particular expertise in the field of psycho-oncology. As medical director of the CuraMed-Akutklinik Allgäu, she brings not only in-depth specialist knowledge but also a deep understanding of her patients' needs to the treatment. The clinic, which opened in 2022 in the idyllic surroundings of the Allgäu region of Württemberg, offers a modern yet comfortable environment that is specifically designed to support the healing process.
Under the direction of Dr. Plenge, the CuraMed Akutklinik Allgäu has established a broad range of treatments covering mental and psychosomatic illnesses such as depression, burnout, post-traumatic stress disorder, chronic pain and many others. One of Dr. Plenge's particular concerns is psycho-oncology, a new focus area of the clinic since April 2024, where patients who are confronted with the mental challenges of cancer receive comprehensive care. Dr. Plenge focuses on individually tailored therapeutic approaches, which can include individual and group psychotherapy sessions as well as innovative methods such as mindfulness-based therapies, therapeutic archery, therapeutic boxing and animal-assisted interventions.
The holistic approach of Dr. Plenge and her team is based on a bio-psycho-social model. Not only the physical, but also the mental and social health of the patient is taken into account. Dr. Claudia Plenge is distinguished not only by her professional expertise, but also by her empathetic and patient-centred approach. With her commitment to innovative therapy concepts and her tireless dedication to the recovery of her patients, she has had a decisive influence on the CuraMed Akutklinik Allgäu and sets standards in psychosomatic and psycho-oncological care.
The editors of the Leading Medicine Guide were able to speak to Dr. Claudia Plenge and learn more about the psycho-oncological services at the CuraMed acute clinic in the Allgäu and how important they are for patients.
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Psychosomatic correlations play a central role in the interaction between the mental and physical health of cancer patients. Cancer is not only a physical but also an immense emotional burden. Stress, anxiety, grief and other intense feelings triggered by a cancer diagnosis can weaken the immune system and negatively impact the healing process. At the same time, physical symptoms such as pain, fatigue or side effects of cancer therapy can severely affect mental health and increase the risk of depression or anxiety disorders. Psychotherapy offers valuable support in this complex interplay.
“In principle, there are psychosomatic correlations in all illnesses, which we here at the CuraMed acute clinic naturally see specifically in the field of psychosomatics, which is not the case in all areas of somatic illnesses. This is also the reason why the specialization as a specialist in psychosomatics has not been around for long. The psychological and somatic areas have been considered separately for far too long. This is becoming increasingly important for oncology patients. In the past, cancer diagnoses, for example, were usually fatal, but today many cancers are chronic diseases. Thanks to improved diagnostics, even very small tumors and markers can now be detected. There are also better therapeutic approaches, longer survival times and better prognoses. Patients who are diagnosed with prostate cancer at the age of 65, for example, are operated on and then receive hormone therapy, which means they can live to be over 80,” explains Dr. Plenge at the beginning of our conversation and adds:
“Cancer patients today need completely different care. After all, the diagnosis is first and foremost about survival, but the soul always lags behind despite all treatments. This is because both a cancer diagnosis and the treatment have a profound psychological effect on well-being. Almost all patients have great fears of a recurrence, which exist from the beginning but often even years after the initial diagnosis. From a purely somatic point of view, patients are cured, but are still psychologically overwhelmed by the entire disease and treatment. Although more and more tumor centers have a psycho-oncological service, at the time of acute therapy with surgery, radiation and chemotherapy, patients are not yet open to it because they are still struggling with survival, the necessary interventions and anesthesia as well as the possible side effects of medication. In recent years, it has been increasingly recognized that psycho-oncological care is necessary far beyond the time of acute diagnosis and therapy. Basic psychosomatic knowledge is particularly important in the specialist fields of gynaecology, oncology and general medicine, so that participation in a course in “Psychosomatic Basic Care” has fortunately also been included in the catalog of these specialist training courses”.
The recommendation for the respective therapy after a cancer diagnosis must be discussed individually with the patient.
“This is usually easier in the context of a GP diagnosis because the doctor and patient often know each other well. Ultimately, it is important that the patient decides how to proceed with the treatment. This makes them the experts on their illness and prevents them from experiencing a feeling of being at the mercy of others and helplessness. After all, it is not just about the body, but also about the patient's soul. In addition, there are social issues regarding the ability to work, employability, financial security, etc., which are unfortunately all too often given too little attention, so that patients receive too little support with these issues. The be-all and end-all of psycho-oncology is not to prevent cancer and cure cancer, but to maintain or improve quality of life. Resources must also be considered here: What can be expanded? Who can be involved in restoring quality of life? All of this contributes to coping with the disease. This includes providing the patient with sufficient information in the form of psychoeducation and developing an acceptance of the situation without remaining in fear. Because a cancer patient will always remain a cancer patient, even if they are cured, as they have a different risk profile than a person without cancer in their biography due to the diagnosis and the treatments they have undergone,” explains Dr. Plenge.
Psycho-oncology therapists face diverse and complex challenges that differ depending on the phase of the cancer. Each phase brings with it specific emotional, cognitive and social burdens that need to be addressed individually.
Many patients are confronted with intense fears, existential questions and a sudden confrontation with their own mortality. The therapist's task is to create space for these feelings, validate them and help the patient process the diagnosis without becoming overwhelmed. “Every patient reacts differently. There is anger, there are tears and fear. That's perfectly all right, because everyone unconsciously chooses their own personal coping strategy based on their previous experiences, and you have to let the patient do that. The task of the psycho-oncologist is then to keep at it. The patient determines the course, the duration, the frequency, the topics, and our task is to keep making an offer and signaling availability, even if this is repeatedly rejected by the patient. It is then good to involve the relatives in the process, of course in the way the patient wants. It is always important not to trivialize or 'catastrophize' fears, but to always make a realistic check, explain the medical part in an understandable way and give the patient the feeling that they are in control. Even if the patient decides against a perhaps promising therapy and the family is against it - the patient decides what to do and what not to do,” comments Dr. Plenge at this point.
During treatment, the focus can be on helping patients to cope with physical stresses such as pain or side effects of the therapy, as well as dealing with the loss of control that many patients feel. At the same time, conflicts between personal life goals and the restrictions imposed by the disease often need to be addressed. In the aftercare phase, when active treatment is complete, feelings of emptiness, uncertainty about the future and fears of relapse often arise. Patients often expect a return to normality, which can be complicated by physical or emotional late effects. Here, therapists must accompany the transition to a 'new normal' and help patients to accept the permanent presence of the illness in their lives. “In such a phase, a patient often suddenly feels the need to talk about grief and death. Here, you have to be there for the patient and also be open to possible spiritual aspects,” emphasizes Dr. Plenge, describing the entire therapy process at the CuraMed acute clinic:
“I usually look after patients in the CuraMed acute clinic for a period of six to eight weeks. Unfortunately, the way things are organized these days means that patients are always required to stay in hospital for as short a time as possible. As a result, a large proportion of the necessary psycho-oncological care is not available due to the catastrophic outpatient care. For patients with private or statutory insurance, however, a so-called F diagnosis (psychological diagnosis) is usually required in order to receive approval for outpatient and/or inpatient psychotherapeutic treatment, with breast cancer being the only exception. Here at the CuraMed Akutklinik Allgäu, we do not offer oncological rehabilitation as is usually the case after cancer treatment. My aim is not to make people fit for work again, which is the goal of rehabilitation, but to help patients regain their courage, zest for life and will to live. The stay in my clinic is an acute inpatient stay in a psychosomatic-psychooncological setting. In principle, it is good if patients are not simply sent home from an acute situation - also because there is usually a major deficit in somatic and physical abilities. It therefore makes sense for them to have a transition to help them. In 'normal' rehabilitation, however, patients are usually discharged in three to four weeks. During this time, the patient experiences all stages of cancer through contact with other patients, hears about recurrences, sees patients with hair loss due to chemotherapy, etc., which is very stressful. It is therefore quite understandable if patients do not want to do this to themselves and prefer to go home, to their safe space, to avoid these confrontations,” Dr. Plenge explains.
Challenges of psycho-oncological care and rehabilitation for cancer patients.
“A maximum of eight out of a total of 37 patients can take part in the psycho-oncological therapy that we offer in-house. This is because we do not 'sort out' these patients as cancer patients, but fully integrate them into the routine of all other patients. They take part in all therapies with the other patients. In addition, they receive individual psychological-oncological therapies and also group therapy together with the other cancer patients, as the exchange between those affected is very important. During these six to eight weeks, I am not only available to the patients as a psychotherapist, but also as a doctor. This is because many patients largely don't understand the doctor's letters they receive and sometimes don't even know their exact state of health. An important part of psycho-oncological therapy is always dealing with anxiety, which is trained with behavioral therapy, among other things. This also deals with issues relating to possible physical impairments, the possible loss of sexuality, social contacts and self-esteem. If a patient already has a pre-existing condition and is therefore psychologically vulnerable, perhaps already suffering from depression or an anxiety disorder, then the treatment spectrum naturally expands. This patient may also need medication support or trauma therapy,” Dr. Plenge explains.
The “F” in an F diagnosis comes from the ICD-10, the international classification of diseases. It stands for mental and behavioral disorders. Each illness in this area is given a specific number, e.g. F32 for depression. In medicine, different letters are used to classify groups of illnesses - “F” denotes mental illnesses.
In psycho-oncology, the connection between emotional well-being and the course of the disease is being intensively researched and used therapeutically. Numerous studies show that emotional states such as chronic stress, anxiety or depression can have a negative impact on the course of cancer.
“When it comes to the possible development of depression, I first need to review the patient's file to check whether it is a reactive depression as a result of a cancer diagnosis or whether the depression already existed before the diagnosis. I then take a classic medical history of the patient, a somatic history, a psychological history and a medication history. I can then form a picture from the information obtained. Sometimes cancer can cause something that the patient has already experienced, and as a trained depth psychologist I would then start here. Medically necessary examinations can also bring back unprocessed negative experiences and lead to initially incomprehensibly violent reactions. However, a depth psychology approach can bring out such unprocessed traumas, which can then be treated,” explains Dr. Plenge.
Family members often play an important role as primary supporters of the patient, but they themselves are also confronted with the emotional challenges of cancer. In such cases, therapy offers support not only to the patient, but also to the family members, as they learn to better deal with their own fears and worries and to support the patient in a healthy way.
“Of course, it's often the case that relatives or partners suffer a great deal. It is very important to be able to offer to help at all. In principle, family members and the patient's social contacts have an important role to play. This can go in two opposite directions. On the one hand, they can be stabilizing because they treat the patient with great understanding and offer help, but they can also be a burden for the patient if, for example, they are blamed by those around them or put under pressure with regard to the therapy. In both cases, it makes sense to involve relatives in the therapy with the patient's consent. Here it is often helpful to form groups of relatives in order to communicate approaches on how best to deal with the cancer patient. You must not forget that the entire family structure can be affected. For example, if there are small children at home but the mother is ill, then the father is alone with everything, possibly overwhelmed and needs help. Sometimes it is “simply” a matter of organizing social services or household help. The children also have questions, which I answer with a lot of openness and transparency, but in an age-appropriate way, or I call in a child psychologist. A partner must also be made aware that in the event of such an illness, medium and long-term thinking is required, including purely financially. It's not something that's over after a few weeks,” says Dr. Plenge about the family situation.
Mindfulness and promoting resilience are key elements in psycho-oncology, as they help cancer patients to deal with the psychological and emotional stress of the disease and to cope better with the challenges during the course of the illness.
Both approaches play an important role in supporting mental health and help to stabilize patients' emotional well-being, which can have a positive impact on the overall healing process. Mindfulness, understood as the ability to experience the moment without judgment and with full attention, is used in psycho-oncology to help patients regulate their thoughts and emotions. This practice helps to recognize and embrace negative thought patterns and fears that are often associated with cancer, rather than suppressing them or letting them overwhelm you.
“There are different pillars of therapy. Firstly, there is talk therapy, whether individually or in group work, on topics that affect everyone. Then there are the specific psycho-oncological topics that are addressed individually. This is all part of psychoeducation, because many patients are not familiar with many things from a purely medical point of view and are often afraid to ask questions. It is also important to share experiences with other patients, because they realize that others are not alone with their thoughts and problems. Patients often learn from each other - that's learning from a model - and see whether what another patient has done is also an option. Here at the CuraMed acute clinic, I have open groups and no disorder-specific groups. In this way, patients also experience that other patients leave therapy after six weeks very strengthened. A major effective factor here at the clinic is the distance from home in order to internalize a different perspective. In addition to the basic talking therapies, we offer dance/body therapy, which primarily helps patients who have lost confidence in their body or access to their body and feelings such as joy. Our creative/art therapy stimulates patients' intuition and creativity for things that cannot be said but need space. Emotion-focused and experience-oriented therapies are about accessing one's own resources. For example, therapeutic climbing on our clinic's own climbing wall is also about regaining confidence in oneself, in one's own body and in other people. Patients have the opportunity to find out how they can still climb the climbing wall with a reduced level of strength. It's all about learning how to dose strength and use it sensibly,” explains Dr. Plenge and continues:
“A clear daily structure is important. That's why there is a program before breakfast to motivate us for the day. Of course, it's also about physical fitness and the musculoskeletal system, but also about getting in touch with yourself in order to train body awareness. This is important because there are patients who no longer feel anything apart from pain. Our meditation, yoga and qi gong classes also help here. In addition, we train our patients to enjoy food and therefore have a very high-quality kitchen to show them that eating can be fun again and is not just for nourishment. All of this also serves to strengthen resilience, which can be regained and also strengthened. It is important for patients to get out of the passive and possibly victim role. The question here should not be “Why me?”, but “What now?”. This self-efficacy must be trained in order to regain a positive attitude to life, which may not prevent recurrence but can improve quality of life. It is therefore very important that psycho-oncology is integrated even more into the tumor boards of hospitals and that its importance in oncology is expanded. In turn, a larger medical component should be integrated into psycho-oncology training, and a better exchange between oncologists and psychologists would be important. Above all, however, I would like to see an expansion of psycho-oncological services in outpatient treatment and a greater willingness on the part of health insurance companies to pay for them. After all, a good service can ultimately prevent patients from falling so low psychologically. Many patients can be helped much earlier”. We conclude our discussion with this appeal.
Thank you very much, Dr. Plenge, for this empathetic insight into the important and necessary work of psycho-oncology!
