Passik S D, Kirsh K L, Rosenfeld B, McDonald M V, Theobald D E
Oncology Symptom Control Research, Indianapolis, IN 46202, USA.
J Pain Symptom Manage. 2001 Feb;21(2):113-20. doi: 10.1016/s0885-3924(00)00249-9.
The side effects of chemotherapy are feared by cancer patients as they begin their treatment. In this study, we investigated patients' anticipatory fears about chemotherapy. We then re-assessed these fears three to six months after the initial interview for patients who received chemotherapy during that time. We also examined symptom distress at these intervals. Hair loss, vomiting, infection, nausea, and weight loss were ranked as the most feared side effects of cancer treatment for the group as they began treatment. Patients beginning chemotherapy endorsed frequent or intense levels of fatigue, worrying about the future, pain, and sleep problems. No differences were found in the reporting of symptoms based on gender, age, or educational level. While changes in symptom distress over the study period were unremarkable, changes in fears about chemotherapy were of interest. The most feared symptoms were re-ordered following the treatment experience. The endorsement of nausea and vomiting, alopecia, and loss of appetite decreased significantly. Thirty-five percent fewer chemotherapy patients reported vomiting as one of their most feared side effects; 45% fewer patients who received anti-emetics reported vomiting as one of their most feared side effects. Effective treatments, such as those that have been developed to treat acute chemotherapy-related emesis, can relieve the fears of patients on treatment. We conclude that patients' fears about treatment are fluid and malleable. Patients' fears of suffering related to chemotherapy treatment change in response to the provision of adequate management. We discuss the implications of these findings for palliative care education.
癌症患者在开始化疗时会害怕化疗的副作用。在本研究中，我们调查了患者对化疗的预期恐惧。然后，对于在此期间接受化疗的患者，我们在初次访谈后的三到六个月重新评估了这些恐惧。我们还在这些时间间隔检查了症状困扰情况。脱发、呕吐、感染、恶心和体重减轻被列为该组患者开始治疗时最害怕的癌症治疗副作用。开始化疗的患者认可频繁或强烈程度的疲劳、对未来的担忧、疼痛和睡眠问题。在基于性别、年龄或教育水平的症状报告方面未发现差异。虽然在研究期间症状困扰的变化不明显，但对化疗的恐惧变化却令人感兴趣。在经历治疗后，最害怕的症状顺序发生了重新排列。对恶心和呕吐、脱发以及食欲不振的认可显著下降。报告呕吐是其最害怕副作用之一的化疗患者减少了35%；接受止吐药治疗的患者中，报告呕吐是其最害怕副作用之一的患者减少了45%。有效的治疗方法，如已开发用于治疗急性化疗相关呕吐的方法，可以减轻正在接受治疗的患者的恐惧。我们得出结论，患者对治疗的恐惧是可变且可塑的。患者对与化疗治疗相关痛苦的恐惧会随着提供充分的管理而改变。我们讨论了这些发现对姑息治疗教育的意义。
