Schulz-Kindermann F, Hennings U, Ramm G, Zander A R, Hasenbring M
Department of Bone Marrow Transplantation, University Hospital Hamburg Eppendorf, Germany.
Bone Marrow Transplant. 2002 Feb;29(4):341-51. doi: 10.1038/sj.bmt.1703385.
Recent research has shown that cancer patients undergoing bone marrow transplantation (BMT) experience moderate to severe mouth pain due to treatment-related mucositis in spite of morphine therapy. Treatment-related emotional distress in BMT patients is also described widely. This study examined several biomedical, psychological and social variables as possible predictors for the intensity of treatment-related mouth pain and anxious mood in 63 cancer patients undergoing BMT or stem cell transplantation (SCT) within a prospective longitudinal design. Biomedical predictors included biomedical risk, mucositis, the mode of transplantation, total body irradiation, age and gender. Psychological predictors were depression (BDI), BMT-related distress, chronic stress and resources in everyday life (KISS), pain-related coping behaviour (KPI-17) and social support (ISSS). Among the social variables we evaluated education, being married and the living situation. Criteria variables were the intensity of mouth pain and anxious mood which were assessed daily by numeric self-rating scales for 24 days after transplantation. Results of stepwise multiple regressions indicated that psychological and social variables were important predictors of mouth pain, besides biomedical variables. Whereas the biomedical variables revealed the most predictive power during the second week after BMT, psychological predictors were more important during the early and late phases of the treatment. Daily anxious mood was best predicted by psychological and social variables. Among the biomedical variables mucositis was most strongly related to mouth pain besides mode of transplantation, risk, TBI and age. Among the psychological variables BMT-related distress was the most important predictor, with resources in private life or at work and pain-related coping modes as further significant predictors. These results imply that relevant predictors should be assessed as high risk factors for an increased vulnerability for treatment-related side-effects before treatment starts indicating an additional offer of psychological treatment in high risk patients.
最近的研究表明，尽管接受了吗啡治疗，但接受骨髓移植（BMT）的癌症患者仍会因治疗相关的粘膜炎而经历中度至重度的口腔疼痛。BMT患者中与治疗相关的情绪困扰也有广泛描述。本研究在前瞻性纵向设计中，考察了几个生物医学、心理和社会变量，作为63例接受BMT或干细胞移植（SCT）的癌症患者治疗相关口腔疼痛强度和焦虑情绪的可能预测因素。生物医学预测因素包括生物医学风险、粘膜炎、移植方式、全身照射、年龄和性别。心理预测因素有抑郁（BDI）、与BMT相关的困扰、慢性应激和日常生活资源（KISS）、疼痛相关应对行为（KPI - 17）和社会支持（ISSS）。在社会变量中，我们评估了教育程度、婚姻状况和生活状况。标准变量是口腔疼痛强度和焦虑情绪，在移植后24天通过数字自评量表每日进行评估。逐步多元回归结果表明，除生物医学变量外，心理和社会变量也是口腔疼痛的重要预测因素。生物医学变量在BMT后第二周显示出最大的预测能力，而心理预测因素在治疗的早期和晚期更为重要。心理和社会变量最能预测每日的焦虑情绪。在生物医学变量中，除移植方式、风险、全身照射和年龄外，粘膜炎与口腔疼痛的相关性最强。在心理变量中，与BMT相关的困扰是最重要的预测因素，个人生活或工作中的资源以及疼痛相关应对方式也是进一步的重要预测因素。这些结果意味着，在治疗开始前，应将相关预测因素评估为治疗相关副作用易感性增加的高风险因素，这表明应对高风险患者额外提供心理治疗。
