Sherman Allen C, Coleman Elizabeth Ann, Griffith Kathleen, Simonton Stephanie, Hine R Jean, Cromer Jeana, Latif Umaira, Farley Harriet, Garcia Rowena, Anaissie Elias J
Behavioral Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, 756, Little Rock, AR 72205, USA.
Support Care Cancer. 2003 Sep;11(9):568-74. doi: 10.1007/s00520-003-0464-6. Epub 2003 Jun 25.
Although peripheral blood stem-cell transplantation (PBSCT) has assumed a growing role in the treatment of multiple myeloma, very few studies have examined the functional and quality-of-life changes experienced by myeloma patients in the transplant setting. Multiple myeloma is characterized by a range of debilitating physical and psychosocial symptoms. However, supportive care needs for patients with this disease are often overlooked or managed only episodically. The current study pilot-tested an interdisciplinary supportive care program designed to provide screening and identify patients at risk early in the course of care. Participants in this pilot project were 61 patients with hematological disorders, predominantly multiple myeloma (85.3%), evaluated during their initial workup. Mean time since diagnosis was 7.4 months. Participants were interviewed by an advanced-practice nurse and completed standardized measures of heath-related quality of life (SF-12), fatigue (POMS-Fatigue), nutritional risk (PG-SGA), pain (Brief Pain Inventory), emotional functioning (Hospital Anxiety and Depression Scale), and sexual concerns (FACIT). Results indicated that difficulties were prevalent across multiple functional domains; 61.4% of patients displayed significant nutritional deficits. Physical functioning was below age-adjusted national norms for 53.5%. Moderate-to-severe fatigue was reported by 39.0%, and one third experienced clinically significant levels of pain, impaired daily functioning associated with pain, and emotional distress. A similar proportion of respondents (33.9%) reported disrupted sexual functioning and difficulty with body image. Findings suggest that early, systematic screening is feasible in a busy transplant center. The prevalence of symptoms highlights the importance of providing screening and proactive intervention for multiple myeloma patients early in the course of treatment and even prior to beginning protocols for high-dose therapy and transplantation.
尽管外周血干细胞移植（PBSCT）在多发性骨髓瘤的治疗中发挥着越来越重要的作用，但很少有研究探讨骨髓瘤患者在移植过程中所经历的功能和生活质量变化。多发性骨髓瘤的特征是一系列使人衰弱的身体和心理社会症状。然而，这种疾病患者的支持性护理需求往往被忽视或仅得到间歇性处理。当前的研究对一个跨学科支持性护理项目进行了试点测试，该项目旨在提供筛查并在护理过程早期识别有风险的患者。这个试点项目的参与者是61名血液系统疾病患者，主要是多发性骨髓瘤患者（85.3%），他们在初次检查时接受了评估。自诊断以来的平均时间为7.4个月。由一名高级执业护士对参与者进行访谈，并让他们完成与健康相关的生活质量（SF - 12）、疲劳（POMS - 疲劳）、营养风险（PG - SGA）、疼痛（简明疼痛量表）、情绪功能（医院焦虑抑郁量表）以及性方面问题（FACIT）的标准化测量。结果表明，多个功能领域都普遍存在困难；61.4%的患者存在明显的营养缺乏。身体功能低于按年龄调整后的国家规范水平的患者占53.5%。39.0%的患者报告有中度至重度疲劳，三分之一的患者经历了临床上显著程度的疼痛、与疼痛相关的日常功能受损以及情绪困扰。类似比例的受访者（33.9%）报告性功能障碍和身体形象方面的问题。研究结果表明，在繁忙的移植中心进行早期、系统的筛查是可行的。症状的普遍性凸显了在治疗过程早期甚至在开始高剂量治疗和移植方案之前，为多发性骨髓瘤患者提供筛查和积极干预的重要性。
