Graves Kristi D, Arnold Susanne M, Love Celia L, Kirsh Kenneth L, Moore Pamela G, Passik Steven D
Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
Lung Cancer. 2007 Feb;55(2):215-24. doi: 10.1016/j.lungcan.2006.10.001. Epub 2006 Nov 3.
Screening for distress in cancer patients is recommended by the National Comprehensive Cancer Network, and a Distress Thermometer has previously been developed and empirically validated for this purpose. The present study sought to determine the rates and predictors of distress in a sample of patients being seen in a multidisciplinary lung cancer clinic. Consecutive patients (N=333) were recruited from an outpatient multidisciplinary lung cancer clinic to complete the Distress Thermometer, an associated Problem Symptom List, and two questions about interest in receiving help for symptoms. Over half (61.6%) of patients reported distress at a clinically significant level, and 22.5% of patients indicated interest in receiving help with their distress and/or symptoms. Problems in the areas of family relationships, emotional functioning, lack of information about diagnosis/treatment, physical functioning, and cognitive functioning were associated with higher reports of distress. Specific symptoms of depression, anxiety, pain and fatigue were most predictive of distress. Younger age was also associated with higher levels of distress. Distress was not associated with other clinical variables, including stage of illness or medical treatment approach. Similar results were obtained when individuals who had not yet received a definitive diagnosis of lung cancer (n=134) were excluded from analyses; however, family problems and anxiety were no longer predictive of distress. Screening for distress in a multidisciplinary lung cancer clinic is feasible and a significant number of patients can be expected to meet clinical criteria for distress. Results also highlight younger age and specific physical and psychosocial symptoms as predictive of clinically significant distress. Identification of the presence and predictors of distress are the first steps toward appropriate referral and treatment of symptoms and problems that contribute to cancer patients' distress.
美国国立综合癌症网络建议对癌症患者进行痛苦筛查，此前已开发出一种痛苦温度计并为此进行了实证验证。本研究旨在确定在多学科肺癌诊所就诊的患者样本中痛苦的发生率及预测因素。从门诊多学科肺癌诊所招募了连续的患者（N = 333），以完成痛苦温度计、相关的问题症状清单以及两个关于对症状寻求帮助的兴趣的问题。超过一半（61.6%）的患者报告有临床显著水平的痛苦，22.5%的患者表示有兴趣就其痛苦和/或症状寻求帮助。家庭关系、情绪功能、缺乏关于诊断/治疗的信息、身体功能和认知功能方面的问题与更高的痛苦报告相关。抑郁、焦虑、疼痛和疲劳的特定症状最能预测痛苦。较年轻的年龄也与更高水平的痛苦相关。痛苦与其他临床变量无关，包括疾病阶段或医疗治疗方法。当尚未确诊为肺癌的个体（n = 134）被排除在分析之外时，获得了类似的结果；然而，家庭问题和焦虑不再是痛苦的预测因素。在多学科肺癌诊所进行痛苦筛查是可行的，预计会有相当数量的患者符合痛苦的临床标准。结果还突出了较年轻的年龄以及特定的身体和心理社会症状可预测临床显著的痛苦。识别痛苦的存在及其预测因素是朝着适当转诊和治疗导致癌症患者痛苦的症状和问题迈出的第一步。
