Rini Christine, Jandorf Lina, Valdimarsdottir Heiddis, Brown Karen, Itzkowitz Steven H
Department of Oncological Sciences, Mount Sinai School of Medicine, New York, New York, USA.
Psychooncology. 2008 Apr;17(4):354-62. doi: 10.1002/pon.1227.
Patients with inflammatory bowel disease (IBD) are one of only three groups at high risk for colorectal cancer (CRC), a leading cause of cancer-related mortality. Yet, no research has examined psychological effects of their high-risk status. The present study offered an initial investigation of three potential predictors of patient distress: disease duration, family history of cancer, and perceived social support. Longer disease duration and stronger family history of cancer are associated with elevated CRC risk in this already high-risk population. Perceived support was conceptualized as a resource that could decrease vulnerability to distress or buffer adverse psychological effects of disease duration and family history. Men and women (n = 223) with IBD participating in a colon disease family registry completed measures for this cross-sectional study. Family history of CRC and non-colorectal cancers among first-degree relatives (FDRs) and more distant relatives (DRs) was examined separately. Hierarchical multiple regression analyses revealed that having greater perceived support predicted lower generalized distress (p<0.001). Having an FDR history of CRC predicted higher CRC-specific distress (p = 0.02). Having a DR history of CRC also predicted higher CRC-specific distress, but only among patients diagnosed more recently (p = 0.03). Clinical implications of these findings are discussed along with future research directions.
炎症性肠病(IBD)患者是仅有的三组结直肠癌(CRC)高危人群之一,结直肠癌是癌症相关死亡的主要原因。然而,尚无研究探讨其高危状态对心理的影响。本研究初步调查了患者痛苦的三个潜在预测因素:疾病持续时间、癌症家族史和感知到的社会支持。在这个本就属于高危人群的群体中,更长的疾病持续时间和更强的癌症家族史与结直肠癌风险升高相关。感知到的支持被概念化为一种资源,它可以降低痛苦的易感性,或缓冲疾病持续时间和家族史对心理的不利影响。参与结肠疾病家族登记的223名患有IBD的男性和女性完成了这项横断面研究的测量。分别检查了一级亲属(FDR)和更远亲属(DR)中结直肠癌和非结直肠癌的家族史。分层多元回归分析显示,感知到更大的支持预示着更低的广泛性痛苦(p<0.001)。有结直肠癌家族史的一级亲属预示着更高的结直肠癌特异性痛苦(p = 0.02)。有结直肠癌家族史的更远亲属也预示着更高的结直肠癌特异性痛苦,但仅在最近诊断的患者中如此(p = 0.03)。讨论了这些发现的临床意义以及未来的研究方向。