Lynch Brigid M, Steginga Suzanne K, Hawkes Anna L, Pakenham Ken I, Dunn Jeff
Viertel Center for Research in Cancer Control, The Cancer Council Queensland, Australia.
Cancer. 2008 Mar 15;112(6):1363-70. doi: 10.1002/cncr.23300.
Psychological distress in cancer survivors can be detrimental to treatment adherence and self-care tasks and is associated with poor health behaviors and decreased overall quality of life. The prevalence, course, and predictors of psychological distress after the diagnosis of colorectal cancer are to date not well described.
A prospective survey of 1822 colorectal cancer patients was undertaken assessing psychological distress and hypothesized predictors including optimism, cancer threat appraisal, social support, and physical activity at 6 and 12 months postdiagnosis. Logistic regression identified correlates of psychological distress at 12 months postdiagnosis.
The prevalence of global psychological distress was low: 8.3% and 6.7% at 6 and 12 months postdiagnosis, respectively. When baseline measures of independent variables were included in a logistic regression model, distress at 6 months postdiagnosis (odds ratio [OR]=10.84), comorbidities (OR=1.64), optimism (OR=0.93), cancer threat appraisal (OR=0.92), and social support (OR=0.94) were significantly associated with distress at 12 months postdiagnosis. A second logistic regression model that included concurrent measures of cancer threat appraisal, social support, and physical activity found that distress at 6 months postdiagnosis (OR=12.49), comorbidities (OR=1.64), optimism (OR=0.94), and concurrent cancer threat appraisal (OR=0.85) were significantly associated with distress at 12 months postdiagnosis.
Distress screening at regular intervals is needed to efficiently detect colorectal cancer patients who require in-depth psychological intervention. Threat appraisal is a modifiable variable that should be included in interventions for colorectal cancer survivors. Further research is needed to investigate the potential for physical activity to reduce distress after cancer.
癌症幸存者的心理困扰可能对治疗依从性和自我护理任务产生不利影响，并与不良健康行为和总体生活质量下降相关。迄今为止，结直肠癌诊断后心理困扰的患病率、病程及预测因素尚未得到充分描述。
对1822例结直肠癌患者进行前瞻性调查，评估诊断后6个月和12个月时的心理困扰及假设的预测因素，包括乐观情绪、癌症威胁评估、社会支持和身体活动。逻辑回归确定诊断后12个月时心理困扰的相关因素。
总体心理困扰的患病率较低：诊断后6个月和12个月时分别为8.3%和6.7%。当将自变量的基线测量值纳入逻辑回归模型时，诊断后6个月的困扰（比值比[OR]=10.84）、合并症（OR=1.64）、乐观情绪（OR=0.93）、癌症威胁评估（OR=0.92）和社会支持（OR=0.94）与诊断后12个月的困扰显著相关。第二个逻辑回归模型纳入了癌症威胁评估、社会支持和身体活动的同期测量值，结果发现诊断后6个月的困扰（OR=12.49）、合并症（OR=1.64）、乐观情绪（OR=0.94）和同期癌症威胁评估（OR=0.85）与诊断后12个月的困扰显著相关。
需要定期进行困扰筛查，以有效检测需要深入心理干预的结直肠癌患者。威胁评估是一个可改变的变量，应纳入结直肠癌幸存者的干预措施中。需要进一步研究以调查身体活动对减轻癌症后困扰的潜力。
