姑息治疗环境中伴有焦虑和抑郁的晚期癌症患者的症状困扰

Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting.

作者信息

Delgado-Guay Marvin, Parsons Henrique A, Li Zhijun, Palmer J Lynn, Bruera Eduardo

机构信息

The University of Texas Medical School at Houston, Lyndon B. Johnson General Hospital, 5656 Kelley St., Houston, TX 77026, USA.

出版信息

Support Care Cancer. 2009 May;17(5):573-9. doi: 10.1007/s00520-008-0529-7. Epub 2008 Nov 13.

DOI:10.1007/s00520-008-0529-7

PMID:19005686

Abstract

BACKGROUND

Mood disorders are among the most distressing psychiatric conditions experienced by patients with advanced cancer; however, studies have not shown a direct association of physical symptoms with depression and anxiety.

PURPOSE

The purpose of this study is to determine the relationship between the frequency and intensity of patients' physical symptoms and their expressions of depression and anxiety.

PATIENTS AND METHODS

We retrospectively reviewed the records of 216 patients who had participated in three previous clinical trials conducted by our group. We assessed patients' demographic data using descriptive statistics. We analyzed physical symptom frequency and intensity using the Edmonton Symptom Assessment System (ESAS) and anxiety and depression using the respective subscales of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D).

RESULTS

Sixty-two percent were male; the median age was 59 years (range 20-91 years). Seventy nine (37%) of the patients had depressive mood (HADS-D > or = 8), and 94 (44%) had anxiety (HADS-A > or = 8). Patients with depressive mood expressed higher frequency of drowsiness (68/78, 64%; p = 0.0002), nausea (52/79, 66%; p = 0.0003), pain (74/79, 94%; p = 0.0101), dyspnea (68/79, 86%; p = 0.0196), worse appetite (72/79, 91%; p = 0.0051), and worse well-being (78/79, 99%; p = 0.0014) and expressed higher intensity of symptoms (ESAS > or = 1) [median (Q1-Q3)] including drowsiness [4 (3-7), p = 0.0174], fatigue [7 (5-8), p < 0.0001], and worse well-being [6 (5-7), p < 0.0001]. Patients with anxiety expressed higher frequency of nausea (59/94, 57%; p = 0.0006), pain (88/94, 89%; p = 0.0031), and dyspnea (84/94, 96%, p = 0.0002) and expressed a higher intensity of pain [6 (3-8), p = 0.0082], fatigue [6 (5-8), p = 0.0011], worse appetite [6 (4-8), p = 0.005], and worse well-being [5 (3-7), p = 0.0007]. Spearman's correlation showed a significant association between HADS-A and HADS-D and other symptoms in the ESAS. Spearman's correlations of HADS with ESAS-Anxiety and ESAS-Depression were 0.56 and 0.39, respectively (p < 0.001).

CONCLUSION

Expression of physical symptoms may vary in frequency and intensity among advanced cancer patients with anxiety and depression. Patients expressing high frequency and intensity of physical symptoms should be screened for mood disorders in order to provide treatment for these conditions. More research is needed.

摘要

背景

情绪障碍是晚期癌症患者经历的最令人痛苦的精神疾病之一；然而，研究尚未表明身体症状与抑郁和焦虑之间存在直接关联。

目的

本研究的目的是确定患者身体症状的频率和强度与其抑郁和焦虑表现之间的关系。

患者与方法

我们回顾性分析了216例曾参与我们团队之前开展的三项临床试验的患者记录。我们使用描述性统计评估患者的人口统计学数据。我们使用埃德蒙顿症状评估系统（ESAS）分析身体症状的频率和强度，使用医院焦虑抑郁量表（HADS - A和HADS - D）的相应子量表分析焦虑和抑郁情况。

结果

62%为男性；中位年龄为59岁（范围20 - 91岁）。79例（37%）患者有抑郁情绪（HADS - D≥8），94例（44%）有焦虑（HADS - A≥8）。有抑郁情绪的患者表现出更高频率的嗜睡（68/78，64%；p = 0.0002）、恶心（52/79，66%；p = 0.0003）、疼痛（74/79，94%；p = 0.0101）、呼吸困难（68/79，86%；p = 0.0196）、食欲减退（72/79，91%；p = 0.0051）以及健康状况较差（78/79，99%；p = 0.0014），并且表现出更高强度的症状（ESAS≥1）[中位数（四分位间距）]，包括嗜睡[4（3 - 7），p = 0.0174]、疲劳[7（5 - 8），p < 0.0001]以及健康状况较差[6（5 - 7），p < 0.0001]。有焦虑的患者表现出更高频率的恶心（59/94，57%；p = 0.0006）、疼痛（88/94，89%；p = 0.0031）和呼吸困难（84/94，96%，p = 0.0002），并且表现出更高强度的疼痛[6（3 - 8），p = 0.0082]、疲劳[6（5 - 8），p = 0.0011]、食欲减退[6（4 - 8），p = 0.005]以及健康状况较差[5（3 - 7），p = 0.0007]。斯皮尔曼相关性分析显示HADS - A和HADS - D与ESAS中的其他症状之间存在显著关联。HADS与ESAS - 焦虑和ESAS - 抑郁的斯皮尔曼相关性分别为0.56和0.39（p < 0.001）。