症状负担是否是即将开始化疗的癌症患者焦虑和抑郁的预测指标？

Is symptom burden a predictor of anxiety and depression in patients with cancer about to commence chemotherapy?

作者信息

Breen Sibilah J, Baravelli Carl M, Schofield Penelope E, Jefford Michael, Yates Patsy M, Aranda Sanchia K

机构信息

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.

出版信息

Med J Aust. 2009 Apr 6;190(S7):S99-104. doi: 10.5694/j.1326-5377.2009.tb02480.x.

DOI:10.5694/j.1326-5377.2009.tb02480.x

PMID:19351303

Abstract

OBJECTIVES

To assess the prevalence, severity and distress from physical symptoms and the prevalence of anxiety and depression in patients about to undergo chemotherapy for potentially curable cancers; and to explore the presence of symptom clusters and investigate their relationships with anxiety and depression.

DESIGN, PARTICIPANTS AND SETTING: Cross-sectional survey of 192 patients with breast or gastrointestinal cancers or lymphoma before first ever chemotherapy treatment with curative intent.

MAIN OUTCOME MEASURES

Hospital Anxiety and Depression Scale to assess anxiety and depression and the Chemotherapy Symptom Assessment Scale to measure physical symptom prevalence, severity and distress ("bother").

RESULTS

Prevalence of anxiety was 45% and depression 25%. The most prevalent physical symptoms were pain (48%), feeling unusually tired (45%) and difficulty sleeping (45%). Physical symptoms rated as most severe were pain (28%), difficulty sleeping (26%) and feeling unusually tired (19%). Physical symptoms causing the most distress were pain (39%), constipation (18%) and nausea (16%). Factor analysis of symptom distress scores indicated that five factors explained 36.7% of the variance and included: gastrointestinal (nausea, vomiting, pain), general malaise (tiredness, feeling weak, headaches), emotional (feeling depressed, feeling anxious), nutritional (changes to appetite, weight loss or gain) and general physical (mouth/throat problems, shortness of breath). Regression analysis indicated that symptom distress for the malaise (beta = 1.46; P < 0.001), nutritional (beta = 0.70; P < 0.05) and gastrointestinal (beta = 0.73; P < 0.05) factors were independent predictors of depression.

CONCLUSIONS

Before commencing chemotherapy, patients are already experiencing distressing symptoms and have high scores for anxiety and depression, partially explained by physical symptom distress. Patients should be routinely screened for both emotional and physical needs and appropriate interventions should be developed.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN012606000178549.

摘要

目的

评估即将接受化疗以治疗潜在可治愈癌症的患者身体症状的患病率、严重程度和困扰程度，以及焦虑和抑郁的患病率；并探索症状群的存在情况，并调查它们与焦虑和抑郁的关系。

设计、参与者和研究背景：对192例首次接受根治性化疗的乳腺癌、胃肠道癌或淋巴瘤患者进行横断面调查。

主要观察指标

采用医院焦虑抑郁量表评估焦虑和抑郁，采用化疗症状评估量表测量身体症状的患病率、严重程度和困扰程度（“烦恼程度”）。

结果

焦虑患病率为45%，抑郁患病率为25%。最常见的身体症状是疼痛（48%）、异常疲倦感（45%）和睡眠困难（45%）。被评为最严重的身体症状是疼痛（28%）、睡眠困难（26%）和异常疲倦感（19%）。造成最大困扰的身体症状是疼痛（39%）、便秘（18%）和恶心（16%）。症状困扰评分的因子分析表明，五个因子解释了36.7%的方差，包括：胃肠道（恶心、呕吐、疼痛）、全身不适（疲倦、虚弱感、头痛）、情绪（情绪低落、焦虑）、营养（食欲改变、体重减轻或增加）和一般身体状况（口腔/咽喉问题、呼吸急促）。回归分析表明，全身不适因子（β = 1.46；P < 0.001）、营养因子（β = 0.70；P < 0.05）和胃肠道因子（β = 0.73；P < 0.05）的症状困扰是抑郁的独立预测因素。