Centre for Psycho-Oncology Research & Training, Department of Community Medicine & Unit for Behavioural Sciences, The University of Hong Kong, Pokulam, Hong Kong.
Psychooncology. 2010 Oct;19(10):1044-51. doi: 10.1002/pon.1658.
The distinct trajectories of psychological distress over the first year of the diagnosis with breast cancer (BC) and its determinants have not been explored.
285 of 405 Chinese women receiving surgery for BC were assessed at 5-day, 1-month, 4-month, and 8-month post-surgery on measures of psychological distress, optimism, treatment decision-making (TDM) difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, and physical symptom distress. Latent growth mixture modelling identified trajectories of psychological response to BC. Multinominal logistic regression compared TDM difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, optimism, and physical symptom distress, by distress pattern adjusted for age, education, employment status, and stage of disease.
Four distinct trajectories of distress were identified, namely, resilience (66%), chronic distress (15%), recovered (12%), and delayed-recovery (7%). TDM difficulties, optimism, satisfaction with consultation, and physical symptom distress predicted distress trajectories. Psychologically resilient women had less physical symptom distress at early post-surgery compared with women with other distress patterns. Compared with the resilient group, women in the recovered or chronic distress groups experienced greater TDM difficulties, whereas women in the delayed-recovery group reported greater dissatisfaction with the initial medical consultation. Women in the chronic distress group reported greater pessimistic outlook.
Optimism and better early post-operative treatment outcomes predicted resilience to distress. Pre-operative interventions helping women to establish a realistic expectation of treatment outcome may minimize disappointment with treatment outcome and resultant distress, whereas post-operative rehabilitation should focus on symptom management.
乳腺癌（BC）诊断后第一年心理困扰的明显轨迹及其决定因素尚未得到探索。
对 405 名接受 BC 手术的中国女性中的 285 名，在手术后 5 天、1 个月、4 个月和 8 个月，评估心理困扰、乐观、治疗决策（TDM）困难、对治疗结果的满意度、对医疗咨询的满意度以及身体症状困扰等方面。潜在增长混合模型确定了对 BC 的心理反应轨迹。多项逻辑回归比较了 TDM 困难、对治疗结果的满意度、对医疗咨询的满意度、乐观和身体症状困扰，根据年龄、教育程度、就业状况和疾病分期调整了困扰模式。
确定了四种不同的困扰轨迹，即韧性（66%）、慢性困扰（15%）、恢复（12%）和延迟恢复（7%）。TDM 困难、乐观、咨询满意度和身体症状困扰预测了困扰轨迹。心理韧性强的女性在术后早期的身体症状困扰较少，与其他困扰模式的女性相比。与韧性组相比，恢复组或慢性困扰组的 TDM 困难更大，而延迟恢复组对初始医疗咨询的满意度较低。慢性困扰组的女性报告了更悲观的前景。
乐观和更好的术后早期治疗结果预测了对困扰的韧性。术前干预帮助女性建立对治疗结果的现实期望，可能会最大限度地减少对治疗结果的失望和由此产生的困扰，而术后康复应侧重于症状管理。
