Department of Community Medicine and Unit for Behavioural Sciences, Centre for Psycho-Oncology Research and Training, School of Public Health, The University of Hong Kong, Pokulam, Hong Kong.
Psychooncology. 2012 Jan;21(1):90-9. doi: 10.1002/pon.1876. Epub 2010 Dec 2.
To explore how initial trajectories of distress experienced during the first year following diagnosis with early-stage breast cancer (ESBC) relate to subsequent long-term(6 years) psychosocial outcomes.
285/303 Chinese women recruited 1-week post-surgery for predominantly ESBC were assessed for distress with the Chinese Health Questionnaire at 1, 4, and 8 months later.Latent growth mixture modeling revealed four distinct distress trajectories during the first 8 months following surgery (Lam et al., 2010). Six years later we reassessed 186 of these 285 women, comparing scores on the Hospital Anxiety and Depression Scale, Impact of Events Scale, and Chinese Social Adjustment Scale by first 8 months’ distress trajectory.
Distress trajectories over the first 8 months post-operatively predicted psychosocial outcomes 6 years later. Women with stable low levels of distress over the first 8 months postoperatively(resilient group) had the best 6-year psychosocial outcomes. Women who experienced chronic distress had significantly greater longer-term psychological distress, cancer-related distress, and poorer social adjustment in comparison to women in the resilient group. Women in the recovered or delayed-recovery groups were comparable to those in the resilient group, except for concerns about appearance and sexuality, and self-image.
Women with an illness trajectory characterized by chronic distress over the first 8 months post-operatively had poorest longer-term psychosocial outcomes. Clarification of determinants of chronic distress and means for early identification of at-risk women are needed.This will enable targeted optimization of interventions to prevent and manage chronic distress,improving ESBC rehabilitation efficiency.
探索早期乳腺癌（ESBC）诊断后第一年经历的初始困扰轨迹如何与随后的长期（6 年）心理社会结局相关。
从 303 名接受 ESBC 手术的中国女性中招募了 285 名，在手术后 1 周、4 个月和 8 个月时使用中国健康问卷评估其困扰程度。潜在增长混合模型揭示了手术后 8 个月内存在四种不同的困扰轨迹（Lam 等人，2010 年）。6 年后，我们重新评估了这 285 名女性中的 186 名，通过前 8 个月的困扰轨迹比较了医院焦虑和抑郁量表、事件影响量表和中国社会适应量表的得分。
术后头 8 个月的困扰轨迹预测了 6 年后的心理社会结局。术后头 8 个月内稳定低水平困扰的女性（韧性组）具有最佳的 6 年心理社会结局。与韧性组相比，长期存在慢性困扰的女性在心理困扰、癌症相关困扰和社会适应方面存在显著的长期不良影响。恢复组或延迟恢复组的女性与韧性组相当，除了对外观和性相关的担忧、自我形象的担忧。
术后头 8 个月困扰轨迹呈慢性困扰的女性具有最差的长期心理社会结局。需要明确慢性困扰的决定因素以及早期识别高危女性的方法。这将能够针对慢性困扰进行有针对性的优化干预，从而改善 ESBC 康复效率。
