College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska 68198-5330, USA.
Curr Opin Support Palliat Care. 2013 Mar;7(1):60-6. doi: 10.1097/SPC.0b013e32835c7d88.
Although clinicians and researchers acknowledge symptom clusters, the focus has been on relieving a single symptom. This review summarizes the recent literature on interventions that focus on relief of symptom clusters in patients with cancer.
Twelve intervention studies meeting inclusion criteria were published in 2011-2012. The timeframe was expanded to 2009-2012 and 24 studies met the criteria: 18 in early stage and 6 in advanced-stage cancer patients. Several cognitive behavioral therapy, complementary therapy, and exercise interventions demonstrated positive outcomes in relieving a variety of symptom clusters in several cancer types. Most psychoeducational interventions using traditional formats or those combined with automated clinician alerts demonstrated effectiveness in reducing a variety of clusters. Clusters that included fatigue and anxiety or depression were reduced by exercise in early stage patients and by methylphenidate in advanced-stage patients. Current NIH R01 funded studies verified the trends in the types of interventions being tested.
Few interventions have been tested and found to be effective in relieving the specific symptom clusters in early and advanced-stage cancer patients. Future research needs to expand our understanding of the mechanisms that initiate co-occurring symptoms. Mechanism-targeted interventions need to be identified and tested in homogeneous samples with specific symptom clusters. Interventions need to be replicated before guidelines can be established.
尽管临床医生和研究人员承认症状群的存在，但他们的关注重点一直放在缓解单一症状上。本文总结了近期关于针对癌症患者症状群缓解的干预措施的文献。
2011 年至 2012 年期间发表了 12 项符合纳入标准的干预研究。研究时间范围扩大到 2009 年至 2012 年，有 24 项研究符合标准：18 项为早期癌症患者，6 项为晚期癌症患者。几种认知行为疗法、补充疗法和运动干预措施在缓解多种癌症类型的各种症状群方面显示出积极的结果。大多数使用传统格式或与自动化临床医生警报相结合的心理教育干预措施在减轻各种群集方面显示出有效性。包括疲劳和焦虑或抑郁的群集可通过早期患者的运动和晚期患者的哌醋甲酯来缓解。目前 NIH R01 资助的研究证实了正在测试的干预类型的趋势。
很少有干预措施经过测试并被证明能有效缓解早期和晚期癌症患者特定的症状群。未来的研究需要扩展我们对引发同时发生的症状的机制的理解。需要确定针对特定症状群的机制靶向干预措施并对其进行测试。在制定指南之前，需要对干预措施进行复制。
