Department of Psychiatry, Medical School, University of Ioannina, Greece.
Psychooncology. 2013 Nov;22(11):2470-7. doi: 10.1002/pon.3308. Epub 2013 May 27.
Treatment decisional preferences impact breast cancer patients' health-related quality of life (HRQoL) and may relate to psychological variables, although many aspects of this relationship remain unknown. This prospective study aimed to assess psychological correlates of treatment decisional preferences and predictors of HRQoL in women with early non-metastatic breast cancer.
Of the 124 women initially assessed for anxiety (Spielberger's State-Trait Anxiety Inventory) and depressive (Center for Epidemiologic Studies-Depression (CES-D)) symptoms, HRQoL (WHOQOL-BREF), and defense mechanisms (Life Style Index), 82 (66.1%) completed the 1-year follow-up. Mean age was 54.6 years (SD = 9.76), and mean disease duration was 19.4 months (SD = 25.55); 19.5% had stage I, 63.4% stage II and 17.1% stage III disease. The predictive power and moderator effects of psychological variables were tested using multiple and hierarchical regression models.
Depressive symptoms and physical HRQoL improved significantly, state anxiety and mental and environment HRQoL remained stable, and social relations HRQoL deteriorated over the 1-year period. Older age (p = 0.021) and higher scores in repression defense (p = 0.044) were independently associated with passive decisional preferences. Earlier stage of cancer (p = 0.043), lower state anxiety (p = 0.039), lower repression scores (p = 0.021) and improvement in depressive symptoms (p < 0.001) predicted physical HRQoL improvement. Moderation analysis showed that active decisional preferences predicted physical HRQoL improvement, but only in those women with lower repression levels.
Defense mechanisms are associated with treatment decisional preferences and interact with factors predicting HRQoL in women with breast cancer. Clinicians should address the patients' anxiety and depressive symptoms and refer patients with high repression tendencies for psychological evaluation and management.
治疗决策偏好会影响乳腺癌患者的健康相关生活质量（HRQoL），并且可能与心理变量有关，但这种关系的许多方面仍不清楚。本前瞻性研究旨在评估早期非转移性乳腺癌女性治疗决策偏好的心理相关性以及与 HRQoL 相关的预测因素。
在最初评估焦虑（Spielberger 的状态-特质焦虑量表）和抑郁（流行病学研究中心抑郁量表（CES-D））症状、HRQoL（WHOQOL-BREF）和防御机制（生活方式指数）的 124 名女性中，有 82 名（66.1%）完成了 1 年随访。平均年龄为 54.6 岁（SD=9.76），平均疾病持续时间为 19.4 个月（SD=25.55）；19.5%为 I 期，63.4%为 II 期，17.1%为 III 期疾病。使用多元和分层回归模型测试心理变量的预测能力和调节效应。
抑郁症状和身体 HRQoL 显著改善，状态焦虑和心理及环境 HRQoL 保持稳定，社会关系 HRQoL 在 1 年内恶化。年龄较大（p=0.021）和压抑防御得分较高（p=0.044）与被动决策偏好独立相关。癌症早期（p=0.043）、较低的状态焦虑（p=0.039）、较低的压抑分数（p=0.021）和抑郁症状的改善（p<0.001）预测了身体 HRQoL 的改善。调节分析表明，积极的决策偏好预测了身体 HRQoL 的改善，但仅在那些压抑水平较低的女性中。
防御机制与治疗决策偏好相关，并与乳腺癌女性 HRQoL 的预测因素相互作用。临床医生应解决患者的焦虑和抑郁症状，并将高压抑倾向的患者转介进行心理评估和管理。
