Hall Daniel L, Mishel Merle H, Germino Barbara B
Department of Psychology, University of Miami, Coral Gables, FL, 33124-0751, USA,
Support Care Cancer. 2014 Sep;22(9):2489-95. doi: 10.1007/s00520-014-2243-y. Epub 2014 Apr 12.
Uncertainty in cancer patients and survivors about cancer-related symptoms, treatment, and disease course has been related to poorer mental and physical health. However, little is known about whether cancer-related uncertainty relates with specific disease and treatment-related outcomes such as fatigue, insomnia, and affect disruptions. In this paper, we report these associations in younger survivors aged 50 years or less, a population increasing in prevalence.
Participants included 313 breast cancer survivors (117 African-Americans and 196 Caucasians) who were aged 24 to 50 years and were 2 to 4 years posttreatment. Self-reported cancer-related uncertainty (Mishel Uncertainty in Illness Scale-Survivor Version), fatigue (Piper Fatigue Scale-Revised), insomnia (Insomnia Severity Index), and negative and positive affect (Positive and Negative Affect Schedule (PANAS)) measures were collected upon study entry.
Hierarchical regression analyses controlled for relevant sociodemographic variables include the following: race, age, years of education, number of children, employment status, marital status, monthly income, smoking status, family history of cancer, endorsement of treatment-induced menopause, and religiosity. Over and above these factors, higher cancer-related uncertainty was significantly associated with more self-reported fatigue (β = .43), insomnia (β = .34), negative affect (β = .43), as well as less positive affect (β = -.33), all ps < .01.
Younger breast cancer survivors who are 2-4 years posttreatment experience cancer-related uncertainty, with higher levels associated with more self-reported psychophysiological disruptions. Cancer survivors who present in clinical settings with high uncertainty about recurrence or management of long-term effects of treatment may thus benefit from assessment of fatigue, insomnia, and affect.
癌症患者及其幸存者对癌症相关症状、治疗及病程存在的不确定性与较差的身心健康状况有关。然而，对于癌症相关不确定性是否与特定的疾病及治疗相关结局（如疲劳、失眠和情绪紊乱）存在关联，我们知之甚少。在本文中，我们报告了这些关联在50岁及以下的年轻幸存者中的情况，这一人群的患病率正在上升。
研究对象包括313名乳腺癌幸存者（117名非裔美国人及196名白种人），年龄在24至50岁之间，处于治疗后2至4年。在研究开始时收集了自我报告的癌症相关不确定性（疾病不确定感量表-幸存者版）、疲劳（Piper疲劳量表-修订版）、失眠（失眠严重程度指数）以及消极和积极情绪（正负性情绪量表）的测量数据。
对相关社会人口统计学变量进行控制的分层回归分析包括以下内容：种族、年龄、受教育年限、子女数量、就业状况、婚姻状况、月收入、吸烟状况、癌症家族史、治疗引起的绝经认可情况以及宗教信仰。除这些因素外，更高的癌症相关不确定性与更多的自我报告疲劳（β = 0.43）、失眠（β = 0.34）、消极情绪（β = 0.43）以及更少的积极情绪（β = -0.33）显著相关，所有p值均<0.01。
治疗后2至4年的年轻乳腺癌幸存者经历癌症相关不确定性，更高水平的不确定性与更多自我报告的心理生理紊乱相关。因此，在临床环境中对复发或治疗长期影响管理存在高度不确定性的癌症幸存者可能会从疲劳、失眠和情绪评估中受益。
