测试癌症症状管理干预措施的差异效应。
Testing the differential effects of symptom management interventions in cancer.
作者信息
Sikorskii Alla, Given Charles W, Siddiqi Azfar-E-Alam, Champion Victoria, McCorkle Ruth, Spoelstra Sandra L, Given Barbara A
机构信息
Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA.
出版信息
Psychooncology. 2015 Jan;24(1):25-32. doi: 10.1002/pon.3555. Epub 2014 Apr 15.
OBJECTIVE
The purpose of this study was to test for moderating effects of patient characteristics on self-management interventions developed to address symptoms during cancer treatment. Patient's age, education, and depressive symptomatology were considered as potential moderators.
METHODS
A secondary analysis of data of 782 patients from two randomized clinical trials was performed. Both trials enrolled patients with solid tumors undergoing chemotherapy. After completing baseline interviews, patients were randomized to a nurse-delivered intervention versus intervention delivered by a 'coach' in trial I and to a nurse-delivered intervention versus an intervention delivered by an automated voice response system in trial II. In each of the two trials, following a six-contact 8-week intervention, patients were interviewed at week 10 to assess the primary outcome of symptom severity.
RESULTS
Although nurse-delivered intervention proved no better than the coach or automated system in lowering symptom severity, important differences in the intervention by age were found in both trials. Patients aged ≤45 years responded better to the coach or automated system, whereas those aged ≥75 years favored the nurse. Education and depressive symptomatology did not modify the intervention effects in either of the two trials. Depressive symptomatology had a significant main effect on symptom severity at week 10 in both trials (p = 0.03 and p < 0.01, respectively). Education was not associated with symptom severity over and above age and depressive symptomatology.
CONCLUSIONS
Clinicians need to carefully consider the age of the population when using or testing interventions to manage symptoms among cancer patients.
目的
本研究旨在检验患者特征对为缓解癌症治疗期间症状而制定的自我管理干预措施的调节作用。患者的年龄、教育程度和抑郁症状被视为潜在的调节因素。
方法
对来自两项随机临床试验的782名患者的数据进行二次分析。两项试验均纳入了接受化疗的实体瘤患者。在完成基线访谈后，试验I中患者被随机分为接受护士提供的干预与由“教练”提供的干预，试验II中患者被随机分为接受护士提供的干预与由自动语音应答系统提供的干预。在两项试验中的每一项中，经过为期8周的六次接触干预后，在第10周对患者进行访谈，以评估症状严重程度的主要结局。
结果
尽管在降低症状严重程度方面，护士提供的干预并不比教练或自动系统更好，但在两项试验中均发现了按年龄划分的干预存在重要差异。年龄≤45岁的患者对教练或自动系统的反应更好，而年龄≥75岁的患者则更倾向于护士。教育程度和抑郁症状在两项试验中均未改变干预效果。在两项试验中，抑郁症状在第10周时对症状严重程度均有显著的主效应（分别为p = 0.03和p < 0.01）。除年龄和抑郁症状外，教育程度与症状严重程度无关。
结论
临床医生在使用或测试管理癌症患者症状的干预措施时，需要仔细考虑人群的年龄。
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