Schneider Annegret, Kotronoulas Grigorios, Papadopoulou Constantina, McCann Lisa, Miller Morven, McBride Jackie, Polly Zoe, Bettles Simon, Whitehouse Alison, Kearney Nora, Maguire Roma
University of Surrey, Guildford, GU2 7XH, United Kingdom.
University of Surrey, Guildford, GU2 7XH, United Kingdom.
Eur J Oncol Nurs. 2016 Oct;24:1-7. doi: 10.1016/j.ejon.2016.07.001. Epub 2016 Jul 18.
To examine the trajectories and predictors of state and trait anxiety in patients undergoing chemotherapy for breast or colorectal cancer.
Secondary analysis of data collected as part of a large multi-site longitudinal study. Patients with breast or colorectal cancer completed validated scales assessing their state and trait anxiety levels (State-Trait Anxiety Inventory) and symptom burden (Rotterdam Symptom Checklist) at the beginning of each chemotherapy cycle. Longitudinal mixed model analyses were performed to test changes of trait and state anxiety over time and the predictive value of symptom burden and patients' demographic (age, gender) and clinical characteristics (cancer type, stage, comorbidities, ECOG performance status).
Data from 137 patients with breast (60%) or colorectal cancer (40%) were analysed. Linear time effects were found for both state (χ = 46.3 [df = 3]; p < 0.001) and trait anxiety (χ = 17.708 [df = 3]; p = 0.001), with anxiety levels being higher at baseline and gradually decreasing over the course of chemotherapy. Symptom burden (β = 0.21; SD = 0.06; p = 0.001) predicted state anxiety throughout treatment, but this effect disappeared when accounting for trait anxiety scores before the start of chemotherapy (β = 0.85; SD = 0.05; p < 0.001). Patients' baseline trait anxiety was the only significant predictor of anxiety throughout treatment.
Changes in the generally stable characteristic of trait anxiety indicate the profoundly life-altering nature of chemotherapy. The time point before the start of chemotherapy was identified as the most anxiety-provoking, calling for interventions to be delivered as early as possible in the treatment trajectory. Patients with high trait anxiety and symptom burden may benefit from additional support.
研究乳腺癌或结直肠癌化疗患者状态焦虑和特质焦虑的轨迹及预测因素。
对作为大型多中心纵向研究一部分收集的数据进行二次分析。乳腺癌或结直肠癌患者在每个化疗周期开始时完成评估其状态焦虑和特质焦虑水平（状态-特质焦虑量表）以及症状负担（鹿特丹症状清单）的有效量表。进行纵向混合模型分析以测试特质焦虑和状态焦虑随时间的变化以及症状负担、患者人口统计学特征（年龄、性别）和临床特征（癌症类型、分期、合并症、东部肿瘤协作组体能状态）的预测价值。
分析了137例乳腺癌（60%）或结直肠癌（40%）患者的数据。发现状态焦虑（χ = 46.3 [自由度 = 3]；p < 0.001）和特质焦虑（χ = 17.708 [自由度 = 3]；p = 0.001）均存在线性时间效应，焦虑水平在基线时较高，并在化疗过程中逐渐降低。症状负担（β = 0.21；标准差 = 0.06；p = 0.001）在整个治疗过程中预测状态焦虑，但在考虑化疗开始前的特质焦虑评分时，这种效应消失（β = 0.85；标准差 = 0.05；p < 0.001）。患者的基线特质焦虑是整个治疗过程中焦虑的唯一显著预测因素。
特质焦虑这一通常稳定的特征发生变化，表明化疗对生活具有深刻的改变作用。化疗开始前的时间点被确定为最引发焦虑的时期，这就要求在治疗过程中尽早进行干预。特质焦虑高且症状负担重的患者可能会从额外的支持中受益。
