新发不可治愈癌症患者及其照护者的痛苦相互依存。
Distress is Interdependent in Patients and Caregivers with Newly Diagnosed Incurable Cancers.
机构信息
Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center & Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 10B, Boston, MA, 02114, USA.
Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
出版信息
Ann Behav Med. 2017 Aug;51(4):519-531. doi: 10.1007/s12160-017-9875-3.
BACKGROUND
Individuals with advanced, incurable cancer often experience high physical and psychological symptom burden. Family and friend caregivers are at risk for emotional distress.
PURPOSE
The aim of the study is to investigate the interrelationship of distress in patient-caregiver dyads at the time of newly diagnosed incurable cancer.
METHODS
From May 2011 to July 2015, within 8 weeks of diagnosis of advanced lung or noncolorectal gastrointestinal cancer, 350 patients and 275 family caregivers were enrolled in a randomized controlled trial of early palliative care. Actor-partner interdependence modeling was used to examine relationships between dyad's self-reported anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale at baseline.
RESULTS
Comparing patients with caregivers, patients reported more depressive symptoms (M = .84; t[274] = 3.17, p = .002, d = .22) and caregivers reported more anxiety symptoms (M =1.62, t[274] = 4.91, p < .001, d = .39). Dyads' anxiety symptoms were positively associated, as were depressive symptoms (rs = .21, ps ≤ .001). Actor-partner interdependence modeling showed that patients' anxiety symptoms were positively associated with their own depressive symptoms, with an equal effect for caregivers (actor effect βs = 0.52, ps < .001). Patients' own anxiety was concurrently positively associated with their caregivers' depressive symptoms, with an equal effect for caregivers to patients (partner effect βs=0.08, ps=.008).
CONCLUSIONS
In the context of newly diagnosed incurable cancer, caregivers experience more pronounced anxiety, while patients report greater depressive symptoms. Findings indicate that anxiety and depressive symptoms are interrelated among dyads facing newly diagnosed incurable disease. Results emphasize the importance of addressing distress in both patients and caregivers. Future research should discern when dyadic versus individual psychosocial interventions would be optimal.
TRIAL REGISTRATION NUMBER
The trial was registered with the ClinicalTrials.gov database (NCT02349412) https://clinicaltrials.gov/ct2/show/NCT02349412 .
背景
晚期、无法治愈的癌症患者通常经历着较高的生理和心理症状负担。患者的家属和朋友照顾者面临着情绪困扰的风险。
目的
本研究旨在调查新诊断为无法治愈的癌症时患者-照顾者配对中困扰的相互关系。
方法
从 2011 年 5 月至 2015 年 7 月，在诊断为晚期肺癌或非结直肠胃肠道癌后 8 周内，招募了 350 名患者和 275 名家庭照顾者，参加了一项早期姑息治疗的随机对照试验。采用演员-伙伴相互依存模型，在基线时使用医院焦虑和抑郁量表评估患者-照顾者对双方焦虑和抑郁症状的自我报告。
结果
与照顾者相比，患者报告的抑郁症状更多（M=0.84；t[274]=3.17，p=0.002，d=0.22），而照顾者报告的焦虑症状更多（M=1.62，t[274]=4.91，p<0.001，d=0.39）。配对者的焦虑症状呈正相关，抑郁症状也是如此（rs=0.21，ps≤0.001）。演员-伙伴相互依存模型显示，患者的焦虑症状与其自身的抑郁症状呈正相关，对照顾者也有同样的影响（演员效应βs=0.52，ps<0.001）。患者自身的焦虑与他们照顾者的抑郁症状呈正相关，对照顾者的影响也相同（伙伴效应βs=0.08，ps=0.008）。
结论
在新诊断为无法治愈的癌症的背景下，照顾者经历更明显的焦虑，而患者报告更多的抑郁症状。研究结果表明，在面对新诊断的无法治愈疾病的患者-照顾者配对中，焦虑和抑郁症状是相互关联的。结果强调了在患者和照顾者中同时处理困扰的重要性。未来的研究应该确定何时对患者和照顾者进行二元或个体社会心理干预是最佳的。
试验注册号
该试验在 ClinicalTrials.gov 数据库中注册（NCT02349412）https://clinicaltrials.gov/ct2/show/NCT02349412。
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