Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA.
Collaborative Cancer Care Research Group, University of California, Davis, Sacramento, CA, USA.
Psychooncology. 2018 Jan;27(1):279-285. doi: 10.1002/pon.4444. Epub 2017 May 18.
The objective of the study is to understand potential differences in psychosocial outcomes from active treatment to survivorship.
Using the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement (n = 1360), we examined and compared psychosocial outcomes among respondents in active treatment with survivors by year(s) since treatment ended. Survey-weighted regression models were used to test associations between year(s) since treatment and depressive symptoms (Patient Health Questionnaire-2), psychological distress (K6), and cancer-specific worry related to recurrence.
Unadjusted estimates showed no significant differences in depressive symptoms or psychological distress between those in active treatment and cancer survivors at any time posttreatment. In contrast, the prevalence of cancer-specific worry was lowest among survivors more than 5 years since treatment (10%), slightly higher among those with less than 1 year since treatment (15%), and highest among those in active treatment (32%). In models controlled for sociodemographic and health-related covariates, the year(s) since treatment ended was inversely associated with the odds of cancer-specific worry but was not associated with depressive symptoms or psychological distress.
In this population-based sample, worry about cancer recurrence may diminish with years since treatment ended, while depressive symptoms and distress are persistent across the trajectory. These findings highlight unmet psychosocial needs among cancer survivors and demonstrate the importance of targeted interventions across the survivorship continuum.
本研究旨在了解积极治疗向生存阶段转变过程中，心理社会结局可能存在的差异。
利用医疗支出面板调查癌症生存者经验补充调查（n=1360），我们通过治疗结束后时间（年），对处于积极治疗阶段的患者与生存者的心理社会结局进行了评估和比较。采用调查加权回归模型检验了治疗结束后时间（年）与抑郁症状（患者健康问卷-2）、心理困扰（K6）和与复发相关的癌症特异性担忧之间的关联。
未经调整的估计显示，在治疗后任何时间，处于积极治疗阶段的患者与癌症生存者之间的抑郁症状或心理困扰均无显著差异。相比之下，治疗后 5 年以上的生存者中癌症特异性担忧的发生率最低（10%），治疗后不到 1 年的生存者稍高（15%），而处于积极治疗阶段的患者最高（32%）。在控制了社会人口统计学和健康相关协变量的模型中，治疗结束后时间与癌症特异性担忧的几率呈负相关，但与抑郁症状或心理困扰无关。
在这个基于人群的样本中，随着治疗结束时间的推移，对癌症复发的担忧可能会减少，而抑郁症状和困扰则会在整个生存轨迹中持续存在。这些发现突出了癌症生存者未满足的心理社会需求，并证明了在整个生存阶段实施针对性干预的重要性。
