Division of Network Services, Memorial Sloan Kettering Cancer Center, West Harrison, NY.
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY.
Psychosomatics. 2018 Sep-Oct;59(5):464-471. doi: 10.1016/j.psym.2018.01.005. Epub 2018 Jan 31.
Physical symptom burden and psychologic symptoms are highly prevalent in women with breast cancer. The Distress Thermometer and Problem List (DT&PL) is commonly used in oncology clinics to screen for distress and its accompanying Physical Problem List (PPL) identifies pertinent physical symptoms.
We sought to identify physical symptoms found on the PPL and evaluate whether they are associated with psychologic symptoms in women with breast cancer.
Patients (n=125) with breast cancer (Stage 0-IV) completed the DT&PL and the Hospital Anxiety and Depression Scale. They reported bother from any of 22 PPL items on the DT&PL. PPL items were assessed for their associations with distress, Hospital Anxiety and Depression Scale-anxiety, and Hospital Anxiety and Depression Scale-depression. The total number of PPL items endorsed per patient was evaluated for associations with psychologic outcomes, controlling for relevant demographic factors.
Most physical problems were associated with depression (n = 13, 87%), and anxiety (n = 8, 53%), but fewer were associated with distress (n = 4, 27%). In multivariate analyses, a higher total number of problems was associated with younger age (p = 0.03) and more depressive symptoms (p < 0.001).
Physical symptom burden detected by the DT&PL co-occurs with depression most commonly and to a lesser extent anxiety and distress in women with breast cancer. Depression is associated with more types of physical symptoms and a total number of physical symptoms. The endorsement of multiple PPL items on the DT&PL should prompt an evaluation for depression. Similarly, depression should prompt the evaluation and treatment of physical symptom burden.
患有乳腺癌的女性普遍存在身体症状负担和心理症状。在肿瘤学临床中，常用痛苦温度计和问题列表（DT&PL）来筛查痛苦，其伴随的身体问题列表（PPL）则确定相关的身体症状。
我们旨在确定 PPL 上发现的身体症状，并评估其是否与乳腺癌女性的心理症状相关。
125 例患有乳腺癌（0-IV 期）的患者完成了 DT&PL 和医院焦虑抑郁量表。他们报告了 DT&PL 上的 22 个 PPL 项目中的任何一个引起的困扰。评估了 PPL 项目与痛苦、医院焦虑抑郁量表-焦虑和医院焦虑抑郁量表-抑郁的相关性。在控制相关人口统计学因素的情况下，评估每位患者所选择的 PPL 项目总数与心理结果的相关性。
大多数身体问题与抑郁（n = 13，87%）和焦虑（n = 8，53%）相关，但与痛苦相关的问题较少（n = 4，27%）。在多变量分析中，更高的问题总数与年龄较小（p = 0.03）和更多的抑郁症状（p < 0.001）相关。
在乳腺癌女性中，DT&PL 检测到的身体症状负担与抑郁最常见，与焦虑和痛苦的相关性较小。抑郁与更多类型的身体症状和身体症状总数相关。DT&PL 上多个 PPL 项目的选择应提示对抑郁进行评估。同样，抑郁应提示对身体症状负担进行评估和治疗。
