“正如我所料”：一项前瞻性队列研究，探讨了在前列腺癌放射治疗过程中，反应期望对副作用体验的影响。
"Just As I Expected": A Longitudinal Cohort Study of the Impact of Response Expectancies on Side Effect Experiences During Radiotherapy for Prostate Cancer.
机构信息
School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.
出版信息
J Pain Symptom Manage. 2019 Feb;57(2):273-281.e4. doi: 10.1016/j.jpainsymman.2018.11.002. Epub 2018 Nov 15.
CONTEXT
Previous research has indicated that pretreatment response expectancies of side effects often predict subsequent toxicity severity. However, this has been largely based on female patients undergoing chemotherapy.
OBJECTIVES
We tested whether this association also occurred in a novel cohort, men with prostate cancer undergoing radiotherapy. We investigated these associations throughout treatment (before and after side effects were medically predicted to occur), controlling known and novel variables.
METHODS
Homogenous male patients scheduled for radiotherapy (N = 35, mean age 71 years) completed baseline (pretreatment) measures; response expectancies of 18 treatment-related side effects; questions about baseline health and hormonal treatment, emotional state, and coping style. Response expectancies of the side effects were again measured two weeks into treatment. The severity of the same 18 toxicities was assessed two and seven weeks into treatment.
RESULTS
Hierarchical multiple linear regressions revealed baseline response expectancies significantly and independently predicted six of 18 toxicities two weeks into radiotherapy, contributing 12%-30% of explained variance (β = 0.39-0.59). Response expectancies assessed two weeks into treatment significantly and uniquely predicted seven of 17 experienced toxicities at seven weeks, explaining 17%-50% of variance (β = 0.49-0.91). Sexual toxicity response expectancies revealed the strongest associations with experience throughout treatment (β = 0.46-0.91), with "inability to reach orgasm" showing the largest effect.
CONCLUSION
In this older male sample, response expectancies of side effects predicted experiences throughout treatment, including the period before toxicities were medically expected. Response expectancies of sexual side effects were robust, independent predictors of subsequent toxicities across treatment, especially issues with orgasm, warranting focus in practice and future research.
背景
先前的研究表明，治疗前对副作用的预期反应往往能预测随后的毒性严重程度。然而，这主要是基于接受化疗的女性患者。
目的
我们测试了这种关联是否也发生在一个新的队列中，即接受放射治疗的前列腺癌男性患者。我们在整个治疗过程中（在副作用被医学预测发生之前和之后）调查了这些关联，控制了已知和新的变量。
方法
接受放射治疗的同质男性患者（N=35，平均年龄 71 岁）完成了基线（治疗前）测量；18 种与治疗相关的副作用的预期反应；关于基线健康和激素治疗、情绪状态和应对方式的问题。在治疗两周后再次测量副作用的预期反应。在治疗两周和七周后评估了同样的 18 种毒性的严重程度。
结果
分层多元线性回归显示，治疗前的预期反应显著且独立地预测了放射治疗两周后 18 种毒性中的 6 种，解释了 12%-30%的方差（β=0.39-0.59）。在治疗两周时评估的预期反应显著且独特地预测了治疗七周时 17 种已体验到的毒性中的 7 种，解释了 17%-50%的方差（β=0.49-0.91）。性毒性预期反应与整个治疗过程中的体验有最强的关联（β=0.46-0.91），其中“无法达到性高潮”的影响最大。
结论
在这个老年男性样本中，副作用的预期反应预测了整个治疗过程中的体验，包括在毒性被医学预测之前的时期。性副作用的预期反应是治疗过程中后续毒性的强大、独立预测因素，尤其是与性高潮有关的问题，值得在实践和未来研究中关注。
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