Department of Medicine, Baylor College of Medicine, Houston, Texas.
Department of Psychology, Rowan University, Glassboro, New Jersey.
Cancer. 2019 Apr 1;125(7):1176-1184. doi: 10.1002/cncr.31906. Epub 2018 Dec 6.
Patients with head and neck cancer (HNC) experience significant physical and psychological morbidity during radiotherapy (RT) that contributes to treatment interruptions and a poor quality of life. Although spouses/partners can help by encouraging patient self-management (eg, self-care) during RT, they often experience high psychological distress rates, lack basic health care knowledge and skills, and report increased marital conflict regarding patient self-management. The current pilot study examined the feasibility and acceptability of a 6-session telephone-based intervention called Spouses coping with the Head And neck Radiation Experience (SHARE), which teaches self-management, communication, and coping skills to patients with HNC and their spouses. The treatment effects of SHARE compared with usual medical care (UMC) in controlling patient physical symptoms and improving patient/spouse psychological and marital functioning also were examined.
Thirty patients who initiated RT and their spouses (60 participants; 40% of whom were racial/ethnic minorities) were randomized to SHARE or UMC, and preintervention and postintervention assessments were completed.
Solid recruitment (70%) and low attrition rates (7%) demonstrated feasibility. Strong program evaluations and homework completion rates (72%) supported acceptability. Significant treatment effects (medium in magnitude) were observed for SHARE compared with UMC with regard to HNC-specific physical symptom burden (Cohen's d, -0.89) and symptom interference (Cohen's d, -0.86). Medium to large effects favoring SHARE also were found for patient and spouse depressive symptoms (Cohen's d, -0.84) and cancer-specific distress (Cohen's d, -1.05).
The findings of the current study support the feasibility, acceptability, and preliminary efficacy of SHARE. They also suggest that programs that empower HNC couples with the necessary skills to coordinate care and manage the challenges of RT together hold great promise for controlling a patient's physical symptoms and improving the psychological functioning of both partners.
头颈部癌症（HNC）患者在接受放射治疗（RT）期间会经历显著的身体和心理痛苦，这导致治疗中断和生活质量下降。尽管配偶/伴侣可以通过鼓励患者在 RT 期间进行自我管理（例如自我护理）来提供帮助，但他们通常会经历较高的心理困扰率，缺乏基本的保健知识和技能，并报告在患者自我管理方面增加了婚姻冲突。目前的初步研究检验了一种名为配偶应对头颈部放射治疗体验的 6 节电话为基础的干预措施（SHARE）的可行性和可接受性，该措施向 HNC 患者及其配偶教授自我管理、沟通和应对技能。还检验了 SHARE 与常规医疗护理（UMC）相比在控制患者身体症状和改善患者/配偶心理和婚姻功能方面的治疗效果。
30 名开始接受 RT 的患者及其配偶（60 名参与者；其中 40%为少数民族）被随机分配到 SHARE 或 UMC 组，并完成了干预前和干预后的评估。
可靠的招募（70%）和低流失率（7%）证明了可行性。强有力的项目评估和家庭作业完成率（72%）支持了可接受性。与 UMC 相比，SHARE 显示出显著的治疗效果（中等程度），在 HNC 特定的身体症状负担（Cohen's d，-0.89）和症状干扰（Cohen's d，-0.86）方面。也发现了有利于 SHARE 的中等至较大效应，表现在患者和配偶的抑郁症状（Cohen's d，-0.84）和癌症特异性困扰（Cohen's d，-1.05）方面。
本研究的结果支持 SHARE 的可行性、可接受性和初步疗效。它们还表明，赋予 HNC 夫妇必要的技能，以共同协调护理和应对 RT 的挑战的方案，为控制患者的身体症状和改善双方的心理功能带来了很大的希望。
