1 Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
2 Núcleo Milenio para el Estudio del Curso de Vida y la Vulnerabilidad, Santiago, Chile.
J Palliat Med. 2019 Jun;22(6):663-669. doi: 10.1089/jpm.2018.0340. Epub 2019 Jan 16.
Improving quality of life (QOL) is important in cancer palliative care (PC) patients. "Spiritual pain" (SP) is common in this population, but it is unknown how it affects QOL. To study the associations between SP and QOL in cancer patients in PC. Cross-sectional. Cancer patients assessed at a PC clinic in Puente Alto, Chile, were enrolled in a longitudinal study to characterize patients' end of life. Inclusion criteria included age ≥18, a primary caregiver, not having delirium, and a Karnofsky performance status (KPS) ≤80. After consenting patients completed baseline surveys that included demographics, single-item questions to assess SP (0-10), financial distress, spirituality-related variables and questionnaires to assess QOL (0-100), and physical (Global distress score-physical) and psychological distress (Hospital Anxiety and Depression Scale), baseline data analyses to explore associations between SP and QOL were adjusted for potential confounders. Two hundred and eight patients were enrolled: mean age was 64, 50% were female, and 67% had SP. In univariate analysis, SP was significantly associated with lower QOL (coefficient [95% confidence interval]: -1.88 [-2.93 to -0.84], < 0.001). Lower QOL was also associated with being younger, lower KPS, higher physical distress, having anxiety or depression, and decreased religiosity and religious coping. In the multivariate analysis, QOL remained independently associated with SP (-1.25 [-2.35; to -0.15], < 0.026), religious coping (11.74 [1.09 to 22.38], < 0.031), and physical distress (-0.52 [-0.89 to -0.16], < 0.005). SP is associated with QOL in cancer patients in PC. SP should be regularly assessed to plan for interventions that could impact QOL. More research is needed.
提高生活质量（QOL）是癌症姑息治疗（PC）患者的重要目标。“精神痛苦”（SP）在这一人群中很常见，但它如何影响 QOL 尚不清楚。研究 SP 与癌症 PC 患者 QOL 之间的关系。 横断面研究。 在智利 Puente Alto 的 PC 诊所接受评估的癌症患者被纳入一项纵向研究，以描述患者的临终情况。纳入标准包括年龄≥18 岁、有主要照顾者、无谵妄和 Karnofsky 表现状态（KPS）≤80。在征得同意后，患者完成了基线调查，包括人口统计学、评估 SP（0-10）的单一问题、财务困境、与灵性相关的变量以及评估 QOL（0-100）的问卷，以及身体（全球痛苦评分-身体）和心理困扰（医院焦虑和抑郁量表）。基线数据分析调整了潜在混杂因素，以探索 SP 与 QOL 之间的关联。共纳入 280 例患者：平均年龄为 64 岁，50%为女性，67%有 SP。在单变量分析中，SP 与 QOL 显著相关（系数[95%置信区间]：-1.88[-2.93 至-0.84]， < 0.001）。较低的 QOL 也与年龄较小、较低的 KPS、较高的身体痛苦、焦虑或抑郁以及宗教信仰和宗教应对能力下降有关。在多变量分析中，QOL 仍与 SP 独立相关（-1.25[-2.35 至-0.15]， < 0.026）、宗教应对（11.74[1.09 至 22.38]， < 0.031）和身体痛苦（-0.52[-0.89 至-0.16]， < 0.005）。 SP 与癌症 PC 患者的 QOL 相关。应定期评估 SP，以制定可能影响 QOL 的干预措施。需要进一步研究。
