Department of Medical Oncology, University Hospital of the Canary Islands, Tenerife, Spain.
Department of Clinical Psychology and Psychobiology. Faculty of Psychology, University of Barcelona, Barcelona, Spain.
Psychogeriatrics. 2019 Sep;19(5):426-434. doi: 10.1111/psyg.12420. Epub 2019 Feb 5.
Coping with cancer and the oncologist-patient relationship can vary depending on the patient's age. Our aim is to examine and compare young and elderly adults with non-metastatic, resected cancer.
Two groups of patients were selected, young (< 40 years) and elderly (> 70) with a diagnosis of non-metastatic, resected cancer requiring adjuvant chemotherapy from a pre-exiting, national database (NEOCOPING Study). Epidemiological variables were collected and subjects' emotional responses, perceptions of the physician-patient relationship, support network, fears, and regret about the decision to receive chemotherapy were assessed with questionnaires validated in previous studies: Mini-Mental Adjustment to Cancer, Brief Summary Inventory (18 items), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-C30, Shared Decision-Making Questionnaire-Physician's version, Shared Decision-Making Questionnaire-Patient's version, and Informed Risk (physician and patient versions).
Data from 46 young and 46 elderly participants were collected. The most common neoplasms in both groups were breast (50%) and colorectal (22%). The younger adults had a higher level of education and were actively employed (72% vs. 7%). The leading coping strategy in the younger cohort was hope, and resignation among the elderly. Young adults sought more social support and the impact of diagnosis was more negative for them than for older individuals. No significant differences were detected in quality of life; both age groups demanded more time at their first visit with the doctor, while the older group exhibited greater satisfaction with shared decision-making. At the end of adjuvant chemotherapy, neither age group regretted their decision to receive said treatment.
Higher levels of education, greater demands of the labour market, and the advent of the age of information have entailed drastic changes in the physician-patient relationship paradigm. This is especially true in the younger cancer patient population, who require more information and active participation in decision-making, can display more anxiety about their diagnosis, but also greater capacity to fight.
应对癌症和医患关系可能因患者年龄而异。我们的目的是检查和比较患有非转移性、可切除癌症的年轻和老年成年人。
从一个现有的国家数据库（NEOCOPING 研究）中选择了两组患者，年轻组（<40 岁）和老年组（>70 岁），这些患者被诊断为患有非转移性、可切除癌症，需要接受辅助化疗。收集了流行病学变量，并使用以前研究中验证过的问卷评估了患者的情绪反应、对医患关系的看法、支持网络、对接受化疗的决定的恐惧和遗憾：癌症心理调整简明量表、简短总结量表（18 项）、欧洲癌症研究与治疗组织生活质量问卷-C30、共享决策问卷-医生版、共享决策问卷-患者版和知情风险（医生和患者版）。
共收集了 46 名年轻患者和 46 名老年患者的数据。两组最常见的肿瘤是乳腺癌（50%）和结直肠癌（22%）。年轻成年人受教育程度较高，积极就业（72%比 7%）。年轻患者的主要应对策略是希望，而老年患者则是听天由命。年轻患者寻求更多的社会支持，诊断对他们的影响比老年患者更负面。两组患者的生活质量无显著差异；两个年龄组在第一次就诊时都需要更多的时间，而老年组对共享决策的满意度更高。在辅助化疗结束时，两个年龄组都没有后悔接受治疗。
更高的教育水平、劳动力市场的更大需求以及信息时代的到来，使医患关系的范式发生了巨大变化。在年轻的癌症患者群体中尤其如此，他们需要更多的信息和积极参与决策，可能对诊断感到更焦虑，但也有更大的抗争能力。
