Giddings Alison
Vancouver Cancer Centre, BC Cancer Agency, Vancouver, British Columbia, Canada.
J Med Imaging Radiat Sci. 2010 Dec;41(4):222-229. doi: 10.1016/j.jmir.2010.08.002. Epub 2010 Dec 15.
Extending the period over which a course of radiation therapy is delivered can have detrimental effects on treatment success. This is especially true for fast growing tumors of the head-and-neck region. The goal of this study was to establish the rates and causes of treatment interruptions for head-and-neck patients at the Vancouver Cancer Centre of the BC Cancer Agency, and to explore the link between emotional distress and missed appointments.
Head-and-neck patients who had missed treatments other than public holidays were identified using the Oncology Reporting System. The charts of these patients were pulled and examined for cause of treatment interruption. The Psychosocial Screen for Cancer (PSSCAN) found in these patients' charts was used to establish anxiety and depression levels. A random sample of PSSCANs from the charts of patients who had not missed appointments was recorded for comparison.
Of the 471 head-and-neck patients included in our analysis, 74% had interruptions in treatment. Gaps of greater than three days were present in 11% of treatment courses. The most common cause of treatment breaks was statutory holidays, responsible for 69% of interruptions. The anxiety and depression scores of patients who had missed appointments for reasons other than holidays were not significantly higher than patients who had not missed appointments.
Rates of treatment time extension in Vancouver were higher than expected, given rates reported from other parts of the world. Policies aimed at reducing or compensating for treatment interruptions have been successful elsewhere, and could also be instituted here. Although many published studies have shown emotional distress can lead to noncompliance in health care, this link was not found here. Several weaknesses in our study design may have contributed to the lack of correlation between anxiety and depression and missed appointments.
延长放射治疗疗程的时间可能会对治疗效果产生不利影响。对于头颈部快速生长的肿瘤来说尤其如此。本研究的目的是确定不列颠哥伦比亚癌症机构温哥华癌症中心头颈部患者治疗中断的发生率及原因，并探讨情绪困扰与错过预约之间的联系。
使用肿瘤学报告系统识别出头颈部患者中除公共假日外错过治疗的患者。调取这些患者的病历并检查治疗中断的原因。利用这些患者病历中发现的癌症心理社会筛查量表（PSSCAN）来确定焦虑和抑郁水平。从未错过预约的患者病历中随机抽取PSSCAN样本进行记录以作比较。
在我们分析的471名头颈部患者中，74%的患者出现了治疗中断。11%的治疗疗程中断时间超过三天。治疗中断最常见的原因是法定假日，占中断原因的69%。因非假日原因错过预约的患者的焦虑和抑郁评分并不显著高于未错过预约的患者。
考虑到世界其他地区报告的发生率，温哥华治疗时间延长的发生率高于预期。旨在减少或补偿治疗中断的政策在其他地方已经取得成功，这里也可以制定。尽管许多已发表的研究表明情绪困扰会导致医疗保健方面的不依从，但在此处未发现这种联系。我们研究设计中的几个弱点可能导致了焦虑、抑郁与错过预约之间缺乏相关性。
