Massachusetts General Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
J Clin Oncol. 2020 Mar 20;38(9):915-925. doi: 10.1200/JCO.19.00013. Epub 2020 Feb 5.
Advanced cancer, with its considerable physical symptoms and psychosocial burdens, represents an existential threat and major stressor to patients and their caregivers. In response to such stress, patients and their caregivers use a variety of strategies to manage the disease and related symptoms, such as problem-focused, emotion-focused, meaning-focused, and spiritual/religious coping. The use of such coping strategies is associated with multiple outcomes, including quality of life, symptoms of depression and anxiety, illness understanding, and end-of-life care. Accumulating data demonstrate that early palliative care, integrated with oncology care, not only improves these key outcomes but also enhances coping in patients with advanced cancer. In addition, trials of home-based palliative care interventions have shown promise for improving the ways that patients and family caregivers cope together and manage problems as a dyad. In this article, we describe the nature and correlates of coping in this population, highlight the role of palliative care to promote effective coping strategies in patients and caregivers, and review evidence supporting the beneficial effects of palliative care on patient coping as well as the mechanisms by which improved coping is associated with better outcomes. We conclude with a discussion of the limitations of the state of science, future directions, and best practices on the basis of available evidence.
晚期癌症患者及其照护者面临着严重的身体症状和心理社会负担，这对他们来说是一种生存威胁和重大压力源。为了应对这种压力，患者及其照护者会采用多种策略来管理疾病和相关症状，例如问题导向、情绪导向、意义导向和精神/宗教应对。这些应对策略的使用与多种结果相关，包括生活质量、抑郁和焦虑症状、疾病理解和临终关怀。越来越多的数据表明，将姑息治疗与肿瘤学治疗相结合的早期姑息治疗不仅可以改善这些关键结果，还可以增强晚期癌症患者的应对能力。此外，基于家庭的姑息治疗干预试验已经显示出改善患者和家庭照护者共同应对和共同管理问题的方式的潜力。在本文中，我们描述了这一人群应对的性质和相关性，强调了姑息治疗在促进患者和照护者有效应对策略方面的作用，并回顾了姑息治疗对患者应对能力的有益影响以及改善应对与更好结果之间的关联机制的证据。最后，我们根据现有证据讨论了科学现状的局限性、未来方向和最佳实践。
