Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Fam Cancer. 2020 Jul;19(3):247-258. doi: 10.1007/s10689-020-00171-8.
In high-risk individuals participating in a pancreatic cancer surveillance program, worrisome features warrant for intensified surveillance or, occasionally, surgery. Our objectives were to determine the patient-reported burden of intensified surveillance and/or surgery, and to assess post-operative quality of life and opinion of surgery. Participants in our pancreatic cancer surveillance program completed questionnaires including the Cancer Worry Scale (CWS) and the Hospital Anxiety and Depression Scale (HADS). For individuals who underwent intensified surveillance, questionnaires before, during, and ≥ 3 weeks after were analyzed. In addition, subjects who underwent intensified surveillance in the past 3 years or underwent surgery at any time, were invited for an interview, that included the Short-Form 12 (SF-12). A total of 31 high-risk individuals were studied. During the intensified surveillance period, median CWS scores were higher (14, IQR 7), as compared to before (12, IQR 9, P = 0.007) and after (11, IQR 7, P = 0.014), but eventually returned back to baseline (P = 0.823). Median HADS scores were low: 5 (IQR 6) for anxiety and 3 (IQR 5) for depression, and they were unaffected by the intensified surveillance period. Of the 10 operated patients, 1 (10%) developed diabetes and 7 (70%) pancreatic exocrine insufficiency. The interviews yielded median quality-of-life scores comparable to the general population. Also, after surgery, patients' attitudes towards surveillance were unchanged (5/10, 50%) or became more positive (4/10, 40%). Although patients were aware of the (sometimes benign) pathological outcome, when asked if surgery had been justified, only 20% (2/10) disagreed, and all would again have chosen to undergo surgery. In conclusion, in individuals at high risk for pancreatic cancer, intensified surveillance temporarily increased cancer worries, without affecting general anxiety or depression. Although pancreatic surgery led to substantial co-morbidity, quality of life was similar to the general population, and surgery did not negatively affect the attitude towards surveillance.
在参加胰腺癌监测计划的高危个体中，令人担忧的特征需要加强监测，或者偶尔需要手术。我们的目的是确定患者报告的强化监测和/或手术的负担，并评估术后生活质量和对手术的看法。我们的胰腺癌监测计划参与者完成了包括癌症担忧量表（CWS）和医院焦虑和抑郁量表（HADS）在内的问卷。对于接受强化监测的个体，分析了监测前、监测中和监测后≥3 周的问卷。此外，还邀请了过去 3 年内接受过强化监测或任何时间接受过手术的受试者进行访谈，包括 12 项简明健康调查问卷（SF-12）。共研究了 31 名高危个体。在强化监测期间，CWS 评分中位数较高（14，IQR7），与监测前（12，IQR9，P=0.007）和监测后（11，IQR7，P=0.014）相比，CWS 评分中位数较高，但最终恢复到基线（P=0.823）。HADS 评分中位数较低：焦虑 5（IQR6），抑郁 3（IQR5），不受强化监测期的影响。在 10 名手术患者中，1 名（10%）发生糖尿病，7 名（70%）发生胰腺外分泌功能不全。访谈得出的生活质量评分与一般人群相当。此外，手术后，患者对监测的态度保持不变（10 名患者中的 5 名，50%）或变得更加积极（10 名患者中的 4 名，40%）。尽管患者知道（有时是良性的）病理结果，但当被问及手术是否合理时，只有 20%（10 名患者中的 2 名）表示不同意，并且所有患者都会再次选择手术。总之，在胰腺癌高危个体中，强化监测暂时增加了癌症担忧，但不影响一般焦虑或抑郁。尽管胰腺手术导致了大量的合并症，但生活质量与一般人群相似，手术也没有对监测的态度产生负面影响。
