Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
Clinical Health Psychology Service, Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital NHS Trust, UK.
Psychooncology. 2020 Nov;29(11):1864-1873. doi: 10.1002/pon.5514. Epub 2020 Aug 25.
Cancer survivors commonly experience long-term anxiety and depression. Anxiety and depression might result from problems emerging during survivorship rather than illness and treatment. This study tested three potential causal paths: (a) concerns about physical symptoms and functional problems and fear of cancer recurrence (FCR) arising during survivorship directly cause anxiety and depression, (b) an indirect path whereby FCR mediates effects of concerns about physical symptoms and functional problems on anxiety and depression, and (c) a reciprocal path whereby anxiety and depression cause concerns about physical symptoms and functional problems and FCR, which exacerbate later anxiety and depression.
Sample of 453 uveal melanoma survivors who completed observations 6-, 12-, 24-, 36-, 48- and 60-months post-diagnosis and did not miss two consecutive observations. Cross-lagged analyses were conducted to predict Hospital Anxiety and Depression Scale subscale scores. Symptoms and functional problems were measured using the EORTC OPT 30 scale, and FCR operationalised by the EORTC OPT 30 worry about recurrence scale. Covariates were age, gender, treatment modality, and visual acuity of the fellow eye and chromosome-3 status (which accurately predicts 10-year survival), worry and anxiety or depression.
All paths received some support, although the indirect path emerged only for anxiety in females. Concerns about physical symptoms, functional problems, and FCR originated in survivorship and appeared to both influence and be influenced by anxiety and depression.
Findings emphasise the importance of actively monitoring survivors to prevent, detect, and intervene in the development of anxiety and depression during survivorship.
癌症幸存者通常会经历长期的焦虑和抑郁。焦虑和抑郁可能是由于生存期间出现的问题而不是疾病和治疗引起的。本研究检验了三种潜在的因果路径：（a）生存期间出现的身体症状和功能问题以及对癌症复发的恐惧（FCR）直接导致焦虑和抑郁；（b）FCR 中介身体症状和功能问题对焦虑和抑郁影响的间接路径；（c）焦虑和抑郁导致身体症状和功能问题以及 FCR，进而加重后期焦虑和抑郁的循环路径。
本研究的样本为 453 名葡萄膜黑色素瘤幸存者，他们在诊断后 6、12、24、36、48 和 60 个月完成了观察，且没有错过连续两次的观察。进行交叉滞后分析以预测医院焦虑和抑郁量表子量表的评分。使用 EORTC OPT 30 量表测量症状和功能问题，使用 EORTC OPT 30 复发担忧量表操作 FCR。协变量包括年龄、性别、治疗方式、对侧眼视力和 3 号染色体状态（准确预测 10 年生存率）、担忧以及焦虑或抑郁。
所有路径都得到了一定程度的支持，尽管只有女性的焦虑存在间接路径。对身体症状、功能问题和 FCR 的担忧源于生存期间，似乎既受到焦虑和抑郁的影响，也影响着焦虑和抑郁。
这些发现强调了积极监测幸存者的重要性，以预防、发现和干预生存期间焦虑和抑郁的发展。
