El-Jawahri Areej, Greer Joseph A, Park Elyse R, Jackson Vicki A, Kamdar Mihir, Rinaldi Simone P, Gallagher Emily R, Jagielo Annemarie D, Topping Carlisle E W, Elyze Madeleine, Jones Bailey, Temel Jennifer S
Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
J Pain Symptom Manage. 2021 Mar;61(3):488-494. doi: 10.1016/j.jpainsymman.2020.08.028. Epub 2020 Aug 31.
Individuals caring for patients with advanced cancer (caregivers) experience psychological distress during the patient's illness course. However, data on the prevalence of bereaved caregivers' psychological distress and its relationship with the quality of patient's end of life (EOL) care are limited.
To describe rates of depression and anxiety symptoms in bereaved caregivers of patients with advanced cancer and to understand the relationship between these outcomes and patient distress at the EOL.
We conducted a secondary analysis of 168 caregivers enrolled in a supportive care trial for patients with incurable lung and gastrointestinal cancers and their caregivers. We used the Hospital Anxiety and Depression Scale to assess caregivers' depression and anxiety symptoms at three months after the patient's death. Caregivers also rated the patient's physical and psychological distress in the last week of life on a 10-point scale three months after the patient death. We used linear regression adjusting for caregiver age, sex, randomization, and cancer type to explore the relationship between bereaved caregivers' depression and anxiety symptoms and their ratings of physical and psychological distress in patients at the EOL.
Of the 168 bereaved caregivers, 30.4% (n = 51) and 43.4% (n = 73) reported clinically significant depression and anxiety symptoms, respectively. Caregiver ratings of worse physical (B = 0.32; P = 0.009) and psychological (B = 0.50; P < 0.001) distress experienced by the patient at the EOL were associated with worse depression symptoms in bereaved caregivers. Only caregiver rating of worse psychological distress experienced by the patient at the EOL (B = 0.42; P < 0.001) was associated with worse bereaved caregivers' anxiety symptoms.
Many bereaved caregivers of patients with advanced cancer experience symptoms of depression and anxiety, which are associated with their perceptions of distress in their loved ones at the EOL.
照顾晚期癌症患者的人（护理者）在患者患病期间会经历心理困扰。然而，关于失去亲人的护理者心理困扰的患病率及其与患者临终关怀质量的关系的数据有限。
描述晚期癌症患者失去亲人的护理者中抑郁和焦虑症状的发生率，并了解这些结果与患者临终时的痛苦之间的关系。
我们对168名护理者进行了二次分析，这些护理者参与了一项针对无法治愈的肺癌和胃肠道癌症患者及其护理者的支持性护理试验。我们使用医院焦虑抑郁量表在患者死亡三个月后评估护理者的抑郁和焦虑症状。护理者还在患者死亡三个月后，用10分制对患者生命最后一周的身体和心理痛苦进行评分。我们使用线性回归，对护理者的年龄、性别、随机分组和癌症类型进行调整，以探讨失去亲人的护理者的抑郁和焦虑症状与他们对患者临终时身体和心理痛苦评分之间的关系。
在168名失去亲人的护理者中，分别有30.4%（n = 51）和43.4%（n = 73）报告有临床显著的抑郁和焦虑症状。护理者对患者临终时身体（B = 0.32；P = 0.009）和心理（B = 0.50；P < 0.001）痛苦程度的评分越高，失去亲人的护理者的抑郁症状就越严重。只有护理者对患者临终时心理痛苦程度的评分越高（B = 0.42；P < 0.001），失去亲人的护理者的焦虑症状就越严重。
许多晚期癌症患者失去亲人的护理者都有抑郁和焦虑症状，这与他们对亲人临终时痛苦的认知有关。
