van de Wiel Mick, Derijcke Sofie, Galdermans Daniella, Daenen Marc, Surmont Veerle, De Droogh Els, Lefebure Anneke, Saenen Erika, Vandenbroucke Elke, Morel Ann-Marie, Sadowska Anna, van Meerbeeck Jan P, Janssens Annelies
University Hospital Antwerp, Department of Thoracic Oncology, Edegem, Belgium.
Department of Pulmonology-Thoracic Oncology, AZ Groeninge, Kortrijk, Belgium.
Clin Lung Cancer. 2021 Mar;22(2):e146-e152. doi: 10.1016/j.cllc.2020.09.010. Epub 2020 Sep 18.
Patients with advanced lung cancer experience high physical symptom burden with substantial psychological distress. Depressive and anxiety symptoms are common and associated with worse quality of life (QoL). Early palliative care (EPC) addresses the complex supportive care needs improving QoL and mood. The mechanisms of EPC are uncertain. We examined whether and how coping strategy, a primary component of EPC, influenced QoL in these patients.
We conducted a multicenter cross-sectional study of patients with advanced lung cancer. A total of 125 patients completed assessments of QoL (QLQ-C15-PAL), depressive and anxiety symptoms (HADS), and coping (brief COPE questionnaire). The data were analyzed by descriptive statistics. To determine whether and how coping strategy influences QoL, correlations and logistic regressions were performed.
Positive reframing correlates significantly with global QoL (r = 0.25, P < .01), emotional well-being (r = 0.33, P < .01), pain (r = -0.30, P < .01), fatigue (r = -0.22, P < .01), loss of appetite (r = -0.22, P < .01) and nausea (r = -0.24, P < .01). Self-blame correlates significantly with worse emotional well-being (r = -0.19, P < .05) and insomnia (r = 0.19, P < .05). Using a 4-step logistic regression model, it was found that anxiety and depressive symptoms fully mediated the relationship between positive reframing and QoL.
Patients with advanced lung cancer using positive reframing as coping strategy, experience higher QoL. The mechanism behind it seems that positive reframing goes along with less anxiety and depressive symptoms leading to a better QoL. Self-blame leads to more insomnia and worse emotional well-being. Providing skills to cope effectively could impact QoL in these patients.
晚期肺癌患者身体症状负担重，伴有严重的心理困扰。抑郁和焦虑症状很常见，且与较差的生活质量（QoL）相关。早期姑息治疗（EPC）可满足复杂的支持性护理需求，改善生活质量和情绪。EPC的机制尚不确定。我们研究了EPC的主要组成部分应对策略是否以及如何影响这些患者的生活质量。
我们对晚期肺癌患者进行了一项多中心横断面研究。共有125名患者完成了生活质量（QLQ-C15-PAL）、抑郁和焦虑症状（HADS）以及应对方式（简易应对方式问卷）的评估。数据采用描述性统计进行分析。为了确定应对策略是否以及如何影响生活质量，进行了相关性分析和逻辑回归分析。
积极重新评价与总体生活质量显著相关（r = 0.25，P <.01）、情绪健康（r = 0.33，P <.01）、疼痛（r = -0.30，P <.01）、疲劳（r = -0.22，P <.01）、食欲减退（r = -0.22，P <.01）和恶心（r = -0.24，P <.01）。自我责备与较差的情绪健康（r = -0.19，P <.05）和失眠（r = 0.19，P <.05）显著相关。使用四步逻辑回归模型发现，焦虑和抑郁症状完全介导了积极重新评价与生活质量之间的关系。
将积极重新评价作为应对策略的晚期肺癌患者生活质量较高。其背后的机制似乎是积极重新评价伴随着较少的焦虑和抑郁症状，从而导致更好的生活质量。自我责备会导致更多的失眠和更差的情绪健康。提供有效的应对技巧可能会影响这些患者的生活质量。
