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睾丸癌幸存者的长期心理健康服务利用情况:一项基于人群的队列研究。

Long-Term Mental Health Service Utilization Among Survivors of Testicular Cancer: A Population-Based Cohort Study.

机构信息

Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Eastern Ontario, Canada.

出版信息

J Clin Oncol. 2021 Mar 1;39(7):779-786. doi: 10.1200/JCO.20.02298. Epub 2021 Jan 28.

Abstract

PURPOSE

Testicular cancer survivors may experience mental illness as a consequence of their cancer diagnosis and treatment.

METHODS

All incident cases of testicular cancer treated with orchiectomy in Ontario, Canada (2000-2010), were identified using the Ontario Cancer Registry. Cases were matched to controls in a 1:5 ratio on age and geography. Population-level databases were used to identify mental health service use episodes; outpatient use included visits to a general practitioner for a mental health concern or any visit to a psychiatrist. Negative binomial regression modeling was used to estimate the rate of mental health service use in the pretreatment (2 years prior until 1 month before orchiectomy), peritreatment (1 month before until 1 month after orchiectomy), and post-treatment periods (1 month after orchiectomy until end of follow-up). Rate ratios (RR) comparing cases with controls in the peri- and post-treatment periods were adjusted for baseline mental health service use.

RESULTS

Two thousand six hundred nineteen cases of testicular cancer were matched to 13,095 controls. There was no baseline difference in the rate of mental health service use. Cases were significantly more likely than controls to have an outpatient visit for a mental health concern in the peritreatment (adjusted RR [aRR], 2.45; 95% CI, 2.06 to 2.92) and post-treatment periods (aRR, 1.30; 95% CI, 1.12 to 1.52). The difference in mental health service use persisted over a median follow-up of 12 years. In the postorchiectomy period, cases with baseline mental health service use were those most likely to use mental health services (aRR, 5.64; 95% CI, 4.64 to 6.85).

CONCLUSION

Testicular cancer survivors use mental health services more often than healthy controls. Survivorship care plans that address the long-term mental healthcare needs of this population are needed.

摘要

目的

睾丸癌幸存者可能会因癌症诊断和治疗而出现精神疾病。

方法

通过安大略癌症登记处确定加拿大安大略省(2000-2010 年)接受睾丸切除术治疗的所有睾丸癌病例。病例按照年龄和地理位置以 1:5 的比例与对照组匹配。利用人群水平数据库来确定精神卫生服务使用情况;门诊使用包括因精神健康问题就诊普通医生或任何就诊精神科医生。采用负二项回归模型来估计治疗前(睾丸切除术前 2 年直至术前 1 个月)、围手术期(术前 1 个月至术后 1 个月)和术后(睾丸切除术 1 个月后至随访结束)的精神卫生服务使用率。调整基线精神卫生服务使用情况后,比较病例组和对照组在围手术期和术后的使用率比(RR)。

结果

2619 例睾丸癌病例与 13095 例对照组匹配。基线精神卫生服务使用率无差异。与对照组相比,病例组在围手术期(调整 RR[aRR],2.45;95%CI,2.06 至 2.92)和术后(aRR,1.30;95%CI,1.12 至 1.52)更有可能因精神健康问题就诊。中位随访 12 年期间,精神卫生服务使用率差异持续存在。在睾丸切除术后,有基线精神卫生服务使用的病例最有可能使用精神卫生服务(aRR,5.64;95%CI,4.64 至 6.85)。

结论

睾丸癌幸存者比健康对照者更频繁地使用精神卫生服务。需要为这一人群制定关注长期精神卫生保健需求的生存者关怀计划。

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