宫颈癌相关痛苦：评估高度脆弱人群的姑息治疗需求。
Cervical Cancer-Associated Suffering: Estimating the Palliative Care Needs of a Highly Vulnerable Population.
机构信息
Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA.
Department of Medicine, Harvard Medical School, Boston, MA.
出版信息
JCO Glob Oncol. 2021 Jun;7:862-872. doi: 10.1200/GO.21.00025.
PURPOSE
To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration.
METHODS
We first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified Delphi process with experts in cervical cancer care to supplement the literature. For each type of suffering, we distinguished between decedents (those who die from cervical cancer in a given year) and nondecedents (those who have cervical cancer in a given year but do not die). By applying the suffering prevalence and duration estimates to the number of decedents, nondecedents, and family caregivers in 2017, we were able to estimate their palliative care needs and the intensity of palliative care needed to respond adequately to this suffering.
RESULTS
There is a high prevalence among decedents of moderate or severe pain (84%), vaginal discharge (66%), vaginal bleeding (61%), and loss of faith (31%). Among both decedents and nondecedents, there is a high prevalence of clinically significant anxiety (63% and 50%, respectively), depressed mood (52% and 38%, respectively), and sexual dysfunction (87% and 83%, respectively). Moderate or severe financial distress is prevalent among decedents, nondecedents, and family caregivers (84%, 74%, and 66%, respectively). More than 40% of decedents and nondecedents are abandoned by their intimate partners. Most patients experience some combination of moderate or severe physical, psychological, social, and spiritual suffering. In total, 258,649 decedents and 2,558,857 nondecedents needed palliative care in 2017, approximately 85% of whom were in low- and middle-income countries where palliative care is rarely accessible.
CONCLUSION
Among women with advanced cervical cancer, suffering is highly prevalent and often severe and multifaceted.
目的
为了为宫颈癌女性提供最佳的姑息治疗，我们研究了最常见的痛苦类型及其严重程度、发生率和持续时间。
方法
我们首先回顾了与宫颈癌相关的主要类型、严重程度、发生率和持续时间的文献。然后，我们与宫颈癌护理专家一起进行了一项改良 Delphi 流程，以补充文献。对于每种痛苦类型，我们区分了死者（当年死于宫颈癌的患者）和非死者（当年患有宫颈癌但未死亡的患者）。通过将痛苦发生率和持续时间估计应用于 2017 年的死者、非死者和家庭照顾者的数量，我们能够估计他们的姑息治疗需求和充分应对这种痛苦所需的姑息治疗强度。
结果
在死者中，中度或重度疼痛（84%）、阴道分泌物（66%）、阴道出血（61%）和失去信仰（31%）的发生率较高。在死者和非死者中，临床上明显的焦虑（分别为 63%和 50%）、抑郁情绪（分别为 52%和 38%）和性功能障碍（分别为 87%和 83%）的发生率较高。死者、非死者和家庭照顾者中中度或重度经济困难的发生率较高（分别为 84%、74%和 66%）。超过 40%的死者和非死者被其亲密伴侣抛弃。大多数患者经历了中度或重度的身体、心理、社会和精神痛苦。2017 年共有 258649 名死者和 2558857 名非死者需要姑息治疗，其中约 85%的患者来自中低收入国家，这些国家很少提供姑息治疗。
结论
在晚期宫颈癌女性中，痛苦普遍存在，且往往严重且多方面。
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