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探索个体化整合肿瘤学方案在局部癌症化疗期间对情绪困扰的有效性。

Exploring the effectiveness of a patient-tailored integrative oncology program on emotional distress during chemotherapy for localized cancer.

机构信息

Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel.

Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

出版信息

Psychooncology. 2022 Feb;31(2):207-218. doi: 10.1002/pon.5794. Epub 2021 Aug 26.

Abstract

STUDY OBJECTIVE

There is a need to explore how patient-tailored integrative oncology (IO) programs reduce emotional distress. This study set out to bridge the IO research gap between non-specific, quality of life-related and specific emotional-related concerns in chemotherapy-treated patients.

METHODS

This pragmatic, prospective and preference-controlled study examined patients attending an integrative-physician consultation and weekly IO treatments during adjuvant/neo-adjuvant chemotherapy for localized cancer. Patients choosing to attend ≥4 IO sessions (highly adherent to integrative care, AIC) were compared to low AIC patients using the ESAS (Edmonton Symptom Assessment Scale) anxiety, depression and sleep; and the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) emotional functioning scale, at baseline, 6 and 12 weeks. Emotional distress was assessed by ESAS anxiety and depression, considered as the primary study outcomes.

RESULTS

Of 439 participants, 260 (59%) were high-AIC and 179 low-AIC, both with similar baseline demographic and cancer-related characteristics. At 6 weeks, high-AIC patients reported greater improvement on ESAS sleep (p = 0.044); within-group improvement on ESAS anxiety and; and EORTC emotional functioning. Compared with low-AIC, high-AIC patients showed greater improvement on ESAS depression (p = 0.022) and sleep (p = 0.015) in those with high baseline ESAS anxiety scores (≥7); and ESAS anxiety (p = 0.049) for patients moderately anxious (4-6) at baseline.

CONCLUSIONS

High-AIC was associated with significantly reduced anxiety, depression and sleep severity at 6 weeks, especially those with high-to-moderate baseline anxiety levels. These findings reduce the research gap, suggesting specific emotional-related effects of IO.

摘要

研究目的

需要探索如何根据患者的情况制定个性化的综合肿瘤学(IO)方案,以减轻其情绪困扰。本研究旨在弥合 IO 研究中存在的差距,即关注化疗患者的非特异性、生活质量相关问题与特定情绪相关问题之间的差距。

方法

本研究为一项实用、前瞻性且基于偏好的研究,纳入在辅助/新辅助化疗期间接受局部癌症治疗的患者,这些患者参加了综合医生咨询和每周的 IO 治疗。通过 ESAS(埃德蒙顿症状评估量表)焦虑、抑郁和睡眠量表,以及 EORTC QLQ-C30(欧洲癌症研究与治疗组织生活质量问卷)情绪功能量表,在基线、6 周和 12 周时,比较选择参加≥4 次 IO 治疗(高度接受综合治疗,AIC)的患者与低 AIC 患者。采用 ESAS 焦虑和抑郁评估情绪困扰,这被认为是主要的研究结果。

结果

在 439 名参与者中,260 名(59%)为高 AIC,179 名(41%)为低 AIC,两组的基线人口统计学和癌症相关特征相似。在 6 周时,高 AIC 患者报告 ESAS 睡眠(p=0.044)、ESAS 焦虑和 EORTC 情绪功能均有更大的改善。与低 AIC 相比,高 AIC 患者在基线 ESAS 焦虑评分≥7 分的患者中,ESAS 抑郁和睡眠(p=0.015)以及 ESAS 焦虑(p=0.022)改善更为明显;在基线时焦虑程度为 4-6 分的中度焦虑患者中,ESAS 焦虑(p=0.049)也得到了改善。

结论

在 6 周时,高 AIC 与焦虑、抑郁和睡眠严重程度显著降低相关,尤其是那些基线时焦虑程度较高或中度的患者。这些发现缩小了研究差距,表明 IO 具有特定的情绪相关作用。

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