Department of Nursing, UCLA School of Nursing, Los Angeles, California, U.S.A.
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
Laryngoscope. 2022 Aug;132(8):1600-1608. doi: 10.1002/lary.30000. Epub 2021 Dec 25.
OBJECTIVES/HYPOTHESIS: Psychosocial distress is common among patients with head and neck cancer (HNC) and is associated with poorer quality of life and clinical outcomes. Despite these risks, distress screening is not widely implemented in HNC care. In this study, we investigated the prevalence of psychosocial distress and its related factors in routine care of patients with HNC.
Data from medical records between September 2017 and March 2020 were analyzed. Psychosocial distress was measured by the National Comprehensive Cancer Network's Distress Thermometer (DT), and a modified HNC-specific problem list; depression and anxiety were assessed using the Patient Health Questionnaire-4. Descriptive statistics and logistic regression were conducted to report prevalence of distress, depression and anxiety, and factors associated with clinical distress. Implementation outcomes, including rates of referrals and follow-up for distressed patients, are also reported.
Two hundred and eighty seven HNC patients completed the questionnaire (age 64.3 ± 14.9 years), with a mean distress score of 4.51 ± 3.35. Of those, 57% (n = 163) reported clinical distress (DT ≥ 4). Pain (odds ratio [OR] = 3.31, 95% CI = 1.75-6.26), fatigue (OR = 2.43, 95% CI = 1.1.7-5.05), anxiety (OR = 1.63, 95% CI = 1.30-2.05), and depression (OR = 1.51, 95% CI = 1.04-2.18) were significantly associated with clinical distress (P < .05). Of patients identified as distressed, 79% received same-day psychosocial evaluation.
Clinical distress was identified in 57% of patients who completed the questionnaire, suggesting that an ultra-brief psychosocial screening protocol can be implemented in routine ambulatory oncology care, and identifies patients whose distress might otherwise go unrecognized.
4 Laryngoscope, 132:1600-1608, 2022.
目的/假设：心理困扰在头颈部癌症（HNC）患者中很常见，与生活质量和临床结局较差有关。尽管存在这些风险，但在 HNC 护理中并未广泛实施痛苦筛查。在这项研究中，我们调查了 HNC 患者常规护理中心理困扰的患病率及其相关因素。
分析了 2017 年 9 月至 2020 年 3 月期间的病历数据。通过国家综合癌症网络的痛苦温度计（DT）和改良的 HNC 特定问题清单来衡量心理困扰；使用患者健康问卷-4 评估抑郁和焦虑。报告了困扰、抑郁和焦虑的患病率以及与临床困扰相关的因素，并进行了描述性统计和逻辑回归。还报告了实施结果，包括为有困扰的患者提供转诊和随访的比率。
287 名 HNC 患者完成了问卷（年龄 64.3±14.9 岁），平均困扰得分为 4.51±3.35。其中，57%（n=163）报告存在临床困扰（DT≥4）。疼痛（优势比[OR] = 3.31，95%置信区间[CI] = 1.75-6.26）、疲劳（OR = 2.43，95% CI = 1.1.7-5.05）、焦虑（OR = 1.63，95% CI = 1.30-2.05）和抑郁（OR = 1.51，95% CI = 1.04-2.18）与临床困扰显著相关（P<.05）。在被确定为困扰的患者中，79%的患者当天接受了心理社会评估。
完成问卷的患者中有 57%被确定为有临床困扰，这表明超简短的心理社会筛查方案可以在常规门诊肿瘤护理中实施，并可识别出那些可能未被发现的困扰患者。
4 Laryngoscope, 132:1600-1608, 2022.
