Shen Jun, Wang Meng, Li Fan, Li Yan, Zhou Jun, Sun Wenwen
Department of Breast Surgery, The First People's Hospital of LianYunGang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, LianYunGang, People's Republic of China.
Cancer Manag Res. 2022 May 20;14:1759-1770. doi: 10.2147/CMAR.S354214. eCollection 2022.
To explore the precise implementation methods of multidisciplinary continuous nursing intervention in patients with breast cancer experiencing negative emotions.
About 30-40% of breast cancer patients have negative emotions, and negative emotions can increase the risk of breast cancer death. Team psychological intervention is helpful to improve negative emotions. How to effectively and accurately implement the multidisciplinary continuous nursing model needs further research.We designed a retrospective analysis of 750 patients with breast cancer in our hospital was made. Their baseline characteristics and follow-up data, pre-treatment self-rating anxiety scale (SAS) scores, and scores in the follow-up period after the treatment (SAS_A) were included in the analysis to verify the correlation between an SAS_A score and a prognosis. Risk prediction models were established for the SAS_A score, and they were screened and verified. A non-inferiority study was conducted through the models to explore the feasibility of the precise multidisciplinary continuous nursing intervention in patients with breast cancer experiencing negative emotions.
The prognosis could be distinguished with the SAS_A scores; AUC = 0.8306, a p-value of <0.0001, and cut-off = 53.5. Based on the Kaplan-Meier (K-M) analysis, the rate of no disease progression of the group with relatively high SAS_A scores was significantly lower than that with relatively low SAS_A scores and a p-value of <0.0001. A regression analysis was conducted to screen variables including income, operation, family, religion, and SAS scores. The fit.select.v1.lrm model was established, and its concordance index (C-index) was 0.676 (0.622, 0.729). Based on the model calibration curve, Prob = 0.4 was selected. In accordance with the non-inferiority design, the minimum 95% confidence interval (CI) of the mean value difference of the two groups should be greater than the cut-off value. If λ = 20%, the cut-off value was 1.316, and 95% CI was (1.198, 1.4336); the possibility of non-inferiority was refused, but their mean value difference was very close.
It is feasible to precisely implement the multidisciplinary continuous nursing intervention in patients with breast cancer experiencing negative emotions based on the prediction model, but further study is required.
探讨多学科连续性护理干预在存在负面情绪的乳腺癌患者中的精准实施方法。
约30%-40%的乳腺癌患者存在负面情绪，负面情绪会增加乳腺癌死亡风险。团队心理干预有助于改善负面情绪。如何有效且精准地实施多学科连续性护理模式有待进一步研究。我们对我院750例乳腺癌患者进行回顾性分析。纳入其基线特征、随访数据、治疗前自评焦虑量表（SAS）评分以及治疗后随访期评分（SAS_A），以验证SAS_A评分与预后的相关性。为SAS_A评分建立风险预测模型，并进行筛选和验证。通过模型进行非劣效性研究，以探讨多学科连续性护理精准干预在存在负面情绪的乳腺癌患者中的可行性。
可通过SAS_A评分区分预后；曲线下面积（AUC）=0.8306，p值<0.0001，截断值=53.5。基于Kaplan-Meier（K-M）分析，SAS_A评分相对较高组的无疾病进展率显著低于评分相对较低组，p值<0.0001。进行回归分析以筛选包括收入、手术、家庭、宗教和SAS评分等变量。建立了fit.select.v1.lrm模型，其一致性指数（C指数）为0.676（0.622，0.729）。基于模型校准曲线，选择概率=0.4。按照非劣效性设计，两组均值差异的最小95%置信区间（CI）应大于截断值。若λ=20%，截断值为1.316，95%CI为（1.198，1.4336）；拒绝非劣效性的可能性，但两组均值差异非常接近。
基于预测模型对存在负面情绪的乳腺癌患者精准实施多学科连续性护理干预是可行的，但仍需进一步研究。
