Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA.
Department of Supportive Medicine, City of Hope National Medical Center, Duarte, CA.
Ann Surg. 2022 Oct 1;276(4):694-700. doi: 10.1097/SLA.0000000000005593. Epub 2022 Jul 15.
There has been an alarming increase in the number of young adults (YA) diagnosed with cancer. The emotional, psychosocial, and financial distress experienced by newly diagnosed YA undergoing cancer surgery remains largely unknown.
A validated biopsychosocial distress screening tool (SupportScreen) was administered to patients diagnosed with cancer before surgery between 2009 and 2017 in a National Cancer Institute Comprehensive Cancer Center. Patients were stratified into YA less than or equal to 45 years and older adults (OA) above 45 years. Descriptive statistics and logistic regression were used to analyze distress outcomes.
In total, 4297 patients were identified, with YA comprising 13.3% (n=573) of the cohort. YA reported higher emotional distress, including increased anxiety (33.8% vs 27.4%, P =0.002), greater fear of procedures (26.7% vs 22%, P =0.018), and difficulty managing emotions (26% vs 20.7%, P =0.006). YA struggled more frequently to manage work/school (29.5% vs 19.3%, P <0.001), finding resources (17.8% vs 11.8%, P <0.001), changes in physical appearance (22.2% vs 13.4%, P <0.001), fatigue (36% vs 27.3%, P <0.001), and ability to have children (18.4% vs 3%, P <0.001). Financial toxicity was significantly higher in the YA group (40.5% vs 28%, P <0.001). While income level was strongly protective against emotional distress and financial toxicity in OAs, it was less protective against the risk of financial toxicity in YA. Younger age was an independent predictor of financial toxicity in a model adjusted to income (odds ratio=1.52, P =0.020).
YA in the prime of their personal and professional years of productivity require special attention when undergoing surgical evaluation for cancer. Resource allocation and counseling interventions should be integrated as part of their routine care to expedite their return to optimal physical and holistic health and mitigate psychosocial distress and financial toxicity.
被诊断患有癌症的年轻人（YA）人数呈惊人增长。接受癌症手术的新诊断 YA 经历的情绪、心理社会和经济困扰在很大程度上尚未可知。
在一家国家癌症研究所综合癌症中心，2009 年至 2017 年间，对接受癌症手术前的患者使用经过验证的生物心理社会困扰筛查工具（SupportScreen）进行评估。患者被分为年龄≤45 岁的 YA 和年龄＞45 岁的成年人（OA）。采用描述性统计和逻辑回归分析来分析困扰结果。
共确定了 4297 例患者，其中 YA 占队列的 13.3%（n=573）。YA 报告的情绪困扰更高，包括更高的焦虑（33.8%比 27.4%，P=0.002）、对手术的更大恐惧（26.7%比 22%，P=0.018）和情绪管理困难（26%比 20.7%，P=0.006）。YA 更频繁地难以兼顾工作/学业（29.5%比 19.3%，P＜0.001）、寻找资源（17.8%比 11.8%，P＜0.001）、外貌改变（22.2%比 13.4%，P＜0.001）、疲劳（36%比 27.3%，P＜0.001）和生育能力（18.4%比 3%，P＜0.001）。 YA 组的财务毒性显著更高（40.5%比 28%，P＜0.001）。虽然收入水平对 OA 患者的情绪困扰和财务毒性具有很强的保护作用，但对 YA 患者财务毒性的风险保护作用较小。在调整收入的模型中，年龄较小是财务毒性的独立预测因素（比值比=1.52，P=0.020）。
在个人和职业生产力的黄金时期，YA 接受癌症手术评估时需要特别关注。资源配置和咨询干预措施应作为其常规护理的一部分进行整合，以加速其恢复最佳身体和整体健康，并减轻心理社会困扰和财务毒性。
