Yeo Theresa P, Cannaday Shawnna, Thompson Richard E, Fogg Ryan, Nevler Avinoam, Lavu Harish, Yeo Charles J
From the Jefferson College of Nursing (TP Yeo), Thomas Jefferson University, Philadelphia, PA.
The Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Cancer Center (TP Yeo, Cannaday, Nevler, Lavu, CJ Yeo), Thomas Jefferson University, Philadelphia, PA.
J Am Coll Surg. 2023 Feb 1;236(2):339-349. doi: 10.1097/XCS.0000000000000469. Epub 2022 Nov 8.
Distress screening of cancer patients is mandated by the American College of Surgeons Commission on Cancer. Clinical implementation remains limited, particularly in surgical oncology settings in individuals with pancreaticobiliary cancers.
This study evaluated differences in mean distress scores based on the National Comprehensive Cancer Network Distress Thermometer & Problem List for patients with pancreaticobiliary cancers, benign pancreatic conditions, and for their significant others (SOs). The distress screening was conducted at the first office visit and postoperatively in a subset of those who had surgery. Distress Thermometer (DT) scores were dichotomized at ≤5 vs >5 and at ≥7 and correlated with Problem List items. The US ZIP Code database was used to correlate income range, percent poverty, and unemployment in the patient's self-identified ZIP code. Regression models were fitted to identify independent predictors of distress.
A total of 547 patients and 184 SOs were evaluated. Thirty percent of patients had DT scores >5, with pancreatic adenocarcinoma patients reporting the highest levels of distress. SOs of pancreatic adenocarcinoma patients reported even greater distress than the patients themselves. As the number of pre-existing medical problems increased; so did DT scores. Distress correlated with physical and emotional problems and worry about insurance coverage and transportation. Higher income level predicted higher DT scores, although poverty predicted lower DT scores. Depression was present in 12% of the patients. Distress improved in those undergoing surgery.
Distress and depression in pancreaticobiliary cancer patients and SOs are prevalent. The findings of this study have multiple actionable implications and require diagnosis, treatment, and referral to supportive care resources.
美国外科医师学会癌症委员会要求对癌症患者进行痛苦筛查。临床实施仍然有限，尤其是在患有胰腺胆管癌的个体的外科肿瘤学环境中。
本研究基于国家综合癌症网络痛苦温度计和问题清单，评估了胰腺胆管癌患者、胰腺良性疾病患者及其重要他人（SO）的平均痛苦评分差异。在首次门诊就诊时以及部分接受手术的患者术后进行痛苦筛查。痛苦温度计（DT）评分分为≤5与>5以及≥7，并与问题清单项目相关联。使用美国邮政编码数据库将患者自行确定的邮政编码中的收入范围、贫困百分比和失业率进行关联。拟合回归模型以确定痛苦的独立预测因素。
共评估了547名患者和184名重要他人。30%的患者DT评分>5，胰腺腺癌患者报告的痛苦程度最高。胰腺腺癌患者的重要他人报告的痛苦甚至比患者本人更大。随着既往存在的医疗问题数量增加，DT评分也增加。痛苦与身体和情绪问题以及对保险覆盖范围和交通的担忧相关。较高的收入水平预测较高的DT评分，尽管贫困预测较低的DT评分。12%的患者存在抑郁。接受手术的患者痛苦有所改善。
胰腺胆管癌患者及其重要他人中的痛苦和抑郁很普遍。本研究的结果有多个可采取行动的意义，需要进行诊断、治疗并转介至支持性护理资源。
