Department of Radiation Oncology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
Department of Psychiatry, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
J Gastrointest Cancer. 2023 Dec;54(4):1347-1352. doi: 10.1007/s12029-023-00939-y. Epub 2023 Jun 7.
The association of treatment-related side effects and tumor characteristics with sexual function, depression, and anxiety were investigated in patients with locally advanced rectum cancer (LARC) receiving neoadjuvant chemoradiotherapy (CRT).
Thirty-two patients who received neoadjuvant CRT with LARC were included. The Arizona Sexual Experiences (ASEX) Scale was used to determine the sexual function status whereas the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) were used to evaluate the depression and anxiety status of the patient, respectively. The patients were asked to fill these scales before and at least 4 weeks after the neoadjuvant CRT. T-test and Mann-Whitney U test were used for the comparison of values.
Median age was 52.5 years (range: 33-76). Twenty-six patients were male, and 6 patients were female. At presentation, the tumor was located mostly in lower third rectum (72%), and 69% of the patients had T3 tumors. There was a statistically significant deterioration in the sexual functions of the patients (p < 0.001), a statistically significant decrease in their anxiety level after CRT (p: 0.037). Depression level was changed from mild to minimal during this process (p: 0.17). A significant deterioration in the ASEX scale was observed especially in patients with grade 2 and above gastrointestinal side effects (p: 0.01).
This prospective study showed that the patient's anxiety and depression levels had decreased during the treatment process probably due to the decrease in the patient's symptoms. However, deterioration of the sexual function status which might be correlated to increased gastrointestinal side effects during CRT has been observed. So, clinical and psychiatric support including therapies for sexual dysfunctions is needed for LARC patients during and after the neoadjuvant CRT.
本研究旨在探讨接受新辅助放化疗（CRT）的局部晚期直肠癌（LARC）患者的治疗相关副作用和肿瘤特征与性功能、抑郁和焦虑之间的关系。
本研究共纳入 32 例接受新辅助 CRT 的 LARC 患者。采用亚利桑那性经验量表（ASEX）评估患者的性功能状况，采用贝克抑郁量表（BDI）和贝克焦虑量表（BAI）评估患者的抑郁和焦虑状况。患者在接受新辅助 CRT 前后至少 4 周填写这些量表。采用 t 检验和曼-惠特尼 U 检验进行数值比较。
中位年龄为 52.5 岁（范围：33-76 岁）。26 例患者为男性，6 例患者为女性。初诊时，肿瘤主要位于直肠下段（72%），69%的患者为 T3 肿瘤。患者的性功能明显恶化（p<0.001），CRT 后焦虑水平明显下降（p=0.037）。在此过程中，抑郁水平从轻度变为轻度（p=0.17）。在出现 2 级及以上胃肠道副作用的患者中，ASEX 量表明显恶化（p=0.01）。
本前瞻性研究表明，患者的焦虑和抑郁水平在治疗过程中有所下降，这可能是由于患者症状减轻所致。然而，在 CRT 期间观察到性功能状态的恶化，这可能与胃肠道副作用的增加有关。因此，LARC 患者在新辅助 CRT 期间和之后需要进行临床和精神支持，包括治疗性功能障碍。
