Department of Family Medicine - University of Michigan Medical School, 1018 Fuller St, Ann Arbor, MI 48104-1213.
FP Essent. 2023 Jun;529:7-13.
In 2022, it was estimated that 18.1 million US adults were cancer survivors. By 2032, this number is projected to increase to 22.5 million. All patients with cancer experience some degree of psychological distress associated with the diagnosis. This can include mental health conditions, most commonly anxiety and depression. Management of such conditions in cancer survivors begins with detection via screening. Commonly used screening tools include the National Comprehensive Cancer Network (NCCN) Distress Thermometer, the 7-item Generalized Anxiety Disorder (GAD-7) scale, and the Patient Health Questionnaire-9 (PHQ-9). Initial management involves patient education and psychotherapy. If needed, pharmacotherapy is similar to that for patients in the general population. Of note, several commonly prescribed antidepressants have been shown to decrease the effects of tamoxifen, which breast cancer survivors may be taking as adjuvant endocrine therapy. Integrative medicine therapies, such as music interventions, yoga, mindfulness meditation, and exercise, have shown benefit. Patients undergoing treatment should have outcomes assessed. Thoughts of self-harm or suicidal ideation are common among cancer survivors with mental health conditions. Clinicians should regularly ask patients about suicidal ideation. If present, this indicates the need for more intensive or altered treatment.
2022 年，据估计有 1810 万美国成年人是癌症幸存者。到 2032 年，这一数字预计将增加到 2250 万。所有癌症患者都经历一定程度与诊断相关的心理困扰。这可能包括心理健康状况，最常见的是焦虑和抑郁。癌症幸存者的此类状况的管理始于通过筛查进行检测。常用的筛查工具包括美国国家综合癌症网络（NCCN）痛苦温度计、7 项广泛性焦虑症（GAD-7）量表和患者健康问卷-9（PHQ-9）。初始管理包括患者教育和心理治疗。如有需要，药物治疗与一般人群中的患者相似。值得注意的是，几种常用的抗抑郁药已被证明会降低乳腺癌幸存者可能作为辅助内分泌治疗服用的他莫昔芬的效果。整合医学疗法，如音乐干预、瑜伽、正念冥想和运动，已显示出益处。接受治疗的患者应评估治疗结果。有心理健康状况的癌症幸存者常有自杀念头或自杀意念。临床医生应定期询问患者自杀意念。如果存在，这表明需要更密集或改变的治疗。
