Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Oncologist. 2024 Feb 2;29(2):166-175. doi: 10.1093/oncolo/oyad253.
Few studies examine how patients with advanced cancer cope with stress. The objective of our study was to evaluate coping strategies adopted by patients with cancer and their relationship with symptom burden.
A secondary data analysis of a prospective cross-sectional survey of patients with cancer and tobacco use was conducted, which examined demographics, symptom burden (Edmonton Symptom Assessment System), and coping strategies (the Brief COPE Questionnaire). Demographic characteristics were summarized by standard summary statistics; we also examined associations between patient characteristics and coping strategies using t-test, rank-sum test, chi-squared test, or Fisher's exact test depending on the distribution of data.
Among 399 patients, the majority were female (60%), Caucasian (70%), the mean age was 56.5 (±12.0) years, and the most common malignancies were gastrointestinal (21%) and breast (19%). Patients with cancer adopted multiple adaptive coping strategies, most frequently acceptance (86.7%) and emotional support (79.9%), with humor (18.5%) being the least. Common maladaptive strategies included venting (14.5%) and self-distraction (36.6%), while substance use (1.0%) was infrequently reported. Of the adaptive strategies, female gender was significantly associated with higher engagement with emotional and instrumental support, positive reframing, religious coping, and acceptance (P < .05 for all). College educated patients reported significantly higher implementation of humor, planning, and acceptance. Maladaptive coping strategies such as denial were associated with increased pain and depression, while patients adopting emotional-focused strategies rated decreased emotional distress.
The majority of patients with advanced cancer reported adopting multiple, adaptive coping strategies, and a minority utilized maladaptive or avoidant strategies, rarely substance use, and may need additional psychological support.
很少有研究探讨晚期癌症患者如何应对压力。我们的研究目的是评估癌症患者采用的应对策略及其与症状负担的关系。
对癌症和烟草使用的前瞻性横断面调查的二次数据分析，检查了人口统计学、症状负担（埃德蒙顿症状评估系统）和应对策略（简要应对策略问卷）。使用标准汇总统计数据总结人口统计学特征；我们还使用 t 检验、秩和检验、卡方检验或 Fisher 精确检验根据数据分布检查患者特征与应对策略之间的关联。
在 399 名患者中，大多数为女性（60%）、白种人（70%），平均年龄为 56.5（±12.0）岁，最常见的恶性肿瘤是胃肠道（21%）和乳腺癌（19%）。癌症患者采用了多种适应性应对策略，最常见的是接受（86.7%）和情感支持（79.9%），而幽默（18.5%）是最少的。常见的适应不良策略包括发泄（14.5%）和自我分散注意力（36.6%），而药物使用（1.0%）很少报告。在适应性策略中，女性与更高的情感和工具性支持、积极的重新构建、宗教应对和接受显著相关（所有 P <.05）。受过大学教育的患者报告实施幽默、计划和接受的比例显著更高。否认等适应不良应对策略与疼痛和抑郁增加有关，而采用情感聚焦策略的患者情绪困扰程度降低。
大多数晚期癌症患者报告采用多种适应性应对策略，少数患者采用适应性或回避性策略，很少使用药物，可能需要额外的心理支持。
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