Chen Jacqueline, Mark Sueann, Mackin Lynda, Paul Steven M, Cooper Bruce A, Hammer Marilyn J, Conley Yvette P, Levine Jon D, Miaskowski Christine
School of Nursing, University of California, San Francisco, CA.
Dana Farber Cancer Institute, Boston, MA.
Semin Oncol Nurs. 2024 Feb;40(1):151577. doi: 10.1016/j.soncn.2023.151577. Epub 2024 Jan 19.
Purposes were to identify subgroups of adult oncology patients (n = 1342) with distinct joint profiles of worst pain and cognitive function (CF) and evaluate for differences in demographic and clinical characteristics, as well as the severity of three distinct types of stress, resilience, and coping.
Measures of pain and CF were evaluated six times over two cycles of chemotherapy. The other measures of demographic and clinical characteristics, stress, resilience, and coping were completed at enrollment (ie, prior to the second or third cycle of chemotherapy).
Using latent profile analysis, four distinct profiles were identified (ie, no pain + moderate CF [27.6%], moderate pain + high CF [22.4%] moderate pain and moderate CF [32.4%, both moderate], severe pain and low CF [17.5%, both severe]). Both moderate and both severe classes reported higher global, cancer-specific, and cumulative life stress, lower levels of resilience, and greater use of disengagement coping strategies. The Both severe class had higher occurrence rates for a number of adverse childhood experiences (ie, family violence in childhood, physical abuse at <16 years, forced sex at <16 years). Risk factors associated with membership in the two worst profiles included: being female, having a lower annual income, having a higher comorbidity burden, and having a poorer functional status.
Findings suggest that 72.4% of the patients reported pain scores in the moderate to severe range and 77.6% reported low to moderate levels of CF. Clinicians need to assess for both symptoms and various types of stress on a routine basis.
旨在识别成年肿瘤患者（n = 1342）中具有不同关节疼痛和认知功能（CF）特征的亚组，并评估其人口统计学和临床特征差异，以及三种不同类型压力、心理韧性和应对方式的严重程度。
在两个化疗周期内对疼痛和CF进行了6次评估。其他人口统计学和临床特征、压力、心理韧性和应对方式的测量在入组时（即化疗第二或第三周期之前）完成。
使用潜在类别分析，识别出四种不同的特征（即无疼痛 + 中度CF [27.6%]，中度疼痛 + 高度CF [22.4%]，中度疼痛和中度CF [32.4%，两者均为中度]，重度疼痛和低度CF [17.5%，两者均为重度]）。中度和重度组均报告了更高的总体、癌症特异性和累积生活压力、更低的心理韧性水平以及更多地使用脱离应对策略。重度组在一些不良童年经历（即童年家庭暴力、16岁前身体虐待、16岁前强迫性行为）方面的发生率更高。与两种最差特征相关的风险因素包括：女性、年收入较低、合并症负担较高以及功能状态较差。
研究结果表明，72.4%的患者报告疼痛评分在中度至重度范围内，77.6%的患者报告CF水平为低至中度。临床医生需要定期评估症状和各种类型的压力。
