Author Affiliations: School of Nursing, University of California, San Francisco (Drs Calvo-Schimmel, Shin, Paul, Cooper, and Miaskowski); Dana Farber Cancer Institute, Boston, Massachusetts (Drs Hammer and Wright); Mount Sinai Medical Center, New York (Drs Blank and Cohen); School of Nursing, University of Pittsburgh, Pennsylvania (Drs Harris and Conley); and School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski).
Cancer Nurs. 2024;47(6):E404-E414. doi: 10.1097/NCC.0000000000001296. Epub 2024 Jan 22.
Depression is a pervasive symptom in patients with gynecological cancer undergoing chemotherapy.
Purposes were to identify subgroups of patients with distinct depression profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life (QOL) outcomes among these subgroups.
Patients with gynecological cancer (n = 231) completed the Center for Epidemiologic Studies-Depression Scale 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct depression profiles. Differences were evaluated using parametric and nonparametric tests.
Three distinct profiles were identified: low (60.1%), high (35.1%), and very high (4.8%). Compared with low class, the other 2 classes had lower functional status and were more likely to self-report a diagnosis of depression. Patients in the 2 worse profiles reported a higher comorbidity burden, higher levels of trait and state anxiety, sleep disturbance, and fatigue, as well as lower levels of cognitive function and poorer QOL. State and trait anxiety, evening fatigue, and sleep disturbance scores exhibit a "dose-response effect" (ie, as the depression profile worsened, the severity of these symptoms increased).
Almost 40% of our sample experienced high or very high levels of depression across 2 cycles of chemotherapy.
Clinicians can use the identified risk factors to identify high patients risk and provide tailored psychological interventions aimed to decrease symptom burden and prevent decrements in QOL.
在接受化疗的妇科癌症患者中，抑郁是一种普遍存在的症状。
旨在确定具有不同抑郁特征的患者亚组，并评估这些亚组在人口统计学和临床特征、常见症状严重程度以及生活质量（QOL）结果方面的差异。
231 例妇科癌症患者在化疗的 2 个周期内完成了 6 次流行病学研究中心抑郁量表评估。所有其他测量均在第二次或第三次化疗周期之前完成。采用潜在剖面分析来确定不同的抑郁特征。使用参数和非参数检验评估差异。
确定了 3 种不同的特征：低（60.1%）、高（35.1%）和极高（4.8%）。与低特征组相比，其他 2 个特征组的功能状态较低，更有可能自我诊断为抑郁症。处于后 2 种较差特征组的患者报告了更高的合并症负担、更高的特质和状态焦虑水平、睡眠障碍和疲劳，以及较低的认知功能和较差的 QOL。状态和特质焦虑、傍晚疲劳和睡眠障碍评分表现出“剂量反应效应”（即，随着抑郁特征的恶化，这些症状的严重程度增加）。
我们的样本中近 40%的患者在 2 个化疗周期内经历了高或极高水平的抑郁。
临床医生可以使用所确定的风险因素来识别高风险患者，并提供量身定制的心理干预措施，以减轻症状负担并防止 QOL 下降。
