Forst Deborah A, Podgurski Alyx F, Strander Sumita M, Whitman Jessica D, Datta Shibani, Pintro Kedie, Horick Nora K, Willis Kelcie D, Sannes Timothy S, Greer Joseph A, El-Jawahri Areej, Jacobs Jamie M, Temel Jennifer S
Massachusetts General Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
J Clin Oncol. 2024 Dec 20;42(36):4252-4262. doi: 10.1200/JCO.24.00065. Epub 2024 Sep 16.
Caregivers of patients with primary malignant brain tumors (PMBT) experience significant psychological distress. We assessed the effect of a psychological intervention (NeuroCARE) on anxiety symptoms among PMBT caregivers.
We conducted a randomized trial of NeuroCARE versus usual care in PMBT caregivers with elevated anxiety (Generalized Anxiety Disorder-7 score ≥5) within 6 months of the patient's diagnosis. NeuroCARE was developed for PMBT caregivers and consists of six telehealth sessions with a behavioral health specialist. Participants completed surveys at baseline, 11-week (postintervention), and 16-week (1-month postintervention) time points. The primary outcome was 11-week anxiety symptoms (Hospital Anxiety and Depression Scale [HADS]-Anxiety Subscale). We also measured depression symptoms (HADS-Depression Subscale), quality of life (QOL; Caregiver QOL survey), caregiver burden (Caregiver Reaction Assessment), self-efficacy (Lewis Cancer Self-Efficacy Scale), coping (Measure of Current Status), and post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-5). We conducted analysis of covariance and linear mixed-effects regression analyses to examine intervention effects on study outcomes.
We enrolled 120 caregivers (60/group) between October 2019 and June 2022; 105 were evaluable for the primary outcome. At 11 weeks, NeuroCARE participants reported significantly lower anxiety symptoms than usual care participants (, 8.87 10.69; = .008). NeuroCARE caregivers also reported significantly lower depression symptoms (, 6.08 7.77; = .004), and better self-efficacy (, 128.81 111.17; < .001) and coping (, 32.25 25.65; < .001) at 11 weeks. Study groups did not differ significantly in 11-week QOL, caregiver burden, or PTSD symptoms. In longitudinal analyses, intervention effects on depression symptoms, self-efficacy, and coping were sustained.
A novel, population-specific psychological intervention led to improved anxiety and depression symptoms, self-efficacy, and coping among PMBT caregivers.
原发性恶性脑肿瘤（PMBT）患者的照护者经历着显著的心理困扰。我们评估了一种心理干预措施（NeuroCARE）对PMBT照护者焦虑症状的影响。
我们对在患者确诊后6个月内焦虑水平升高（广泛性焦虑障碍-7量表评分≥5）的PMBT照护者进行了一项NeuroCARE与常规护理的随机试验。NeuroCARE是专门为PMBT照护者开发的，包括与行为健康专家进行的六次远程医疗会诊。参与者在基线、11周（干预后）和16周（干预后1个月）时间点完成调查。主要结局是11周时的焦虑症状（医院焦虑抑郁量表[HADS]-焦虑子量表）。我们还测量了抑郁症状（HADS-抑郁子量表）、生活质量（QOL；照护者QOL调查）、照护者负担（照护者反应评估）、自我效能感（刘易斯癌症自我效能量表）、应对方式（现状测量）和创伤后应激障碍（PTSD）症状（DSM-5创伤后应激障碍检查表）。我们进行了协方差分析和线性混合效应回归分析，以检验干预对研究结局的影响。
2019年10月至2022年6月期间，我们招募了120名照护者（每组60名）；105名可用于主要结局评估。在11周时，NeuroCARE组的参与者报告的焦虑症状显著低于常规护理组（分别为8.87对10.69；P = 0.008）。NeuroCARE组的照护者在11周时还报告了显著更低的抑郁症状（分别为6.08对7.77；P = 0.004），以及更好的自我效能感（分别为128.81对111.17；P < 0.001）和应对方式（分别为32.25对25.65；P < 0.001）。研究组在11周时的生活质量、照护者负担或PTSD症状方面没有显著差异。在纵向分析中，干预对抑郁症状、自我效能感和应对方式的影响持续存在。
一种新颖的、针对特定人群的心理干预措施改善了PMBT照护者的焦虑和抑郁症状、自我效能感和应对方式。
