Calvo-Schimmel Alejandra, Hammer Marilyn J, Conley Yvette P, Paul Steven M, Cooper Bruce A, Shin Joosun, Harris Carolyn, Morse Lisa, Levine Jon D, Miaskowski Christine
American Cancer Society, Atlanta, GA.
Dana Farber Cancer Institute, Boston, MA.
Semin Oncol Nurs. 2025 Apr;41(2):151809. doi: 10.1016/j.soncn.2025.151809. Epub 2025 Feb 13.
Anxiety and depression are common symptoms in oncology patients undergoing chemotherapy. Study purpose was to evaluate for differences in severity of common symptoms (ie, fatigue, energy, sleep disturbance, cognitive function, pain) and quality of life (QOL) outcomes among three subgroups of oncology outpatients with distinct joint anxiety and depression profiles.
Oncology outpatients (N = 1328) completed measures of state anxiety and depression, six times over two cycles of chemotherapy. Latent profile analysis was done to identify subgroups of patients with distinct joint state anxiety AND depression profiles. Patients completed measures of trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain, as well as generic and disease-specific measures of QOL at enrollment. Differences among the classes in symptom severity scores and QOL scores were evaluated using parametric and non-parametric tests.
Three distinct joint anxiety AND depression profiles were identified and named: Low Anxiety and Low Depression (57.5%, Both Low), Moderate Anxiety and Moderate Depression (33.7%, Both Moderate), and High Anxiety and High Depression (8.8%, Both High). All of the symptom severity scores showed a "dose-response effect" (ie, as the joint anxiety AND depression profiles worsened, the severity of all of the symptoms increased). Likewise, for both the general and disease-specific QOL (except spiritual well-being) measures, all of the scores decreased as the joint anxiety AND depression profiles worsened. Compared to the Both Low classes, the other two classes reported lower scores for the spiritual well-being domain.
More than 40% of patients receiving chemotherapy experience moderate to high levels of both anxiety AND depression. These patients report an extremely high symptom burden and significant decrements in all domains of QOL.
Clinicians need to perform comprehensive assessments of depression and anxiety and other common symptoms and QOL outcomes during chemotherapy. In addition, referrals for targeted interventions are needed to manage multiple symptoms and improve patients' QOL.
焦虑和抑郁是接受化疗的肿瘤患者常见的症状。本研究旨在评估具有不同联合焦虑和抑郁特征的三组肿瘤门诊患者在常见症状（即疲劳、精力、睡眠障碍、认知功能、疼痛）严重程度和生活质量（QOL）结果方面的差异。
肿瘤门诊患者（N = 1328）在两个化疗周期内完成了六次状态焦虑和抑郁测量。进行潜在类别分析以识别具有不同联合状态焦虑和抑郁特征的患者亚组。患者在入组时完成了特质焦虑、早晚疲劳、早晚精力、睡眠障碍、认知功能和疼痛的测量，以及生活质量的一般和疾病特异性测量。使用参数检验和非参数检验评估各亚组在症状严重程度评分和生活质量评分上的差异。
识别并命名了三种不同的联合焦虑和抑郁特征：低焦虑和低抑郁（57.5%，两者均低）、中度焦虑和中度抑郁（33.7%，两者均中度）以及高焦虑和高抑郁（8.8%，两者均高）。所有症状严重程度评分均显示出“剂量反应效应”（即随着联合焦虑和抑郁特征加重，所有症状的严重程度增加）。同样，对于一般和疾病特异性生活质量（精神健康除外）测量，随着联合焦虑和抑郁特征加重，所有评分均降低。与两者均低的亚组相比，其他两个亚组在精神健康领域的评分较低。
超过40%接受化疗的患者经历中度至高度的焦虑和抑郁。这些患者报告了极高的症状负担以及生活质量所有领域的显著下降。
临床医生在化疗期间需要对抑郁、焦虑以及其他常见症状和生活质量结果进行全面评估。此外，需要进行针对性干预的转诊，以管理多种症状并改善患者的生活质量。
