Lo Stephen B, Holtze Mia, Post Kathryn E, Eche-Ugwu Ijeoma Julie, Cooley Mary E, Pirl William F, Temel Jennifer S, Greer Joseph A
Center for Psychiatric Oncology & Behavioral Sciences (S.B.L., M.H., K.E.P. J.A.G.), Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School (S.B.L., K.E.P, I.J.E.U., M.E.C., W.F.P, J.S.T, J.A.G.), Boston, Massachusetts, USA.
Center for Psychiatric Oncology & Behavioral Sciences (S.B.L., M.H., K.E.P. J.A.G.), Massachusetts General Hospital, Boston, Massachusetts, USA.
J Pain Symptom Manage. 2025 Aug;70(2):e121-e128. doi: 10.1016/j.jpainsymman.2025.03.030. Epub 2025 Apr 4.
Dyspnea (breathlessness) is a distressing and disabling symptom affecting over 70% of patients with advanced lung cancer. Although dyspnea treatments are limited, recent research on a brief, nurse-led behavioral intervention for dyspnea in patients with advanced lung cancer demonstrated improvements in dyspnea-related functioning compared to usual care.
We examined whether depression and anxiety moderate the efficacy of a brief behavioral intervention for dyspnea in advanced lung cancer.
This secondary analysis of a randomized controlled trial examined a two-session, nurse-led behavioral intervention for dyspnea in 247 patients with advanced lung cancer. Patients self-reported dyspnea-related functioning (Modified Medical Research Council Dyspnea Scale), multidimensional dyspnea (Cancer Dyspnea Scale), and depression and anxiety (Hospital Anxiety and Depression Scale [HADS]) at baseline and post-treatment (8 weeks later). The PROCESS macro tested depression and anxiety as treatment moderators for dyspnea and probed interactions when P's < 0.15 using the Johnson-Neyman procedure due to reduced power in testing moderators.
Baseline depressive symptoms moderated the intervention's impact on dyspnea functioning (b = -0.074, P = 0.075), with significant benefits observed in those reporting >6 on baseline scores of the HADS-Depression subscale. Any post-treatment improvement on the HADS-Anxiety subscale (b = 0.069, P = 0.135) and improvements of at least 3 on the HADS-Depression subscale (b = 0.671, P = 0.009) significantly enhanced outcomes for total dyspnea and dyspnea functioning, respectively.
Patients with elevated baseline depression and improved distress may benefit more from this intervention for dyspnea. Considering treatment moderators helps optimize resources, but additional research on treatment adaptations is needed to enhance care for all.
呼吸困难是一种令人痛苦且使身体功能受限的症状，影响着超过70%的晚期肺癌患者。尽管呼吸困难的治疗方法有限，但最近一项针对晚期肺癌患者进行的由护士主导的简短行为干预研究表明，与常规护理相比，该干预在改善与呼吸困难相关的身体功能方面取得了成效。
我们研究了抑郁和焦虑是否会调节晚期肺癌患者呼吸困难简短行为干预的疗效。
这项对一项随机对照试验的二次分析，研究了针对247例晚期肺癌患者进行的由护士主导的为期两阶段的呼吸困难行为干预。患者在基线和治疗后（8周后）自我报告与呼吸困难相关的身体功能（改良医学研究委员会呼吸困难量表）、多维呼吸困难（癌症呼吸困难量表）以及抑郁和焦虑（医院焦虑抑郁量表[HADS]）。由于在测试调节因素时功效降低，因此使用PROCESS宏程序将抑郁和焦虑作为呼吸困难治疗的调节因素进行测试，并在P值<0.15时使用约翰逊-奈曼程序探究相互作用。
基线抑郁症状调节了干预对呼吸困难功能的影响（b=-0.074，P=0.075），在医院焦虑抑郁量表抑郁分量表基线得分>6的患者中观察到显著益处。医院焦虑抑郁量表焦虑分量表治疗后的任何改善（b=0.069，P=0.135）以及医院焦虑抑郁量表抑郁分量表至少改善3分（b=0.671，P=0.009）分别显著增强了总呼吸困难和呼吸困难功能的治疗效果。
基线抑郁程度较高且痛苦有所改善的患者可能从这种呼吸困难干预中获益更多。考虑治疗调节因素有助于优化资源，但需要对治疗调整进行更多研究，以改善对所有患者的护理。
