DiLorenzo T A, Jacobsen P B, Bovbjerg D H, Chang H, Hudis C A, Sklarin N T, Norton L
Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Ann Oncol. 1995 Sep;6(7):705-11. doi: 10.1093/oxfordjournals.annonc.a059288.
The contribution of classical conditioning processes to patients' distress before chemotherapy infusions (anticipatory distress) was compared to other potential sources of distress (e.g., trait anxiety). We hypothesized that posttreatment distress (putative unconditioned response) would become a stronger predictor of anticipatory distress as patients underwent more treatment infusions (putative conditioning trials).
Fifty women with early stage breast cancer, undergoing standard chemotherapy, completed questionnaires in the clinic prior to each of eight consecutive treatment infusions, as well as telephone interviews to assess side effects following infusions.
Consistent with the conditioning hypothesis, posttreatment distress became significantly related to anticipatory distress at the fourth infusion and became the strongest predictor by the sixth. Path analysis indicated that posttreatment distress had a direct influence on anticipatory distress, and that trait anxiety had an indirect influence by influencing apprehension about chemotherapy which, in turn, directly predicted anticipatory distress.
The results of the present study contribute to an emerging view of anticipatory distress as a conditioned response in chemotherapy patients. Results demonstrate that conditioning factors may be one of the strongest predictors of anticipatory distress in the later phases of chemotherapy treatment.
将经典条件作用过程对化疗输液前患者痛苦（预期痛苦）的影响与其他潜在痛苦来源（如特质焦虑）进行比较。我们假设，随着患者接受更多的治疗输液（假定的条件作用试验），治疗后痛苦（假定的无条件反应）将成为预期痛苦的更强预测指标。
50名接受标准化化疗的早期乳腺癌女性患者，在连续八次治疗输液前在诊所完成问卷，并在输液后通过电话访谈评估副作用。
与条件作用假设一致，治疗后痛苦在第四次输液时与预期痛苦显著相关，并在第六次输液时成为最强的预测指标。路径分析表明，治疗后痛苦对预期痛苦有直接影响，特质焦虑通过影响对化疗的担忧产生间接影响，而对化疗的担忧又直接预测预期痛苦。
本研究结果有助于形成一种新观点，即将预期痛苦视为化疗患者的一种条件反应。结果表明，条件作用因素可能是化疗后期预期痛苦的最强预测指标之一。
