van't Spijker A, Trijsburg R W, Duivenvoorden H J
Department of Medical Psychology and Psychotherapy, Erasmus University Rotterdam, The Netherlands.
Psychosom Med. 1997 May-Jun;59(3):280-93. doi: 10.1097/00006842-199705000-00011.
In a review of the literature from 1980 to 1994 on psychological and psychiatric problems in patients with cancer, the prevalence, severity, and the course of these problems (i.e., depression, anxiety, and general psychological distress) were studied with the help of meta-analyses and qualitative analyses. Apart from this, qualitative analyses were also applied with respect to other relevant variables.
A literature search in MEDLINE was conducted and cross-references of articles identified via MEDLINE. Meta-analysis was applied when possible.
There seemed to be a wide variation across studies in psychological and psychiatric problems. Meta-analysis showed no significant differences between cancer patients and the normal population with respect to anxiety and psychological distress. However, cancer patients seemed to be significantly more depressed than normals. Compared with psychiatric patients, cancer patients were significantly less depressed, anxious, or distressed. Compared with a sample of other medical patients, cancer patients showed significantly less anxiety. With respect to course, a significant decrease was found in the meta-analysis for anxiety, but not for depression. Further meta-analyses showed significant differences among groups of cancer patients with regard to tumor site, sex, age, design of the study, and year of publication. From the qualitative analyses, it seemed that medical, sociodemographic, and psychological variables were related inconsistently to psychological and psychiatric problems.
With the exception of depression, the amount of psychological and psychiatric problems in patients with cancer does not differ from the normal population. The amount of psychological and psychiatric problems is significantly less in cancer patients than in psychiatric patients. The amount of anxiety is significantly less in cancer patients than in other groups of medical patients with mixed diagnoses, whereas depression is not. Future studies should aim at exploring possible causes for the sometimes impressive differences in psychological or psychiatric problems among patients with cancer.
在回顾1980年至1994年关于癌症患者心理和精神问题的文献时，借助荟萃分析和定性分析研究了这些问题（即抑郁、焦虑和一般心理困扰）的患病率、严重程度及病程。除此之外，还针对其他相关变量进行了定性分析。
在MEDLINE中进行文献检索，并查阅通过MEDLINE识别的文章的参考文献。尽可能应用荟萃分析。
各项研究中，心理和精神问题的差异似乎很大。荟萃分析表明，癌症患者与正常人群在焦虑和心理困扰方面无显著差异。然而，癌症患者的抑郁程度似乎明显高于正常人。与精神科患者相比，癌症患者的抑郁、焦虑或困扰程度明显更低。与其他内科患者样本相比，癌症患者的焦虑程度明显更低。关于病程，荟萃分析发现焦虑有显著下降，但抑郁没有。进一步的荟萃分析表明，癌症患者组在肿瘤部位、性别、年龄、研究设计和发表年份方面存在显著差异。从定性分析来看，医学、社会人口统计学和心理变量与心理和精神问题的关联并不一致。
除抑郁外，癌症患者的心理和精神问题数量与正常人群无异。癌症患者的心理和精神问题数量明显少于精神科患者。癌症患者的焦虑程度明显低于其他混合诊断的内科患者组，而抑郁程度则不然。未来的研究应致力于探究癌症患者心理或精神问题有时存在显著差异的可能原因。
