Niimi M, Akaza H, Takeshima H, Hinotsu A, Takahashi H, Kano K, Otani M, Ishikawa S, Noguchi R, Oda E, Ohashi Y
Graduate School of Medical Science, University of Tsukuba.
Nihon Hinyokika Gakkai Zasshi. 1997 Aug;88(8):752-61. doi: 10.5980/jpnjurol1989.88.752.
Telling cancer patients the true diagnosis is inevitable to acquire informed consent especially in the Western world. In Japan, however, no such consensus has been established yet. We investigated the influence of telling the true diagnosis on QOL of prostate cancer patients.
We measured physical, mental and social aspect of prostate cancer outpatients by the General Health Questionnaire (GHQ) and the international Prostate Symptom Score (I-PSS). Using the general linear models we tried to explore which variables would attribute to "severe depression", "anxiety and insomnia" and "social dysfunction".
No significant differences were found in any of the eight variables (age, performance status, clinical stage, I-PSS and Goldberg's four factors of GHQ) among the two groups that were informed the true diagnosis or not. The correlation structures of "severe depression", "somatic symptoms" and I-PSS are significantly different in the two groups. As a result of the analysis by the GLM, "somatic symptoms", I-PSS and clinical stages had main effect on "severe depression". Also, there was an interaction between the effect of telling the true diagnosis and "somatic symptoms".
These results suggest that the mental condition of prostate cancer patients remain stable when they are in good physical condition regardless of being informed the true diagnosis or not. However, the patients who weren't told the true diagnosis have a tendency to get depression accompanying deterioration of physical condition. It is therefore considered that telling the true diagnosis makes the patients understand the changes of their physical conditions and help their mind to be stable.
在西方世界，告知癌症患者真实诊断结果对于获得知情同意是必不可少的。然而，在日本，尚未达成这样的共识。我们研究了告知真实诊断结果对前列腺癌患者生活质量的影响。
我们通过一般健康问卷（GHQ）和国际前列腺症状评分（I-PSS）对前列腺癌门诊患者的身体、心理和社会方面进行了测量。我们使用一般线性模型来探索哪些变量会导致“严重抑郁”、“焦虑和失眠”以及“社会功能障碍”。
在被告知或未被告知真实诊断结果的两组患者中，八个变量（年龄、身体状况、临床分期、I-PSS以及GHQ的戈德堡四个因子）中的任何一个均未发现显著差异。两组中“严重抑郁”、“躯体症状”和I-PSS的相关结构存在显著差异。通过广义线性模型分析，“躯体症状”、I-PSS和临床分期对“严重抑郁”有主要影响。此外，告知真实诊断结果的效应与“躯体症状”之间存在交互作用。
这些结果表明，无论是否被告知真实诊断结果，前列腺癌患者在身体状况良好时其心理状况保持稳定。然而，未被告知真实诊断结果的患者有随着身体状况恶化而出现抑郁的倾向。因此，认为告知真实诊断结果能使患者了解其身体状况的变化并有助于其心理稳定。
