Hollen P J, Hobbie W L, Finley S M
Northeastern University, College of Nursing, Boston, Massachusetts 02115, USA.
Cancer Nurs. 1997 Oct;20(5):305-14. doi: 10.1097/00002820-199710000-00001.
The purpose of this correlational study was to examine factors related to cognitive late effects of treatment that may be predictors of decision making and risk behaviors for cancer-surviving adolescents. A convenience sample of 52 survivors (ages 14-19 years, disease-free for 5 years, no treatment for 2 years, and with all types of cancer except primary brain tumors) participated in this study at two regional survivor follow-up clinics. A medical record review, a semistructured interview with the teen, and intelligence testing on a separate day were used to collect data. A history of cancer therapy threatening cognitive function (defined as > or = 18 gy of radiotherapy, intrathecal or high-dose systemic methotrexate, or both) was a marginally significant predictor of poorer-quality decision making in the first regression model. Poorer-quality decision making was a significant predictor of one or more risk behaviors in the second model. Younger age at initial treatment and lower cognitive ability (full-scale IQ) were not significant predictors for either of the models. There were no significant differences for the Wechsler IQ subtests related to abstract and analytic ability by cognitive threat status. Post hoc analysis indicated that lack of sensitivity to change of the Wechsler IQ measure may have affected outcomes. Abstract and/or analytic ability may be important links for decision making and risk behaviors of teen survivors, thus warranting further examination within a larger sample. Intervention to improve decision making needs to be provided for teen survivors; this may be true especially when there is a history of therapy threatening cognitive function.
这项相关性研究的目的是检验与治疗的认知后期效应相关的因素，这些因素可能是癌症幸存青少年决策和风险行为的预测指标。在两个地区性的幸存者随访诊所，52名幸存者（年龄在14 - 19岁之间，无病生存5年，2年未接受治疗，患有除原发性脑肿瘤外的所有类型癌症）的便利样本参与了本研究。通过病历审查、与青少年的半结构化访谈以及在另一天进行的智力测试来收集数据。在第一个回归模型中，有威胁认知功能的癌症治疗史（定义为放疗剂量≥18 Gy、鞘内或高剂量全身甲氨蝶呤治疗或两者皆有）是决策质量较差的边缘显著预测指标。在第二个模型中，决策质量较差是一种或多种风险行为的显著预测指标。初始治疗时年龄较小和认知能力较低（全量表智商）在两个模型中均不是显著预测指标。与认知威胁状态相关的韦氏智力量表子测试在抽象和分析能力方面没有显著差异。事后分析表明，韦氏智商测量对变化缺乏敏感性可能影响了结果。抽象和/或分析能力可能是青少年幸存者决策和风险行为的重要关联因素，因此需要在更大样本中进一步研究。需要为青少年幸存者提供改善决策的干预措施；当存在威胁认知功能的治疗史时尤其如此。
