DeKeyser F G, Wainstock J M, Rose L, Converse P J, Dooley W
Nursing Research, Hadassah-Hebrew University School of Nursing, Jerusalem, Israel.
Oncol Nurs Forum. 1998 Sep;25(8):1415-22.
PURPOSE/OBJECTIVES: To investigate distress and its association with immune function among women with suspected breast cancer.
Prospective, descriptive, correlational study.
An outpatient breast clinic at a tertiary urban hospital.
A convenience sample of women who had either a fine needle aspiration or open breast biopsy for a suspicion of breast cancer. Thirty-five women comprised the study sample, 6 with malignant and 29 with benign tumors.
Data were collected at three points in time. The first time (T1) was after the physician visit when the need for breast biopsy was ascertained. The second time (T2) was 7-10 days postbiopsy, and the third time (T3) was 7-10 days after T2. At T1, T2, and T3, participants filled out the Brief Symptom Inventory (a measure of psychological distress) and the Adapted Symptom Distress Scale (a measure of symptom distress) and provided a blood sample. Demographic data also were collected at T1. Immune function was measured by serum cytokine levels of transforming growth factor beta (TGF beta) and tumor necrosis factor alpha (TNF alpha).
Psychological distress, symptom distress, and immune function.
Psychological distress scores were moderate to high. Symptom distress was either nonexistent or slight. Significant correlations between psychological distress and symptom distress were found at T2 and T3. At T2, significant relationships between psychological distress and TNF alpha and between symptom occurrence and TNF alpha were found. Psychological and symptom distress scores were significantly different between women with malignant versus benign tumors at all three times. No differences in cytokine levels were found between the groups.
These results suggest the strong effect that the diagnostic process has on psychological distress and its potential effects on immune functioning. Distress was significantly greater for women with malignant disease; however, women with benign disease continued to have elevated levels of distress.
Nurses should be aware of the extremely stressful nature of the diagnostic phase and should continue to provide support, knowing that this distress continues throughout this phase, particularly for women diagnosed with malignancy.
目的/目标：调查疑似乳腺癌女性的心理困扰及其与免疫功能的关联。
前瞻性、描述性、相关性研究。
一所城市三级医院的门诊乳腺科。
因疑似乳腺癌接受细针穿刺或开放性乳腺活检的女性的便利样本。35名女性组成研究样本，其中6名患有恶性肿瘤，29名患有良性肿瘤。
在三个时间点收集数据。第一次（T1）是在医生就诊确定需要进行乳腺活检之后。第二次（T2）是活检后7 - 10天，第三次（T3）是在T2之后7 - 10天。在T1、T2和T3时，参与者填写简明症状量表（一种心理困扰测量工具）和适应性症状困扰量表（一种症状困扰测量工具）并提供血样。在T1时还收集了人口统计学数据。通过转化生长因子β（TGFβ）和肿瘤坏死因子α（TNFα）的血清细胞因子水平来测量免疫功能。
心理困扰、症状困扰和免疫功能。
心理困扰得分中等至较高。症状困扰不存在或轻微。在T2和T3时发现心理困扰与症状困扰之间存在显著相关性。在T2时，发现心理困扰与TNFα之间以及症状出现与TNFα之间存在显著关系。在所有三个时间点，患有恶性肿瘤与良性肿瘤的女性在心理和症状困扰得分上存在显著差异。两组之间细胞因子水平无差异。
这些结果表明诊断过程对心理困扰有强烈影响及其对免疫功能的潜在影响。患有恶性疾病的女性的困扰明显更大；然而，患有良性疾病的女性的困扰水平也持续升高。
护士应意识到诊断阶段极具压力的性质，并应持续提供支持，因为要知道这种困扰在整个阶段都会持续，尤其是对于被诊断为恶性肿瘤的女性。
