Newell S, Sanson-Fisher R W, Girgis A, Bonaventura A
New South Wales Cancer Council Cancer Education Research Program, Newcastle, Australia.
Cancer. 1998 Oct 15;83(8):1640-51.
Modern cancer treatments can cure or prolong patients' lives. However, the associated physical and psychosocial problems can detrimentally affect patients' compliance with treatment and, ultimately, their outcomes. Therefore, oncologists need to recognize the problems experienced by their patients and, when possible, help resolve these problems.
The authors conducted a cross-sectional survey of physical symptoms, anxiety, depression, and perceived needs among 204 consenting patients visiting an outpatient medical oncology department. Immediately following consultations with consenting patients, medical oncologists and registrars also completed a survey in which they indicated their perception of each patient's level of each problem. These two data sets were then compared.
Five oncologists' perceptions of patients' levels of the major physical symptoms cited in the survey (fatigue, nausea, vomiting, and hair loss) demonstrated the highest levels of awareness, with sensitivity rates up to 80%. Although sensitivity was less than 50% for all other physical symptoms, specificity was greater than 78% for all symptoms except fatigue. Only 17% of patients classified as clinically anxious and 6% of those classified as clinically depressed were perceived as such by their oncologists. However, the oncologists perceived much higher levels of perceived needs than patients reported, resulting in high sensitivity but low specificity rates. Oncologists' knowledge of and rapport with their patients and the pressure of their workloads were associated with their awareness of their patients' reported problems.
Medical oncologists' perceptions may not accurately reflect their patients' reported physical and psychosocial experiences. Further interventions should be developed to assist oncologists in detecting such problems, especially psychosocial ones.
现代癌症治疗方法能够治愈患者或延长其生命。然而，与之相关的身体和心理社会问题会对患者的治疗依从性产生不利影响，并最终影响治疗效果。因此，肿瘤学家需要认识到患者所经历的问题，并在可能的情况下帮助解决这些问题。
作者对204名到门诊肿瘤内科就诊并同意参与的患者进行了一项关于身体症状、焦虑、抑郁及感知需求的横断面调查。在与同意参与的患者会诊后，肿瘤内科医生和住院医生也完成了一项调查，在调查中他们表明了对每位患者各问题严重程度的看法。然后对这两组数据集进行比较。
肿瘤学家对调查中列出的主要身体症状（疲劳、恶心、呕吐和脱发）患者严重程度的认知程度最高，敏感度高达80%。尽管对所有其他身体症状的敏感度均低于50%，但除疲劳外所有症状的特异度均大于78%。只有17%被临床诊断为焦虑的患者以及6%被临床诊断为抑郁的患者被肿瘤学家识别出来。然而，肿瘤学家感知到的患者需求水平远高于患者自己报告的水平，导致敏感度高但特异度低。肿瘤学家对患者的了解和融洽关系以及工作量压力与他们对患者报告问题的认知度相关。
肿瘤内科医生的认知可能无法准确反映患者报告的身体和心理社会经历。应制定进一步的干预措施，以帮助肿瘤学家发现此类问题，尤其是心理社会问题。
