浸润性乳腺癌钼靶X线表现与受体水平的关系

目的 对浸润性乳腺癌的钼靶X线表现与雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER2)的表达状况进行比较,分析其相关性.方法 70例经手术病理证实的浸润性乳腺癌,术前均行乳腺钼靶X线检查,术后病理标本经免疫组织化学染色判断ER、PR和HER2表达情况.将钼靶X线表现中的肿瘤毛刺征、恶性钙化及肿瘤大小等与ER、PR和HER2表达状况进行比较研究.结果 70例中,ER表达阳性者39例(55.7%),PR表达阳性者37例(52.9%),HER2过表达者18例(25.7%).毛刺组HER2过表达率低于无毛刺组(15.9%对42.3%),差异有显著性(P=0.015).钙化组和无钙化组间ER、PR阳性率和HER2过表达率差异均无显著性.40～49岁组PR阳性率明显高于其他组(P=0.034).而ER、PR和HER2表达状况与肿瘤大小及患者月经状况之间无显著性相关.结论 我国女性浸润性乳腺癌患者的钼靶X线表现可在一定程度上反映ER、PR和HER2的表达状况.     

ER、PR和HER2联合检测对乳腺癌脑转移瘤发生的预测价值

目的 探讨ER、PR和HER2联合检测对乳腺癌脑转移瘤发生的预测价值.方法 选取135例乳腺癌患者作为观察对象,其中24例出现脑转移瘤患者为转移组,111例非脑转移瘤者为非转移组.采用免疫组化法(IHC),检测转移组和非转移组乳腺癌组织中ER、PR和HER2表达水平.结果 转移组ER阳性率为29.2%,显著低于非转移组的56.8%(P<0.05);转移组PR阳性率为25.0%,显著低于非转移组的54.9%(P<0.05);转移组HER2阳性率为62.5%,显著高于非转移组的18.9%(P<0.05);ER(-)、PR(-)和HER2(+)联合检测乳腺癌脑转移的灵敏度为64.00%,特异性为87.27%、准确性为82.96%.结论 乳腺癌脑转移瘤患者乳腺癌组织中ER、PR和HER2表达水平发生变化,其中ER、PR的表达缺失及HER2的过表达可能参与脑转移瘤的发生发展,ER、PR阴性表达与HER2蛋白阳性表达联合检测乳腺癌脑转移的准确性良好,可为临床应用提供参考依据.     

HER2和ER/PR双阳性表达的Ⅰ～Ⅲ期乳腺癌患者生存分析

目的:研究HER2受体和激素受体(ER和/或PR)双阳性表达乳腺癌患者预后,以指导临床治疗.方法:收集我院2002年1月～2003年12月可手术且HER2阳性表达乳腺癌患者93例,HER2阳性表达采用免疫组化方法及荧光原位杂交方法确认,其中ER/PR阳性者59例,ER和PR阴性者34例,两组患者的临床特征(年龄、病理类型、肿瘤直径、淋巴结转移数目、治疗方案)无统计学差异,分析两组乳腺癌患者的5年总生存率及无病生存率.结果:HER2和ER/PR双阳性表达乳腺癌患者与HER2单阳性表达5年总生存率分别为92%和88%(P=0.380),5年无病生存率分别为81%和82%(P=0.999).结论:辅助蒽环类化疗及三苯氧胺内分泌治疗不能改善HER2和ER/PR双阳性乳腺癌患者的总生存率和无病生存率,对双阳性患者应加强治疗力度.     

~(18)F-16α-氟雌二醇正电子发射计算机断层显像在晚期雌激素受体阳性乳腺癌诊疗中的初步应用

目的探讨~(18)F-16α-氟雌二醇(~(18)F-FES)正电子发射计算机断层显像(PET/CT)评估晚期乳腺癌患者雌激素受体(ER)状态及预测内分泌疗效的应用价值。方法选取2012年1月至2017年12月间福建省立医院收治的13例晚期乳腺癌患者,对患者行~(18)F-FDG及~(18)F-FES PET/CT显像,对ER+(ER阳性)者行内分泌治疗一个月后再次复查FES PET/CT显像,分析穿刺病灶基线FES最大标准化摄取值(SUVmax)与免疫组化ER表达的相关性,分析病灶基线FES SUVmax值与治疗疗效的关系。结果 13例患者,8例ER+,FES SUVmax (3. 45±2. 10),5例ER-,SUVmax为(0. 88±0. 19),以FES SUVmax> 1. 5为ER阳性,则FES SUVmax诊断乳腺癌病灶ER阳性的敏感度为75. 0%,特异度100. 0%,阳性预测值100. 0%,阴性预测值71. 0%,2例假阴性患者均为ER低表达(1%和5%); 6例ER+患者进行内分泌治疗,PR病例基线FES SUVmax明显高于SD病例,差异有统计学意义(P <0. 05)。结论乳腺癌病灶FES的摄取值与免疫组织化学ER的检测结果具有良好的相关性,病灶基线FES摄取值可预测内分泌治疗的疗效,为晚期乳腺癌个体化治疗提供新的思路。     

三阴乳腺癌保乳治疗的疗效分析

目的 探讨三阴乳腺癌行保乳治疗后的疗效观察.方法 行保乳手术治疗的乳腺癌患者593例,所有病例的ER、PR、HER2/neu状态均经病理证实,根据ER、PR、HER2/neu的状态分为三阴乳腺癌(ER、PR、HER2/neu 均为阴性)及非三阴乳腺癌(ER、PR、HEE2/neu其中任何一项为阳性)两组.其中三阴乳腺癌92例,非三阴乳腺癌501例.结果 截止2009年11月,共随访593例,中位随访时间为52月,出现局部复发病例11例,远处转移28例,死亡16例.三阴乳腺癌组比非三阴乳腺癌组有较高的远处转移率,预后较差.但三阴乳腺癌和非三阴乳腺癌患者在术后的局部复发率上无明显差异.结论 三阴乳腺癌相较非三阴乳腺癌总体预后差,但没有证据说明三阴乳腺癌行保乳手术后局部复发率更高.患者不必因为三阴乳腺癌而缩小其保乳治疗的指征,三阴乳腺癌患者仍是保乳治疗的合适人选.     

乳腺癌原发灶与转移灶分子分型指标表达差异的研究

目的 乳腺癌患者激素受体(hormone receptor,HR)、人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)和增殖细胞核抗原Ki-67的表达状态直接影响治疗方案的制订.本研究通过比较可手术乳腺癌原发灶与腋窝淋巴结转移灶及治疗后远处转移灶之间HR、HER2和Ki-67表达状况,探讨其表达的一致性,以期为乳腺癌患者综合治疗方案的制订提供参考.方法 选取2015-03-01-2016-04-30就诊于山东大学附属山东省肿瘤医院(162例)和梁山县人民医院(23例)的185例乳腺癌患者作为研究对象.患者均为女性,年龄24～79岁,中位年龄49岁.浸润性导管癌171例,浸润性小叶癌14例.初治直接接受手术治疗患者110例,其中有腋窝淋巴结转移77例;复发转移患者接受转移灶穿刺患者75例,其中肝脏转移43例,肺脏转移32例.所有标本均检测ER、PR、HER2和Ki-67表达,比较原发灶与腋窝淋巴结及远处转移灶的表达情况.结果 原发灶与腋窝淋巴结转移灶ER、PR、HER2和Ki-67表达差异均无统计学意义(均P＞0.05),ER变化率为3.9％,PR为7.8％,HER2为11.7％,Ki-67为20.8％.原发灶与远处转移灶比较,PR和Ki-67表达差异有统计学意义(均P值＜0.05),而ER和HER2表达差异无统计学意义(均P＞0.05),ER变化率为21.3％,PR为29.3％,HER2为18.7％,Ki-67为29.3％.结论 乳腺癌原发灶与转移腋窝淋巴结ER、PR、HER2和Ki-67表达状况一致性较高;原发灶与远处转移灶PR和Ki-67的表达存在差异,ER和HER2的表达无差异,这可能受多种因素的影响,建议对原发灶及转移灶同时进行生物学信息的检测,为患者制订治疗方案提供可靠的生物学信息.     

HER2 阳性乳腺癌组织MICA/B高表达延长患者的无病生存期

目的：探讨人表皮生长因子受体2（humman epidermal growth factor receptor 2,HER2）阳性乳腺癌组织中主要组织相容性复合体-I 类链相关蛋白A和B(MHC class I chain-related protein A/B,MICA/B)的表达水平与患者无病生存期（disease-free survival,DFS）的关系。方法：收集南方医科大学郑州人民医院2009 年1 月至2010 年6 月HER2 阳性乳腺癌癌旁组织存档蜡块26 例及乳腺癌蜡块100 例,免疫组化染色检测癌旁组织及癌组织MICA/B的表达水平,采用Kaplan-Meier 生存曲线分析其与患者临床病理特征和DFS的关系。结果：MICA/B在癌旁组织中呈阴性(0/26);乳腺癌组织中MICA/B表达率为92%（92/100）,其中高表达为65%（65/100）;MICA/B 在Ⅰ期的高表达率高于Ⅱ~Ⅲ期（77.55% vs 52.94%,P<0.05),在T1 期的高表达率高于T2~T4 期（75.00% vs 52.27%,P<0.05）;ER、PR 阳性（阳性细胞数≥1%）组MICA/B 高表达率显著低于ER、PR 阴性组（ER：52.38% vs 74.14%;PR：51.35% vs 73.02%,均P<0.05）。MICA/B的表达与患者的临床分期、ER、PR的表达及肿瘤大小有关（均P<0.05）,与绝经状态、组织学分级及淋巴结转移无关（均P>0.05）。无论靶向治疗组（90.6% vs 72.2%,P<0.05）或非靶向治疗组（78.4% vs 58.8%,P<0.05）MICA/B高表达组6 年DFS均显著高于低表达组。结论：HER2 阳性乳腺癌组织中MICA/B高表达与患者的DFS密切相关,可作为患者预后的潜在预测指标。     

绝经前ER阳性HER2阴性乳腺癌转移特征分析

目的 分析绝经前雌激素受体(ER)阳性、人类表皮生长因子受体2(HER2)阴性乳腺癌患者复发转移特征.方法 回顾性分析154例ER阳性HER2阴性绝经前复发转移性乳腺癌患者的临床资料,对患者临床及复发转移特征进行总结分析.结果 154例绝经前ER阳性HER2阴性乳腺癌患者,中位发病年龄45岁(26~53岁),中位无病生存时间(DFS)52.4个月(6.1~329.1个月),复发转移多发生在术后2~5年(49.4%,76/154);非内脏转移较内脏转移多发(55.8% vs 44.2%);骨转移最多(52.6%,81/154),内脏转移以肺多见(26.6%,41/154);多因素分析显示,淋巴结转移状态是DFS的主要影响因素(P﹤0.05).结论 绝经前ER阳性HER2阴性乳腺癌患者复发转移多发生在术后2~5年,主要为非内脏转移,骨转移最多;淋巴结转移状态是影响DFS的重要因素.     

HER3在乳腺癌中的表达及临床意义

目的探讨乳腺癌患者HER3与HER2、ER和PR之间的关系及其对乳腺癌预后的影响。方法采用免疫组织化学SP法检测癌组织中HER3、HER2、ER和PR蛋白的表达,对患者随访,随访终点为总生存时间(overall survival,OS)。结果 HER2、HER3、ER和PR在136例乳腺癌患者中的阳性表达率分别为:50%、41.18%、60.9%和27.21%。HER3与年龄、淋巴结转移、分期、肿瘤类型以及化疗状态的差异无统计学意义(P>0.05)。HER3阳性与阴性患者OS差异有统计学意义(P=0.015)。HER3(+)HER2(+)组乳腺癌患者较其他组OS明显缩短(P=0.047)。HER3的表达与PR表达无明显关系(P=0.214),但可抑制ER产生(P=0.001)。HER2阳性和HER3的过度表达高度相关(P=0.000)。结论HER3可作为独立的临床预后因子,HER3阴性患者OS较长。     

ER和PR阴性乳腺癌雄激素受体与HER2表达相关性及其临床意义

目的 激素受体阴性(ER-/PR-)乳腺癌具有明显的肿瘤异质性,临床治疗手段相对有限.本研究探讨激素受体阴性乳腺癌组织中,雄激素受体(androgen receptor,AR)和HER2表达的相关性,及其与临床病理参数和预后的相关性.方法 收集中国人民解放军福州总医院经手术治疗并病理确诊的乳腺癌120例,中位年龄52岁.采用FISH法检测收集的激素受体阴性乳腺癌组织HER2/neu基因状态,分为HER2阳性(HER2过表达组)和HER2阴性(三阴组)两组,每组60例.并采用EliVisionTM plus免疫组化法检测AR、Ki-67、EGFR表达,分析HER2和AR表达与临床病理参数、3年无病生存期(disease free survival,DFS)的相关性.结果 AR在激素受体阴性乳腺癌组织阳性率为61.67％(74/120),HER2过表达组和三阴组分别为73.33％(44/60)和50.00％(30/60).激素受体阴性乳腺癌组织中,AR表达与月经状态、肿瘤大小、组织学分级、EGFR表达及HER2状态相关,均P值＜0.05;在HER2过表达组中,AR表达与月经状态、淋巴结受累、EGFR表达相关,均P值＜0.05;三阴组中,AR表达与肿瘤大小和组织学分级相关,均P值＜0.05.Kaplan-Meier法分析显示,HER2过表达组中AR表达与患者的3年DFS呈正相关,P＜0.05;Cox回归法分析结果示,肿瘤大小、淋巴结受累、EGFR表达、AR表达均与患者的3年DFS有关,P＜0.05.结论 AR可能成为筛选激素受体阴性乳腺癌高危人群和预测其预后的辅助指标之一,可作为激素受体阴性乳腺癌的新治疗靶点,为不同HER2状态乳腺癌治疗提供新思路.     

Fluoxetine versus placebo in advanced cancer outpatients: a double-blinded trial of the Hoosier Oncology Group.

PURPOSE: To determine whether fluoxetine improves overall quality of life (QOL) in advanced cancer patients with symptoms of depression revealed by a simple survey. PATIENTS AND METHODS: One hundred sixty-three patients with an advanced solid tumor and expected survival between 3 and 24 months were randomly assigned in a double-blinded fashion to receive either fluoxetine (20 mg daily) or placebo for 12 weeks. Patients were screened for at least minimal depressive symptoms and assessed every 3 to 6 weeks for QOL and depression. Patients with recent exposure to antidepressants were excluded. RESULTS: The groups were comparable at baseline in terms of age, sex, disease distribution, performance status, and level of depressive symptoms. One hundred twenty-nine patients (79%) completed at least one follow-up assessment. Analysis using generalized estimating equation modeling revealed that patients treated with fluoxetine exhibited a significant improvement in QOL as shown by the Functional Assessment of Cancer Therapy-General, compared with patients given placebo (P =.01). Specifically, the level of depressive symptoms expressed was lower in patients treated with fluoxetine (P =.0005), and the subgroup of patients showing higher levels of depressive symptoms on the two-question screening survey were the most likely to benefit from treatment. CONCLUSION: In this mix of patients with advanced cancer who had symptoms of depression as determined by a two-question bedside survey, use of fluoxetine was well tolerated, overall QOL was improved, and depressive symptoms were reduced.     

Treatment of depressive symptoms in patients with early stage breast cancer undergoing adjuvant therapy

Background Studies have shown that there is a high prevalence of depression in cancer patients. Women with breast cancer may have an even higher risk of depression particularly in a postmenopausal or estrogen deficiency state. A small number of randomized controlled trials have examined the efficacy of antidepressants compared to that of a placebo in cancer patients, but some results have been difficult to interpret due to a heterogeneous patient group. In the current investigation, we screened newly diagnosed early stage breast cancer patients for depressive symptoms prior to the initiation of adjuvant therapy and investigated whether the oral antidepressant fluoxetine affected depressive symptoms, completion of adjuvant treatment, and quality of life. Methods Patients with newly diagnosed early stage breast cancer were screened for depressive symptoms prior to the initiation of adjuvant therapy. Patients with depressive symptoms were randomized to a daily oral fluoxetine or a placebo. Patients were then followed for 6 months and evaluated for quality of life, completion of adjuvant treatment, and depressive symptoms. Results A high percentage of patients with newly diagnosed early stage breast cancer were found to have depressive symptoms prior to the initiation of adjuvant therapy. The use of fluoxetine for 6 months resulted in an improvement in quality of life, a higher completion of adjuvant treatment (chemotherapy, hormonal therapy, chemotherapy plus hormonal therapy), and a reduction in depressive symptoms compared to patients who received placebo. Conclusions An antidepressant should be considered for early stage breast cancer patients with depressive symptoms who are receiving adjuvant treatment.     

氟西汀治疗40例癌症相关性抑郁症的效果

[目的]观察氟西汀治疗癌症相关性抑郁症的疗效.[方法]40例癌症合并抑郁症患者抗肿瘤治疗的同时给予氟西汀治疗,观察抗肿瘤治疗结果与抑郁症治疗效果的关系及停用氟西汀后的复燃率.[结果]33例抑郁缓解,缓解率82.5%.经抗肿瘤治疗有效的25例,口服氟西汀后抑郁症状缓解23例,抑郁缓解率为92.0%,停药后抑郁复燃2例,复燃率仅为8.7%;经抗肿瘤治疗无效15例,其抑郁缓解10例,缓解率66.7%,停药后复燃8例,复燃率高达80.0%.[结论]氟西汀可明显缓解癌症患者的抑郁症状,对经抗肿瘤治疗有效且无明显躯体症状的癌症患者,经氟西汀治疗抑郁缓解后可停抗抑郁药治疗,而对抗肿瘤治疗无效的癌症患者,建议长期应用抗抑郁药.     

Anxiety and depression in Iranian breast cancer patients before and after diagnosis

A prospective study was conducted to measure anxiety and depression in Iranian breast cancer patients before and after diagnosis using the Hospital Anxiety and Depression Scale (HADS). The HADS was administered at two points in time: before diagnosis and 3 months after. In all, 168 breast cancer patients were interviewed. While 48% of patients had severe symptoms of anxiety at both baseline and follow-up, more than 60% of patients had no symptoms of depressive illness at pre-and post-diagnosis assessments. Comparing anxiety and depression before diagnosis and after 3 months, there were no significant differences between patients' scores on anxiety (P = 0.42) and depression (P = 0.98) subscales. The results showed that patients with advanced disease and a lower performance status were more anxious and experienced more depression. The study findings suggest that severe symptoms of anxiety are the most frequent symptoms in Iranian breast cancer patients. It seems that during the process of diagnosis and 3 months after psychological morbidity persists in patients who suffer from breast cancer.     

Screening for major depressive disorder in adults with glioma using the PHQ-9: a comparison of patient versus proxy reports

When screening for depression in glioma patients, the utility of proxy carer report is unknown. We studied how patients and proxies differed in the frequency, severity and agreement of reported depressive symptoms, the external validity of these reports, and whether patient-proxy agreement was associated with cognitive function. This was a cross-sectional study within a prospective cohort study of depression in glioma. Eligible patients were adults with a new diagnosis of cerebral glioma whose cohabiting partners chose to attend study interviews. Patients completed the Patient Health Questionnaire-9 (PHQ-9, maximum score 27) to screen for major depressive disorder. Proxies independently completed the PHQ-9 ‘for the patient’. A structured clinical interview for MDD was then given. From 55 couples attending, 41 participated (74 %). Patient-proxy total PHQ-9 score differed by 3 or more points in 26/41 cases (63.4 %). Disagreement within dyads ranged from ?7 to +10 points. Proxies observed more individual depressive symptoms than patients reported (mean 2.7 vs 1.8 symptoms respectively, p = 0.013, Wilcoxon Rank Sum Test), and a greater severity of symptom burden (mean PHQ-9 score 8.4 vs 6.8 respectively, p = 0.016, Wilcoxon Rank Sum Test). Proxies were more reliable than patients on objective behavioural symptoms of depression. Dyadic agreement was not associated with severity of patient cognitive impairment. There was frequent disagreement between glioma patients and proxies reports of depressive symptoms. Proxies reported more depressive symptoms than patients, and were more reliable when reporting observable behavioural symptoms. When diagnosing depression in glioma, collateral history should be obtained.     

Age-related longitudinal changes in depressive symptoms following breast cancer diagnosis and treatment

Younger women being treated for breast cancer consistently show greater depression shortly after diagnosis than older women. In this longitudinal study, we examine whether these age differences persist over the first 26 months following diagnosis and identify factors related to change in depressive symptoms. A total of 653 women within 8 months of a first time breast cancer diagnosis completed questionnaires at baseline and three additional timepoints (6, 12, and 18 months after baseline) on contextual/patient characteristics, symptoms, and psychosocial variables. Chart reviews provided cancer and treatment-related data. The primary outcome was depressive symptomatology assessed by the Beck Depression Inventory. Among women younger than age 65, depressive symptoms were highest soon after diagnosis and significantly decreased over time. Depressive symptoms remained stable and low for women aged 65 and older. Age was no longer significantly related to depressive symptoms in multivariable analyses controlling for a wide range of covariates. The primary factors related to levels of and declines in depressive symptomatology were the ability to pay for basics; completing chemotherapy with doxorubicin; and decreases in pain, vasomotor symptoms, illness intrusiveness, and passive coping. Increased sense of meaning/peace and social support were related to decreased depression. Interventions to reduce symptoms and illness intrusiveness, improve a sense of meaning and peace, and increase social support, may help reduce depression and such interventions may be especially relevant for younger women.     

肺癌患者的躯体化症状及与焦虑抑郁的相关性研究

背景与目的 肺癌是一种严重威胁人类健康的恶性肿瘤,其发病率及死亡率近年始终排在全国首位.肺癌患者常伴发焦虑、抑郁等情绪问题,而焦虑抑郁等情绪问题会进一步引发一系列躯体症状.目前,临床上对于肺癌患者的躯体化症状认识不足,相关的临床研究较少,本研究以肿瘤内科患者为研究对象,探究肺癌患者的躯体化症状及其与焦虑、抑郁的相关性分析.方法 对符合躯体化症状诊断标准的肺癌患者,用患者健康问卷躯体症状群量表(Patient Health Questionnaire-15,PHQ-15)中文版进行躯体症状统计,用汉密尔顿焦虑他评量表(Hamilton Anxiety Scale,HAMA)和汉密尔顿抑郁他评量表(Hamilton Depres-sion Scale,HAMD)评定焦虑和抑郁状态.计算焦虑或抑郁检出率及不同程度躯体化症状人数,分析躯体化症状与焦虑、抑郁的相关性,统计不同躯体化症状发生频率的分布情况.结果 50例具有躯体化症状的肺癌患者中,存在焦虑抑郁情绪的患者有43例,仅焦虑、仅抑郁及焦虑合并抑郁的患病率分别为10%、10%、66%,其中躯体化症状程度越高,焦虑合并抑郁的检出率越高.躯体化症状与焦虑、抑郁的相关分析显示,PHQ-15总分、PHQ-15阳性症状数目与HAMA得分(r=0.752,P<0.001;r=0.710,P<0.001)、HAMD得分(r=0.648,P<0.001;r=0.618,P<0.001)呈显著正相关.具有躯体化症状的肺癌患者临床症状出现频率由高到低依次是疲劳(96%)、虚弱感(88%)、睡眠障碍(84%)、头晕(82%)、肢体或关节疼痛(80%)等;不同性别肺癌患者之间的躯体化症状比较差异无统计学意义(P>0.05).结论 具有躯体化症状的肺癌患者焦虑、抑郁常见,躯体化症状与焦虑、抑郁密切相关,此类患者最常见的临床症状为非特异性全身不适症状.     

Pharmacological treatment of depression in women with breast cancer: a systematic review

The objective of this study is to review the literature on pharmacological treatment of depression in women with breast cancer. According to the PRISMA guidelines, we conducted a systematic review of randomized, controlled clinical trials and open label prospective studies on antidepressants effects on depression in women with breast cancer up to January 14, 2013. In this analysis, a total of 213 studies were identified, and six studies met the inclusion criteria. Of the six studies, three were placebo-controlled randomized controlled clinical trials with fluoxetine, a selective serotonin reuptake inhibitor; and Mianserin—a noradrenergic and specific serotonergic antidepressant. Both studies found that fluoxetine and mianserin significantly improved depressive symptoms and quality of life (QOL) compared with placebo. Conversely, desipramine, a tricyclic antidepressant, and the SSRI, paroxetine, showed no significant effects on depression compared with placebo. A double-blind, parallel group study comparing a tricyclic antidepressant, amitriptyline, and paroxetine showed a significant and comparable improvement in depression and QOL. Two open label, prospective studies found that escitalopram and the norepinephrine reuptake inhibitor, reboxetine, significantly improved depression and QOL compared with baseline values. In conclusion, depression is a clinical problem in patients with breast cancer. Pharmacological treatment with antidepressants may improve depression and QOL. However, the evidence is limited, and the studies are too heterogeneous to recommend one regimen or drug over another. Further antidepressant studies are needed to guide depression treatment in patients with breast cancer.     

抗忧郁焦虑药对癌症患者忧郁焦虑情绪的影响

目的 了解抗忧郁焦虑药物对进行常规治疗的癌症患者焦虑、忧郁情绪的影响。方法 对39例伴有焦虑忧郁的肿瘤患者,在常规放疗、化疗及生物治疗的基础上给予抗忧郁焦虑药物百优解治疗,用药方法为每日口服百优解20mg,共6周,观察治疗前及治疗后第1、2、4、6周HAMA、HAMD量表总分、因子分和减分离的变化情况,结果进行统计学分析。结果 从第2周开始患者焦虑、忧郁情绪有所改善,较治疗前明显好转,第6周时焦虑、忧郁情绪改善有效率分别为74.36%和76.92%。结论 伴有焦虑、忧郁的肿瘤患者在常规治疗的同时配合抗忧郁焦虑药物治疗,有助于改善患者的焦虑和忧郁情绪,提高了患者的生存质量。     

Depression and anxiety in older patients with hematological cancer (70+) – Geriatric,social, cancer- and treatment-related associations

ObjectivesOlder patients are often underrepresented in clinical and epidemiological studies and the knowledge of the effect of hematologic cancer on mental health in the elderly is sparse. Objectives of our study are to provide information on depression and anxiety in older patients with hematological cancer (HCP), compared to a community sample (CS), and to investigate factors associated with depression and anxiety.Materials and MethodsWe conducted a prospective study with interview assessments of HCP (ICD: C81 – C96) age ≥ 70 years to assess depressive symptoms (PHQ-9) and anxiety (GAD-7) in comparison to a CS matched by age and sex. Hierarchical Regression analysis was used to determine the association of depression and anxiety with quality of life (QoL) as well as geriatric, social, cancer- and treatment-related factors.Results200 patients (response rate 50.5%, Mean age = 76 years, 64% male) and 225 citizens (response rate 44.5%) were interviewed. Compared to the CS, HCP showed significantly higher levels of depression. There was no difference in levels of anxiety between the two groups. Geriatric characteristics including limited mobility, need for care, comorbidity, as well as ongoing chemotherapy, lack of partnership, and low QoL were associated with depression. Anxiety in HCP was associated with detrimental social interaction, cognitive and emotional functioning, poor nutrition, and comorbidity.ConclusionsOlder patients with hematologic cancer are at high risk to experience depressive symptoms and low QoL. Health care professionals should assess geriatric symptoms and screen for depression to allow for early interventions and improve treatment outcomes.