中国恶性肿瘤患者抑郁患病率及其相关因素的研究

<正>一、背景近年来,恶性肿瘤发病率不断攀升。在罹患恶性肿瘤之后,患者需要面对躯体状态的改变、社会功能的下降或丧失,以及治疗及死亡的恐惧。自1975年在首届心理肿瘤学国际会议上正式确立了心理-肿瘤学分科,并成立了心理-肿瘤研究机构以来,恶性肿瘤相关性抑郁问题逐渐受到关注[1]。目前,世界卫生组织已将恶性肿瘤明确为一种社会心理性疾病。随着科学的发展,肿瘤的治疗理论逐步从单纯的抗肿瘤药物治疗,转变为肿瘤的综合治疗,再过渡到现在的改善生存率与改善生存质量并重,体现了现代医学越来越重视满足患者的生理、心理及社会各方面的需要。     

社区肿瘤患者家属抑郁障碍与患者生活质量相关因素的关系

[目的]了解上海市社区肿瘤患者家属中抑郁障碍的流行情况,分析其与患者症状、生活质量及抑郁障碍之间的相互关系.[方法]从上海市肿瘤登记系统的彭浦社区肿瘤患者资料中,采用随机抽样的方法纳入200名现患病人及家属,家属填写ZUNG抑郁自评量表(ZSDS),患者填写ZSDS、症状自评量表和FACT-G自评量表.[结果]肿瘤患者家属中抑郁障碍发生率为16%,多为轻度抑郁障碍,其严重程度受到患者抑郁障碍的发生、FACT-G评分和纳差症状的影响.家属ZSDS评分和抑郁障碍的发生受到患者疾病分期、抑郁障碍的发生、ZSDS评分和FACT-G评分的影响.多元线性回归模型可以解释家属ZSDS评分31.5%的变化,其中患者ZSDS评分、FACT-G总分和身体状况评分等3个变量分别可解释家属ZSDS评分28.3%、1.5%和1.7%的变化.Logistic回归模型分析也显示患者ZSDS评分对家属抑郁障碍发生的影响最大.Fisher线性判别分析显示,患者纳差程度和FACT-G评分组成的判别函数可预测家属抑郁障碍的发生.[结论]上海市社区肿瘤患者家属抑郁障碍与患者抑郁障碍、生活质量及症状有关,应当在全面评估的基础上,对社区肿瘤患者及其家属的心理干预作为一个整体,并进行个体化的支持.     

老年癌症患者抑郁状况及其影响因素调查

目的：调查老年癌症患者抑郁发生状况,分析影响老年癌症患者抑郁发生的因素。方法：采用抑郁自评量表（SDS）对我院109例老年癌症患者进行问卷调查;采集患者血清标本进行免疫功能分析;收集患者临床资料,分析影响老年癌症患者抑郁的相关因素。结果：109例老年癌症患者中78例（71.6%）患有抑郁;其中,女性患者和男性患者发生抑郁的百分比分别为83.3%和64.2%,差异有统计学意义（P=0.049）;49例伴癌痛的老年癌症患者中39例（79.6%）患有抑郁,43例处于疾病进展期的老年癌症患者中37例（86.0%）患有抑郁,差异均有统计学意义（P=0.022,P=0.003）。结论：老年癌症患者抑郁发生率高,女性较男性更易发生;伴癌痛及处于疾病进展期与抑郁的发生及严重程度成正相关。     

肿瘤相关性抑郁及其相关因素分析

[目的]分析肿瘤相关性抑郁的发生情况及相关因素,为临床诊疗提供依据.[方法]对213例恶性肿瘤患者以问卷调查方式收集临床资料,采用Zung抑郁自评量表分析肿瘤相关性抑郁的相关因素.[结果]肿瘤相关性抑郁的发生率为46.0％,其发生率与肿瘤发病部位、家族史、居住地无关(P＞0.05),但与性别、年龄、肿瘤分期、中医分型、慢性癌痛、KPS评分、化疗方案种类、治疗副作用、知情情况、费用负担方式、文化程度、收入相关(P＜0.05).[结论]肿瘤相关性抑郁发生率较高,尤其是女性、中晚期、有多次化疗史、KPS评分低、伴慢性癌痛患者,应重视其心理状况,身心同治,以提高患者生存质量.     

影响癌症病人抑郁状况的因素研究

目的 了解社区癌症患者中抑郁的发病情况，进一步探讨影响癌症患者发生抑郁的相关因素。方法 对上海市社区5780例癌症患者，通过自评和访谈的方法，用癌症患者生活质量自评量表FACT-G、抑郁自评量表Zung以及有关癌症患者疾病和社会信息的一般状况登记表采集数据，采用logistic回归分析方法对数据进行统计分析。结果 本组患者抑郁发生率为24．1％。与癌症患者抑郁发生密切相关的因素分别为：年龄、受教育程度、婚姻状况、收入、职业、肿瘤转移、疼痛、KPS评分、参加锻炼，其相关系数和显著性检验分别为0．011、0．000；0．160、0．000；0．085、0．016；0．22、0．000；0．062、0．000；0．404、0．005；0．696、0．000；0．032、0．000；0．102、0．000。结论 年纪大、受教育程度低、离异或丧偶、收入低、出现肿瘤转移、伴有癌痛症状、KPS评分低、很少进行体育锻炼的患者，其抑郁的发生率相应高。农民的抑郁发生率较其它工作者高。     

胃肠道恶性肿瘤患者焦虑抑郁状态及其影响因素

目的:了解胃肠道恶性肿瘤患者抑郁焦虑情况,并探讨导致胃肠道恶性肿瘤患者抑郁焦虑发生的相关因素。方法:选取2010年-2013年来我院接受治疗的胃肠道恶性肿瘤患者120例,采用问卷方式调查焦虑及抑郁发生情况,与国内常模比较SAS及SDS评分,并找出其中影响胃肠道肿瘤患者放化疗后焦虑抑郁状态的因素。结果:患者整体的焦虑抑郁发生率为44.17%,焦虑抑郁患者的SAS、SDS评分显著高于国内常模（P<0.05）。影响患者焦虑抑郁发生的主要因素为疼痛、担心住院费用、担心医疗费用、担心医护人员的工作情况等11项。结论:影响胃肠道恶性肿瘤患者焦虑、抑郁发生的因素是多方面的,需要采取综合措施才能进行有效干预。     

上海市社区癌症患者抑郁状况初步研究

目的探讨社区癌症患者发生抑郁的相关因素,以提高临床工作者对癌症患者抑郁的认识,为在社区中开展癌症患者抑郁的防治提供理论依据.方法选择上海市社区癌症患者共计2525例,调查方法包括自评和访谈,采用国内外通用的癌症患者生活质量自评量表FACT-G,抑郁自评量表Zung以及有关癌症患者疾病和社会信息的一般状况登记表.采用多元Logistic回归分析方法处理数据.结果本组患者抑郁发生率为23.3%,有5种因素与社区中的癌症患者抑郁发生密切相关,依次为:KPS评分、受教育程度、疼痛状况、收入和年龄,其相关系数和显著性检验分别为-0.044、0.000;0.189、0.000;0.720、0.000;0.217、0.000;0.012、0.003.结论KPS评分下降、受教育程度低、出现癌痛症状、收入状况差和年龄大的患者,其抑郁的发生率也相应高.     

化疗对消化系统肿瘤患者抑郁情绪的影响

目的：分析消化系统肿瘤患者化疗前后抑郁情绪的变化情况并探讨化疗在其中的作用及可能的原因。方法：选择115名消化道肿瘤患者,在化疗前后进行问卷调查,问卷包括三个表,分别为一般资料问卷调查、汉密尔顿抑郁量表、自动思维问卷。分析化疗前后患者的抑郁情况及影响因素。结果：肿瘤术后患者化疗前有抑郁情绪的为40例,抑郁情绪发生率为38.8%,两周期后有抑郁情绪的为59人,抑郁情绪发生率为57.3%,化疗前后比较,化疗后相比化疗前抑郁发生率有一定提高,化疗后 HAMD 得分（9.42±6.09）高于化疗前得分（7.67±5.61）,并具有显著性差异。患者化疗前后一般资料中,性别、职业和肿瘤类别与患者HAMD 得分无显著性差异。年龄不同,其 HAMD 得分存在差异性,年龄越高 HAMD 得分越低,50岁以下HAMD 得分最高,80岁以上 HAMD 得分最低。根据 HAMD 得分我们把被试患者分为抑郁组（HAMD 总得分>7分）和非抑郁组（HAMD 总得分≤7分）,化疗前抑郁组负性自动思维总得分为54.43±7.66,高于非抑郁的43.38±4.29（P <0.05）;化疗两周期后抑郁组负性自动思维总得分为58.62±7.70,同样高于非抑郁情绪组的49.77±2.94（P <0.05）,将肿瘤患者化疗前后进行比较,化疗后患者负性自动思维总分为54.65±7.43,高于化疗前负性自动思维总分为47.67±7.93,差异具有统计学意义（P <0.05）。结论：消化系统肿瘤患者普遍存在抑郁情绪,化疗后患者抑郁发生率高于化疗前,化疗后 HAMD 评分高于化疗前。消化系统肿瘤患者术后化疗期抑郁情绪与年龄相关,年龄越高,HAMD 得分越低,与职业、性别和肿瘤类型无显著性差异。消化系统肿瘤患者在化疗后的负性自动思维总得分明显升高,表明负性自动思维在消化系统肿瘤患者术后化疗期抑郁情绪的产生中有重要作用。     

晚期恶性肿瘤患者及家属抑郁焦虑状况及影响因素

[目的]探讨晚期恶性肿瘤患者及家属抑郁焦虑状况及影响因素。[方法]采用Ζung编制的抑郁自评量表（SDS）和焦虑自评量表（SAS）及抑郁焦虑影响因素调查表,分别对210例晚期恶性肿瘤住院患者及其416例家属进行调查分析。[结果]恶性肿瘤患者及家属抑郁焦虑发生率及SDS和SAS评分均高于中国常模,均有显著性差异（P〈0.001）。影响患者和家属抑郁的前5位因素分别依次是：治疗费用、治疗效果、治疗不良反应、对家庭责任未尽、生活自理能力下降和治疗效果、治疗不良反应、治疗费用、生活自理能力下降、对家庭责任未尽。影响患者和家属焦虑的前5位因素分别依次是：治疗效果、治疗费用、生活自理能力下降、对家庭责任未尽、治疗不良反应和治疗效果、治疗不良反应、治疗费用、对家庭责任未尽、对疾病的恐惧。[结论]晚期恶性肿瘤患者及家属抑郁焦虑发生率均高于正常人,针对其主要影响因素积极干预,可能改善患者及家属负性心理状况,提高生活质量。     

女性乳腺癌危险因素的病例对照研究

[目的]探讨江苏女性乳腺癌的危险因素。[方法]用病例对照研究的方法,对经病理确诊的206例乳腺癌患者及经年龄频数匹配（±2．5岁）214例对照资料进行非条件Logistic回归分析。[结果]被动吸烟（OR=2．21,95％CI：1．32～3．701、自然流产史（OR=1．71,95％CI：0．65—4．55）、口服避孕药服用史（OR=3．70,95％CI：2．00～6．82）、有良性乳腺疾病史（OR=2．69,95％CI：1．66～4．36）、肥猪肉（OR=2．39,95％CI：1．34～4．28）及腌制类食品年摄入量高（OR=4．71,95％CI：2．91～7．60）、轻体力活动职业（OR=6．29,95％CI：2．95～13．42）可能是女性乳腺癌发生的危险因素。而经常参加体育锻炼（OR=0．44,95％CI：0．26～0．74）、月经初潮年龄晚（OR=0．19,95％CI：0．06—0．65）、鲜奶（0R=0．32,95％CI：0．20～0．511、新鲜豆类（0R=0．07,95％CI：0．04—0．13）和水果年摄入量高（OR=0．30,95％CI：0．18—0．48）则降低乳腺癌发生的风险。[结论]减少口服避孕药、肥猪肉及腌制类食品的摄入,增加新鲜水果、新鲜豆类摄入,加强体育锻炼,对患有良性乳腺疾病的妇女加强体检。加大乳腺癌预防及健康宣教工作可预防乳腺癌的发生。     

Assessment of Depression and Anxiety in Breast Cancer Patients: Prevalence and Associated Factors

Introduction: Having breast cancer or receiving treatment has been seen as a traumatic experience for women dueto its impacts on their self-image and sexual relationship, and may lead to an psychological reactions such as denial,anger, or intense fear toward their disease and treatment process. Also many of breast cancer patients have psychiatricmorbidities such as depression and anxiety. Purpose: The purpose of this study was to assess the prevalence andassociated factors of depression and anxiety in breast cancer patients, in order to identify independent predictors of mentalhealth disorders risk. Material and Methods: A cohort of 152 breast cancer patients who were attending an outpatientoncology department was recruited. Data were collected with a structured questionnaire consisted by social, clinicaland demographic information and PHQ-2 and GAD-2 scales. Results: The mean age of the patients was 53.25 years(SD=12.10), 69.7% of the patients underwent mastectomy and 30.3% ongectomy. Chemotherapy received 46.1% ofpatients as adjuvant therapy, 15.8% radiotherapy and 38.2% received both chemotherapy and radiotherapy. A largepercentage found to be classified as depressed (38.2%) and anxious (32.2%) and factors that found to be associatedwere age, marital status, educational level, stage of cancer from univariate analyses and place of residence, religion,symptoms burden from multivariate analysis (for depression and anxiety). Conclusions: Breast cancer patients arein high risk for developing psychiatric disorders such as depression and anxiety. Being rural resident, non-OrthodoxChristian and experiencing extend symptom burden can be predicting factors associated with depression and anxietyin breast cancer patients.     

Factors Associated with Suicide Risk in Advanced Cancer Patients: A Cross-Sectional Study

The study aimed to find out to what degree suicidal thoughts and associated factors affect the suicide risk of advanced cancer patients. The frequency of suicidal thoughts among patients with cancer, especially in the advanced stages, is about 3 times greater than the adult average in South Korea. We recruited 457 participants with four types of cancers (colon, breast, cervical, and lung) using stratified sampling. Data collection was carried out through one-on-one interviews by trained nurses using a structured questionnaire. Advanced cancer patients with high, vs. low, levels of anxiety and pain had a higher suicide risk. In contrast, having one’s spouse as the primary care provider was associated with a low suicide risk. Overall, the three factors of anxiety, pain, and the primary caregiver being one’s spouse explained 17.2% of the variance in suicide risk. In conclusion, we derived influencing factors of suicide risk using a sample of patients with various types of advanced cancer. The results provide systematic baseline data for preparing nurse-led interventions to prevent suicidal thoughts and suicide attempts among advanced cancer patients.     

盆腔恶性肿瘤患者抑郁、焦虑发生影响因素分析

[目的]探讨盆腔恶性肿瘤患者抑郁、焦虑的发病特点及其相关影响因素.[方法]采用Zung抑郁自评量表(SDS)、焦虑自评量表(SAS)及患者一般临床特征调查表对128例盆腔恶性肿瘤患者进行数据采集及相关因素分析.[结果] 128例盆腔恶性肿瘤患者中有抑郁障碍者87例(67.97％),平均得分62.61±6.97分.有焦虑者38例(29.69％),平均得分58.84±9.49分.Logistic回归多因素分析显示,抑郁、焦虑的发生率均与患者年龄、文化程度、医疗费用来源、临床分期、慢性癌痛呈显著相关性(P＜0.05),而与患者性别、KPS评分、日常锻炼无相关性.[结论]盆腔恶性肿瘤患者中抑郁和焦虑发生率较高.对于老年、肿瘤晚期、伴有慢性癌痛等因素的患者,需要进行心理—生理方面的综合干预.     

Depression and Suicide Ideas of Cancer Patients and Influencing Factors in South Korea

Background: This study compared risk factors for depression and suicidal ideas among cancer patientsfor comparison with the general population, and identified influencing factors. Materials and Methods: Weanalyzed data from 2,472 cancer patients in the National Cancer Center and nine Regional Cancer Centersand frequency-matched data for age and sex from 2,349 members of the general population who completed theNational Health and Nutrition Examination Survey in 2008. Logistic regression analysis was used to identifyfactors affecting depression and suicidal ideas. Results: Cancer patients were not likely to have more depression(OR=0.96, 95%CI=0.79-1.18) and were less likely to have suicidal ideas (OR=0.64, 95%CI=0.53-0.79) comparedto the general population. Female sex, more stress, and lower quality of life were influencing factors. Theadditional risk factors for suicidal ideas among cancer patients included income (OR=0.62, 95%CI=0.43-0.91),smoking (OR=1.63, 95% CI=1.06-2.50), recurrence (OR=1.50, 95%CI=1.15-1.95), and chemotherapy (OR=1.66,95%CI=1.26-2.19). Conclusions: No differences appeared in depression rates between cancer patients and thegeneral population, and cancer patients were less likely to have suicidal ideas. However, cancer patients werelikely to have more risk factors than the general population, and those classified as being at high risk of suicideshould receive distress management and social economic support, from early in the treatment process.     

Depression and Anxiety Levels in Early Stage Turkish Breast Cancer Patients and Related Factors

Psychiatric disorders such as depression and anxiety are common among cancer patients. If left untreated,these disorders can lead to poor treatment compliance, prolonged hospital stay and reduced life quality. In thisprospective study, we aimed determine anxiety and depression levels and related factors among female breastcancer patients presenting to a breast surgery clinic in Istanbul and who met the inclusion criteria. Data werecollected using a questionnaire and the Hospital Anxiety and Depression Scale (HAD). The mean age was 48.2years and the mean post-operative period was 17.9 months. It was found that 46.3 % of the patients had stageI, and 53.7 % stage II, 59.3 % of them undergoing breast conserving surgery and 40.7 % mastectomy. Whenevaluated according to the HAD Scale, it was found that anxiety scores of 35.1 % of the patients and depressionscores of 17.1 % of the patients were higher than their cut-off points. With regard to the affecting factors,depression scores of those with no family history of breast cancer were significantly higher than those with nofamily history of breast cancer (t= 1.53; p= 0.03); that the depression scores of the patients who underwentmastectomy were significantly higher than those who underwent breast conserving surgery (t= 1.75; p= 0.04).Additionally, it was found that low income was an important risk factor for anxiety; whereas a history of breastcancer in the family and mastectomy was an important risk factor for depression.These results indicate theimportance of determining psychiatric problems and appropriate approaches in addition to medical treatmentin breast cancer patients.     

Risk of Anxiety and Depression after Diagnosis of Young-Onset Colorectal Cancer: A Population-Based Cohort Study

Given the increasing incidence of young-onset colorectal cancer (yCRC; <50 years), we aimed to evaluate the risk of depression and anxiety in individuals with yCRC in comparison to average-age-onset CRC (aCRC; ≥50 years) and to cancer-free controls, with stratification by sex. Our cohort study identified individuals (≥18 years) with CRC and cancer-free controls (10:1) matched on age and sex using population-based linked administrative health databases in British Columbia, Canada. We assessed depression and anxiety using validated algorithms. We evaluated the risk of depression and anxiety using multivariable Cox proportional hazard models. The cohort included 54,634 individuals with CRC (46.5% female, mean age 67.9 years) and 546,340 controls (46.5% female, mean age 67.9 years). Those with yCRC as compared to aCRC had an increased risk for depression (adjusted hazard ratio [aHR] 1.41; 95% confidence interval [CI] 1.25 to 1.60), and when stratified by sex, the risk was only significant among males (aHR 1.76; 95% CI 1.48 to 2.10). When comparing individuals with yCRC to cancer-free controls, the overall risk of depression (aHR 1.00; 95% CI 0.92 to 1.10) and anxiety (aHR 1.10; 95% CI 0.95 to 1.27) was non-significant; however, males had a significantly higher risk for mental health disorders, specifically depression (aHR 1.17; 95% CI 1.03 to 1.33). Altogether, our findings that individuals with yCRC experience higher risk of depression compared to those with aCRC as well as cancer-free controls, particularly among males, suggest effects of age and sex on mental health outcomes.     

541例女性晚期非小细胞肺癌患者的预后因素分析

背景与目的随着女性肺癌发病率的攀升,其独特的临床和流行病学特征及良好预后引起了学界的关注。本研究通过回顾性分析女性晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的临床资料,探讨其预后相关因素。方法收集541例女性晚期NSCLC患者的临床资料,并随访至死亡。主要观察指标为总生存(overallsurvival,OS)。采用SPSS11.0统计软件进行生存分析。结果全组腺癌占80.2%(434/541),总体中位OS为15个月(95%CI:13.87-16.13),1年、2年、5年生存率分别为58.8%、23.7%和3.20%。单因素分析显示,临床分期、ECOG评分、体重下降、临床症状、血行转移和一线治疗后化疗方案数>1、一线化疗有效、曾接受靶向治疗或放疗均与中位OS明显相关(P值均<0.05)。治疗前体重下降、ECOG评分、靶向治疗及一线化疗有效为生存的独立预后因素(P值均<0.05)。结论女性晚期NSCLC患者的病理类型以腺癌为主,体重下降、ECOG评分、接受靶向治疗及一线化疗有效可能成为女性晚期NSCLC患者生存的独立预后指标。     

Depression and the Risk of Breast Cancer: A Meta-Analysis of Cohort Studies

Background: Whether depression causes increased risk of the development of breast cancer has long beendebated. We conducted an updated meta-analysis of cohort studies to assess the association between depressionand risk of breast cancer. Materials and Methods: Relevant literature was searched from Medline, Embase,Web of Science (up to April 2014) as well as manual searches of reference lists of selected publications. Cohortstudies on the association between depression and breast cancer were included. Data abstraction and qualityassessment were conducted independently by two authors. Random-effect model was used to compute the pooledrisk estimate. Visual inspection of a funnel plot, Begg rank correlation test and Egger linear regression test wereused to evaluate the publication bias. Results: We identified eleven cohort studies (182,241 participants, 2,353cases) with a follow-up duration ranging from 5 to 38 years. The pooled adjusted RR was 1.13(95% CI: 0.94 to1.36; I2=67.2%, p=0.001). The association between the risk of breast cancer and depression was consistent acrosssubgroups. Visual inspection of funnel plot and Begg’s and Egger’s tests indicated no evidence of publicationbias. Regarding limitations, a one-time assessment of depression with no measure of duration weakens the test ofhypothesis. In addition, 8 different scales were used for the measurement of depression, potentially adding to themultiple conceptual problems concerned with the definition of depression. Conclusions: Available epidemiologicalevidence is insufficient to support a positive association between depression and breast cancer.     

Second Malignancy in Stomach Cancer Patients and Its Possible Risk Factors

To identify possible risk factors of multiple primary cancersin stomach cancer patients, a case-control analysis based ondata from medical records was conducted on 73 patients (54 malesand 19 females) with stomach cancer who were affected by oneor more other primary cancers subsequently or concurrently (cases)and 146 patients with stomach cancer alone (controls), by matchingsex, age, time of the operation for stomach cancer and survivalperiod. The relative risks (RR) for cancer history in the father(RR = 3.21), for family history of stomach cancer (RR = 2.52)and for history of hemorrhoids (RR = 3.15) were significantlyincreased in both sexes. The proportion of professionals inmales was significantly higher in cases than in controls. Ina conditional multiple logistic regression analysis for males,the adjusted relative risk (aRR) for family history of cancerin two or more members (aRR = 3.54) was statistically significant.Smoking tended to increase the risk of multiple primary cancersin males, especially in the cases with smoking-related secondmalignancy (RR =4.83). These data suggest the possibility thatboth genetic and environmental factors are involved in the multiplicityof cancer in stomach cancer patients.