结直肠癌根治术后患者复发恐惧现状及其影响因素分析

目的 调查结直肠癌根治术后患者复发恐惧现状及其影响因素,为针对性干预措施的制定提供参考。方法 采用一般资料调查表、疾病进展恐惧简化量表、心理弹性简化量表和领悟社会支持量表对胃肠外科就诊的146例结直肠癌根治术后患者进行调查。结果 结直肠癌根治术后患者的复发恐惧得分为(31.05±7.74)分,得分≥34分者占患者总数46.57%;心理弹性与领悟社会支持得分分别为(32.53±6.83)、(58.44±9.41)分。多元线性回归分析显示,性别、年龄、心理弹性和领悟社会支持是结直肠癌根治术后患者复发恐惧的独立影响因素(F=30.482,P<0.001),共解释43.5%的变异量。结论 结直肠癌根治术后患者复发恐惧状况不容乐观,医护人员除需多关注女性、年龄低的患者外,还需注重多角度挖掘结直肠癌根治术后患者的正向积极心理,充分调动患者社会支持系统,以有效改善患者的复发恐惧。     

Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence

Background

Despite the fact that the fear of cancer recurrence is to varying degrees almost universal in cancer survivors, there is a lack of validated multidimensional instruments to evaluate this issue specifically.

Purpose

The goal of this study was to develop and empirically validate a multidimensional self-report scale for assessing the fear of cancer recurrence, the Fear of Cancer Recurrence Inventory (FCRI).

Methods

A provincial medical databank was used to randomly select a pool of 1,704 French-Canadian patients who had been treated for breast, prostate, lung, and colorectal cancer within the past 10 years. Of these, 300 patients were asked to complete the FCRI on two occasions.

Results

The factorial analysis conducted on the final 42-item scale revealed a seven-component solution (64% of the variance) including the following factors: triggers, severity, psychological distress, coping strategies, functioning impairments, insight, and reassurance. The results also supported the internal consistency (α?=?0.95) and the temporal stability (r?=?0.89) of the FCRI, as well as its construct validity with other self-report scales assessing fear of cancer recurrence (r?=?0.68 to 0.77) or related constructs such as psychological distress (r?=?0.43 to 0.77) and quality of life (r?=??0.20 to ?0.36).

Conclusions

This study suggests that the French-Canadian version of the FCRI is a reliable and valid instrument for evaluating the multidimensional aspects of the fear of cancer recurrence.     

前列腺癌患者治疗及生活质量调查——基于网络问卷的真实世界研究

目的研究中国前列腺癌患者不同治疗方式后的不良反应和生活质量的真实世界数据。 方法以北京抗癌乐园前列腺癌组患者为调查对象,通过社交媒体电子调查问卷收集患者的基本信息、诊断信息、TNM分期、治疗方式以及治疗后的不良反应,问卷设计基于欧洲癌症研究与治疗组织生命质量测定量表C30和PR25,采用Pearson χ²检验比较手术治疗患者与放射治疗组患者全身不良反应、泌尿系统不良反应、直肠不良反应、血液学不良反应、性功能障碍的发生率,概率频数小于5时采用Fisher精确检验方法。 结果共收集228例患者信息,接受过手术治疗、放射治疗（包括术后放射治疗）、内分泌治疗、化疗、粒子植入的比例分别为50.0%（114/228）、77.6%（177/228）、80.3%（183/228）、7.89%（18/228）、3.95%（9/228）,治疗不良反应前10位为乏力（42.5%,97/228）、大便次数增多（42.1%,96/228）、白细胞减低（39.5%,90/228）、尿频（31.6%,72/228）、夜尿增多（27.6%,63/228）、贫血（20.2%,46/228）、腹泻（19.7%,45/228）、尿急（19.7%,45/228）、性功能障碍（18.4%,42/228）、睡眠质量下降（18.4%,42/228）。手术患者漏尿发生率高于放射治疗患者,且差异具有统计学意义（23.7% vs 5.0%,χ²=12.200,P<0.001）,性功能障碍的发生率高于放射治疗患者,但差异无统计学意义（21.1% vs 15.0%,χ²=1.140,P=0.286）,放射治疗患者治疗中尿频症状和大便次数增多症状均高于手术组患者,但差异无统计学意义（32.5% vs 30.7%,χ²=0.071,P=0.791;45.0% vs 34.2%,χ²=2.310,P=0.286）。针对不良反应的治疗选择居首位的是服用中药（46.9%,107/228）。 结论不同治疗手段的不良反应和对生活质量的影响不同,应根据患者对未来生活质量的要求选择合理治疗方案。     

前列腺癌药物去势后早期血清激素变化与生活质量评估

目的 探讨内分泌治疗对前列腺癌患者生活质量的影响.方法42例失去手术指征的进展期前列腺癌患者,每28天皮下注射诺雷德(3.6 mg)1次,分时段测定血清睾酮及前列腺特异抗原(PSA),并对相关生活质量进行调查.结果 治疗3周后可达去势水平[血清睾酮由(568.15±198.25)μg/L到(17.46±3.81)μg/L];治疗1月后血清PSA明显下降[由(92.14±29.43)μg/L降至(20.26±4.31)μg/L],前列腺体积缩小,梗阻症状改善,但疼痛、因病所致日常活动受限等情况均无显著变化.精神疲软、乏力和食欲不振等较用药前显著加重;全身健康情况、性功能较前显著减退.结论 药物去势可在短期内明显降低前列腺癌患者血清睾酮和PSA水平,减轻排尿困难症状;但对健康相关的生活质量有明显的影响.     

Individual quality of life following radical prostatectomy in men with prostate cancer

PURPOSE: The aim of this study was to examine the individual quality of life (QoL) of men following radical prostatectomy for prostate cancer. The following research questions were addressed: (a) What are the most important areas of quality of life for men following radical prostatectomy? (b) How do these men rate their satisfaction in each area and what is the relative importance of each area to their overall quality of life? METHODS: The purposive sample consisted of 11 men with prostate cancer who had undergone a radical prostatectomy 3 to 4 months earlier. QoL was examined using the SEIQoL-DW (Schedule for the Evaluation of Individual QoL: A Direct Weighting Procedure). The data were analyzed by means of qualitative content analysis (five most important QoL areas). FINDINGS: The 11 respondents named a total of 55 QoL areas which they described and labelled. They then rated their current satisfaction in each area, and how important each one was to them. A second analysis of the content was made to identify the main QoL areas. The 55 quality of life areas mentioned by respondents were reduced to the following categories: health, activity, family, relationship with a partner, autonomy, independence, hobby, financial security, and sexuality. Health, family, and relationship with a partner are the thee areas which had the most impact on QoL. Overall, the respondents had a high quality of life value. Impotence and incontinence did not appear to have a very negative impact on quality of life. CONCLUSIONS: SEIQoL-DW was used for the first time in patients with prostate cancer. In a urology department where nurses and patients are confronted daily with the topics of intimacy, sexuality, and sense of embarrassment, more importance should be placed on the topic of sexuality when taking a patient history. Nurses should be trained in communication techniques that enable them to engage patients in a safe and therapeutic dialogue about their sexual concerns related to the diagnosis of prostate cancer. SEIQoL-DW can support the communication with patients.     

Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy

Monga U, Garber SL, Thornby J, Vallbona C, Kerrigan AJ, Monga TN, Zimmermann KP. Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy.

Objective

To show fatigue prevention and quality of life (QOL) improvement from cardiovascular exercise during radiotherapy.

Design

Prospective enrollment (n=21), randomized to exercise (n=11) and control groups (n=10), with pre- and post-radiotherapy between- and within-group comparisons.

Setting

Academic medical center.

Participants

Localized prostate cancer patients undergoing radiotherapy.

Interventions

The interventional group received radiotherapy plus aerobic exercise 3 times a week for 8 weeks whereas the control group received radiotherapy without exercise.

Main Outcome Measures

Pre- and post-radiotherapy differences in cardiac fitness, fatigue, depression, functional status, physical, social, and functional well-being, leg strength, and flexibility were examined within and between 2 groups.

Results

No significant differences existed between 2 groups at pre-radiotherapy assessment. At post-radiotherapy assessment, the exercise group showed significant within group improvements in: cardiac fitness (P<.001), fatigue (P=.02), Functional Assessment of Cancer Therapy-Prostate (FACT-P) (P=.04), physical well-being (P=.002), social well-being (P=.02), flexibility (P=.006), and leg strength (P=.000). Within the control group, there was a significant increase in fatigue score (P=.004) and a decline in social well-being (P<.05) at post-radiotherapy assessment. Between-group differences at post-radiotherapy assessment were significant in cardiac fitness (P=.006), strength (P=.000), flexibility (P<.01), fatigue (P<.001), FACT-P (P=.006), physical well-being (P<.001), social well-being (P=.002), and functional well-being (P=.04).

Conclusions

An 8-week cardiovascular exercise program in patients with localized prostate cancer undergoing radiotherapy improved cardiovascular fitness, flexibility, muscle strength, and overall QOL and prevented fatigue.     

青年乳腺癌患者癌症复发恐惧影响因素分析

目的分析青年乳腺癌患者癌症复发恐惧影响因素,并讨论家庭干预措施。方法选取2019年9月—2020年11月医院接收的128例青年乳腺癌患者作为调查对象,采用一般资料调查问卷、癌症患者恐惧疾病进展简化量表(FoP-Q-SF)、疾病不确定感量表(MUIS)、汉密尔顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、领悟社会支持量表(PSSS)进行调查。根据患者有无癌症复发恐惧分为发生组和未发生组,并采用多因素Logistic回归分析青年乳腺癌患者癌症复发恐惧危险因素。结果经FoP-Q-SF调查显示,128例患者共有59例出现癌症复发恐惧。经单因素及多因素Logistic回归分析显示,文化程度低、已婚、家庭人均月收入低、焦虑抑郁、社会支持低是青年乳腺癌患者癌症复发恐惧的独立危险因素(P<0.05)。结论在青年乳腺癌患者中,癌症复发恐惧发生率较高,且文化程度低、已婚、家庭人均月收入低、焦虑抑郁、社会支持低是癌症复发恐惧的独立危险因素,临床应积极根据上述因素进行家庭干预,以降低癌症复发恐惧发生率。     

癌症焦虑量表在乳腺癌患者术后复发恐惧检测中的应用

目的：了解癌症焦虑量表（ CWS）评分与乳腺癌患者疾病指标的相关性,判断患者的肿瘤复发恐惧程度及分布特征。方法随机选取青岛大学附属医院乳腺病诊疗中心接受诊治的乳腺癌术后未复发患者85例,采用CWS ,以书信或电子邮件的形式进行调查。结果共发放问卷114份,其中85例完成CWS量表的填写,有效回收率74．6％。85例患者 CWS 得分8～22分,平均得分为（11．84±4．06）分;接受保乳手术与接受局部治疗＋全身性治疗患者焦虑程度高于改良手术和只接受局部治疗患者,组间比较差异有统计学意义（χ2值分别为9．071,16．406;P＜0．05）。结论 CWS量表可作为我国乳腺癌患者的肿瘤复发恐惧心理检测工具。对于CWS评分较高的患者,建议临床医疗及护理人员提供适合的心理干预和支持治疗以降低其肿瘤复发恐惧。     

原发性乳腺癌患者复发恐惧及其影响因素研究*

目的: 探讨原发性乳腺癌患者复发恐惧现状及影响因素,为临床护理干预提供参考。方法: 采取便利抽样的方法,选取208例原发性乳腺癌术后患者,采用一般资料调查表、中国大五人格问卷简式版和癌症复发担忧量表进行调查。结果: 本研究原发性乳腺癌术后患者癌症复发担忧（Concern About Recurrence Scale,CARS）总得分为（80.63±18.513）分,不同年龄、居住地、文化水平、家庭人均收入、宗教信仰、TNM疾病分期患者CARS得分差异有统计学意义（P<0.05）。患者大五人格特征得分中宜人性得分最高,而外向性得分最低。多元线性回归分析结果显示,患者的年龄、居住地、文化水平、家庭人均收入有负向预测作用,而神经质人格具有正向预测作用（P<0.05）。结论: 原发性乳腺癌术后患者普遍存在不同程度的复发恐惧感,原发性乳腺癌术后患者神经质与复发恐惧呈正相关,宜人性、外向性、开放性、严谨性与复发恐惧呈负相关。建议医护人员根据患者不同特点,分析患者复发恐惧的来源,通过研究乳腺癌患者癌症复发担忧与人格特质的相关性,为临床制定更为科学的护理措施提供依据,从而帮助其减轻复发恐惧感。     

The long‐term quality of life and information needs of prostate cancer survivors

What are the quality of life (QoL) and information needs of long‐term prostate cancer survivors? Numbers of prostate cancer survivors are increasing and it is vital that their QoL issues and information needs are understood. The long‐term effects of surviving prostate cancer is poorly understood. Specialist nurses play a key role in their management. A cross‐sectional survey was used. The study questionnaire [(European Organization for Research and Treatment of Cancer‐Quality of Life Questionnaire) EORTC‐QLQ‐30 and EORTC QOL‐INFO25] was posted to 398 prostate cancer survivors attending an Irish centre managed by a clinical nurse specialist and consultant. Completed questionnaires (n = 195) were returned (response rate 49%). Overall, the men demonstrated a Global Health Status/QoL score of 77·6 (SD 20·7), demonstrating a high or healthy level of functioning. Men on hormonal therapy demonstrated inferior physical function in comparison to other treatment options. Fatigue and insomnia were the most frequent symptom experienced, while age was the most significant demographic variable affecting symptom scales. Men undergoing active surveillance for prostate cancer management were least happy with information received (p = 0·019). Comparison with EORTC QLQ‐C30 international reference values suggests that this cohort report a high/healthy QoL. However, a significant proportion of men expressed a need for the receipt of further information, especially men on active surveillance. Specialist nurses are in a unique position to meet the information needs of long‐term prostate cancer patients. However, planning is needed to ensure there are enough specialist nurses to meet the information needs of a growing number of men surviving prostate cancer.     

前列腺癌根治患者术后尿失禁自我管理措施的研究进展

本文综述了前列腺癌根治患者术后尿失禁自我管理措施现状及存在问题,旨在为临床护理及健康宣教提供更系统、全面的参考和借鉴,使患者掌握多元的尿失禁应对方法,提高其生活质量水平,从身体到心理快速回归社会.     

Evaluation of the prognostic nutritional index for the prognosis of Chinese patients with high/extremely high-risk prostate cancer after radical prostatectomy

BACKGROUNDThe incidence of prostate cancer (PCa) is on the rise in China. The risk level of patients with PCa is associated with disease-free survival rate at 10 years after radical prostatectomy. Predicting prognosis in advance according to the degree of risk can provide a reference for patients, especially treatment options and postoperative adjuvant treatment measures for high-risk/extremely high-risk patients.AIMTo explore the predictive value of the prognostic nutritional index (PNI) for biological recurrence in Chinese patients with high/extremely high-risk PCa after radical prostatectomy.METHODSThe biochemical test results and clinical data of 193 patients who underwent radical prostatectomy for the first time from January 2015 to December 2020 were retrospectively collected. The PNI value of peripheral blood within 1 wk before surgery was calculated, and during the follow-up period, prostate-specific antigen ≥ 0.2 ng/mL was considered to have biological recurrence. The receiver operating characteristic (ROC) curve was used to calculate the optimal critical value and area under the curve (AUC) of the patients. According to the critical value, the progression-free survival of the high PNI group and low PNI group was compared. The independent influencing factors of the patients'' prognosis were obtained by the Cox proportional hazards regression model.RESULTSThe non-biological recurrence rates at 1, 3, and 5 years were 92.02%, 84.05%, and 74.85%, respectively. The optimal critical value for PNI to predict biological recurrence was 46.23, and the AUC was 0.789 (95% confidence interval: 0.651-0.860; P < 0.001). The sensitivity and specificity were 82.93% and 62.30%, respectively. In accordance with the optimal critical value of the ROC curve (46.23), 193 patients were further divided into a high PNI group (PNI ≤ 46.23, n = 108) and low PNI group (PNI > 46.23, n = 85). The incidence of postoperative complications in the high PNI group was lower than that in the low PNI group (21.18% vs 38.96%). Kaplan-Meier survival analysis showed that the overall survival rate at 5 years in the low PNI group was 87.96% (13/108), which was lower than that in the high PNI group (61.18%, 33/85; P < 0.05). Low PNI [hazard ratio (HR) = 1.74; P = 0.003] and positive incisal margin status (HR = 2.14; P = 0.001) were independent predictors of biological recurrence in patients with high/extremely high-risk PCa.CONCLUSIONThe PNI has predictive value for the prognosis of patients with high/extremely high-risk PCa, and is an independent prognostic factor. Patients with low PNI value have a shorter time of non-biological recurrence after prostatectomy. It is expected that the combined prediction of other clinicopathological data will further improve the accuracy and guide postoperative adjuvant therapy to improve the quality of prognosis.     

自我管理教育对前列腺癌去势治疗后患者生活质量的影响

目的 探讨自我管理教育对前列腺癌去势治疗后患者生活质量的影响.方法 将46例前列腺癌行去势治疗患者分为两组,分别为对照组和实验组,对照组采用常规健康教育,实验组实施自我管理教育.结果 实施自我管理教育后,实验组的躯体功能、社会功能、心理功能高于对照组,差异有统计学意义(P＜0.05).结论 自我管理教育能提高前列腺癌去势治疗后患者的躯体功能、社会功能、心理功能,从而改善生活质量.     

光声成像在前列腺癌诊断和治疗中的研究进展

光声成像(photoacoustic imaging PAI)是一种新型的非电离式和非侵入式的成像方法,具有高分辨率实时血管显像和在不使用外源造影剂的情况下获得血氧饱和度等信息的特性,并能与超声等成像技术结合,因此在临床各个学科中能很好地应用。目前光声成像技术在前列腺癌的诊疗研究中发展迅速,本文将主要对光声成像技术在前列腺癌诊断和治疗方面的研究进展进行综述。