鼻咽癌放疗患者负性情绪与心理弹性及自我效能的关系

目的 探讨鼻咽癌放疗患者负性情绪与心理弹性及自我效能的关系.方法 分别应用Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS)、心理弹性量表及中文版癌症自我效能感量表对60例接受放疗的鼻咽癌患者进行调查,分析鼻咽癌放疗患者SAS评分、SDS评分与心理弹性及自我效能的关系.结果 60例鼻咽癌放疗患者心理弹性评分为(58.33±2.25)分,SAS评分为(50.51±5.17)分,SDS评分为(47.51±4.38)分,自我效能评分为(20.70±2.98)分.不同年龄、学历、临床分期及是否接受过放疗宣教的鼻咽癌患者在SAS评分、SDS评分、心理弹性评分及自我效能评分等方面差异有统计学意义(P<0.05),不同经济状况的患者自我效能评分比较,差异有统计学意义(P<0.05).经Pearson分析,SAS评分、SDS评分与心理弹性及自我效能呈负相关(P<0.01).结论 鼻咽癌放疗患者负性情绪与心理弹性及自我效能有密切的关系,临床上可通过提高鼻咽癌放疗患者心理弹性及自我效能从而减轻患者焦虑、抑郁情绪,改善患者生活质量.     

人性化护理对乙肝相关性肝细胞癌患者术后负性情绪及自我效能的影响

目的探讨人性化护理对乙肝相关性肝细胞癌患者负性情绪及自我效能感的影响。方法选取2013年3月至2017年3月间上海市松江区中心医院收治的82例乙肝相关性肝细胞癌患者,采用随机数表法将患者分为观察组与对照组,每组41例,观察组患者采用人性化护理,对照组患者采用常规护理,观察不同护理方式对患者术后负性情绪、自我效能感、术后肝功能指标及HBVDNA水平的影响效果。结果护理前,两组患者的焦虑自评量表(SAS)和抑郁自评量表(SDS)自评量表评分比较,差异无统计学意义(P> 0. 05);术后6个月,观察组患者SAS和SDS自评量表评分显著低于护理前及对照组同期,差异均有统计学意义(均P <0. 05)。护理前,两组患者一般自我效能感量表(GSES)评分比较,差异无统计学意义(P> 0. 05)。术后1周和术后6个月时,观察组GSES评分显著高于对照组及本组护理前,差异均有统计学意义(均P <0. 05)。入院时,两组组间肝功能指标及检查结果比较,差异无统计学意义(P> 0. 05)。术前,观察组患者总胆红素(TBIL)显著低于对照组患者;术后3d,观察组患者TBIL和丙氨酸转移酶(ALT)显著低于对照组患者;术后6个月时,观察组患者TBIL、ALT、天门冬氨酸基转移酶(AST)及乙肝病毒脱氧核糖核酸(HBV-DNA)均显著低于对照组患者,差异均有统计学意义(均P <0. 05)。结论人性化护理用于乙肝相关性肝细胞癌患者能够降低患者不良情绪,提高患者自我效能,并有助于改善患者术后肝功能及HBV-DNA水平,有益于患者预后康复,具有一定的借鉴价值。     

认知行为护理干预对早期卵巢癌患者负面情绪和自我效能感的影响

目的探讨认知行为护理干预对早期卵巢癌患者负面情绪和自我效能感的影响。方法将98例早期卵巢癌患者随机分为干预组和对照组,每组49例。对照组患者给予常规护理,干预组患者在给与常规护理的基础上进行认知行为护理干预,比较两组患者的负面情绪和自我效能感。结果两组患者护理后焦虑自评量表(SAS)和抑郁自评量表(SDS)评分均较护理前降低(P<0.05)。干预组SAS和SDS评分分别为(36.4±9.3)分和(36.8±10.7)分,均低于对照组,差异有统计学意义(P<0.05)。两组患者护理后一般自我效能感量表(GSES)评分均较护理前升高(P<0.05);干预组GSES评分为(31.5±4.2)分,高于对照组,差异有统计学意义(P<0.05)。结论实施认知行为干预有助于缓解早期卵巢癌患者的负面情绪,提高自我效能感,促进患者身心健康。     

乳腺癌化疗患者正念水平与负性情绪及生活质量的相关性分析

目的:分析乳腺癌化疗患者正念水平与负面情绪及生活质量的相关性。方法:选择2016年4月至2018年5月在我院住院化疗的乳腺癌患者189例,按照中文版正念量表(MAAS)对患者正念水平进行评估,分为高正念水平组患者87例,低正念水平组患者102例。采用癌症康复系统评价简表（CARES-st）对患者生活质量进行评价,采用焦虑自评量表（SAS）以及抑郁自评量表（SDS）对患者负性情绪进行评定。分析患者正念水平与负性情绪及生活质量之间的相关性。结果:高正念水平组患者SAS、SDS评分均显著低于低正念水平组（P<0.05）。高正念水平组患者生活质量各维度评分及生活质量总评分均显著低于低正念水平组（P<0.05）。乳腺癌化疗患者正念水平评分与SAS、SDS及生活质量各维度评分、生活质量总分均呈显著负相关关系（P<0.05）。结论:乳腺癌化疗患者整体处于低正念状态,患者正念水平可影响其负性情绪以及生活质量,因此在治疗过程中应采取积极措施提高患者正念水平,从而有助于改善患者负性情绪以及生活质量。     

乳腺癌放化疗患者认知功能障碍的影响因素分析

目的探讨乳腺癌放化疗患者发生认知功能障碍的影响因素。方法选取100例乳腺癌放化疗患者作为研究对象,对患者的基线资料进行问卷调查,应用蒙特利尔认知评估量表(MoCA)、一般性自我效能量表、心理弹性量表对患者的认知情况进行评估,并分析乳腺癌放化疗患者发生认知功能障碍的影响因素。结果100例乳腺癌放化疗患者中,认知功能障碍者24例,认知功能障碍的发生率为24%(24/100)。单因素分析结果显示,不同年龄、文化水平、婚姻状况、工作情况、放化疗不良反应程度、运动锻炼情况、自我效能水平、心理弹性水平乳腺癌放化疗患者的认知功能障碍发生情况比较,差异均有统计学意义(P﹤0.05);不同合并症情况、TNM分期、放化疗情况乳腺癌放化疗患者的认知功能障碍发生情况比较,差异均无统计学意义(P﹥0.05)。多因素分析结果显示,年龄≥60岁、放化疗不良反应程度为2～3级是乳腺癌放化疗患者发生认知功能障碍的危险因素(P﹤0.05),而运动锻炼≥3次/周、自我效能高等水平、心理弹性高等水平是乳腺癌放化疗患者发生认知功能障碍的保护因素(P﹤0.05)。结论乳腺癌放化疗患者认知功能障碍的发生与其年龄、放化疗不良反应程度、运动锻炼情况、自我效能和心理弹性水平有关,积极提高患者的自我效能和心理弹性水平有助于减轻患者的认知功能障碍,从而提高患者的生活质量。     

多样性心理干预对乳腺癌患者负性情绪、心理弹性和生存质量的影响

目的 探讨多样性心理干预对乳腺癌患者负性情绪、心理弹性和生存质量的影响.方法 采用随机数字表法将120例乳腺癌患者分为干预组和对照组,各60例.两组患者均给予常规的健康教育及治疗指导,干预组同时给予多样性心理干预.比较两组患者干预前后的心理弹性水平、负性情绪和生存质量.结果 干预后,干预组患者的心理弹性水平总评分为(75.27±9.41)分,高于对照组患者的(71.04±9.06)分(P﹤0.05).干预后,干预组患者中文版乳腺癌患者生命质量测定量表(QLICP-BR)中社会能力、心理状态、特异模块、共性症状维度的评分及总分均高于对照组患者(P﹤0.05).干预后,干预组患者焦虑抑郁量表中的焦虑亚量表(HADS-A)和抑郁亚量表(HADS-D)评分均明显低于对照组患者(P﹤0.01).结论 多样心理干预对乳腺癌患者的心理功能、负性情绪均具有明显的调节作用,可改善患者的生命质量.     

家属同步健康教育对乳腺癌患者术后自我效能和功能锻炼依从性的影响

目的 探讨家属同步健康教育对乳腺癌患者术后自我效能和功能锻炼依从性的影响.方法 选取120例行乳腺癌根治术的患者,采用随机数字表法分为同步组和非同步组各60例,两组患者术后均给予功能锻炼指导及健康教育,同步组同时对患者家属给予健康教育.随访3个月后,比较两组患者的锻炼依从性、自我效能(GSES)、肩关节功能评分.结果 出院3个月后,同步组患者的锻炼依从率(93.33%)高于非同步组(78.33%),差异有统计学意义(P﹤0.05);同步组患者的GSES评分明显高于非同步组,差异有统计学意义(P﹤0.001);同步组患者的肩关节功能(疼痛程度、日常生活活动能力、主动活动范围、肌力)评分均明显高于非同步组,差异有统计学意义(P﹤0.001).结论 家属同步健康教育对乳腺癌患者术后自我效能和功能锻炼依从性具有积极的促进作用.     

认知行为干预对乳腺癌患者不良情绪和生活质量的影响

目的探讨认知行为干预对乳腺癌患者不良情绪和生活质量的影响。方法回顾性分析86例女性乳腺癌患者的临床资料,所有患者均接受术后化疗。根据入院后护理方法的不同将患者分为对照组和观察组,每组43例,对照组患者接受常规护理,观察组患者在对照组的基础上接受认知行为干预。比较护理干预前后两组患者的焦虑抑郁量表(HADS)评分及生活质量评分。结果干预前,两组患者的焦虑和抑郁量表评分比较,差异均无统计学意义(P﹥0.05);干预后,两组患者的焦虑和抑郁量表评分均低于本组干预前(P﹤0.05),且观察组患者的焦虑和抑郁量表评分均明显低于对照组(P﹤0.01)。干预前,两组患者的各项生活质量评分比较,差异均无统计学意义(P﹥0.05);干预后,观察组患者情绪功能、认知功能、总体健康评分均高于对照组,疲乏、恶心呕吐、失眠评分均低于对照组,差异均有统计学意义(P﹤0.05)。结论认知行为干预可以有效改善乳腺癌化疗患者的不良情绪,提高其生活质量,值得推广。     

Prospective evaluation of cognitive function in patients with early breast cancer receiving adjuvant chemotherapy

Aim: To assess cognitive function prospectively in women with early breast cancer before, during and after the administration of adjuvant chemotherapy. Methods: Between May 2000 and November 2001, 35 assessable patients were entered into the study. Thirty‐one received oral cyclophosphamide, methotrexate and 5‐fluorouracil (CMF) and four received epirubicin and cyclophosphamide followed by CMF ((cyclophosphamide, methotrexate and 5‐fluorouracil)). Testing consisted of the completion of a battery of neuropsychological and psychological inventories and was performed prior to chemotherapy and repeated after 3 (n = 31) and 6 months (n = 30) of chemotherapy and also 6 months after the completion of chemotherapy (n = 27). Results: Prior to chemotherapy a proportion of the patients already exhibited some evidence of impairment of cognitive function. However, on completion of chemotherapy, the neuropsychological scores for short‐term verbal memory and verbal learning were significantly lower than prior to, or 6 months after chemotherapy. In all other domains, cognitive function either remained constant or even appeared to improve. Symptom scales showed that fatigue, nausea and vomiting, constipation and diarrhea were worst half way through the chemotherapy. Quality of life scales indicated that functioning was best after completion of chemotherapy. Conclusion: Patients with early breast cancer may have impaired cognitive function before chemotherapy. Although transient deteriorations in verbal memory and verbal learning were observed on completion of chemotherapy, overall, cognitive function did not decline. It is likely that practice effects influenced our findings.     

小剂量口服沙利度胺对三阴性乳腺癌患者凝血系统功能的影响

目的:观察三阴性乳腺癌患者服用小剂量沙利度胺前后凝血指标变化,以探讨小剂量沙利度胺是否能增加栓塞事件风险。方法:选取2008年至 2012年于中国医科大学附属盛京医院住院的三阴性乳腺癌患者292例,将患者按治疗过程中是否进行化疗分为化疗组（145例）与非化疗组（147例）,均给予沙利度胺100mg每日一次口服。服药前和连续服用沙利度胺3个月、6个月后抽取患者外周静脉血,用4色荧光流式细胞仪检测血小板活化程度,自动分析凝血仪检测患者部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、D-二聚体（DD）。比较患者血小板活化程度、内外源性凝血途径功能变化。结果:收治的292例患者,去除退组的55例,服用沙利度胺前后APTT、PT值、血小板活化程度均无显著变化。化疗组服沙利度胺前FIB为（3.4±0.92）g/L,DD值为（242.7±249.7）μg/L;服沙利度胺6个月后FIB为（3.9±2.4）g/L（t=-2.48,P=0.021）,DD值为（354.2±236.1）μg/L(t=-2.1,P=0.047)。FIB、DD值较前升高,有显著意义。非化疗组FIB值较前升高,但无显著意义(t=-1.83,P=0.078),服药前DD值为（225.6±156.8）μg/L,之后为（267.3±206.7）μg/L,升高有显著意义(t=-2.69,P=0.012)。结论:小剂量口服沙利度胺不能影响三阴性乳腺癌患者血小板活化,亦不能影响内外源凝血因子,但有可能增加深静脉血栓发生几率。     

The effect of modafinil on cognitive function in breast cancer survivors

BACKGROUND:

The authors conducted a randomized clinical trial examining the effects of modafinil in reducing persistent fatigue in patients after treatment for cancer and performed secondary analyses to assess the effect of modafinil on cognitive function.

METHODS:

Breast cancer patients who reported a score of ≥2 on the Brief Fatigue Inventory were enrolled in the study. In phase 1 (P1), patients received 200 mg modafinil open‐label once daily for 4 weeks. In phase 2 (P2), patients with a positive response after P1 were randomized either to an additional 4 weeks of modafinil or to placebo. Tests of memory and attention selected from the Cognitive Drug Research (CDR) computerized cognitive assessment were performed at baseline (before modafinil) and after completing phases 1 and 2. The paired differences for each test score were subjected to a Wilcoxon signed rank test.

RESULTS:

Of the 82 women who were enrolled, 76 completed P1, and 68 completed all assessments in the study. Modafinil had a significant effect on the Speed of Memory (P = .0073) and Quality of Episodic Memory (P < .0001) during P1 of the study. After randomization at Week 8, those patients who continued modafinil demonstrated significantly greater improvement in Speed of Memory (P = .029), Quality of Episodic Memory (P = .0151), and mean Continuity of Attention (P = .0101) relative to the group that was switched to placebo.

CONCLUSIONS:

The authors found that modafinil improved cognitive performance in breast cancer survivors by enhancing some memory and attention skills. Although confirmation is needed, these findings suggest that modafinil may enhance quality of life in this patient population. Cancer 2009. © 2009 American Cancer Society.     

Objective and self-reported cognitive dysfunction in breast cancer women treated with chemotherapy: a prospective study

The objective of this study is to investigate if changes in cognitive functions can be recognised in patients undergoing chemotherapy for breast cancer. Forty women with breast cancer and without depression underwent cognitive evaluation before and after 6 months of chemotherapy; emotional evaluation was performed before and after 1, 3 and 6 months of chemotherapy. Self-reported cognitive deficit evaluation was included. Global cognitive functioning before starting chemotherapy was good. After 6 months of treatment there was a significant decline in some cognitive functions, particularly involving the attention subdomain. Objective cognitive deficit resulted independent from the emotional status. On the contrary, self-perceived mental dysfunction was unrelated to the objective cognitive decline, but it was associated with depression and anxiety. Breast cancer chemotherapy can induce domain-specific cognitive dysfunction. Patients' self-perception of mental decline is unrelated to objective cognitive deficit. Breast cancer patients negatively judge their cognitive performances if they have a negative emotional functioning.     

The influence of erythropoietin on cognitive function in women following chemotherapy for breast cancer

Objective: Cognitive dysfunction is a potential side effect of chemotherapy, and erythropoietin might be protective. A previously reported study compared quality‐of‐life in women undergoing chemotherapy for breast cancer who were randomized to receive epoetin‐alfa or standard care. Here, we report a non‐randomized sub‐study in which cognitive function of participants was evaluated at 12–30 months after chemotherapy. Methods: The primary endpoint was the proportion of women with moderate–severe cognitive impairment, as measured by the High Sensitivity Cognitive Screen (HSCS). Subjects also completed the Revised Hopkins Verbal Learning Test (HVLT‐R), the Functional Assessment of Cancer Therapy—Fatigue (FACT‐F) and FACT‐G self‐report questionnaires for fatigue and quality‐of‐life, and the Hospital Anxiety and Depression Scale. Results: Of 278 patients receiving adjuvant treatment in the primary study, 87 participated in the sub‐study: 45 had received epoetin‐alfa and 42 standard care. Groups were well matched for age and type of chemotherapy. Eight patients (9%) had moderate–severe cognitive dysfunction by the HSCS: six of them in the epoietin‐alfa group (not significant). There were no significant differences in the HVLT‐R, or in fatigue, but patients who had received epoetin‐alfa reported better quality‐of‐life. Conclusion: This study failed to demonstrate a protective effect of epoetin‐alfa against the development of delayed cognitive dysfunction after chemotherapy. Copyright © 2008 John Wiley & Sons, Ltd.     

Predictive biomarkers for triple negative breast cancer treated with platinum-based chemotherapy

Treatment of triple negative breast cancer (TNBC) has been a big challenge since it is defined. To date, platinum-based chemotherapy has played a significant role in the treatment of TNBC patients. However, some patients do not respond to platinum salts or gradually develop chemoresistance, resulting in little effect, or even some adverse effects. Here, we review numerous preclinical and clinical investigations to summarize possible mechanisms and potential predictive biomarkers of platinum in TNBC. The homologous recombination deficiency (HRD) resulting from the loss of BRCA function is the main rationale of platinum efficacy in TNBC. BRCA mutation and methylation have been demonstrated to be important potential biomarkers. Based on genome-wide effects, BRCA-like classifier can identify the functional loss of BRCA and work as the predictor. HRD score that is able to identify the “BRCAness” and predict the sensitivity of platinum is increasingly considered. Taken together, all findings suggest that HR deficiency profile encompassed by BRCA mutation and high HRD score could predict response to platinum, even to other DNA-damage inducing agents. p53 family members and molecular subtypes of TNBC are also important alternative considerations for predicting platinum response based on the preclinical trials. Currently, tumor infiltrating lymphocyte level and thrombocytopenia are emerging as predictive biomarkers.