癌症患者抑郁治疗的临床研究

目的通过抗抑郁治疗提高癌症患者的生活质量。方法50例抑郁患者中轻度抑郁占52%,中度抑郁占36%,重度抑郁占12%。轻度抑郁患者采取心理治疗和康复指导,中度抑郁患者采用抗抑郁药物和中药治疗。结果治疗后SDS评分下降10分占56%,下降20分占18%,有效率74%。结论通过抗抑郁治疗可缓解癌症患者抑郁和焦虑等情感障碍,促进康复,提高生活质量。     

疼痛对癌症患者抑郁和生活质量影响的研究

目的了解癌症患者疼痛和抑郁的发生率,疼痛对癌症患者生活质量的影响;探讨癌痛与肿瘤患者发生抑郁的相关性.方法以住院患者为主,采用癌症生活质量自评量表FACT-G、SDS抑郁自评量表、疼痛数字分级法(NRS)以及一般状况评定量表收集癌症患者相关资料.结果本研究入组患者236例,均为病理确诊的癌症患者,其中疼痛的发生率为64.4%,轻、中度痛占55.9%,重度痛占8.5%;抑郁的发生率为34.3%.不同程度的疼痛与身体状况、情感状况和功能状况的损害明显相关(P=0.001,0.047,0.008).疼痛与肿瘤患者的抑郁发生明显相关(P《0.001),癌症患者抑郁的发生率在无痛组、轻度痛组、中度痛组和重度痛组分别为14.3%,7.7%,60%,80%.结论癌症患者中约2/3发生疼痛,1/3发生抑郁.疼痛是影响癌症患者生活质量的主要因素;疼痛与抑郁的发生密切相关.     

癌症患者的生活质量研究

本文综述了生活质量概念的提出、研究历史及其定义，阐述了ＱＯＬ研究的必要性、重要性及其在癌症临床研究中的作用及地位，提出了ＱＯＬ研究目前所存在的一些问题并预测其发展趋势。     

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。     

上海市社区癌症患者生活质量及其影响因素

背景与目的:目前癌症患者生活质量的评价已经成为肿瘤临床研究的终点指标之一,其综合反映了癌症患者的生存、预后和生活状况.本研究试图通过了解上海市社区癌症患者生活质量及其影响因素,探索有针对性的干预措施,评价医疗卫生服务效果.方法:采用整群抽样的方法从上海肿瘤病例数据库中选取社区中7 967例癌症患者进行问卷调查并填写FACT-G自评量表,共回收合格调查表6 694份.统计描述其生活质量的流行病学分布,使用多元线性逐步回归分析数据,确定影响患者生活质量的主要因素.结果:社区癌症患者中,平均生活质量评分为107.62±18.77(95%CI:107.17～108.07).患者生存期、诊断时期别、肿瘤有无转移、治疗状况、体能评分KPS和疼痛VAS评分是生活质量的主要影响因素.结论:早期诊断癌症、提高临床治疗效果、提供社区康复指导与止痛服务对于提高社区癌症患者的生活质量会有帮助.     

上海市社区女性乳腺癌患者抑郁和生活质量状况研究

背景与目的:乳腺癌是目前上海女性中发病率最高的恶性肿瘤,也是最易发生抑郁的癌症.为此,本研究旨在了解上海市社区女性乳腺癌患者的抑郁和生活质量状况及其影响因素.方法:采用整群抽样的方法从上海肿瘤病例数据库中选取社区中1 328名女性乳腺癌患者进行问卷调查并填写自评量表,共回收合格调查表1 172例.统计描述其抑郁状况和生活质量水平的流行病学分布,确定患者的抑郁发生和生活质量的主要影响因素及抑郁发生和生活质量的关系.结果:上海市社区女性乳腺癌现患者抑郁发生的比例为22.9%(95%CI:20.0%～25.0%),平均的生活质量评分为107.62分(95%CI:106.41～108.83).乳腺癌患者存活期、诊断时期别、治疗状况、体能评分KPS、疼痛VAS评分等因素是影响患者抑郁发生和生活质量的主要因素,抑郁的发生严重影响了患者的生活质量.结论:早期诊断乳腺癌、提高临床治疗效果、提供社区康复指导服务可降低其抑郁的发生比例,提高社区乳腺癌患者的生活质量.     

艾迪注射液改善年老体弱晚期癌症患者生活质量的临床观察

目的观察艾迪注射液治疗年老体弱的晚期癌症患者的近期疗效、疼痛缓解情况、生活质量及生存期的影响。方法将143例老年晚期癌症患者随机数字表法随机分为治疗组和对照组，其中对照组71例，给予对症、支持等常规治疗；治疗组72例，在对照组用药基础上给予艾迪注射液50～60ml加入0．9％氯化钠溶液250ml静脉滴注，1次／d，21d为1个疗程，2个疗程结束后评价两组的近期疗效、疼痛缓解情况、生活质量变化及生存期。结果治疗组有效【完全缓解（CR）＋部分缓解（PR）]率仅为2．8％（2／72），对照组无缓解病例；而临床受益[CR＋PR＋无变化（sD）1率为66．7％（48／72），明显高于对照组31．0％（22／71），差异有统计学意义（P〈0．05）。治疗组疼痛缓解总有效率为67．6％（25／37）；明显高于对照组36．1％（13／36）（P〈0．05）。治疗组中位生存期为6．2个月，高于对照组5．1个月（P〉0．05）。治疗组治疗前、后生活质量良好率分别为18．1％（13／72）和66．7％（48／72），对照组分别为15．5％（11／71）和22．5％（16／71）（P〈0．05）。治疗组不良反应极小。结论艾迪注射液治疗年老体弱的晚期癌症患者有一定抑制肿瘤生长的作用，能缓解癌痛并提高晚期癌症患者的生活质量，安全，值得临床推广应用。     

抗抑郁药物联合阿片类药物和心理干预治疗晚期癌痛伴抑郁的疗效观察

目的研究抗抑郁药物作为辅助性干预措施对伴有抑郁状态和癌痛晚期癌症患者的治疗效果。方法将68例患者随机分为两组,进行为期4周的临床观察。对照组联合使用阿片类药物以及心理干预,治疗组联合使用阿片类药物、心理干预以及抗抑郁药物度洛西汀,采用汉密尔顿抑郁量表(HAMD17)、视觉模拟评分法(VAS)于治疗前及治疗后第1、2、4周末进行疗效评估,观察辅助性抗抑郁药物对伴有抑郁状态的癌痛患者抑郁情绪及联合用药对疼痛改善、阿片类药物使用的情况。结果在治疗后第1、2、4周末,治疗组患者HAMD17评分显著降低,抑郁情绪明显改善(P<0.05),对照组患者治疗前后HAMD17评分无明显下降(P>0.05)。治疗组患者在治疗后第2、4周末HAMD17焦虑/躯体化、体重、认知障碍、睡眠障碍以及阻滞各因子分均有显著下降(P<0.05)。治疗组患者阿片类药物使用量在治疗前后无明显增加(P>0.05),而对照组患者阿片类药物使用量在第4周末有显著增加(P<0.05)。治疗组患者在用药期间未见明显的不良反应。结论对伴有抑郁状态的晚期癌痛患者,单纯的心理干预和止痛治疗不能明显改善患者抑郁情绪;在接受阿片类药物和心理干预的同时联合抗抑郁药物度洛西汀,其效果优于阿片类药物联合心理干预,能明显缓解患者抑郁情绪,并有益于疼痛的控制。     

我国癌症病情告知对癌症患者及家属焦虑抑郁和生活质量影响Meta分析

目的 采用Meta分析方法探讨癌症病情告知对患者及家属焦虑、抑郁和生活质量的影响.方法 检索PubMed、Cochrane Library、中国知识基础设施工程(CNKI)、万方和维普电子数据库,查找自建库至2020-08-31公开发表的关于我国癌症病情告知对癌症患者及家属焦虑抑郁和生活质量影响的相关文献.中文检索式:...     

The impact of optimism on anxiety,depression and quality of life in urogenital cancer patients

Objective: The purpose of the present study was to examine the relationship between optimism and anxiety, depression and health‐related quality of life (HRQOL). A further aim was to investigate the predictive value of optimism for anxiety, depression and HRQOL, quantified with and without controlling the corresponding base level. Methods: A total of 427 urogenital cancer patients were asked to complete the Life Orientation Test (LOT), the Hospital Anxiety and Depression Scale (HADS) and the health survey SF‐8 during their stay in the hospital (T1), two weeks later (T2) and three months later. Results: Finally, 275 patients (64.4%) completed all questionnaires. Optimism at T1 was significantly associated with anxiety (r=?0.35), depression (r=?0.41) and HRQOL (physical: r=0.29; mental: r=0.27) and can predict outcome variables three months later. After controlling for the base levels of anxiety, depression and HRQOL, the predictive value of optimism remained significant but small. The incrementally variance explained by the LOT varied between 2.1% in anxiety and 8.2% in physical HRQOL. Conclusion: Especially patients with a low level of optimism and a high level of pessimism are at risk for higher levels of anxiety and depression in addition to lowered HRQOL. Copyright © 2009 John Wiley & Sons, Ltd.     

氟西汀增强中晚期癌症患者止痛疗效观察

为观察氟西汀在癌症疼痛的治疗中对三阶梯止痛治疗的增强作用以及对患者抑郁、焦虑状态的影响。对70例伴有疼痛肿瘤患者随机分为治疗组和对照组,每组35例。对照组采用WHO三阶梯给药原则与方法,治疗组在此基础上加用氟西汀。用药6周后比较2组在疼痛缓解率和抑郁、焦虑状态方面的差异。结果显示,治疗组与对照组疼痛缓解率分别为83.30%和55.6%,两组比较有显著性差异(P<0.05);治疗组患者治疗后其焦虑自测量表(SAS)与抑郁自测量表(SDS)评分明显降低。初步研究结果提示,氟西汀可增强镇痛效果,缓解患者的焦虑、抑郁状态,且不良反应少。     

An open-label study of the effects of bupropion SR on fatigue, depression and quality of life of mixed-site cancer patients and their partners

This preliminary study investigated whether bupropion sustained release (SR) improved symptomatic fatigue, depression and quality of life in cancer patients and caregiver quality of life. The sample consisted of a prospective open case series of 21 cancer patients, with fatigue and with or without depression at moderate to severe levels, referred for psychiatric assessment from a tertiary care cancer centre. Both patient symptom ratings and caregiver ratings were measured before and after 4 weeks of treatment with the maximally tolerated dose of bupropion in the range of 100-300 mg per day. At trial completion, significant improvement was found for symptoms of fatigue and depression. Subjects were divided into two groups: depressed and non-depressed (based on a cut-off score of 17 on the Hamilton Depression Rating Scale). Both groups reported improvement for fatigue and depressive symptoms. Depressed subjects and their caregivers did not experience any change in quality of life, while the non-depressed subjects and their caregivers reported improvements. Results from this small group of patients suggest that bupropion may have potential as an effective pharmaceutical agent for treating cancer-related fatigue. A randomized, placebo-controlled trial with this medication is indicated.     

心理干预对癌痛患者疗效及焦虑抑郁的影响

目的 观察心理干预联合止痛药物对癌痛患者治疗效果和焦虑抑郁的影响.方法 选取200例伴有疼痛的肿瘤患者,采用随机数字表法分为干预组和对照组,每组各100例.所有患者均进行癌痛规范化治疗,干预组在癌痛规范化治疗的基础上联合心理干预,4周后采用数字评分法(NRS)及医院焦虑抑郁量表(HAD)对患者的疼痛程度进行评定.结果 干预组患者治疗后的癌痛缓解率为92%,高于对照组的81%,差异有统计学意义(P﹤0.05);干预组患者治疗后的焦虑、抑郁评分低于对照组,差异均有统计学意义(P﹤0.05);干预组患者治疗后便秘的发生率为41%,明显低于对照组的62%,差异有统计学意义(P﹤0.01).结论 心理干预联合止痛药物可缓解癌痛程度,减轻患者的焦虑和抑郁,降低便秘的发生率.     

Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre

The purpose of the present study is to determine the impact of illness characteristics and psychopathological comorbidity on the quality of life (QoL) of radio-oncological patients in health-related and individual dimensions. Sixty-three of 93 eligible patients (40 women and 23 men) were included in the study during their radiation therapy visit to an outpatient centre annexed to a community hospital in Southern Bavaria, Germany. In a semi-structured interview, we elicited individually relevant life domains rated by the patients according to the 'Schedule for the Evaluation of Individual Quality of Life - Direct Weighting'. In addition, the participants completed the 'European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30' and the 'Hospital Anxiety and Depression Scale'. We also assessed the demand for psychotherapy and utilization of psycho-oncological services. In total, 9.5% of the examined patients suffer from clinically relevant anxiety and/or depression [total Hospital Anxiety and Depression Scale (HADS) score >19]. There was a weak positive correlation between Karnofsky's Performance Status and QoL. Anxiety and depression were significantly correlated with impaired QoL, especially with impaired individual QoL. There was no association between psychopathological comorbidity and the requirement for psycho-oncological support. Conversely, patients who report difficulties in accepting help had a significantly lower QoL. Psychopathological comorbidity has a considerable influence on QoL of patients undergoing radiotherapy. Measuring the individual QoL appears as an adapted needs assessment and helps the psychotherapist in focusing on the patient's problems and desires. Furthermore, the patient's QoL is a main target in providing or planning mental health care in non-university oncological services.     

Anxiety, depression, and quality of life in caregivers of patients with cancer in late palliative phase.

BACKGROUND: Limited research has been done on mental health and health-related quality of life (QOL) of primary caregivers (PCs) to patients staying at home with advanced cancer. This study examines anxiety, depression, and QOL in PCs of patients with cancer in the late palliative phase. PATIENTS AND METHODS: The sample consisted of 49 PCs of women with breast cancer and 47 PCs of men with prostate cancer. QOL was rated with the Medical Outcome Study Short Form (SF-36), and mental health with the Hospital Anxiety and Depression Scale (HADS). The findings were compared with age-adjusted norm data (norm). RESULTS: Physical QOL was significantly higher than norm in both genders, while mental QOL was significantly lower in male PCs. The level of anxiety was significantly higher than norm in both genders. No significant difference for level of depression was found in either gender, while caseness of HADS-defined depression was significantly more prevalent in female PCs compared with norm. CONCLUSION: PCs of both genders had significantly more anxiety than norm samples. Health care personnel in contact with PCs should consider screening them for mental symptoms and QOL and, if necessary, recommend further evaluation by their doctors.     

癌痛对抑郁及免疫功能的影响

目的:分析癌痛与抑郁和免疫功能之间的相关性。方法:收集我科室从2013年1月至2016年12月收治的73例晚期肿瘤患者,37例癌痛组,36例无癌痛组,进行数字疼痛强度量表(NRS)、抑郁自评量表(SDS)、生活质量、免疫功能等的调查分析比较。结果:癌痛与无癌痛的两组患者抑郁的发生比较有统计学意义(P＜0.05),癌痛程度与抑郁程度有相关性(P＜0.05);癌痛与无癌痛的两组患者生活质量的比较差异有统计学意义(P＜0.05)。癌痛与无癌痛的两组患者CD3+、CD4+、CD8+比较差异无明显统计学意义(P＞0．05)。结论:抑郁的发生与癌痛相关,抑郁程度和癌痛程度也有极大关联。癌痛可明显影响患者生活质量,但对免疫功能影响不明显。     

The association of depression and anxiety with health‐related quality of life in cancer patients with depression and/or pain

Objectives: Depression is known to be a major problem in cancer patients, and evidence is emerging about the importance of anxiety. Because the disorders are highly comorbid, we examined the relationship of anxiety and depression with health‐related quality of life (HRQL) in cancer patients. Methods: Sample included 405 adult oncology patients participating in a randomized controlled trial of telecare management for pain and depression. This secondary cross‐sectional analysis of baseline data examined independent and additive effects of anxiety and depression on HRQL, disability, and somatic symptom severity. Results: In 397 patients who screened positive for either pain or depression or both, 135 had comorbid anxiety and depression, 174 had depression but not anxiety, and 88 had neither. Differences existed across all nonphysical HRQL domains and were more pronounced incrementally across the three groups in the expected direction. In GLM modeling, anxiety and depression were each associated with all the domains when modeled separately (p<0.0001). When modeled together, anxiety and depression had independent and additive effects on the mental health domains of HRQL and on somatic symptom burden. In other domains (vitality, perceived disability, overall quality of life, and general health perceptions), only depression had an effect. Conclusion: Anxiety and depression have strong and independent associations with mental health domains and somatic symptom burden in cancer patients. However, depression has a more pervasive association with multiple other domains of HRQL. Paying attention to both anxiety and depression may be particularly important when addressing mental health needs and somatic symptom distress. Copyright © 2009 John Wiley & Sons, Ltd.