临终综合护理对肿瘤晚期患者生活质量的影响

目的探讨临终综合护理对肿瘤晚期患者生活质量的影响。方法选取2014年1月至2015年1月间中国医科大学附属盛京医院收治的87例晚期胃癌、肝癌和肺癌患者,采用随机数字表法分为观察组与对照组。观察组44例,在常规护理的基础上采用临终综合护理干预,对照组43例,采用常规护理。对两组患者负面情绪、疼痛程度和生活质量评分状况进行对比研究。结果护理干预4周后,观察组患者的负面情绪(抑郁自评量表和焦虑自评量表)评分分别为(40.71±4.92)分和(38.46±3.27)分,均低于对照组患者的(51.73±3.67)分和(55.21±4.62)分,两组比较,差异均有统计学意义(均P<0.05)。观察组患者疼痛程度明显低于对照组患者,两组比较,差异有统计学意义(P<0.05)。观察组患者的生活质量评分为(487.53±44.71)分,高于对照组患者的(417.93±34.24)分,两组比较,差异有统计学意义(P<0.05)。结论临终综合护理干预明显缓解肿瘤晚期患者的负面情绪和疼痛,能够显著提高生活质量。     

肿瘤晚期患者疼痛规范管理的临床观察

目的探讨肿瘤晚期患者疼痛规范管理的临床疗效。方法选取2015年1月至2016年1月间首都医科大学附属北京世纪坛医院收治的118例肿瘤晚期疼痛患者,采用随机数字表法分为观察组与对照组,每组59例。观察组患者实施疼痛规范管理,对照组患者实施常规疼痛管理,于护理干预前后采用视觉模拟评分法(VAS)评分,比较两组患者疼痛缓解情况及护理满意度。结果护理干预后,两组患者VAS评分降低,且观察组患者VAS评分为(3.8±0.7)分,低于对照组患者的(5.4±1.0)分,差异均有统计学意义(均P<0.05)。观察组患者护理满意度(96.6%)高于对照组患者(78.0%),差异有统计学意义(P<0.05)。结论疼痛规范管理可减轻肿瘤晚期疼痛患者的癌痛,提高患者的护理满意度。     

延续性护理结合癌痛护理质量指标在消化道肿瘤癌痛患者中的应用

目的探讨延续性护理结合癌痛护理质量指标在消化道肿瘤癌痛患者中的应用。方法选取2016年1月至2018年2月间上海复旦大学附属华山医院北院收治的82例消化道系统癌痛患者,采用随机数字表法分为观察组和对照组,每组41例。对照组患者采用延续性护理干预,观察组患者在对照组基础上结合癌痛护理质量指标进行延续性干预。比较两组患者干预1个月、2个月和3个月服药依从性和疼痛数字分级(NRS)≥4分患者比率,统计两组患者干预前后生命质量测定量表(FACT-G中文版)评分。结果观察组患者干预1个月、2个月和3个月服药依从性评分分别为(99. 05±0. 62)分、(99. 24±0. 47)分和(99. 35±0. 52)分,对照组患者分别为(93. 05±4. 16)分、(89. 07±3. 96)分和(85. 32±4. 79)和,差异均有统计学意义(均P <0. 05)。观察组患者干预1个月、2个月和3个月NRS≥4分比率分别为12. 2%、12. 2%和14. 6%,均低于对照组的36. 6%、43. 9%和41. 5%,差异均有统计学意义(均P <0. 05)。观察组和对照组患者干预后FACT-G评分分别为(63. 89±3. 08)分和(59. 42±3. 69)分,均较干预前升高,且观察组患者评分高于对照组,差异均有统计学意义(均P <0. 05)。结论癌痛护理质量指标用于延续性护理可提高消化道肿瘤癌痛患者的服药依从性,降低癌痛程度,改善生活质量。     

经外周静脉穿刺中心静脉置管综合护理在消化道肿瘤患者中的应用及对副反应量表评分的影响

目的探讨经外周静脉穿刺中心静脉置管(PICC)综合护理在消化道肿瘤手术患者护理中的应用及对患者副反应量表(TESS)评分的影响。方法选取2016年1月至2017年6月间哈尔滨医科大学附属肿瘤医院收治的60例消化道肿瘤患者作为研究对象。采用随机数表法将所有患者分为研究组和对照组,每组30例。研究组患者采用PICC综合护理,对照组患者采用PICC常规护理。比较两组患者的并发症发生率和TESS评分。结果研究组患者的出血量、导管堵塞、肿大及静脉炎等并发症发生率为10. 0%,显著低于对照组患者的20. 0%,差异有统计学意义(P <0. 05)。护理前,两组患者TESS评分比较,差异无统计学意义(P> 0. 05)。护理后,研究组患者的TESS评分为(1. 02±0. 64)分,显著低于对照组患者的(1. 89±0. 75)分,差异有统计学意义(P <0. 05)。结论PICC综合护理在消化道肿瘤手术患者护理中应用,可减少患者并发症发生率,同时恢复较快,适于临床推广应用。     

个案管理模式配合多元化睡眠护理对脑肿瘤患者术后心理状况和睡眠质量的影响

目的探讨个案管理模式配合多元化睡眠护理对脑肿瘤患者术后心理状况和睡眠质量的影响。方法选取2018年3月至2019年3月间西安市第九医院收治的行手术治疗的130例颅内脑肿瘤术后患者,采用随机数表法分为观察组与对照组,每组65例。观察组患者采用个案管理模式配合多元化睡眠护理干预,对照组患者采用常规护理模式干预,比较两组患者的心理状况和睡眠质量。结果干预前,两组患者症状自评量表(SCL-90)评分比较,差异无统计学意义(P> 0. 05)。干预后,两组患者SCL-90评分均降低,且观察组患者改善更多,差异均有统计学意义(均P <0. 05)。干预前,两组患者匹兹堡睡眠质量指数(PSQI)评分比较,差异无统计学意义(P> 0. 05)。干预后,两组患者PSQI评分均降低,且观察组患者改善更多,差异均有统计学意义(均P <0. 05)。结论个案管理模式配合多元化睡眠护理,能有效改善脑肿瘤患者的术后心理状况与睡眠质量,值得广泛推广。     

手术室护理干预对肿瘤手术患者应激反应的影响

目的探讨手术室护理干预对肿瘤手术患者应激反应的影响。方法选取2016年11月至2017年12月间在陕西省宝鸡市中心医院接受手术治疗的177例肿瘤患者,按照入院先后顺序排序并按照奇偶数分组,其中,观察组89例,对照组88例,在接受肿瘤手术治疗的基础上,对照组患者采用常规的护理干预措施,观察组患者以常规护理为基础开展手术室护理干预。比较两组患者的应激反应情况以及护理满意度。结果观察组的心率和血压显著优于对照组,差异均有统计学意义(均P <0. 05)。观察组术后不良反应发生情况显著低于对照组,差异均有统计学意义(均P <0. 05)。手术前,两组患者抑郁评分和焦虑评分比较,差异无统计学意义(P> 0. 05)。手术后,观察组抑郁评分和焦虑评分低于对照组,差异均有统计学意义(均P <0. 05)。观察组护理满意度为92. 1%,高于对照组患者的78. 4%,差异有统计学意义(P <0. 05)。结论手术室护理干预的实施,能够有效改善患者心理状况,可改善心率和血压的波动情况,减少不良的应激反应,提升护理满意度,进而从整体上提升手术治疗的效果。     

肝癌介入治疗中疼痛患者心理学特征及术中实施心理干预的效果

目的肝癌介入治疗中疼痛患者的心理学特征及实施心理干预后的临床效果。方法选取2012年1月至2015年10月间陕西省肿瘤医院收治的60例肝癌介入治疗患者为研究对象,采用随机数字表法分为观察组和对照组,每组30例。观察组在对照组基础上给予心理干预,对照组给予常规护理干预。比较两组患者的症状自评状况、疼痛程度及睡眠质量。结果干预前观察组SAS评分为(54.72±4.46)分,SDS评分为(56.28±5.42)分;对照组SAS评分为(55.28±4.52)分,SDS评分为(57.83±5.31)分。两组对比,差异均无统计学意义(均P>0.05)。观察组干预前VAS评分为(8.41±2.46)分,对照组为(8.39±2.82)分,组间比较差异无统计学意义(P>0.05)。干预后观察组VAS评分为(3.13±0.73)分,对照组为(6.62±1.28)分,观察组显著低于对照组,差异有统计学意义(P<0.05)。观察组干预前PSQI得分为(14.43±3.23)分,对照组为(15.36±2.31)分,组间比较无统计学意义(P>0.05)。干预后观察组PSQI得分为(6.33±1.45)分,对照组为(9.31±2.06)分,观察组显著低于对照组,差异有统计学意义(P<0.05)。结论肝癌介入治疗中,疼痛患者除了必要的基础护理及药物治疗外,有针对性进行心理干预能有效改善症状,缓解疼痛,改善睡眠。     

基于情感适应理论的心理干预对胆管癌患者负性情绪的改善效果

目的探讨基于情感适应理论的心理干预对胆管癌患者负性情绪的改善效果。方法选取2014年3月至2018年3月间山东省立第三医院收治的268例胆管癌患者,采用随机抽签分组方法将其均分为对照组和研究组,每组134例。对照组患者采用常规心理护理,研究组患者在对照组患者的基础上实施基于情感适应理论的心理干预,采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评价两组患者护理前后的负性情绪。结果治疗前,对照组患者的HAMA和HAMD评分为(27. 5±3. 6)分和(27. 8±3. 1)分,研究组患者的HAMA和HAMD评分为(28. 6±3. 7)分和(27. 5±3. 3)分,两组组间比较,差异无统计学意义(P> 0. 05)。对照组患者治疗后的HAMA和HAMD评分为(23. 6±1. 6)分和(22. 4±1. 0)分,与本组治疗前比较,差异有统计学意义(P <0. 05)。研究组患者治疗后的HAMA和HAMD评分为(18. 7±1. 7)分和(16. 2±1. 1)分,与本组治疗前比较,差异有统计学意义(P <0. 05)。且研究组患者治疗后HAMA和HAMD评分低于对照组患者,差异有统计学意义(P <0. 05)。结论对于胆管癌患者负性情绪的改善治疗来说,在常规心理护理的基础上实施基于情感适应理论的心理干预的方法比单一的心理护理有更好的效果,对患者焦虑及抑郁情况的改善有积极意义,值得推广。     

临终关怀护理联合心理辅导对晚期肿瘤患者不良情绪及生活质量的影响

目的探讨临终关怀联合心理辅导对晚期肿瘤患者不良情绪和生活质量的影响。方法选取2015年5月至2017年3月间广东省阳春市人民医院收治的162例晚期肿瘤患者,按照护理方式不同分为试验组和对照组,每组81例。对照组患者采用常规护理方法,试验组患者在对照组基础上采用临终关怀护理联合心理辅导,比较两组患者护理前后抑郁自评量表(SDS)、焦虑自评量表(SAS)和自尊量表(SES)评分及护理前后生活质量评分。结果护理前,两组患者焦虑、抑郁和自尊心理评分比较,差异无统计学意义(P> 0. 05)。护理后,两组患者焦虑和抑郁评分均低于护理前,自尊评分高于护理前,且试验组患者焦虑和抑郁评分均低于对照组,自尊评分高于对照组,差异均有统计学意义(均P <0. 05)。护理后,试验组患者躯体症状、睡眠质量、精神状况和社会情况评分均高于对照组,差异均有统计学意义(均P <0. 05)。结论临终关怀联合心理辅导可有效改善晚期肿瘤患者的不良情绪,提高生活质量。     

同感心心理沟通对肝癌介入治疗疼痛者的临床价值

目的探讨同感心心理沟通在肝癌介入治疗疼痛患者中的应用效果。方法选取2017年12月至2018年12月间陕西省榆林市第二医院收治的86例实施介入治疗的肝癌患者,根据护理模式不同分为研究组和对照组,其中,采用常规护理和同感心心理沟通的45例患者纳入研究组,采用常规护理的41例患者纳入对照组。比较两组患者焦虑和抑郁状况及疼痛评分。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)评分比较,差异无统计学意义(P>0. 05);护理后,研究组患者SAS和SDS评分,均低于对照组,差异均有统计学意义(均P <0. 05)。研究组患者疼痛评分为(3. 68±0. 35)分低于对照组患者的(4. 12±1. 25)分,差异有统计学意义(P <0. 05)。结论同感心心理沟通作为一种非药物干预措施,可有效缓解肝癌介入治疗患者的疼痛状况,改善患者的焦虑和抑郁状态。     

Oral complications of cancer and cancer therapy

Answer questions and earn CME/CNE Oral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long‐term oral health and general well‐being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long‐term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long‐term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time. CA Cancer J Clin 2012. © 2012 American Cancer Society.     

Endocrine sequelae of cancer and cancer treatments

Introduction Exposure to cancer and its treatments, including chemotherapy and radiotherapy, may result in late adverse effects including endocrine dysfunction. Endocrine disorders are the most commonly reported long-term complications of cancer treatment, especially by adult survivors of childhood cancers. This review will explore the endocrinologic adverse effects from non-endocrine cancer therapies. Methods Searches including various Internet-based medical search engines such as PubMed, Medline Plus, and Google Scholar were conducted for published articles. Results One hundred sixty-nine journal articles met the inclusion criteria. They included case reports, systematic analyses, and cohort reports. Endocrine disorders including hypothalamus dysfunction, hypopituitarism, syndrome of inappropriate anti-diuretic hormone secretion, diabetes insipidus, growth hormone disorders, hyperprolactinemia, gonadotropin deficiency, serum thyroid hormone-binding protein abnormalities, hypothyroidism, hyperthyroidism, hypomagnesium, hypocalcemia, hyperparathyroidism, hyperparathyroidism, adrenal dysfunction, gonadal dysfunction, hypertriglyceridemia, hypercholesterolemia, diabetes mellitus, and glycosuria were identified and their association with cancer therapies were outlined. Discussion/conclusions The journal articles have highlighted the association of cancer therapies, including chemotherapy and radiotherapy, with endocrine dysfunction. Some of the dysfunctions were more often experienced than others. Especially in patients treated with radiotherapy, some endocrinologic disorders were progressive in nature. Implications for cancer survivors Recognition and awareness of endocrine sequelae of cancer treatments may permit for early detection and appropriate follow-up care for cancer survivors, thus improving their overall health and quality of life.     

前列腺癌和乳腺癌的对比性研究

人体一些肿瘤的生长对某些激素有一定的依赖关系,激素阻断可抑制其生长,被称为激素相关性肿瘤,如甲状腺癌、乳腺癌、子宫内膜癌及前列腺癌等.其中前列腺癌和乳腺癌为人群中发病率较高的两种恶性肿瘤,在很多方面均具有类似的特点.将二者在各方面进行对比性研究,有利于总结前列腺癌治疗方案,提高治疗效果.     

Family history of cancer among cancer patients

Family history of cancer was examined for 9,131 cancer patients who were reported to the Aichi Cancer Registry in 1979-1981, and were over 20 years old at diagnosis. The rate of patients whose parents and/or siblings had cancer of any site was 24.5%. The rate was 9.2% for father, 8.4% for mother, 6.0% for brother(s), and 5.2% for sister(s). A significant site concordance between study patient and family member with cancer was observed for cancer of the breast, colon and rectum, and stomach. The rate of family history of breast cancer patients was 3.3 times higher than the corresponding rate for other cancer patients (3.1% vs 0.9%). Similarly, the ratio was 2.2 in colon and rectum cancer (4.2% vs 1.9%), and 1.6 in stomach cancer (16.5% vs 10.1%). An increased risk of cancer was observed when both brother and sister had cancer. This may suggest an important role of environmental exposure at an early age, as well as genetic factors, in the development of cancer. The age distribution curve of the colon and rectum cancer patients who had a family history of the same cancer was found to be bimodal with the larger peak in the 40s and the smaller peak in the 70s. This may suggest a differential contribution of genetic and environmental factors to the development of colon and rectum cancer.     

Notification of cancer in breast cancer patients

The notification of the name of disease is a premise for making the system of informed consent more complete in case of cancer treatment. In Japan, however, the notification of cancer can hardly be said to have an attained social consensus. Considering that the notification can ultimately improve patients quality of life (QOL), the breast cancer group of our department informs all breast cancer patients of their diseases in principle. This paper reports and discusses the results of a survey by questionnaire on the notification of cancer in 100 patients with breast cancer. The notification of cancer was received favorably in 83% of the patients. For those who answered, the explanation on the notification was convincing and it accounted for 81%. An examination of background factors of patients who had not been convinced revealed that many of them were suffered from advanced cancer. After the notification, a human relationship with the family and friends aggravated few of them and improved in 30% (family) and 18% (friends), respectively. The notification of cancer was thus suggested to contribute to the improvement of QOL. Although 83% well received the notification of their own diseases, only 21% were affirmative for the notification of cancer in case of a member of the family. We medical professionals should make a further effort not to make the notification of cancer the pronouncement death but to make it an aid for patients to live better.     

Skeletal sequelae of cancer and cancer treatment

Introduction  Survivors of cancer may experience lingering adverse skeletal effects such as osteoporosis and osteomalacia. Skeletal disorders are often associated with advancing age, but these effects can be exacerbated by exposure to cancer and its treatment. This review will explore the cancer and cancer treatment-related causes of skeletal disorders. Methods  We performed a comprehensive search, using various Internet-based medical search engines such as PubMed, Medline Plus, Scopus, and Google Scholar, for published articles on the skeletal effects of cancer and cancer therapies. Results  One-hundred-forty-two publications, including journal articles, books, and book chapters, met the inclusion criteria. They included case reports, literature reviews, systematic analyses, and cohort reports. Skeletal effects resulting from cancer and cancer therapies, including hypogonadism, androgen deprivation therapy, estrogen suppression, glucocorticoids/corticosteroids, methotrexate, megestrol acetate, platinum compounds, cyclophosphamide, doxorubicin, interferon-alpha, valproic acid, cyclosporine, vitamin A, NSAIDS, estramustine, ifosfamide, radiotherapy, and combined chemotherapeutic regimens, were identified and described. Skeletal effects of hyperparathyroidism, vitamin D deficiency, gastrectomy, hypophosphatemia, and hyperprolactinemia resulting from cancer therapies were also described. Discussion/Conclusions  The publications researched during this review both highlight and emphasize the association between cancer therapies, including chemotherapy and radiotherapy, and skeletal dysfunction. Implications for cancer survivors  These studies confirm that cancer survivors experience a more rapid acceleration of bone loss than their age-matched peers who were never diagnosed with cancer. Further studies are needed to better address the skeletal needs of cancer survivors.     

Malignant transformation of thyroid cancer; poorly differentiated cancer and anaplastic cancer transformation

The prognosis of thyroid cancer depends largely on histological differentiation and clinical stage. The prognosis in anaplastic cancer is worst, in well differentiated cancer it is best; poorly differentiated cancer takes a middle position. The prognosis of patients with differentiated cancer is generally good, however, there are cases with malignant transformation such as poorly differentiated, anaplastic and squamous-cell cancer transformation. We studied the frequency and the inducement factors of malignant transformation in patients with thyroid cancer. The frequency of poorly differentiated, anaplastic and squamous-cell cancer transformation was 13.6%, 6.4% and 0.7%, respectively. In anaplastic cancer transformation, irradiation is an important factor.