妇科恶性肿瘤患者治疗后性功能障碍的研究进展

妇科恶性肿瘤本身会对患者身体、心理、社会和精神方面造成严重的负面影响,这些患者经手术、放疗、化疗甚至是联合治疗后,性功能受损严重,导致女性性功能障碍（female sexual dysfunction,FSD）,包括性欲低下、性唤起障碍、性高潮障碍和性交疼痛等.性功能障碍对身心健康、社会关系和总体生活质量均有重大不良影响,目前研究表明,心理干预以及综合康复治疗能够有效缓解患者性功能障碍,从而提高生活质量.     

癌症治疗与性功能的恢复

许多癌症患者在接受治疗以汁后,都会在性生活方面发生一些改变。将近半数的乳腺或者生殖系统癌症的女性患者和高于半数的前列腺癌男性患者,在接受较长时间的治疗后,会在相当的一段时间内遭遇性生活障碍的问题。许多癌症患者说他们并不希望自己的性生     

癌症患者生活质量指标调查

目的分析评价癌症患者在治疗中生活质量(Quality of Life,QOL)指标的自身需求与临床医生的主观测量情况,以确定临床治疗与社会支持决策.方法随机调查在我院治疗中确诊为癌症的患者和临床医生分别为68例和75例,采用欧洲癌症联盟组织研制,经过适当修改的生活质量问卷--核心30(QLQ-C30)包括"健康自我评价"、"社会人际关系"、"心理状态"、"经济状况"、"躯体症状"和"身体功能"等6个指标维度30个因子,进行患者自评与医评问卷调查.结果QOL 6个维度总均分较高的两个维度分别为[1]"健康自我评价",[2]"社会人际关系",医生组与病人组相同.病人组"心理状态"分值最低,医生组"身体功能"分值最低.结论患者和医生均对"健康自我评价"、"社会人际关系"两项指标要求最高.说明患者的主观感受、人际关系与治疗相关较大.病人对"心理状态"与治疗的关系认识不够.医生比较重视病人的"躯体症状",但对病人的"经济状况"及"身体功能"方面较忽视.     

女性生殖器官恶性肿瘤患者性生活质量调查分析

目的　探讨女性生殖器官恶性肿瘤患者的性生活质量 ,以实施心理干预 ,提高生活质量。方法　采用性欲低下、性厌恶、性交疼痛诊断量表 ,对 10 0例女性生殖器官恶性肿瘤患者进行问卷调查 ,让病人根据 6个月内情况进行评定。结果　性欲低下 5 0 % ,与担心工作能力、家庭关系情况、今后对性生活相当满足愿望有非常显著性差异 ,P <0 0 0 1。性厌恶 6 8% ,与年龄、职业、对性生活适当满足愿望有非常显著性差异 ,P <0 0 0 1。性交疼痛 35 % ,与担心工作能力、家庭关系、生育能力有非常显著性差异 ,P <0 0 0 1。 4 0～ 4 9岁性厌恶、性交疼痛有差异P <0 0 5 ,5 0岁以上性欲低下有差异P <0 0 5。结论　女性生殖器官恶性肿瘤患者存在不同程度的性功能障碍     

100例癌症患者的情绪障碍分析

１００例癌症患者的情绪障碍分析李宁，乐晓玻第三军医大学新桥医院（６３００３７）众所周知，癌症称之为＂绝症＂，是世界医学上难以攻克的课题之一，它不仅给患者、也给社会带来惊恐不安，它不得不引起肿瘤专科医师们的高度重视，以及各类人员的关注，致使这个复杂的个...     

乳腺癌患者术后性功能障碍的发生与处置

乳腺癌患者手术后出现性功能障碍的问题是很突出的，其常见的性功能障碍有：性冷淡、性高潮障碍、性生活停止和性交疼痛等。乳腺癌患者除手术外往往还要接受诸如化疗、放疗、内分泌治疗等其它治疗，所有这些针对癌症的治疗会使患者出现一系列新的问题，并且都会对患者的性功能产生影响。国外多年前就开始了对此问题的探讨，研究较为深入。而国内对此问题的重视还刚刚开始，研究还基本上是空白。虽然目前对于乳腺癌患者术后性功能障碍的总体发生率很难有一个准确的判断，但是大家一致认为肿瘤治疗对于乳腺癌患者性功能的影响是毋容质疑的。对…     

癌痛及其对癌症患者生活质量影响的调查

目的　探讨癌痛及其对癌症患者生活质量的影响。方法　应用简明健康状况调查表(SF 36简表 )及简明疼痛调查表 (briefpaininventoryBPI)对 2 0 0例住院患者的癌痛情况、癌痛对其生活质量的影响及癌痛的处理进行系统的调查。结果　 (1)疼痛的发生率为 6 9 0 % ,其中轻度疼痛占2 1.5 % ,中度疼痛占 19.0 % ,重度疼痛占 2 8.5 %。 (2 )中、重度疼痛患者中消化道肿瘤比例较高。 (3)疼痛与疾病分期无关 (P >0 .0 5 )。 (4)疼痛的发生与骨转移的存在密切相关 (P <0 .0 1)。 (5 )无论是轻度、中度还是重度疼痛 ,均严重影响患者的日常生活、情绪、行走能力、工作、睡眠 ,且随着疼痛程度的加重 ,影响也逐渐加深。但在对生活乐趣和社交两方面的影响上 ,中度疼痛和重度疼痛差异无显著性 (P >0 .0 5 )。 (6 )中度疼痛对患者精神状态的影响要早于重度疼痛 ,因此在癌症患者的疼痛达到中度时 ,就应在止痛治疗的同时密切配合对其心理上的治疗 ,以期达到更好的疼痛缓解。 (7)在疼痛处理上 ,未经适当处理的占 41.3% ;在重度疼痛中 ,强阿片类药物应用仅达 5 2 .1% ,与WHO要求的阶梯止痛治疗原则差距较大。结论　疼痛是影响生活质量的一个重要因素 ,而癌痛的治疗尚存在较大差距。要达到WHO提出的到 2 0 0 0年使全世界癌症患者     

乳腺癌手术方式对女性性功能影响的初步对照分析

目的:研究乳腺癌术式对乳腺癌患者性功能的影响.方法: 选择152乳腺癌手术患者(其中改良根治术113例数,简称改良根治组;保留乳房手术患者39名,简称保乳组)和47例乳腺良性疾病组患者(对照组),采用乳腺癌术后性生活质量调查问卷评估乳癌改良根治术和保乳手术术式对乳腺癌患者术后性功能的影响.结果: 三组之间性功能障碍率差异显著(P<0.01),改良根治组性欲低下率、性厌恶率、性唤起障碍率、性高潮障碍程度、性交疼痛程度显著高于保乳组及对照组(P<0.01),保乳术组性欲低下、性厌恶、性交痛、性唤起障碍率显著高于对照组(P<0.01).结论: 乳腺癌手术对乳腺癌患者性功能具有重要影响,与保乳术相比,改良根治术对乳腺癌患者性功能的影响更为显著.     

乳腺癌手术方式对女性性功能影响的初步对照分析

目的：研究乳腺癌术式对乳腺癌患者性功能的影响。方法：选择152乳腺癌手术患者（其中改良根治术113例数,简称改良根治组;保留乳房手术患者39名,简称保乳组）和47例乳腺良性疾病组患者（对照组）,采用乳腺癌术后性生活质量调查问卷评估乳癌改良根治术和保乳手术术式对乳腺癌患者术后性功能的影响。结果：三组之间性功能障碍率差异显著（P〈0．01）,改良根治组性欲低下率、性厌恶率、性唤起障碍率、性高潮障碍程度、性交疼痛程度显著高于保乳组及对照组（P〈0．01）,保乳术组性欲低下、性厌恶、性交痛、性唤起障碍率显著高于对照组（P〈0．01）。结论：乳腺癌手术对乳腺癌患者性功能具有重要影响,与保乳术相比,改良根治术对乳腺癌患者性功能的影响更为显著。     

认知干预对鼻咽癌患者治疗后性功能的影响

[目的]探讨认知干预对鼻咽癌（NPC）患者性功能的影响。[方法]31例新入院的NPC患者作为干预组，在治疗前进行认知干预，40例来院复查的NPC患者作为对照组，分别采用0’Leary（1995）男性性功能问卷和女性性功能指数（FSFI）量表评估患者治疗前及治疗结束3个月至1年内的性功能状况。[结果]治疗前后男性性功能总分及性欲、勃起、射精、知觉和满意度得分在于预组分别为30．59±1．23和31.74±1．62、2．04±0．12和1．77±0．17、8.93±3．59和9.37±0．61、6．96±0．23和6.81±0．35、7．85±0．64和8．85±0．70、3．07±0．16和3．15±0．18，对照组为37．89±0、65和30．02±1-32，2．14±0．16和1．50±0．18、11．53±0．21和10．69±0.49、7．83±0．01和4．50±0.63、11.06±0．43和10.75±0．49、3．64±0．11和1．083±0．29，干预组总分在治疗前后变化无统计学意义（P=0.392），但在对照组却有统计学意义的下降（P=0．008）。[结论]认知干预保护了NPC患者治疗后的性功能，有一定的临床价值。     

Sexual Dysfunction in Females after Cancer Treatment: an Unresolved Issue

Cancer besides being a leading cause of mortality also creates a myriad of morbidities in survivors whether treated or untreated. Among women surviving after gynecological malignancies sexual dysfunction is a morbidity unexplored in Indian context because of cultural barriers. With the increasing proportion of women surviving carcinoma of the cervix, quality of life has become an important clinical issue. Despite the immense distress it causes in patients, sexual dysfunction is neither screened nor treated in Indian scenario. Despite this recognition, the area is not well researched and there is a paucity of information on the impact of cancer treatment on sexual health in Indian Context. Research has shown that up to 50% of women treated for cervix cancers have sexual dysfunction as they recover and become cancer survivors. This article aims to review the phases of sexual response and how each may be affected by the physical and emotional stress of cancer diagnosis and treatment. We will then discuss existing tools for assessment of sexual function and approaches to their treatment. Finally, we will conclude with advice to health care professionals based on current research and suggest questions for future study.     

中国癌症患者心理干预研究

目的：探讨运用心理行为干预对改善癌症患者心理和躯体功能方面的效果。方法：289例放，化疗住院患者随机进入干预组或对照组，采用情绪和生活质量问卷，分别对两组患者进行3次测查（放疗或化疗前，中，后），结果：组间比较，各项情绪指标和大多数生活质量指标以及总体情绪和总体生活质量状况，干预组比对照组改善明显，组内动态观察，各项情绪指标和生活质量指标，在干预后的效果更加明显，结论：对放，化疗患者实施恰当的心理行为干预，在临床是可行，有效的。     

Sexual Health as a Survivorship Issue for Female Cancer Survivors

As more and more people are successfully treated for and live longer with cancer, greater attention is being directed toward the survivorship needs of this population. Women treated for cancer often experience issues related to sexual health and intimacy, which are frequently cited as areas of concern, even among long‐term survivors. Unfortunately, data suggest that providers infrequently discuss these issues. We reviewed a contemporary understanding of sexual health of women and the impact of treatment on both sexual function and intimacy. We also provide a review of the diagnosis using the newest classification put forth by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and potential treatments, including both endocrine and nonendocrine treatments that the general oncologist may be asked about when discussing sexual health with his or her patients.     

芬太尼贴剂用于老年癌痛患者的临床效果观察

目的：探讨老年癌痛患者使用芬太尼透皮贴剂的效果和安全性.方法：63例伴有中度疼痛的癌症晚期患者,年龄大于65岁且伴不同程度的进食困难.入组前使用过解热镇痛药、曲马多、弱阿片类、强痛定等中度镇痛药物,且疼痛不能缓解者.使用西安杨森生产的芬太尼透皮贴剂,初始剂量从2.5 mg开始,连续使用两周,评价治疗前后疼痛缓解程度,生活质量及出现的不良反应.结果：芬太尼透皮贴剂能有效缓解癌病,不良反应轻,改善和提高伴有中度疼痛的老年晚期癌症患者的生活质量.结论：老年癌痛患者使用芬太尼透皮帖剂安全有效.     

芬太尼透皮贴剂治疗中重度癌痛433例临床观察

目的:进一步评价芬太尼透皮贴剂治疗中、重度疼痛的疗效、安全性及对生活质量的影响,为临床合理用药提供参考资料.方法:采用多中心随机开放方法,对433例中、重度疼痛患者使用芬太尼透皮贴剂进行观察,芬太尼的初始剂量是2.5mg或参照吗啡芬太尼折算表计算,贴膜每3日更换1次,在使用期间根据疼痛情况进行剂量调整,直到患者无痛或基本无痛.结果:可评价患者336例,其癌痛缓解率100%,41.6%的患者第1次使用后未再进行剂量调整,57.3%的患者调整过1～3次.芬太尼的中位剂量7.5mg,其中92.9%患者在2.5～10mg之内.不良反应轻,主要为恶心、便秘、头晕、呕吐、嗜睡、排尿困难等.治疗后生活质量有明显改善.结论:芬太尼透皮贴剂治疗中、重度疼痛的疗效显著,使用方便,不良反应轻,能明显改善患者的生活质量,绝大多数患者的调整次数在3次以内,大多数患者的使用剂量在每3天2.5～10mg.     

Autologous Platelet-Released Growth Factor and Sexual Dysfunction Amendment: A Pilot Clinical Trial of Successful Improvement Sexual Dysfunction after Pelvic Irradiation

Sexual dysfunction (SDF) is a common sequel to cancer treatment which affects the quality of life in womentreated with pelvic radiotherapy. The aim of this study was to evaluate the safety, symptom resolution and objectiveimprovement the injection of autologous platelet released growth factor (APRGF) for treatment of SDF in cited patients.This prospective pilot study enrolled 10 cancer-free patients with SDF who underwent pelvic radiotherapy at least 5years ago, randomly. Each patient was received 1-2 cc APRGF within four weeks and all patients were re-evaluatedat eight weeks and six months. CD34 immuno histochemistry and Masson’s trichrome staining were performed onvaginal biopsy section for angiogenesis and fibrosis assay respectively. Sexual satisfaction after the injection of APRFGwas clinically difference and the entire patient had sexual satisfaction. In the patient’s follow-up, none of them needsto repeat the treatment. Our results declared that APRGF injection was effective and symptoms were disappeared inthe entire patients. Significant objective improvements in vaginal diameter (mean before injection, 6.5 cm vs 7.1 cmafter injection) (p-value = 0.001) and vaginal flexibility (mean before treatment, 0.72 cm vs 1.85 cm after injection)(P-value = 0.026) were observed. Characteristics of discharge before the injection in 60% of patients were includeddry vagina and 40% had mild discharge but after injection 40% of patients had moderate and also 60% had mild andsufficient discharge (P-value= 0.190). Overally, our patients reported better sexual function and showed better vaginalfunction indexes, after APRFG injection.     

Quality of life in cancer patients with pain in Beijing

Objective:To investigate the quality of life(QOL) of cancer pain patients in Beijing,and explore the effect of cancer pain control on patients’ QOL.Methods:Self-developed demographic questionnaire,numeric rating scale and SF-36 questionnaire were used together among 643 cancer pain patients in 28 Grade 2nd to 3rd general hospitals and 2 Grade 3rd cancer hospitals.Results:The SF-36 eight dimensions scores ranged from 31.75 to 57.22 in these cancer pain patients.The t test and Wilcoxon rank sum test were used to compare the QOL between pain controlled(PC) group and pain uncontrolled(PUC) group,and the results showed that patients in PC group had the higher QOL scores in 6 areas of SF-36(P<0.05).Binary logistic regression results found that pain management satisfaction scores(P<0.001),family average personal monthly income(P=0.029),current receiving chemotherapy(P=0.009) and cancer stage(P<0.001) were the predictors to cancer pain controlled results.Conclusion: Cancer patients with pain in Beijing had poor QOL. Pain control will improve the QOL of cancer pain patients.     

A Pilot Randomized Controlled Trial of Brief Cognitive‐Behavioral Therapy for Anxiety in Patients with Terminal Cancer

Introduction.

Patients with terminal cancer often experience marked anxiety that is associated with poor quality of life. Although cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety disorders, the approach needs to be adapted to address realistic concerns related to having cancer, such as worries about disease progression, disability, and death. In this pilot randomized controlled trial (clinicaltrials.gov identifier {"type":"clinical-trial","attrs":{"text":"NCT00706290","term_id":"NCT00706290"}}NCT00706290), we examined the feasibility and potential efficacy of brief CBT to reduce anxiety in patients with terminal cancer.

Methods.

We adapted CBT by developing treatment modules targeting skills for relaxation, coping with cancer worries, and activity pacing. Adults with incurable malignancies and elevated anxiety based on the Hamilton Anxiety Rating Scale (HAM-A) were randomly assigned to individual CBT or a waitlist control group. Primary outcomes included the number of completed CBT visits and the change in HAM-A scores from baseline to 8-week follow-up per a treatment-blind evaluator. The feasibility criterion was 75% adherence to the intervention.

Results.

We randomized 40 patients with terminal cancers to CBT (n = 20) or waitlist control (n = 20) groups; 70% completed posttreatment assessments. Most patients who received CBT (80%) participated in at least five of the required six therapy sessions. Analysis of covariance models, adjusted for baseline scores, showed that those assigned to CBT had greater improvements in HAM-A scores compared to the control group, with an adjusted mean difference of –5.41 (95% confidence interval: –10.78 to –0.04) and a large effect size for the intervention (Cohen''s d = 0.80).

Conclusion.

Providing brief CBT tailored to the concerns of patients with terminal cancer was not only feasible but also led to significant improvements in anxiety.     

Sexual Disorders of Patients With Metastatic Renal Cell Carcinoma (mRCC) Treated With Antiangiogenic Therapies

Background

Targeted therapies, in particular antiangiogenic therapies (AATs), have become the standard of treatment for metastatic renal cell carcinoma (mRCC). Although common adverse effects like fatigue have been well-established, sexual disorders induced by these treatments, although often reported, have been poorly evaluated. The aim of this study was to evaluate the impact of AATs on the sexual life of patients with mRCC and the relationships with quality of life (QoL), fatigue, and biologic parameters.