影响癌症病人抑郁状况的因素研究

目的 了解社区癌症患者中抑郁的发病情况，进一步探讨影响癌症患者发生抑郁的相关因素。方法 对上海市社区5780例癌症患者，通过自评和访谈的方法，用癌症患者生活质量自评量表FACT-G、抑郁自评量表Zung以及有关癌症患者疾病和社会信息的一般状况登记表采集数据，采用logistic回归分析方法对数据进行统计分析。结果 本组患者抑郁发生率为24．1％。与癌症患者抑郁发生密切相关的因素分别为：年龄、受教育程度、婚姻状况、收入、职业、肿瘤转移、疼痛、KPS评分、参加锻炼，其相关系数和显著性检验分别为0．011、0．000；0．160、0．000；0．085、0．016；0．22、0．000；0．062、0．000；0．404、0．005；0．696、0．000；0．032、0．000；0．102、0．000。结论 年纪大、受教育程度低、离异或丧偶、收入低、出现肿瘤转移、伴有癌痛症状、KPS评分低、很少进行体育锻炼的患者，其抑郁的发生率相应高。农民的抑郁发生率较其它工作者高。     

硒酸酯多糖对癌症患者血清MDA含量及CuZn—SOD活性的影响

了解硒酸酯多糖对肿瘤患者丛内ＭＤＡ及ＣｕＺｎ－ＳＯＤ活性的影响。方法；对６０例肿瘤病人随机分成３组：不服硒组，服硒４００μｈ／ｄ组及服８００μｇ／ｄ组并与１５名正常人对照比较。结果：癌症患者血清ＭＤＡ明显高于正常人，血清Ｓｅ及ＣｕＺＮ－ＳＯＤ活性明显低于正常人，服硒酸酯多糖者化疗后血清Ｓｅ较不服者明显升高，ＣｕＺｎ－ＳＯＤ也明显升高，ＭＤＡ含量显著下降；     

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抑郁状况初步研究

目的探讨社区癌症患者发生抑郁的相关因素,以提高临床工作者对癌症患者抑郁的认识,为在社区中开展癌症患者抑郁的防治提供理论依据.方法选择上海市社区癌症患者共计2525例,调查方法包括自评和访谈,采用国内外通用的癌症患者生活质量自评量表FACT-G,抑郁自评量表Zung以及有关癌症患者疾病和社会信息的一般状况登记表.采用多元Logistic回归分析方法处理数据.结果本组患者抑郁发生率为23.3%,有5种因素与社区中的癌症患者抑郁发生密切相关,依次为:KPS评分、受教育程度、疼痛状况、收入和年龄,其相关系数和显著性检验分别为-0.044、0.000;0.189、0.000;0.720、0.000;0.217、0.000;0.012、0.003.结论KPS评分下降、受教育程度低、出现癌痛症状、收入状况差和年龄大的患者,其抑郁的发生率也相应高.     

癌症康复期患者的集体心理干预对照研究

目的：探讨集体心理干预技术对康复期癌症患者心理问题及机体免疫系统的影响。方法：将64例接受常规治疗的住院癌症患者随机分组，其中心理干预组34例，在常规治疗基础上施予集体心理干预；对照组30例，采用常规治疗，观察期8周。疗效评定采用Hamilton抑郁量表及免疫系统免疫指标，分别于治疗前与治疗后8周评定。结果：治疗后干预组的Hamilton抑郁量表总评分明显低于对照组，干预组的免疫系统指标除CD8外，CD3、CD4、CD4／CD8、NK活性均较治疗前有显著性提高，其中NK活性一项，干预组与对照组比较差异有极显著性（P＜0．01）。结论：集体心理干预能明显减轻癌症患者抑郁焦虑情绪，提高机体免疫功能。     

社区肿瘤患者抑郁患病状况及其影响因素研究

[目的]了解社区肿瘤患者中抑郁的患病状况，探讨肿瘤患者发生抑郁的可能影响因素。[方法]对上海市新华社区464例癌症患者，使用抑郁自评量表Zung评价抑郁状况，采用调查问卷收集一般人口学信息和疾病相关信息，采用多因素Logistic回归等统计学方法分析影响因素。[结果]社区肿瘤患者中抑郁症患病率17.9%，男性、女性分别为16.3%和19.3%；高龄组（≥80岁）抑郁患病率达31.3%，高于其他年龄组患病率（P=0.006）。受教育程度和有无疼痛是影响抑郁状况的主要因素，初中及初中以下文化程度患者发生抑郁的可能性是初中以上文化程度者的2.013倍（OR=2.013,95%CI：1.154-3.510）；有疼痛者发生抑郁的可能性是没有疼痛者的2.947倍（OR=2.947,95%CI：1.578-5.504）。[结论]尽管本社区肿瘤患者抑郁症状患病率目前较低，但文化程度较低，有疼痛症状的肿瘤患者出现抑郁症状的可能性较大，应加强对这一人群的心理健康指导和支持。     

外周血IGF-1检测对癌症相关性抑郁诊断作用的临床研究

目的 探讨胰岛素样生长因子-1(IGF-1)与癌症和抑郁的发生进展之间的联系,为癌症相关性抑郁(CRD)早期诊断及病情监测提供可靠的生物学指标.方法 对经病理确诊并使用汉密顿抑郁量表(HAMD)及抑郁、焦虑自评量表(SDA、SAS)调查评定出的58例癌症相关性抑郁患者(其中29例为轻-中度抑郁,29例为严重抑郁),29例无抑郁的癌症患者(对照组),采用酶联免疫吸附法(ELISA)检测其血清IGF-1水平.结果 抑郁组和对照组的平均IGF-1水平分别是289.18±52.62,129.45±34.34(P＜0.01).IGF-1水平在对照组、轻-中度抑郁组及严重抑郁组逐步升高,差异有显著性(P＜0.01).逐步Logistic回归分析显示IGF-1(OR=2.558)为独立危险因素.结论 检测外周血IGF-1水平有助于癌症相关性抑郁的早期诊断.     

硒酸酯多糖对癌症患者血清MDA含量及CuZn-SOD活性的影响

目的：了解硒酸酯多糖对肿瘤患者体内ＭＤＡ及ＣｕＺｎ－ＳＯＤ活性的影响。方法：对６０例肿瘤病人随机分成３组：不服硒组，服硒４００μｇ／ｄ组及服８００μｇ／ｄ组并与１５名正常人对照比较。结果：癌症患者血清ＭＤＡ明显高于正常人（Ｐ＜０．０１），血清Ｓｅ及ＣｕＺｎ－ＳＯＤ活性明显低于正常人（Ｐ＜０．０１，Ｐ＜０．０５）；服硒酸酯多糖者化疗后血清Ｓｅ较不服者明显升高（Ｐ＜０．０５），ＣｕＺｎ－ＳＯＤ也明显升高（Ｐ＜０．０１），ＭＤＡ含量显著下降（Ｐ＜０．０５）；服４００μｇ／ｄ组与服８００μｇ／ｄ组之间上述各指标均无明显差异。结论：肿瘤病人摄入适量（４００μｇ／ｄ）硒酸酯多糖可能增加体内ＣｕＺｎ－ＳＯＤ活性，减轻了化疗药物对正常细胞的过氧化损伤。     

食管癌患者血清SOD活性MDA水平变化及其临床意义

目的：探讨超氧化物歧化酶（ＳＯＤ）活性及脂质过氧化物（ＭＤＡ）水平在食管癌诊断中的临床意义。方法：应用黄嘌呤氧化酶法的改进羟胺法，测定了１００例食管癌不同病期（初发期、缓解期）手术前后，放疗前后病人血清超氧化物歧化酶（ＳＯＤ）活力及ＭＤＡ水平。结果：食管癌患者初发病例及复发病例的血清中ＳＯＤ活性ＭＤＡ水平与手术后及放疗后相比有显著性差异（Ｐ〈０．０１）。结论：自由基损伤参与了食管癌的发生、发展及转     

患癌后的情绪变化

癌症是危害人类健康的重大疾病之一，在很多国家和地区，癌症已经超过心血管疾病而成为人类的第一杀手。临床统计数字显示：90％以上的癌症均与精神、情绪有直接或间接的关系。精神创伤、不良情绪，可能成为癌症的先兆。当得知患癌后，癌症又成为一个重大精神刺激，使患者产生焦虑、紧张、恐惧、愤怒、抑郁，甚至悲观绝望等一系列情绪反应，而且会使之前的不良情绪更为严重。国外有关调查表明，癌症患者中47％患有精神障碍，67％以上表现有情绪障碍。     

Pre-transplant depression as risk factor for survival of patients undergoing allogeneic haematopoietic stem cell transplantation

Introduction: Depression is discussed as a possible risk factor for survival in cancer patients. We explored this relationship for patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT). Patients and methods: The depression subscale of the Hospital Anxiety and Depression Scale (HADS) served as a measure for depression. One hundred and thirty‐eight patients (mean age 41 years; different diagnoses) participating in a psycho‐oncology study filled in the HADS after admission for allogeneic HSCT. They were followed‐up for at least two years; 72 patients died during follow‐up. Results: Depression scores were not correlated with medical and psychosocial objective factors with the exception of having under‐aged children. Controlling for medical factors that showed up as predictors for survival in our sample (patient's age at HSCT, having had a transplant before, risk for treatment failure) the HADS depression score (range 0–21) emerged as an independent predictor (Cox regression): hazard ratio = 1.087, 95% CI = 1.018–1.161. Conclusion: Depression is probably not a simple indicator of a worse health status. Further research is needed to decide if depression must be considered as an independent risk factor for survival when diagnosed in the pre‐transplant period. Copyright © 2007 John Wiley & Sons, Ltd.     

Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data.

PURPOSE: To evaluate self-reported depression rates in patients with inoperable lung cancer and to explore demographic, clinical, and quality-of-life (QOL) factors associated with depression and thus identify patients at risk. PATIENTS AND METHODS: Nine hundred eighty-seven patients from three palliative treatment trials conducted by the Medical Research Council Lung Cancer Working Party formed the study sample. 526 patients (53%) had poor prognosis small-cell lung cancer (SCLC) and 461 patients (47%) had good prognosis non-small-cell lung cancer (NSCLC). Hospital Anxiety and Depression Scale data and QOL items from the Rotterdam Symptom Checklist were analyzed, together with relevant demographic and clinical factors. RESULTS: Depression was self-rated in 322 patients (33%) before treatment and persisted in more than 50% of patients. SCLC patients had a three-fold greater prevalence of case depression than those with NSCLC (25% v 9%; P <.0001). An increased rate for women was found for good performance status (PS) patients (PS of 0 or 1) but the sex difference reduced for poor PS patients (PS of 3 or 4) because of increased depression rates for men (chi(2) for trend, P <.0001). Multivariate analysis showed that functional impairment was the most important risk factor; depression increased by 41% for each increment on the impairment scale. Pretreatment physical symptom burden, fatigue, and clinician-rated PS were also independent predictors, but cell type was not. CONCLUSION: Depression is common and persistent in lung cancer patients, especially those with more severe symptoms or functional limitations. Psychologic screening and appropriate intervention is an essential part of palliative care.     

Clinical biopsychosocial risk factors for depression in lung cancer patients: a comprehensive analysis using data from the Lung Cancer Database Project

BackgroundVarious risk factors for depression in lung cancer patients have been suggested but have been examined separately in studies with relatively small sample sizes. The present study examined the biopsychosocial risk factors of depression in lung cancer patients, focusing on psychological factors in the largest patient sample reported to date.Patients and methodsA total of 1334 consecutively recruited lung cancer patients were selected, and data on cancer-related variables, personal characteristics, health behaviors, physical symptoms, and psychological factors were obtained. The participants were divided into groups with or without depression using the Hospital Anxiety and Depression Scale.ResultsAmong the recruited patients, 165 (12.4 % ) manifested depression. The results of a binary logistic regression analysis were significant (overall R², 36.5 % ), and a greater risk for depression was strongly associated with psychological factors, such as personality characteristics (neuroticism) and coping style (low fighting spirit, helplessness/hopelessness, and anxious preoccupation). Although the contributions of cancer-related variables, personal characteristics, health behaviors, and clinical state were relatively low, cancer stage, cancer type, sex, and age correlated significantly with depression.ConclusionDepression was most strongly linked with personality traits and coping style, and using screening instruments to identify these factors may be useful for preventive interventions.     

氟哌噻吨美利曲辛治疗乳腺癌患者焦虑、抑郁情绪的疗效观察

目的:评价氟哌噻吨美利曲辛在乳腺癌患者焦虑、抑郁情绪中的治疗效果。方法:利用90项症状清单、焦虑自评量表、抑郁自评量表对筛选的181例存在焦虑、抑郁情绪症状的乳腺癌患者进行评估。随机分为药物治疗组及对照组,治疗组给予氟哌噻吨美利曲辛口服,治疗2周后再次量表评估,评价药效。结果:经药物治疗后存在焦虑情绪的乳腺癌患者中约63.5%症状消失,存在抑郁情绪的乳腺癌患者中约58.6%症状消失。结论:口服氟哌噻吨顿美利曲辛对改善乳腺癌患者焦虑、抑郁情绪问题效果明显。     

恶性肿瘤抑郁症的临床研究进展

抑郁是肿瘤患者姑息治疗过程中较为常见的疾病。抑郁症状以及其他心理疾病均降低了病人的生活质量,同时可能是导致癌症死亡率增加的一个独立的危险因素。约75%伴有明显抑郁情绪的癌症患者从未接受过任何心理或药物相关治疗。本文将就肿瘤抑郁症的流行病学、影响因素及诊疗进展等进行综述。     

A Comparison of Two Scales to Determine Prevalence of Mood Disorders in Omani Patients Recently Diagnosed with Cancer

Objectives: Studies on the prevalence rate of mood disorders in patients recently diagnosed with cancer from Middle East are scare in the literature. Therefore, this study assesses the prevalence rates of anxiety and depression, and their associations with socio-demographic factors, in recently diagnosed patients with cancer living in the Sultanate of Oman. Methods: In this prospective study, adult patients were interviewed within the first three months of diagnosis of cancer using the Hospital Anxiety and Depression Scale (HADS), and the Centre for Epidemiological Studies Depression (CES-D) Scale. Associations were studied among symptoms of anxiety and depression, and the socio-demographic factors, along with levels of agreement between the two scales. Results: Eighty-nine patients were interviewed, and 65% were females. Using the HADS tool, 41.6% of patients had anxiety, 28% had depression, whereas 5.6% displayed severe depression. Using the CES-D tool, 41.6% of patients had depression, and 11.2% had severe depression. A fair correlation between the CES-D and HADS tools was evidenced with a Cohen’s Kappa coefficient value of 0.37 (P<0.001). The socio-demographic factors were not significantly associated with the presence of anxiety and depression (P >0.05). Conclusion:Collectively, these findings indicate high prevalence rates of anxiety and depression in Omani patients recently diagnosed with cancer along with a significant correlation between the two scales. These results support the implementation of screening tools early in the trajectory of cancer illness to improve the overall healthcare of these patients.     

Prevalence of Depression in Breast Cancer Survivors: a Systematic Review of Observational Studies

Background: Depression is common in breast cancer patients. The aim of this paper was to make a systematicreview of its prevalence and associated factors oin breast cancer survivors. Materials and Methods: An extensivesystematic electronic review (PUBMED, CINAHL, PsyINFO and Ovid) and handsearch were carried out toretrieve published articles up to November 2012, using Depression OR Dysthymia AND (Cancer OR Tumor ORNeoplasms as the keywords. Information about the design of the studies, measuring scale, characteristics of theparticipants, prevalence of depression and its associated factors from the included studies were extracted andsummarized. Results: We identified 32 eligible studies that recruited 10,826 breast cancer survivors. Most werecross-sectional or prospective designed. The most frequent instrument used to screen depression was the Centerfor Epidemiological Studies for Depression (CES-D, n=11 studies) followed by the Beck Depression Inventory(BDI, n=6 studies) and the Hospital Anxiety and Depression Scale (HADS, n=6 studies). CES-D returned aboutsimilar prevalence of depression (median=22%, range=13-56%) with BDI (median=22%, range=17-48%) buthigher than HADS (median=10%, range=1-22%). Depression was associated with several socio-demographicvariables, cancer-related factors, treatment-related factors, subject psychological factors, lifestyle factors, socialsupport and quality of life. Conclusions: Breast cancer survivors are at risk for depression so that detection ofassociated factors is important in clinical practice.     

Depression in cancer patients

Depression is seen in many cancer patients. It is an especially important issue in palliative care, as depression can be more common in patients who are at the end of life. Accurate assessment and treatment can have a powerful impact on improving a patient's quality of life. This article reviews the definition and the differential diagnosis of depression in cancer patients. It then focuses on some of the treatment options available, including pharmacotherapy and psychotherapy.     

Psychoaffective repercussions of pain in cancer patients

PurposePain often induces in cancer patient emotional disorders such as anxiety, depression and alteration of quality of life. The purpose of our work was to assess the impact of the intensity of pain and those characteristics on anxiety, depression state and quality of life of cancer patients.Material and methodsThis is an analytical cross-sectional study including 106 cancer patients with pain. We evaluated four parameters: pain intensity by visual analogue scale, the presence of anxiety and of depression using the Hospital Anxiety and Depressive Scale, and the alteration of quality of life by 36-item Short-Form Health Survey.ResultsPatients’ average age was 55 years old. The sex ratio was 0.79. Pain intensity was low in 16%, moderate in 49.1% and intense in 34.9% of patients. The prevalence of anxiety and depression was 49.1% and 54% of patients, respectively. The independent factors correlated to the occurrence of anxiety were: pain intensity, bone localization, continuous progression, chronicity of pain, advanced stage, hospitalization at day hospital, the partial or no response to analgesic treatment. The independent factors correlated to the onset of depression were: intensity of pain, advanced stage of the disease, bone localization, step 2 or 3 of analgesic, and partial or no response to analgesic treatment.ConclusionThe prevalence of anxiety and depression in our patients was slightly higher than those reported in the literature. The main factors correlated with the onset of depression and anxiety were: severe pain, bone location, and advanced stage of the disease.     

A systematic review of dyadic studies examining depression in couples facing breast cancer

Abstract

Problem identification: The aim was to synthesize the dyadic literature on depression among couples in which one person has breast cancer.

Literature search: A database search (PubMed, PsychInfo, CINAHL) was conducted to synthesize the literature. Studies’ methodological quality was evaluated, and correlates of depression/interdependence were abstracted.

Data evaluation/synthesis: Ten (of 270) studies met the inclusion criteria and were of satisfactory methodological quality. Depression is prevalent in both patients and partners, and was correlated with many psychosocial variables including sexual satisfaction, relationship quality, social support, and appraisal of health. Depression in one member of the dyad predicted depression in their companion.

Conclusions: Levels of relationship quality, sexual satisfaction, and support felt by couples facing breast cancer may be predictive of depression in each individual. The depressive state of one partner appears to influence the other. More research is needed to support dyadic strategies for mitigating depression in couples facing breast cancer.