综合干预对晚期卵巢癌患者生活质量、心理状态及癌因性疲乏的影响

目的探讨综合干预对晚期卵巢癌患者生活质量、心理状态及癌因性疲乏的影响。方法随机数字表法将86例晚期卵巢癌患者对照组和研究组,每组43例,对照组患者给予常规护理干预,研究组患者在常规护理干预的基础上给予综合干预。采用生活质量综合评定问卷(GQOLI-74)评估两组患者的生活质量,采用癌症疲乏量表(CFS)评估两组患者的癌因性疲乏程度,采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估两组患者的心理状态。结果干预前,两组患者GQOLI-74、CFS、HAMD、HAMA量表评分比较,差异均无统计学意义(P﹥0.05)。干预后,两组患者物质功能、社会功能、心理功能、躯体功能评分以及GQOLI-74总分均高于本组干预前,且研究组患者物质功能、社会功能、心理功能、躯体功能评分及GQOLI-74总分均高于对照组患者,差异均有统计学意义(P﹤0.05)。干预后,研究组患者认知疲乏、情感疲乏、躯体疲乏评分及CFS总分均低于本组干预前和对照组患者,对照组患者躯体疲乏评分及CFS总分均低于本组干预前,差异均有统计学意义(P﹤0.05)。干预后,研究组患者HAMD、HAMA评分均低于对照组患者,差异均有统计学意义(P﹤0.05)。结论综合干预可以进一步改善患者的生活质量及心理状态,并减轻患者的癌因性疲乏程度。     

药学干预结合心理行为干预对接受化疗的结肠癌患者生存质量影响

目的:观察药学干预结合心理行为干预对结肠癌患者辅助化疗期间恶心、呕吐、情绪及生活质量的影响。方法:采用前瞻性研究,184例结肠癌术后患者随机分为干预组(n=92,接受化疗、药学干预结合心理行为干预)和对照组(n=92,接受化疗)。药学干预是针对化疗引起的恶心呕吐,经临床药师优化对症治疗方案和指导用药;心理行为干预由心理医师针对给患者带来压力的因素进行干预。对比两组患者恶心严重程度、呕吐频次、焦虑、抑郁发生率及程度和生活质量。结果:化疗的前3个周期干预组对止吐药物的完全缓解率分别为57.6%、65.2%和67.4%,对照组为34.8%、43.5%和46.7%,明显低于干预组(P=0.002,P=0.0 0 3,P=0.003)。干预组的急性和迟发性恶心症状为Median 4.1和Median 5.3,对照组为Median 8.5和Median 8.8,明显高于干预组(P=0.032,P=0.038);干预组的急性和迟发性呕吐频率(Median 0.4,Median 0.2),对照组为(Median 1.2,Median 0.8),明显高于干预组(P=0.014,P=0.028)。干预组患者在化疗前(基线)时的焦虑自评量表评分(SAS)和抑郁自评量表评分(SDS)总分较对照组差异无统计学意义(P>0.05);干预组患者在化疗前三个周期的SAS和SDS总分较对照组相应周期差异有统计学差异(P<0.05)。生活质量评分:干预组总健康状况评分较对照组高(P=0.031),情绪状况较对照组升高(P=0.023),食欲丧失、恶心和呕吐的症状评分较对照组降低(P=0.025,P=0.029)。结论:心理医师和临床药师对结肠癌患者辅助化疗期间进行心理行为干预及药学干预可减轻患者恶心、呕吐等不良反应,并能改善患者情绪,提高生活质量。     

Long-term effect of a nurse-led psychosocial intervention on health-related quality of life in patients with head and neck cancer: a randomised controlled trial

Background:

Head and neck cancer (HNC) patients are prone to have a poor health-related quality of life after cancer treatment. This study investigated the effect of the nurse counselling and after intervention (NUCAI) on the health-related quality of life and depressive symptoms of HNC patients between 12 and 24 months after cancer treatment.

Methods:

Two hundred and five HNC patients were randomly allocated to NUCAI (N=103) or usual care (N=102). The 12-month nurse-led NUCAI is problem-focused and patient-driven and aims to help HNC patients manage with the physical, psychological and social consequences of their disease and its treatment. Health-related quality of life was evaluated with the EORTC QLQ-C30 and QLQ H&N35. Depressive symptoms were evaluated with the CES-D.

Results:

At 12 months the intervention group showed a significant (P<0.05) improvement in emotional and physical functioning, pain, swallowing, social contact, mouth opening and depressive symptoms. At 18 months, global quality of life, role and emotional functioning, pain, swallowing, mouth opening and depressive symptoms were significantly better in the intervention group than in the control group, and at 24 months emotional functioning and fatigue were significantly better in the intervention group.

Conclusion:

The NUCAI effectively improved several domains of health-related quality of life and depressive symptoms in HNC patients and would seem a promising intervention for implementation in daily clinical practice.     

Results of a multi-componential psychosocial intervention programme for women with early-stage breast cancer in Spain: quality of life and mental adjustment

The effectiveness of a structured psychosocial intervention for women with breast cancer was studied in relation to a control group. The study was conducted in a hospital setting in Spain, and the aim of the intervention programme was to foster a higher quality of life and a more positive mental adjustment to the cancer. Three measures were used: baseline, post-treatment and 6-month follow-up for both groups. The dependent variables examined were quality of life and mental adjustment. The independent variable was the psychosocial intervention programme. Subjects were 188 women who had been operated for breast cancer and who satisfied a series of medical criteria, had no history of psychological problems and were between 25 and 65 years old. The results have shown that the psychosocial intervention programme was highly effective in improving the patients' quality of life, as compared with baseline measures, as well as compared with the control group. Additionally, the intervention increased the patients' fighting spirit and hopefulness/optimism, and reduced their anxious preoccupation as coping styles. These changes persevered at the 6-month follow-up.     

家庭护理干预对肠癌造瘘患者自护能力及生活质量的影响

目的 探讨家庭护理干预对肠癌造瘘患者自护能力及生活质量的影响.方法 选取2020年5月至2021年5月间青岛市中心医院收治的110例肠癌造瘘患者,采用随机数表法分为观察组和对照组,每组55例.观察组患者采用家庭护理措施干预,对照组患者采用常规护理措施干预,比较两组患者的护理满意度、自护能力和生活质量.结果 观察组患者护...     

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。     

护理干预对卵巢癌化疗患者生活质量的影响

目的探讨全程系统化护理干预对卵巢癌化疗患者生活质量的影响。方法将84例卵巢癌术后化疗患者随机分为干预组（41例）和对照组（43例）,对照组行常规护理,干预组实施全程系统化护理干预,化疗前和化疗后3个月使用焦虑自评量表（SAS）、抑郁自评量表（SDS）及生活质量核心量表（EORTCQLQ—c30）评定患者的生活质量。结果干预组的整体生活质量、躯体功能、情绪功能、社会功能得分高于对照组,症状维度和单项问题中疲倦、恶心呕吐、失眠、食欲下降得分低于对照组,两组差异均有统计学意义（P〈0．05）。结论对卵巢癌化疗患者实施全程系统化护理,可改善患者的焦虑、抑郁情绪,提高生活质量。     

心理干预对恶性肿瘤患者及其配偶生活质量影响的研究

目的:建立心理干预模式,研究其对恶性肿瘤患者及其配偶生活质量的临床效果。方法:收集大港医院住院恶性肿瘤患者及配偶共120对,随机分为干预组(64对)和对照组(56对);入院1周内两组患者均填写症状自评量表(SCL-90)及简明健康状况调查表(SF-36),以评测患者及配偶心理健康水平和生活质量水平;对照组给予常规护理,干预组在常规护理的基础上给予心理干预,6周后,对患者及配偶心理健康水平及生活质量进行重新评价,确定干预对患者及配偶的影响作用。结果:1)SCL-90量表测量结果提示,患者组在总分、阳性项目数、躯体化、强迫、人际关系、抑郁、焦虑及恐惧方面因子分高于常模;配偶在总分、阳性项目数、人际关系、抑郁及焦虑方面因子分高于常模;患者在躯体化、强迫、恐惧因子分上高于配偶;配偶在焦虑、抑郁因子分上高于患者。2)与常模相比较,患者生活质量各维度得分均显著下降,配偶在活力、社会功能、情绪角色和精神健康维度得分下降。3)影响患者生活质量的因素包括患者的肿瘤分期、患者的抑郁、配偶的焦虑和抑郁、患者的SCL-90总分及家庭月收入。4)6周后,干预组患者及配偶心理健康水平及生活质量优于对照组。结论:恶性肿瘤患者和配偶均存在不同程度和不同维度的心理健康水平及生活质量水平的下降;患者及配偶的心理水平失衡是导致患者生活质量下降的重要因素;心理干预有利于改善恶性肿瘤患者及配偶的心理健康水平,并有利于提高其生活质量;恶性肿瘤的临床护理工作应重视患者及配偶的生活质量,把生活质量作为一个重要的医疗评价指标。     

药物干预对中重度晚期癌痛患者生活质量影响的临床研究

目的：调查与分析药物干预对58例中重度晚期癌痛患者疗效及生活质量的影响。方法选择58例中重度晚期癌性疼痛患者,合理规范使用三阶梯镇痛药物,利用简明疼痛调查量表（BPI）及癌症患者生活质量量表（QOL-C30）对患者治疗前、治疗后1周及治疗后1个月情况进行调查和分析。结果患者药物治疗后 NRS（numeral rating scale）评分较治疗前低（P ＜0．05）,治疗后1周及治疗后1个月的疼痛缓解总有效率分别为86．1％及91．3％。药物的主要不良反应有便秘、恶心、呕吐、排尿困难、嗜睡、瘙痒等,QOL-C30量表六项功能指标及总体健康、总体生活质量评价治疗前后均存在显著性差异（均P ＜0．05）,其中角色功能、认知功能、总体健康及总体生活质量评价治疗后两阶段（1周及1个月）相比较存在显著性差异（均 P ＜0．05）。结论药物干预对中重度晚期癌痛患者有效,药物不良反应如消化道反应恶心、呕吐、便秘等不容忽视,生活质量中身体功能、情绪功能及社会功能应得到长期关注,并采取相应措施干预,不断改善和提高患者整体生活质量。     

心理干预对老年非小细胞肺癌化疗患者心理状态及生活质量的影响

目的分析心理干预对老年非小细胞肺癌(NSCLC)患者心理状态及生活质量的影响。方法根据干预措施的不同将101例NSCLC患者分为干预组(n=51)和对照组(n=50)。对照组患者接受化疗常规化疗方案,给予生活和一般心理指导,干预组患者在对照组的基础上联合心理干预。干预前后,采用焦虑自评量表(SAS)及抑郁自评量表(SDS)评估两组患者的焦虑状态和抑郁状态,采用欧洲癌症研究与治疗组织(EORTC)生活质量核心30问卷调查(QLQ-C30)和卡氏功能状态(KPS)评分评估两组患者的生活质量。结果干预后,干预组患者SDS评分低于干预前,对照组患者SAS、SDS评分均低于本组干预前和干预组患者,差异均有统计学意义(P<0.05)。干预后,两组患者功能和总体健康维度评分均高于本组干预前,症状和特异性维度评分均低于本组干预前,且干预组患者功能和总体健康维度评分均高于对照组患者,症状和特异性维度评分均低于对照组患者,差异均有统计学意义(P<0.05)。两组患者KPS评分均低于本组干预前,且干预组患者KPS评分均低于对照组患者,差异均有统计学意义(P<0.05)。干预组患者皮肤黏膜损伤、肾脏毒性、神经毒性和过敏反应的发生率均低于对照组患者,差异均有统计学意义(P<0.05)。结论心理干预可减轻老年NSCLC化疗患者焦虑、抑郁的程度,提高其生活质量,对改善老年NSCLC化疗患者心理状态及生活质量有积极的影响。     

个性化健康教育联合心理干预对乳腺癌化疗患者心理健康状况和生活质量的影响

目的 探讨个性化健康教育联合心理干预对乳腺癌化疗患者心理健康状况和生活质量的影响.方法 根据干预方法的不同将194例乳腺癌化疗患者分为对照组和观察组,每组97例,对照组患者给予常规健康教育联合心理干预,观察组患者给予个性化健康教育联合心理干预.两组患者均随访3个月,分别采用抑郁自评量表(SDS)、状态-特质焦虑问卷(S...     

Direct improvement of quality of life using a tailored quality of life diagnosis and therapy pathway: randomised trial in 200 women with breast cancer

Background:

Despite thousands of papers, the value of quality of life (QoL) in curing disease remains uncertain. Until now, we lacked tools for the diagnosis and specific treatment of diseased QoL. We approached this problem stepwise by theory building, modelling, an exploratory trial and now a definitive randomised controlled trial (RCT) in breast cancer, whose results we report here.

Methods:

In all, 200 representative Bavarian primary breast cancer patients were recruited by five hospitals and treated by 146 care professionals. Patients were randomised to either (1) a novel care pathway including diagnosis of ‘diseased'' QoL (any QoL measure below 50 points) using a QoL profile and expert report sent to the patient''s coordinating practitioner, who arranged QoL therapy consisting of up to five standardised treatments for specific QoL defects or (2) standard postoperative care adhering to the German national guideline for breast cancer. The primary end point was the proportion of patients in each group with diseased QoL 6 months after surgery. Patients were blinded to their allocated group.

Results:

At 0 and 3 months after surgery, diseased QoL was diagnosed in 70% of patients. The QoL pathway reduced rates of diseased QoL to 56% at 6 months, especially in emotion and coping, compared with 71% in controls (P=0.048). Relative risk reduction was 21% (95% confidence interval (CI): 0–37), absolute risk reduction 15% (95% CI: 0.3–29), number needed to treat (NNT)=7 (95% CI: 3–37). When QoL therapy finished after successful treatment, diseased QoL often returned again, indicating good responsiveness of the QoL pathway.

Conclusion:

A three-component outcome system including clinician-derived objective, patient-reported subjective end points and qualitative analysis of clinical relevance was developed in the last 10 years for cancer as a complex intervention. A separate QoL pathway was implemented for the diagnosis and treatment of diseased QoL and its effectiveness tested in a community-based, pragmatic, definitive RCT. While the pathway was active, it was effective with an NNT of 7.     

Mapping the quality of life and unmet needs of urban women with metastatic breast cancer

Enhancing quality of life and reducing the unmet needs of women are central to the successful management of advanced breast cancer. The objective of this study was to investigate the quality of life and support and information needs of urban women with advanced breast cancer. This study was conducted at four large urban hospitals in Melbourne, Australia. A consecutive sample of 105 women with advanced breast cancer completed a questionnaire that contained the European Organization of Research and Treatment of Cancer Quality of Life Q-C30 and the Supportive Care Needs Survey. Between one quarter and a third of the women reported difficulties with their physical, role and social functioning, and a little over a quarter of the women reported poor global health status. Fatigue was a problem for most women. The highest unmet needs were in the psychological and health information domains. Almost no differences in unmet needs were detected when comparing different demographic and disease characteristics of women. Health care providers should routinely monitor the quality of life and needs of women with advanced breast cancer to ensure that appropriate treatment, information or supportive services are made available.     

营养干预对宫颈癌患者同步放化疗耐受性及生活质量的影响

目的:探讨营养干预对宫颈癌患者同步放化疗耐受性及生活质量(QOL)的影响。方法:将86例宫颈癌患者随机分为营养干预组和对照组,观察两组患者的放疗中断率、化疗完成次数及放疗剂量达40Gy时生活质量评分情况。结果:营养干预组的放疗中断率为2.3%（1/43）,对照组为18.6%（8/43）,P=0.03;营养干预组完成化疗周期数为4.0±0.98,对照组为3.3±1.28,P=0.005;放射剂量达40Gy时两组患者QOL评分的差异有统计学意义（P＜0.01）。结论:营养干预能有效提高宫颈癌患者同步放化疗的耐受性,提高其生活质量。     

晚期乳腺癌患者年龄和生存质量对其家庭照顾者生存质量的影响

目的：探讨晚期乳腺癌患者年龄及生存质量对其家庭照顾者的生存质量的影响。方法选取130例晚期乳腺癌患者及其130名家庭照顾者为研究对象,家庭照顾者完成照顾者生活质量指数-癌症表（CQOLC）问卷调查,所有的患者和家庭照顾者完成线性模拟自评量表（LASA）调查评估生活质量（QOL）,心境量表（POMS）评估心理状态。结果年龄≥65岁的晚期乳腺癌患者其照顾者心理健康、情感健康、精神健康、社会支持、总POMS分和总CQOLC分均高于年龄﹤65岁的患者照顾者,差异均具有统计学意义（P﹤0.05）。患者LASA中总的QOL评分﹥50分的晚期乳腺癌患者照顾者总QOL分、心理健康、身体健康、情感健康、精神健康、总POMS分和总CQOLC分均高于LASA中总的QOL评分≤50分的患者照顾者,差异均具有统计学意义（P﹤0.05）。结论晚期乳腺癌患者年龄≥65岁、生存质量高,其相应的家庭照顾者生存质量亦高。     

激励式护理干预对恶性肿瘤患者焦虑抑郁情绪及生活质量的影响

目的探讨激励式护理干预对恶性肿瘤患者焦虑抑郁情绪及生活质量的影响。方法将110例恶性肿瘤患者,随机分为对照组和观察组。对照组患者给予常规专业护理。观察组患者在常规专业护理的基础上,加用激励式护理干预措施。采用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)评定恶性肿瘤患者干预前后的心理状态。同时应用生活质量量表(SF-36)观察两组恶性肿瘤患者干预前后的生活质量。结果干预1个月后,观察组患者SAS、SDS评分的改善情况优于对照组,差异有统计学意义(P<0.01)。干预1个月后,观察组患者总体健康、生理功能、生理职能、躯体疼痛、活力、社会功能、情感职能、精神健康等生活质量评分优于对照组,差异均有统计学意义(P<0.01)。结论激励式护理干预措施能够激发恶性肿瘤患者战胜疾病的信心,改善心理状况,并提高患者的生活质量。     

多样性心理干预对宫颈癌患者心理状态、希望水平、睡眠质量及生活质量的影响

目的探讨多样性心理干预对宫颈癌患者心理状态、希望水平、睡眠质量和生活质量的影响。方法根据干预方式的不同将150例宫颈癌患者分为对照组(给予常规临床干预)和观察组(给予多样性心理干预)各75例。比较两组患者干预前后的焦虑自评量表(SAS)、抑郁自评量表(SDS)、Herth希望水平量表(HHI)、匹兹堡睡眠质量指数(PSQI)、Spitzer生活质量指数(SQLI)评分。结果干预后,观察组患者的SAS、SDS评分均明显低于对照组患者,差异均有统计学意义(P﹤0.01)。干预后,观察组患者的HHI中行动态度、积极态度、亲密关系的评分及总分均明显高于对照组,差异均有统计学意义(P﹤0.01)。干预后,两组患者的PSQI评分均低于本组干预前,SQLI评分均高于本组干预前,差异均有统计学意义(P﹤0.05);干预后,观察组患者的PSQI评分明显低于对照组,SQLI评分明显高于对照组,差异均有统计学意义(P﹤0.01)。结论多样性心理干预能够促进宫颈癌患者的心理健康,提高其希望水平,改善其睡眠和生活质量。     

安宁疗护改善重症监护病房晚期肺癌疼痛患者生存质量的效果观察

目的分析安宁疗护改善重症监护室(ICU)晚期肺癌疼痛患者生存质量的效果。方法随机数字表法将100例晚期肺癌患者随机分为对照组与干预组,每组50例,对照组患者接受常规干预措施,干预组患者在此基础上给予安宁疗护。干预前后,根据世界卫生组织(WHO)疼痛分级法比较两组患者的疼痛情况;采用患者尊严量表(PDI)比较两组患者的尊严水平;采用总体幸福感量表(GWB)比较两组患者的主观幸福感;采用欧洲癌症治疗研究组织的生活质量核心问卷(EORTC QLQ-C30)比较两组患者的生存质量。结果干预前,两组患者疼痛程度、PDI量表、GWB量表和EORTC QLQ-C30量表评分比较,差异均无统计学意义(P﹥0.05)。干预后,干预组患者疼痛程度弱于对照组患者,差异有统计学意义(P﹤0.05),干预组患者症状困扰、心理状况、依赖性、精神安宁和PDI量表总分均低于本组干预前和对照组患者(P﹤0.05),生活的满足和兴趣、对健康的担心、精力、抑郁或愉快的心境、对情感和行为的控制、松弛和紧张、幸福感总分均高于本组干预前和对照组患者(P﹤0.05),躯体功能、角色功能、情绪功能、认知功能和总分均高于本组干预前和对照组患者(P﹤0.05)。结论安宁疗护能够减轻ICU晚期肺癌疼痛患者疼痛程度,维护患者临终前尊严,提高其主观幸福感,并改善生存质量。     

Economic stress among low-income women with cancer: effects on quality of life

BACKGROUND: Attention to the economic consequences of cancer has grown as the number of cancer survivors is increasing. Although prevalent among low-income minority survivors, the impact of economic stress on quality of life (QOL) remains largely unexplored. METHODS: Data are reported for 487 predominantly Hispanic low-income women with a primary diagnosis of breast or gynecological cancer and undergoing active treatment or follow-up. Cross-sectional and longitudinal analyses examined the effects of economic concerns on QOL, depression, and anxiety. RESULTS: Rates of unemployment, medical cost and wage concerns, and financial stress were high in this study population, at baseline, respectively, 70%, 68%, 47%, and 49%. The proportions reporting unemployed status and medical cost concerns stayed flat from baseline to 6 months, followed by a pronounced drop at 12 months. Patient reported rates of lost wage worries increased from baseline to 6 months, followed by a moderate decrease. Functional, emotional, physical, and social-family well-being and depression and anxiety scores exhibited consistent linear improvement from baseline to 12 months. Over 12 months, patients reporting economic concerns had significantly poorer functional, emotional, and affective well-being. CONCLUSIONS: Economic stress is negatively associated with QOL, highlighting the importance of addressing economic stress in low-income women with cancer.