胃癌术后患者营养情况调查及其与自我管理效能感的关系

目的探讨胃病术后患者营养情况与自我管理效能感的关系。方法选择郑州大学附属郑州中心医院收治的106例胃癌根治术后患者为研究对象,采用主观全面评价量表(PG-SGA)评价患者的营养情况,根据PG-SGA得分情况将患者分为PG-SGA-A级(营养良好)、PG-SGA-B级(可疑营养不良、中度营养不良)、PG-SGA-C级(重度营养不良)。采用癌症自我管理效能感量表中文版(C-SUPPH)评价患者的自我管理效能感。比较不同PG-SGA患者C-SUPPH评分情况,并分析PG-SGA评分和C-SUPPH评分的相关性。结果本研究106例患者中可疑营养不良及营养不良者共51例,占51.89%。在PG-SGA-A、PG-SGA-B、PG-SGA-C组患者中,C-SUPPH量表中正性态度、自我减压、自我决策及总分方面依次降低(F=24.106、20.332、17.995和38.512,P<0.001)。PG-SGA评分与C-SUPPH量表正性态度、自我减压、自我决策及总分均呈负相关性(r=-0.645、-0.472、-0.514和-0.503,P均<0.001)。结论胃癌术后患者营养不良发生率较高,患者的自我管理效能感与营养状况密切相关。     

消化道肿瘤患者癌因性疲乏与血清炎性因子及下丘脑-垂体-肾上腺素轴水平的相关性

目的 了解消化道肿瘤患者的疲乏水平,探讨癌因性疲乏(CRF)与血清炎性因子及下丘脑-垂体-肾上腺素(HPA)轴水平的相关性.方法 采用简易疲乏量表评估患者的疲乏水平,采用免疫比浊法测定血清C反应蛋白(CRP)水平,免疫微粒电发光法测定皮质醇水平,酶联免疫吸附试验(ELISA)测量血清中白细胞介素(IL)-6、IL-1β、肿瘤坏死因子-α(TNF-α)、促肾上腺皮质激素(ACTH)和去甲肾上腺素(NE)的水平.结果 消化道肿瘤患者CRF平均总体得分为(3.15±1.93)分,疲乏程度为轻中度,疲乏水平与血清中CRP、TNF-α水平呈明显正相关(r=0.321,P=0.000;r=0.265,P=0.000),与HPA轴中的NE、ACTH水平呈明显正相关(r=0.174,P=0.015;r=0.257,P=0.000),与皮质醇水平无关(r=0.033,P=0.652).美国东部肿瘤协作组(ECOG)得分(t=8.081,P=0.000)、文化程度(t=-4.244,P=0.000)、正在接受的治疗(t=4.563,P=0.000)、自诊断至采血日时间(t=3.453,P=0.001)、CRP(t=2.837,P=0.006)是CRF的重要影响因素.结论 消化道肿瘤患者CRF状况普遍存在,CRF与HPA轴中的NE、ACTH水平呈正相关.医务人员应重视对患者血清中炎性因子及激素水平的测定,改善患者的疲乏状况,提高生命质量.     

乳腺癌患者术后自我效能感对早期功能锻炼依从性的影响

目的调查乳腺癌患者术后自我效能感与早期功能锻炼依从性的现状,并探讨二者之间的关系。方法于2018年12月至2019年2月在四川省8家综合医院收集行乳腺癌改良根治术后2个月的女性乳腺癌患者298例为研究对象。采用一般资料调查表、癌症自我管理效能感量表(SUPPH)和乳腺癌术后功能锻炼依从性量表进行问卷调查。结果乳腺癌术后患者的自我效能感总分为(95.18±22.52)分,其中正性态度、自我减压和自我决策分别为(51.54±12.37)、(33.34±8.51)和(10.30±2.50)分。功能锻炼依从性总分为(49.16±7.95)分,其中身体锻炼依从性、术后注意事项依从性和主动寻求建议依从性分别为(23.17±4.06)、(14.61±3.04)和(11.38±2.85)分。总体自我效能感与总体功能锻炼依从性呈正相关(r=0.521,P0.001)。年龄、学历、是否有未成年子女和正性态度是乳腺癌患者术后功能锻炼依从性的主要影响因素(R~2=0.456,F=65.116,P0.001)。结论建议加强对高年龄段、低学历以及无未成年子女患者的心理关怀和健康教育,从提升正性态度改善自我效能感出发,促进功能锻炼依从性的提高。     

自我效能干预对胶质瘤患者术后自我管理效能、心理状态及癌因性疲乏的影响

目的 探讨自我效能干预对胶质瘤患者术后自我管理效能、心理状态及癌因性疲乏的影响。方法 根据干预方法的不同将98例显微镜下胶质瘤切除术患者分为对照组（n=49）和观察组（n=49）,对照组患者采用常规干预,观察组患者在对照组的基础上进行自我效能干预。比较两组患者的自我管理效能[中文版癌症自我管理效能感量表（C-SUPPH）]、心理状态[抑郁自评量表（SDS）、焦虑自评量表（SAS）]、癌因性疲乏情况[癌症疲乏量表（CFS）]、满意度、住院时间及并发症发生情况。结果 干预后,两组患者正性态度、自我决策、自我减压评分均高于本组干预前,观察组患者正性态度、自我决策、自我减压评分均高于对照组,差异均有统计学意义（P<0.05）。干预后,两组患者SDS、SAS评分均低于本组干预前,观察组患者SDS、SAS评分均低于对照组,差异均有统计学意义（P<0.05）。干预后,两组患者行为严重程度、认知、感知、情感评分均低于本组干预前,观察组患者行为严重程度、认知、感知、情感评分均低于对照组,差异均有统计学意义（P<0.05）。观察组患者总满意度明显高于对照组,住院时间明显短于对照组,并发症...     

女性生殖系统肿瘤教学中护理学生学习动机和职业认同的相关研究

目的 探讨女性生殖系统肿瘤教学中护理学生的学习动机与职业认同的现状及其相关性。方法 2022年6月应用人口学特征调查表、学习动机量表以及职业认同量表对郑州卫生健康职业学院1 001名护理学生进行调查。结果 护理学生学习动机总分为(124.16±21.31)分,职业认同总分为(61.28±12.07)分。父亲最高学历、母亲最高学历、是否自己选择的专业、在校成绩等级与护理学生的学习动机总分有关(F=3.739,P=0.005;F=4.923,P=0.001;F=30.625,P<0.001;F=8.245,P<0.001)。年级、性别、是否自己选择的专业、在校成绩等级与护理学生的职业认同总分有关(F=3.367,P=0.035;F=4.509,P=0.034;F=90.424,P<0.001;F=13.154,P<0.001)。学习动机总分与职业认同总分以及各维度之间呈正相关(r=0.178～0.614,P<0.001)。结论 女性生殖系统肿瘤教学中护理学生的学习动机和职业认同以及各维度之间存在着相互影响和相互促进的关系,护理学生的学习动机和职业认同总分对于其...     

癌症患者生存质量影响因素分析

目的:分析影响癌症患者生存质量的相关因素。方法:调查对象为2009-12-10-2010-12-31在我院住院的癌症患者,全部被试者完成一般资料问卷、中国癌症患者生活质量调查问卷(QLQ)、数字疼痛强度量表(NRS)、抑郁自评量表(SDS)和社会支持评定量表(SSRS)。应用SPSS 19.0统计学软件,采用ANOV方差分析、Pearson相关性分析以及多元逐步回归分析等方法完成数据统计。结果:符合本次调查的癌症患者有234例,男119例(50.85%),女115例(49.15%)。平均年龄(60.92±12.13)岁。婚姻状况(F=2.671,P=0.048)、受教育程度(F=2.858,P=0.024)、性格特征(F=11.223,P=0.000)、病后锻炼情况(F=14.574,P=0.000)、癌症病程(F=5.014,P=0.001)、治疗方式(F=2.293,P=0.028)、疼痛程度(F=10.639,P=0.000)、抑郁程度(F=11.321,P=0.000)和社会支持(F=4.726,P=0.000)等均影响患者的生存质量水平。病后锻炼情况(r=0.360,P=0.000)、总社会支持(r=0.345,P=0.026)、主观支持(r=0.338,P=0.035)以及对支持的利用度(r=0.439,P=0.000)与患者的生存质量呈正相关,疼痛程度(r=-0.489,P=0.000)、抑郁程度(r=-0.745,P=0.000)与患者的生存质量呈负相关。多元逐步回归分析发现,最后纳入回归方程的因素有4个,分别为抑郁程度、疼痛程度、病后锻炼情况和对支持的利用度,回归方程为Y(生存质量)=59.403-0.389X14(抑郁程度)-0.624X13(疼痛程度)+1.252X7(病后锻炼情况)+0.387X18(对支持的利用度)。结论:良好的婚姻状况、较高的受教育程度、性格外向、癌症病程短和较少的有创性治疗,均有助于癌症患者保持较好的生存质量水平。疼痛和抑郁可能是影响癌症患者生存质量的2个重要因素,随着疼痛程度和抑郁程度的加重,癌症患者的生存质量下降;病后参与适宜的身体锻炼可能通过改善患者的情绪状态而改善其生存质量;癌症患者获得的社会支持越多,其感知的生存质量可能越好。     

膀胱癌术后灌注化疗患者感知伴侣回应性与恐惧疾病进展的相关性分析

目的 分析膀胱癌术后灌注化疗患者感知伴侣回应性与恐惧疾病进展的相关性。方法 选取2022年10月至2023年5月在河南省人民医院泌尿外科确诊并治疗的158例非肌层浸润性膀胱癌患者作为研究对象,分别采用感知伴侣回应性量表(PPRS)及恐惧疾病进展简化量表(FoP-Q-SF)调查患者感知伴侣回应性、恐惧疾病进展情况,分析其相关性。结果 158例患者PPRS评分18～66(41.25±2.04)分,其中感知低48例(30.38%)、感知中等88例(55.70%)、感知高22例(13.92%)。FoP-Q-SF评分16～52(41.28±2.08)分,其中低水平41例(25.95%)、中等水平63例(39.87%)、高水平54例(34.18%)。不同感知伴侣回应性患者FoP-Q-SF评分比较差异有统计学意义(F=462.878,P<0.001)。PPRS评分与FoP-Q-SF评分呈负相关(r=-0.736,P=0.001)。结论 膀胱癌术后灌注化疗患者感知伴侣回应性处于较低水平,恐惧疾病进展处于较高水平,两者呈负相关,加强伴侣支持对改善患者心理状态有重要意义。     

乳腺癌患者术后自我效能感对早期功能锻炼依从性的影响

目的调查乳腺癌患者术后自我效能感与早期功能锻炼依从性的现状,并探讨二者之间的关系。方法于2018年12月至2019年2月在四川省8家综合医院收集行乳腺癌改良根治术后2个月的女性乳腺癌患者298例为研究对象。采用一般资料调查表、癌症自我管理效能感量表(SUPPH)和乳腺癌术后功能锻炼依从性量表进行问卷调查。结果乳腺癌术后患者的自我效能感总分为(9518±2252)分,其中正性态度、自我减压和自我决策分别为(5154±1237)、(3334±851)和(1030±250)分。功能锻炼依从性总分为(4916±795)分,其中身体锻炼依从性、术后注意事项依从性和主动寻求建议依从性分别为(2317±406)、(1461±304)和(1138±285)分。总体自我效能感与总体功能锻炼依从性呈正相关(r=0521,P<0001)。年龄、学历、是否有未成年子女和正性态度是乳腺癌患者术后功能锻炼依从性的主要影响因素(R2=0456,F=65116,P<0001)。结论建议加强对高年龄段、低学历以及无未成年子女患者的心理关怀和健康教育,从提升正性态度改善自我效能感出发,促进功能锻炼依从性的提高。     

康复期肺癌患者癌因性疲乏与血清皮质醇激素相关性的初步研究

[目的]探讨康复期肺癌患者癌因性疲乏与血清皮质醇激素水平的关系.[方法] 59例康复期肺癌患者分成疲乏组(39例疲乏患者)和非疲乏组(20例非疲乏患者),利用多维疲乏症状量表-简化版(MFSI-SF)和疲劳症状量表(FSI)对患者进行评估.电化学发光法检测血清皮质醇的水平,酶联免疫吸附法测定血清促肾上腺皮质激素(ACTH)的水平.[结果]疲乏组患者血清皮质醇水平低于非疲乏组(118.86±11.74nmol/L vs 166.43±62.82nmol/L,P＜0.05),促肾上腺皮质激素水平高于非疲乏组(100.17±31.36ng/L ys 52.87±26.20ng/L,P＜0.05).疲乏组患者MFSI-SF评分与血清皮质醇激素水平呈负相关(r=-0.820,P＜0.001),与血清促肾上腺皮质激素水平呈正相关(r=0.813,P＜0.001);疲乏组患者FSI评分与血清皮质醇激素水平呈负相关(r=-0.778,P＜0.001),与血清促肾上腺皮质激素水平呈正相关(r=0.629,P＜0.001).[结论]疲乏组患者癌因性疲乏评分增高,而血清皮质醇激素水平降低,促肾上腺皮质激素水平升高.血皮质醇激素水平低下在一定程度上影响康复期肺癌患者癌因性疲乏的严重程度.     

基于4R模式的干预对胃癌化疗患者营养状况及疾病感知的影响

目的 探讨基于4R模式的干预对胃癌化疗患者营养状况及疾病感知的影响。方法 依据干预方式的不同将90例胃癌化疗患者分为对照组（n=45）和观察组（n=45）,对照组患者给予常规干预,观察组患者在对照组的基础上给予基于4R模式的干预。比较两组患者的癌因性疲乏程度[癌症疲乏量表（CFS）]、心理状态[抑郁自评量表（SDS）和焦虑自评量表（SAS）]、自我效能[中文版癌症自我管理效能感量表（C-SUPPH）]、疾病感知[疾病感知问卷修订版（IPQ-R）]以及营养指标[白蛋白（ALB）、前白蛋白（PAB）、转铁蛋白（TRF）]。结果 干预后,两组患者C-SUPPH评分均高于本组干预前,SDS、SAS评分均低于本组干预前,观察组患者C-SUPPH评分高于对照组,SDS、SAS评分均低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者CFS、IPQ-R量表各维度评分均低于本组干预前,观察组患者CFS、IPQ-R量表各维度评分均低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者血清ALB、PAB、TRF水平均低于本组干预前,观察组患者血清ALB、PAB、TRF水平均高于对照组...     

Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy.

PURPOSE: To evaluate the effectiveness of a supervised home-based flexible training program on cardiorespiratory fitness (CRF), mental distress, and health-related quality of life (HRQOL) parameters in young and middle-aged cancer patients shortly after curative chemotherapy. PATIENTS AND METHODS: One hundred eleven patients age 18 to 50 years who had received chemotherapy for lymphomas or breast, gynecologic, or testicular cancer completed the trial. These patients were randomly allocated to either an intervention group (n = 59), which underwent a 14-week training program, or a control group (n = 52) that received standard care. Primary outcome was change in CRF, as determined by Astrand-Rhyming indirect bicycle ergometer test (maximum oxygen uptake [VO(2max)]), between baseline (T0) and follow-up (T1). Secondary outcomes were mental distress, as assessed by the Hospital Anxiety and Depression Scale, and HRQOL, as assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire. Two-way analysis of covariance was used to analyze changes from T0 to T1. RESULTS: VO(2max) increased by 6.4 mL/kg(-1)/min(-1) in patients in the intervention group and by 3.1 mL/kg(-1)/min(-1) in patients in the control group (P < .01). The fatigue score decreased by 17.0 points in the control group compared with only 5.8 points in the intervention group (P < .01). There were no intergroup differences in mental distress or HRQOL. CONCLUSION: A supervised, home-based, flexible training program has significant effect on CRF in young and middle-aged cancer patients shortly after curative chemotherapy, but it has no favorable effect on patients' experience of fatigue, mental distress, or HRQOL.     

追踪管理模式对乳腺癌患者心理状态、自我管理能力及生活质量的影响

目的探讨追踪管理模式对乳腺癌患者心理状态、自我管理能力及生活质量的影响。方法根据干预方法的不同,将100例乳腺癌化疗患者分为追踪管理组和常规对照组,每组50例。常规对照组患者予以常规干预措施,追踪管理组患者在常规对照组的基础上予以追踪管理模式干预。比较两组患者的心理状态、自我管理能力及生活质量。结果干预后,追踪管理组患者的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分均低于常规对照组,运动锻炼、认知性症状管理实施、与医师沟通评分均高于常规对照组,躯体功能、角色功能、情绪功能、认知功能、社会功能及总体健康状况评分均高于常规对照组,差异均有统计学意义(P﹤0.05)。结论追踪管理模式能够缓解乳腺癌患者的焦虑、抑郁情绪,提高其自我管理能力及生活质量。     

A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer-related fatigue

BACKGROUND: It has been shown that nonpharmacologic interventions are effective management techniques for cancer-related fatigue (CRF) in cancer survivors. However, few studies have investigated their effectiveness in patients who are receiving chemotherapy. In this study, the authors tested the effectiveness of a brief behaviorally oriented intervention in reducing CRF and improving physical function and associated distress in individuals who were receiving chemotherapy. METHODS: For this randomized controlled trial, 60 patients with cancer were recruited and received either usual care or the intervention. The intervention was delivered on an individual basis on 3 occasions over a period from 9 weeks to 12 weeks, and the objective of the intervention was to alter fatigue-related thoughts and behavior. Primary outcomes were assessed as follows: CRF using the Visual Analogue Scale-Global Fatigue; physical functioning using the European Organization for Research and Treatment of Cancer Quality-of-Life Core 30 Questionnaire, and CRF-associated distress using the Fatigue Outcome Measure. Assessments were made on 4 occasions: at baseline (T0), at the end of chemotherapy (T1), 1 month after chemotherapy (T2), and 9 months after recruitment (T3). Normally distributed data were analyzed using t tests and random-slope/random-intercept mixed models. RESULTS: The intervention demonstrated a trend toward improved CRF, although this effect was reduced once confounders had been controlled statistically. There was a significant improvement in physical functioning (coefficient, 10.0; 95% confidence interval, 2.5-17.5; P = .009), and this effect remained once the confounding effects of mood disturbance and comorbid disorders were controlled statistically. No decrease in fatigue-related distress was detected. CONCLUSIONS: The behaviorally oriented intervention brought about significant improvements in physical functioning, indicated a trend toward improved CRF, but detected no effect for fatigue-related distress.     

Effects of cognitive behavior therapy combined with Baduanjin in patients with colorectal cancer

BACKGROUNDCancer-related fatigue (CRF) is the most common concomitant symptom in the treatment of colorectal cancer (CRC). Such patients often present with subjective fatigue state accompanied by cognitive dysfunction, which seriously affects the quality of life of patients.AIMTo explore the effects of cognitive behavior therapy (CBT) combined with Baduanjin exercise on CRF, cognitive impairment, and quality of life in patients with CRC after chemotherapy, and to provide a theoretical basis and practical reference for rehabilitation of CRC after chemotherapy. METHODSFifty-five patients with CRC after radical resection and chemotherapy were randomly divided into either an experimental or a control group. The experimental group received the intervention of CBT combined with exercise intervention for 6 mo, and indicators were observed and measured at baseline, 3 mo, and 6 mo to evaluate the intervention effect.RESULTSCompared with the baseline values, in the experimental group 3 mo after intervention, cognitive function, quality of life score, and P300 amplitude and latency changes were significantly better (P < 0.01). Compared with the control group, at 3 mo, the experimental group had significant differences in CRF, P300 amplitude, and quality of life score (P < 0.05), as well as significant differences in P300 latency and cognitive function (P < 0.01). Compared with the control group, at 6 mo, CRF, P300 amplitude, P300 latency, cognitive function and quality of life score were further improved in the experimental group, with significant differences (P < 0.01). The total score of CRF and the scores of each dimension were negatively correlated with quality of life (P < 0.05), while the total score of cognitive impairment and the scores of each dimension were positively correlated with quality of life (P < 0.05). CONCLUSIONCBT combined with body-building Baduanjin exercise can improve CRF and cognitive impairment in CRC patients after chemotherapy, and improve their quality of life.     

微场景健康教育平台在乳腺癌化疗PICC置管患者出院后的应用效果

目的探讨微场景健康教育平台在乳腺癌化疗PICC置管患者出院后的临床应用效果。方法选取2015年7月至2020年6月间湖北省武穴市第一人民医院收治的67例女性乳腺癌患者,按照护理方式不同分为观察组34例和对照组33例。对照组患者采用常规护理项目及健康教育,观察组患者在对照组基础上增加微场景健康教育宣教,比较两组患者置管相关并发症发生情况、护理前后自我管理能力变化及护理满意度。结果观察组患者PICC置管并发症发生率为2.9%,低于对照组的18.2%,两组比较,差异有统计学意义(P<0.05)。干预前,两组患者自我管理能力各项评分比较,差异无统计学意义(P>0.05)。干预后,观察组患者自我管理能力各项评分均高于对照组,差异均有统计学意义(均P<0.05)。健康教育后,观察组患者护理满意度为94.1%,高于对照组的75.8%,两组比较,差异有统计学意义(X^2=4.45,P<0.05)。结论微场景健康教育平台能降低乳腺癌PICC置管患者出院后并发症发生率,提高自我管理能力,提高患者及家属满意度。     

Can older cancer patients tolerate chemotherapy? A prospective pilot study

BACKGROUND: To the authors' knowledge, few data currently are available regarding the tolerance to chemotherapy in older cancer patients. This prospective pilot study evaluated the changes in functional, mental, nutritional, and comorbid status, as well as the quality of life (QOL), in geriatric oncology patients receiving chemotherapy. METHODS: Sixty patients age > or = 70 years who were undergoing cancer chemotherapy were recruited in a university-based comprehensive cancer center. Changes in physical function were measured by the Eastern Cooperative Oncology Group performance status (ECOG PS) and Instrumental Activities of Daily Living (IADLs), mental health changes were measured by the Mini-Mental State Examination and the Geriatric Depression Scale (GDS), comorbidity was measured by Charlson's index and the Cumulative Illness Rating Scale-Geriatric, nutrition was measured by the Mini-Nutritional Assessment, and QOL was measured by the Functional Assessment of Cancer Therapy-General (FACT-G). Changes were assessed at baseline and at the end of treatment (EOT). Grade 4 hematologic and Grade 3-4 nonhematologic toxicities were recorded. RESULTS: Thirty-seven patients (63%) completed both assessments. Older cancer patients demonstrated a significant decline in measurements of physical function after receiving chemotherapy, as indicated by changes in scores on the IADL (P = 0.04) and on the physical (P = 0.01) and functional (P = 0.03) subscales of the FACT-G. They also displayed worse scores on the GDS administered postchemotherapy (P < 0.01). Patients who experienced severe chemotoxicity had more significant declines in ECOG PS (P = 0.03), IADL (P = 0.03), and GDS (P = 0.04), and more gain in the social well-being subscale (P = 0.02) of the FACT-G, than those who did not experience severe chemotoxicity. However, changes in most scores were small in magnitude clinically. No significant change was found between baseline and EOT in nutrition, comorbidity, and other aspects of the FACT-G. CONCLUSIONS: Older cancer patients undergoing chemotherapy may experience toxicity but generally can tolerate it with limited impact on independence, comorbidity, and QOL levels. It is important to recognize and monitor these changes during geriatric oncology treatment.     

晚期非小细胞肺癌三线治疗疗效及生存分析

背景与目的随着高效低毒药物的出现,越来越多的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者有机会接受三线治疗,但目前三线的标准治疗除厄洛替尼外尚无其它选择方案。本研究旨在比较单药化疗、靶向药物与双药联合化疗在晚期NSCLC患者三线治疗中的疗效与安全性。方法回顾分析115例IIIb期/IV期接受三线治疗的NSCLC患者的疗效及生存状况。采用Kaplan-Meier曲线、Cox多因素生存分析模型进行单因素和多因素分析。结果单药组、靶向治疗组与双药联合组中位无进展生存时间(progression free survival,PFS)分别为2.30个月、3.17个月和2.37个月(P=0.045),三线治疗后的中位生存时间(overall survival,OS)分别为8.00个月、10.40个月和7.87个月(P=0.110),III度-IV度毒性反应发生率分别为33.3%、18.2%和68.8%(P<0.001)。多因素分析显示体能状况(per-formance status,PS)评分(P<0.001)是PFS的独立预后因素,既往无吸烟史(P=0.011)、PS评分0分-1分(P<0.001)和一二线治疗疗效获得疾病控制(P=0.044)是三线治疗OS的独立预后因素。结论 PS评分较好、既往不吸烟和一二线治疗疗效疾病控制的患者在三线治疗中更能获益,与化疗单药或双药相比靶向药物组PFS显示出优势。     

Perineural invasion is a prognostic factor in stage II colorectal cancer but not a treatment indicator for traditional chemotherapy: a retrospective cohort study

BackgroundPerineural invasion (PNI) is considered a risk factor of survival but does not yet inform treatment decisions, and has not been studied separately in stage II colorectal cancer (CRC) patients whose postoperative traditional chemotherapy is controversial. This cohort study aimed to assess the association of PNI with basic clinicopathological features and patient outcomes after curative resection and the effects of PNI on responses to adjuvant chemotherapy in stage II CRC.MethodsThe clinical data of 371 stage II CRC patients who underwent curative-intent surgery at the National Cancer Center/Cancer Hospital in 2014 were retrospectively reviewed. The adjuvant chemotherapy data were acquired from follow-up information. PNI status was examined, and the overall survival (OS) and disease-free survival (DFS) rates were analyzed.ResultsPNI was detected in 82 of the 371 patients (22.1%) and was closely correlated with preoperative serum carcinoembryonic antigen (CEA) levels (P=0.030), gross tumor type (P=0.010), tumor differentiation (P=0.010), p stage (P<0.001), and extramural vascular invasion (EMVI) (P<0.001). The median follow-up time was 71 months. The 5-year OS was 84.1% and 96.5% (P<0.001), and the 5-year DFS was 75.6% and 91.3% (P<0.001) for PNI-positive (+) and PNI-negative (−) patients, respectively. The multivariate regression analyses identified PNI as an independent negative prognostic factor for DFS [hazard ratio (HR): 2.95; 95% confidence interval (CI), 1.546–5.626; P=0.001] and OS (HR: 3.966; 95% CI, 1.642–9.575; P=0.002). Among PNI (+) patients, DFS and OS were positively correlated with CEA levels (P=0.005 and P=0.004, respectively). Postoperative chemotherapy failed to improve DFS (P=0.480 and P=0.267, respectively) and OS (P=0.940 and P=0.077, respectively) regardless of whether the patients were PNI positive or not.ConclusionsIn stage II CRC patients, PNI was a poor independent predictor for DFS and OS. Among PNI (+) patients, CEA levels were positively correlated with DFS and OS. Traditional postoperative adjuvant chemotherapy does not improve outcomes of PNI (+) patients. Therefore, as to the active role of PNI and vacancy for treatment in allusion to PNI, follow-up of PNI (+) patients with elevated CEA level should be strengthened and further research on drug conducted on PNI deserve to be carried on.     

Post-treatment skin reactions reported by cancer patients differ by race, not by treatment or expectations

Cancer patients may experience skin problems while undergoing chemotherapy and radiation therapy. Frequency of skin reactions may be influenced by skin pigmentation and psychological factors. A Symptom Inventory completed by 656 cancer patients nationwide before and after chemotherapy, radiation therapy, or chemotherapy plus radiation therapy was analysed to determine if treatment type, race (Black vs White), and pretreatment expectations influenced post-treatment skin reactions. Subsequent analysis of a local Symptom Inventory completed weekly for 5 weeks by 308 patients receiving radiation therapy examined severity of reported skin reactions. Significantly more patients receiving radiation therapy had stronger expectations of skin problems (62%) than patients receiving chemotherapy (40%, P=0.001) or chemotherapy plus radiation therapy (45%, P=0.003). Overall, expectations did not correlate with patient reported post-treatment skin problems in white (r=0.014, P=0.781) or black (r=0.021, P=0.936) patients. Although no significant difference was found between black and white patients in their pretreatment expectations of skin problems (P=0.32), black patients (10 out of 18, 56%) reported more skin problems than white patients (90 out of 393, 23%, P=0.001). Similarly, the local study showed that significantly more black patients (1 out of 5, 20%) reported severe skin reactions at the treatment site than white patients (12 out of 161, 8%). A direct correlation was observed between severity of skin problems and pain at the treatment site (r=0.541, P<0.001). Total radiation exposure did not significantly correlate with the report of skin problems at the treatment site for white or black patients. Overall, black patients reported more severe post-treatment skin problems than white patients. Our results suggest that symptom management for post-treatment skin reactions in cancer patients receiving radiation treatment could differ depending on their racial background.