Comorbid symptoms of emotional distress in adult survivors of childhood cancer.
Comorbid symptoms of emotional distress in adult survivors of childhood cancer.
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DOI：
10.1002/cncr.30171
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发表时间：
2016-10-15
期刊：
影响因子：
6.2
通讯作者：
Krull, Kevin R.
中科院分区：
文献类型：
--
作者：
D'Agostino, Norma Mammone;Edelstein, Kim;Zhang, Nan;Recklitis, Christopher J.;Brinkman, Tara M.;Srivastava, Deokumar;Leisenring, Wendy M.;Robison, Leslie L.;Armstrong, Gregory T.;Krull, Kevin R.
关键词：
儿童癌症幸存者有情绪困扰症状的风险，但以前没有检查过症状合并症。我们研究了1970年至1999年诊断的儿童癌症成年幸存者的痛苦概况。在儿童癌症幸存者研究的幸存者（N= 16，079）和兄弟姐妹（N= 3，085）中检查了来自简明症状量表-18的自我报告的抑郁，焦虑和躯体化症状。潜伏特征分析确定了具有个体和共病症状的幸存者群。疾病，治疗和人口统计学预测的痛苦合并症模式进行了检查，使用多项逻辑回归。确定了四个临床相关的配置文件：所有分量表上的低痛苦（无症状，62%）;所有分量表上的高痛苦（共病痛苦，11%）;躯体化升高（躯体症状，13%）;抑郁和焦虑升高（情感困扰，14%）。与兄弟姐妹相比，较少的幸存者无症状（62% v.74%，p<0.0001），更多的幸存者有共病困扰（11% v.5%，p<0.0001）。白血病（OR 1.34，95%CI 1.12-1.61）、中枢神经系统肿瘤（OR 1.30，95%CI 1.05-1.61）和肉瘤（OR 1.26，95%CI 1.01-1.57）的生存者比实体瘤生存者有更高的共病窘迫风险。精神活性药物与共病抑郁相关（p < 0.0001），表明这组患者对传统的药物治疗无效。共病抑郁与健康感知差（OR 31.7，95%CI 23.1-43.3）、头痛（OR 3.2，95%CI 2.8-3.7）和身体疼痛（OR 4.0，95%CI 3.2-5.0）相关。很大一部分幸存者有患共病痛苦的风险，这可能需要广泛的治疗方法，而不仅仅是针对个别症状。我们研究了儿童癌症幸存者的情绪困扰概况。我们确定了四种独特的模式，包括一组需要不同干预方法的共病症状。
Childhood cancer survivors are at risk for emotional distress symptoms, but symptom comorbidity has not been previously examined. We examined distress profiles in adult survivors of childhood cancer diagnosed between 1970 and 1999. Self-reported depression, anxiety, and somatization symptoms from the Brief Symptom Inventory-18 were examined in survivors (N=16,079) and siblings (N=3,085) from the Childhood Cancer Survivor Study. Latent profile analysis identified clusters of survivors with individual and comorbid symptoms. Disease, treatment and demographic predictors of distress comorbidity patterns were examined using multinomial logistic regressions. Four clinically relevant profiles were identified: low distress on all subscales (asymptomatic, 62%); high distress on all subscales (comorbid distress, 11%); elevated somatization (somatic symptoms, 13%); elevated depression and anxiety (affective distress, 14%). Compared to siblings, fewer survivors were asymptomatic (62% v. 74%, p<0.0001) and more had comorbid distress (11% v. 5%, p<0.0001). Survivors of leukemia (OR 1.34, 95%CI 1.12–1.61), CNS tumor (OR 1.30, 95%CI 1.05–1.61), and sarcoma (OR 1.26, 95%CI 1.01–1.57) had higher comorbid distress risk than solid tumor survivors. Psychoactive medications were associated with comorbid distress (p’s< 0.0001), suggesting this group was refractory to traditional medical management. Comorbid distress was associated with poor perceived health (OR 31.7, 95%CI 23.1–43.3); headaches (OR 3.2, 95%CI 2.8–3.7) and bodily pain (OR 4.0, 95%CI 3.2–5.0). A significant proportion of survivors are at risk for comorbid distress, which may require extensive treatment approaches beyond those utilized for individual symptoms. We examined emotional distress profiles in childhood cancer survivors. We identified four unique patterns, including a group with comorbid symptoms that require different intervention approaches.
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影响因子：
6.2
作者：
Brinkman, Tara M.;Zhang, Nan;Recklitis, Christopher J.;Kimberg, Cara;Zeltzer, Lonnie K.;Muriel, Anna C.;Stovall, Marilyn;Srivastava, Deo Kumar;Sklar, Charles A.;Robison, Leslie L.;Krull, Kevin R.
通讯作者：
Krull, Kevin R.
DOI：
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