Screening for untreated depression in cancer patients: a Japanese experience
Screening for untreated depression in cancer patients: a Japanese experience
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筛查癌症患者中未经治疗的抑郁症：日本的经验
DOI：
10.1093/jjco/hyw104
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发表时间：
2016
期刊：
影响因子：
2.4
通讯作者：
Uchitomi Y
中科院分区：
文献类型：
--
作者：
6.Inouguch H;Shimizu K;Shimoda H;Yoshiuchi K;Akechi T;Uchida M;Ogawa A;Fujisawa D;Inoue S;Uchitomi Y
癌症患者的支持性治疗指南建议常规 临床实践中的心理筛查，以及日本国民 该项目建议使用抑郁筛查， 冲击温度计。然而，以前的一项研究主张的有效性， 遇险和冲击温度计可能高估了它的有效性， 该研究包括已经接受治疗但不是筛选目标的患者。 这项研究重新评估了Distress的性能和有用性， 使用足够的样本量和适当研究的冲击温度计 方法患者在两家高度专业化的医院连续招募， 日本的三所大学医院入选标准为（i）接受 积极的抗癌治疗，（ii）东部肿瘤协作组 组体能状态评分<3和（iii）年龄>20岁。患者 正在接受精神病治疗的人被排除在研究之外。后 完成痛苦和冲击温度计，患者进行评估， 金标准复合国际诊断访谈， 研究人员对病人的痛苦和影响不知情， 结果44例（9%）接受精神病治疗的患者， 排除在最终分析中纳入的468例受试者中，仅3例目前 抑郁症（0.6%）。使用先前研究建议的截止点， 阳性和阴性预测值分别为0.02和0.99， 结论我们的数据表明，筛查未经治疗的癌症患者的抑郁症， 在所研究的特定临床环境中没有用， 应在适当情况下进行筛查。由于没有 基于证据的建议，关于心理学的背景， 筛选是必要的，需要进一步的研究。
ObjectiveGuidelines for supportive care in cancer patients have recommended routine psychological screening in clinical practice, and a Japanese national project has recommended screening for depression using the Distress and Impact Thermometer. However, a previous study advocating the validity of the Distress and Impact Thermometer may have overestimated its effectiveness, as the study included already-treated patients who were not screening targets. This study re-evaluated the performance and usefulness of the Distress and Impact Thermometer using an adequate sample size and appropriate study design.MethodsPatients were consecutively recruited at two highly specialized hospitals and three university hospitals in Japan. Inclusion criteria were (i) undergoing aggressive anti-cancer treatment, (ii) the Eastern Cooperative Oncology Group performance status score <3 and (iii) age >20 years. Patients who were receiving psychiatric treatment were excluded from the study. After completing the Distress and Impact Thermometer, patients were evaluated with the gold-standard Composite International Diagnostic Interview by researchers who were blinded to the patients’ Distress and Impact Thermometer scores.ResultsForty-four patients (9%) who were receiving psychiatric treatment were excluded. Of 468 subjects included in the final analysis, only 3 had current depression (0.6%). Using cutoff points recommended by the previous study, the positive and negative predictive values were 0.02 and 0.99, respectively.ConclusionsOur data indicated that screening for untreated depression in cancer patients was not useful in the specific clinical settings that were studied, and such screening should be implemented in appropriate contexts. Since there are no evidence-based recommendations regarding contexts in which psychological screening is essential, further research is needed.