Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer.
Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer.
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DOI：
10.1016/j.jpsychores.2008.03.005
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发表时间：
2008-12
影响因子：
4.7
通讯作者：
Ternel, Jennifer S.
中科院分区：
文献类型：
--
作者：
Greer, Joseph A.;Pirl, William F.;Park, Elyse R.;Lynch, Thomas J.;Ternel, Jennifer S.
由于血液学毒性导致的化疗剂量延迟和减少在晚期非小细胞肺癌（NSCLC）患者中很常见。然而，有关化疗依从性的行为或心理预测因素的数据有限。本研究的目的是探索该患者人群中输注剂量延迟和减少的频率和临床预测因素。50例新诊断为高体力状态（ECOG PS=0-1）的晚期NSCLC患者在诊断后8周内完成了生活质量（FACT-L）和情绪（HADS）基线评估。对参与者进行了为期六个月的前瞻性随访。化疗给药数据来自病历审查。所有患者在研究过程中均接受化疗，开始时使用含铂双联（74%）、口服表皮生长因子受体酪氨酸激酶抑制剂（14%）或肠外单药（12%）。40%（N=20）的患者在计划输注中出现给药延迟（38%）和/或减量（16%）。Fisher精确检验显示，发生中性粒细胞减少症、诊断时吸烟或报告基线焦虑加重的患者更有可能发生剂量延迟或减少。化疗依从性与患者的人口统计学资料、体能状态或生活质量之间无相关性。在该样本中，超过三分之一的晚期NSCLC患者经历了给药延迟或减少处方化疗方案。行为和心理因素，如吸烟和焦虑症状，似乎在化疗依从性中起着重要作用，但需要进一步研究来证实这些发现。
Dose delays and reductions in chemotherapy due to hematologic toxicities are common among patients with advanced non-small-cell lung cancer (NSCLC). However, limited data exist on behavioral or psychological predictors of chemotherapy adherence. The goal of this study was to explore the frequency and clinical predictors of infusion dose delays and reductions in this patient population. Fifty patients newly diagnosed with advanced NSCLC of high performance status (ECOG PS=0-1) completed baseline assessments on quality of life (FACT-L) and mood (HADS) within eight weeks of diagnosis. Participants were followed prospectively for six months. Chemotherapy dosing data came from medical chart review. All patients received chemotherapy during the course of the study, beginning with either a platinum-based doublet (74%), an oral epidermal growth factor receptor-tyrosine kinase inhibitor (14%), or a parenteral single agent (12%). Forty percent (N=20) of patients had either a dose delay (38%) and/or reduction (16%) in their scheduled infusions. Fisher’s exact tests showed that patients who experienced neutropenia, smoked at the time of diagnosis, or reported heightened baseline anxiety were significantly more likely to experience dose delays or reductions. There were no associations between chemotherapy adherence and patient demographics, performance status, or quality of life. In this sample, over one-third of patients with advanced NSCLC experienced either a dose delay or reduction in prescribed chemotherapy regimens. Behavioral and psychological factors, such as tobacco use and anxiety symptoms, appear to play an important role in chemotherapy adherence, though further study is required to confirm these findings.
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