Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy
Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy
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DOI：
10.1200/jco.2004.01.241
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发表时间：
2004-02-01
影响因子：
45.3
通讯作者：
Bowie, E
中科院分区：
文献类型：
--
作者：
Given, C;Given, B;Bowie, E
目的描述一项随机试验，在诊断为实体瘤并接受第一疗程化疗的患者中进行认知行为干预，以减轻症状严重程度，并确定在支持治疗药物存在的情况下，干预是否对症状严重程度有附加或相互作用。患者和方法从综合和社区癌症中心收集患者（N = 237），进行访谈，并随机分配到实验干预（N = 118）或常规治疗（N = 119）。基于15种症状的严重程度评分的症状严重程度指数是主要结果。每个病人的癌症部位、诊断阶段、化疗方案和支持性药物的使用都从医疗记录中了解到。结果各组在基线时相等，各组的特征磨损无差异。10周和20周未接受化疗的患者比例各组间无差异。在第10周和第20周的观察中，实验组与基线症状严重程度之间存在显著的相互作用。实验组患者在进入试验时症状严重程度较高，在第10周和第20周时报告的严重程度显著降低。在随访中控制化疗治疗状态和支持治疗药物并没有改变实验干预的效果。结论与单纯的常规护理相比，实验干预对入组时症状严重程度较高的患者是有效的。年龄、性别、癌症部位或分期以及支持性药物并没有改变这种认知行为干预对症状严重程度的影响。(C) 2004年由美国临床肿瘤学会主办。
Purpose To describe a randomized trial of a cognitive behavioral intervention on reducing symptom severity among patients diagnosed with solid tumors and undergoing a first course of chemotherapy and to determine whether the intervention had an additive or interactive effect on symptom severity in the presence of supportive care medications.Patients and Methods Patients (N = 237) were accrued from comprehensive and community cancer centers, interviewed, and randomly assigned to either the experimental intervention (n = 118) or conventional care (n = 119). A symptom severity index, based on summed severity scores across 15 symptoms, was the primary outcome. Each patient's site of cancer, stage at diagnosis, chemotherapy protocols, and use of supportive medications were learned from medical records.Results Groups were equivalent at baseline, and attrition by characteristics by group was not different. The proportion of patients not receiving chemotherapy at 10 and 20 weeks did not differ by group. At the 10 and 20-week observations, there was a significant interaction between the experimental group and baseline symptom severity. Patients in the experimental group who entered the trial with higher symptom severity reported significantly lower severity at 10 and 20 weeks. Controlling for chemotherapy treatment status at follow-up and supportive care medications did not alter the effect of the experimental intervention.Conclusion Compared with conventional care alone, the experimental intervention was effective among patients who entered the trial with higher levels of symptom severity. Age, sex, site or stage of cancer, and supportive medications did not modify the effect of this cognitive behavioral intervention on symptom severity. (C) 2004 byAmerican Society of Clinical Oncology.