PSYCHOLOGICAL OUTCOMES OF DIFFERENT TREATMENT POLICIES IN WOMEN WITH EARLY BREAST-CANCER OUTSIDE A CLINICAL-TRIAL
PSYCHOLOGICAL OUTCOMES OF DIFFERENT TREATMENT POLICIES IN WOMEN WITH EARLY BREAST-CANCER OUTSIDE A CLINICAL-TRIAL
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DOI：
10.1136/bmj.301.6752.575
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发表时间：
1990-09-22
影响因子：
105.7
通讯作者：
BAUM, M
中科院分区：
文献类型：
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作者：
FALLOWFIELD, LJ;HALL, A;BAUM, M
目的：在临床试验之外，根据外科医生的意见或患者的选择，对接受乳房切除术或乳房保留手术的早期乳腺癌女性进行不同治疗策略的心理结局评估。确定接受保乳手术的女性中报告的精神病发病程度是否与她们参与随机临床试验相关。设计图：前瞻性多中心研究，利用患者之间的个体和动机差异以及外科医生治疗早期乳腺癌患者的不同管理政策。设置：12个地区综合医院，三个伦敦[英国]教学医院，和四个私立医院。患者：269名75岁以下的女性，可能诊断为I期或II期乳腺癌，被转诊给22名不同的外科医生。干预措施：手术和放疗或辅助化疗，或两者兼而有之，这取决于个别外科医生对管理早期乳腺癌的偏好。主要观察指标：术后2周、3个月和12个月采用标准方法评估焦虑和抑郁。结果如下：在269名妇女中，31名接受了赞成乳房切除术的外科医生的治疗，120名接受了赞成乳房保留术的外科医生的治疗，118名接受了提供治疗选择的外科医生的治疗。接受外科医生治疗的女性中有62人有资格选择手术，其中43人选择了保乳手术。所有治疗组中焦虑、抑郁和性功能障碍的发生率均较高。接受乳房切除术的妇女和接受乳房肿瘤切除术的妇女之间的焦虑和抑郁发生率没有显着差异。观察到外科医生类型对抑郁症发生率的显著影响，由提供选择的外科医生治疗的患者比由其他外科医生治疗的患者表现出更少的抑郁症（p = 0.06）。接受外科医生治疗的妇女中，有资格选择治疗的妇女和同一组中无法选择治疗的妇女的精神病发病率没有显著差异。大多数妇女（159/244）将癌症恐惧作为她们的主要恐惧，而不是失去乳房的恐惧。接受乳房切除术和乳房肿块切除术的女性的精神病发病率与癌症研究运动乳房保护研究中发现的相似。(At 12个月时，本研究中28%接受乳房切除术的妇女焦虑，而早期研究中为26%，本研究中27%接受乳房肿瘤切除术的妇女焦虑，而早期研究中为31%。在本研究和早期研究中，21%接受乳房切除术的女性患有抑郁症，19%接受乳房肿瘤切除术的女性患有抑郁症，而早期研究中为27%。 结论：目前还没有证据表明，早期乳腺癌妇女接受保乳手术治疗后的精神病发病率低于接受乳房切除术的妇女。同意参加随机临床试验的女性放弃自主权进行决策，与那些在临床试验之外接受乳腺癌治疗的女性相比，不会遇到任何不同的心理，性或社会问题。
Objectives: To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon''s opinion or the patient''s choice. To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery was associated with their participation in a randomised clinical trial. Design: Prospective, multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer. Setting: 12 District general hospitals, three London [UK] teaching hospitals, and four private hospitals. Patients: 269 Women under 75 with a probable diagnosis of stage I or II breast cancer who were referred to 22 different surgeons. Interventions: Surgery and radiotherapy or adjuvant chemotherapy, or both, depending on the individual surgeon''s stated preferences for managing early breast cancer. Main outcome measures: Anxiety and depression as assessed by standard methods two weeks, three months, and 12 months after surgery. Results: Of the 269 women, 31 were treated by surgeons who favoured mastectomy, 120 by surgeons who favoured breast conservation, and 118 by surgeons who offered a choice of treatment. Sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery, and 43 of these chose breast conserving surgery. The incidences of anxiety, depression, and sexual dysfunction were high in all treatment groups. There were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy. A significant effect of surgeon type on the incidence of depression was observed, with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons (p = 0.06). There was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose. Most of the women (159/244) gave fear of cancer as their primary fear rather than fear of losing a breast. The overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the Cancer Research Campaign breast conservation study. (At 12 month 28% of women who underwent mastectomy in the present study were anxious compared with 26% in the earlier study, and 27% of women in the present study who underwent lumpectomy were anxious compared with 31% in the earlier study. In both the present and earlier study 21% of women who underwent mastectomy were depressed, and 19% of women who underwent lumpectomy in the present study were depressed compared with 27% in the earlier study.) Conclusions: There is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy. Women who surrender autonomy for decision making by agreeing to participate in randomised clinical trials do not experience any different psychological, sexual, or social problems from those women who are treated for breast cancer outside a clinical trial.