Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis
Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis
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DOI：
10.1111/j.1440-1614.2004.01358.x
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发表时间：
2004-05-01
影响因子：
4.6
通讯作者：
Smith, GC
中科院分区：
文献类型：
--
作者：
Kissane, DW;Grabsch, B;Smith, GC
目的：评估乳腺癌妇女的心理社会发病率，并比较早期和晚期乳腺癌妇女的差异率。方法：在这份报告中，303名患有早期乳腺癌的妇女，在基线时进行精神病学评估，（作为辅助化疗期间认知存在团体疗法研究的一部分），与200名晚期乳腺癌患者（在连续表达组治疗试验中进行了类似评估）进行比较。结构化精神访谈加自我报告的措施被用来评估精神病发病率，生活质量和认知态度cancer.Results：早期患者，平均年龄为46岁，平均3个月后手术，并有一个整体患病率的DSM-IV精神病诊断为45%。转移性患者的平均年龄为51岁，初次诊断后平均63个月，DSM-IV诊断的总体患病率为42%;两种比率之间的差异无统计学意义。在早期乳腺癌患者中，36.7%患有情绪障碍，9.6%患有重度抑郁症，27.1%患有轻度抑郁症。在转移性样本中，31%患有情绪障碍，6.5%患有重度抑郁症，24.5%患有轻度抑郁症。焦虑症出现在8.6%的早期组和6%的晚期疾病的妇女。疲劳，抑郁症的历史，以及无助，绝望或辞职的认知态度与两组的抑郁症显着相关。从转移性样本的妇女显着减少痛苦的脱发，但更不满意的身体形象，并有较高的淋巴水肿和潮热率比早期women.Conclusions：社会心理困扰的比率高，相似，在早期和晚期乳腺癌患者，虽然疾病相关的原因是不同的。这些数据提出了一个挑战，临床服务提供全面的支持服务，以减轻这种痛苦。
Objective: To assess psychosocial morbidity in women with breast cancer and to compare the differential rates between women with early stage and advanced disease.Method: In this report, 303 women with early stage breast cancer, psychiatrically assessed at baseline (as part of a study of cognitive-existential group therapy during adjuvant chemotherapy), are compared with 200 women with advanced breast cancer (similarly assessed in a trial of supportive-expressive group therapy). A structured psychiatric interview plus self-report measures were used to assess psychiatric morbidity, quality of life and cognitive attitude to cancer.Results: The early stage patients, whose mean age was 46 years, were on average 3 months post-surgery and had an overall prevalence of DSM-IV psychiatric diagnosis of 45%. The metastatic patients, whose mean age was 51 years, were on average 63 months post-primary diagnosis and had an overall prevalence of DSM-IV diagnosis of 42%; the difference between the two rates was not statistically significant. Of women with early stage breast cancer, 36.7% had mood disorders, 9.6% suffering from major depression and 27.1% from minor depression. In the metastatic sample 31% had mood disorders, 6.5% having major depression and 24.5% with minor depression. Anxiety disorders were present in 8.6% of the early stage group and 6% of women with advanced disease. Fatigue, a past history of depression, and cognitive attitudes of helplessness, hopelessness or resignation were significantly associated with depression in both groups. The women from the metastatic sample were significantly less distressed by hair loss but more dissatisfied with body image, and had higher rates of lymphoedema and hot flushes than the early stage women.Conclusions: The rates of psychosocial distress are high, and similar, across patients with both early and advanced stage breast cancer, although the illness related causes of distress are different. These data present a challenge to clinical services to provide a comprehensive range of support services to ameliorate this distress.