ADJUVANT PSYCHOLOGICAL THERAPY FOR PATIENTS WITH CANCER - A PROSPECTIVE RANDOMIZED TRIAL
ADJUVANT PSYCHOLOGICAL THERAPY FOR PATIENTS WITH CANCER - A PROSPECTIVE RANDOMIZED TRIAL
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DOI：
10.1136/bmj.304.6828.675
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发表时间：
1992-03-14
影响因子：
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通讯作者：
BLISS, JM
中科院分区：
文献类型：
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作者：
GREER, S;MOOREY, S;BLISS, JM
目的：探讨辅助心理治疗对肿瘤患者生活质量的影响。设计-前瞻性随机对照试验，比较接受心理治疗的患者与未接受治疗的患者的生活质量，在治疗前，8周和4个月的随访中测量。背景-英国皇家马斯登医院CRC心理医学小组。患者——174名年龄在18岁至74岁之间的患者，确诊为恶性疾病，预期寿命至少为12个月，或心理发病率的各种衡量指标得分高于先前确定的分界点。干预-辅助心理治疗，一个简短的，问题集中，认知行为治疗方案，专门为个别癌症患者的需要而设计。主要结果测量-医院焦虑和抑郁量表、癌症心理适应量表、鹿特丹症状检查表、疾病心理适应量表。结果：156例（90%）患者完成了为期8周的试验；137例患者（79%）获得了4个月的随访数据。治疗8周时，治疗组的斗志得分显著高于对照组，而无助感、焦虑关注和宿命论得分显著低于对照组；焦虑;心理症状;关于医疗保健的方向。这些差异表明每种情况都有所改善。在四个月时，接受治疗的患者在焦虑方面的得分明显低于对照组；心理症状;还有心理困扰。在临床上，治疗组严重焦虑患者的比例从基线时的46%下降到8周时的20%和4个月时的20%，对照组分别从48%下降到41%和43%。治疗组抑郁患者的比例在基线时为40%，8周时为13%，4个月时为18%，对照组分别为30%，29%和23%。结论：辅助心理治疗可显著改善癌症患者的各种心理困扰。在4个月的随访中，在8周观察到的治疗效果在一些但不是所有措施中持续存在。
Objective - To determine the effect of adjuvant psychological therapy on the quality of life of patients with cancer.Design - Prospective randomised controlled trial comparing the quality of life of patients receiving psychological therapy with that of patients receiving no therapy, measured before therapy, at eight weeks, and at four months of follow up.Setting - CRC Psychological Medicine Group of Royal Marsden Hospital.Patients - 174 patients aged 18-74 attending hospital with a confirmed diagnosis of malignant disease, a life expectancy of at least 12 months, or scores on various measures of psychological morbidity above previously defined cut off points.Intervention - Adjuvant psychological therapy, a brief, problem focused, cognitive-behavioural treatment programme specifically designed for the needs of individual cancer patients.Main outcome measures - Hospital anxiety and depression scale, mental adjustment to cancer scale, Rotterdam symptom checklist, psychosocial adjustment to illness scale.Results - 156 (90%) patients completed the eight week trial; follow up data at four months were obtained for 137 patients (79%). At eight weeks, patients receiving therapy had significantly higher scores than control patients on fighting spirit and significantly lower scores on helplessness, anxious preoccupation, and fatalism; anxiety; psychological symptoms; and on orientation towards health care. These differences indicated improvement in each case. At four months, patients receiving therapy had significantly lower scores than controls on anxiety; psychological symptoms; and psychological distress. Clinically, the proportion of severely anxious patients dropped from 46% at baseline to 20% at eight weeks and 20% at four months in the therapy group and from 48% to 41% and to 43% respectively among controls. The proportion of patients with depression was 40% at baseline, 13% at eight weeks, and 18% at four months in the therapy group and 30%, 29%, and 23% respectively in controls.Conclusions - Adjuvant psychological therapy produces significant improvement in various measures of psychological distress among cancer patients. The effect of therapy observed at eight weeks persists in some but not all measures at four month follow up.