Psychological responses to cancer recurrence - A controlled prospective study
Psychological responses to cancer recurrence - A controlled prospective study
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DOI：
10.1002/cncr.21309
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发表时间：
2005-10-01
期刊：
影响因子：
6.2
通讯作者：
Wells-DiGregorio, S
中科院分区：
文献类型：
--
作者：
Andersen, BL;Shapiro, CL;Wells-DiGregorio, S
背景。关于癌症复发诊断的心理反应缺乏了解。方法。一项正在进行的随机临床试验为前瞻性研究提供了背景。患有 II/III 期乳腺癌的女性 (N = 227) 在诊断/手术后和辅助治疗前进行了初步评估，然后每 6 个月重新评估一次。试验进行八年后，30 名患者复发 (R)，并在第二次诊断后不久接受了评估。他们的数据与没有疾病证据的试验患者样本（无疾病 [DF]；n = 90）进行了比较。各组在研究组、疾病阶段、雌激素受体状态、绝经状态和自初次诊断以来的时间方面进行匹配。 结果。正如假设的那样，R 组患者复发时的癌症特异性压力高于 DF 组在同等时间点的压力水平 (P < 0.05)。重要的是，R 组报告的复发诊断所带来的压力与初次诊断所报告的压力相同。健康状况和症状的测量也发现了相同的结果。相比之下，情绪困扰和社会功能分析显示，R 组在癌症复发时没有出现破坏模式，其水平与 DF 组相当。结论。据作者所知，这是首次对患者对癌症复发的反应进行对照、前瞻性心理分析。研究结果与癌症压力源的学习理论概念一致。患者的压力被“划分”，至少在最初几周不会导致弥漫性情绪困扰和生活质量破坏，这突显了患者在面临癌症复发时的恢复能力。
BACKGROUND. There is a dearth of knowledge regarding the psychological responses to a diagnosis of cancer recurrence.METHODS. An ongoing randomized clinical trial provided the context for prospeclive study. Women with Stage II/III breast carcinoma (N = 227) were initially assessed after their diagnosis/surgery and before adjuvant therapy and then reassessed every 6 months. Eight years into the trial, 30 patients had recurred (R) and were assessed shortly after receiving their second diagnosis. Their data were compared with a sample of trial patients who had no evidence of disease (disease free [DF]; n = 90). The groups were matched on study arm, disease stage, estrogen receptor status, menopausal status, and time since initial diagnosis.RESULTS. As hypothesized, patients' cancer-specific stress at recurrence in the R group was higher (P < 0.05) than stress levels for the DF group at the equivalent point in time. Importantly, the R group reported stress for their recurrent diagnosis equivalent to that reported for their initial diagnosis. Identical results were found for measures of health status and symptomatology. In contrast, analyses for emotional distress and social functioning showed no pattern of disruption for the R group at cancer recurrence and levels equivalent to that of the DF group.CONCLUSIONS. To the authors' knowledge, this was the first controlled, prospective psychological analysis of patients' responses to cancer recurrence. The findings were consistent with a learning theory conceptualization of the cancer stressor. Patients' stress was "compartmentalized" and did not, at least in the early weeks, result in diffuse emotional distress and quality of life disruption, underscoring the resilience of patients when confronted with cancer recurrence.