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肿瘤慢性疼痛与生活质量 现代医学的发展更加强调心理因素在疾病的发生、发展和预后中的作用，癌症将对患者产生严重的心理冲击，致使增加许多心理问题，如焦虑、抑郁情绪，继而引起各种躯体症状。目前研究表明，癌症患者中抑郁的发生率为10％～60％，而在晚期癌痛患者中抑郁的发生率高达77％，抑郁情绪可影响癌症患者的疼痛治疗效果，加重病情及降低生活质量，因此对伴有抑郁状态的癌痛患者的治疗显得尤为重要。为此，卫咨康讯公司对此领域进行文献学专项研究，对科学引文数据库SCI（1995至今）发表文文献进行统计，同广大神经精神科科医师和内分泌科医师共同分享此领域的研究进展，帮助医师更多得把握研究趋势。 一、研究的年度发表与引用趋势
从SCI的发表数量和引用频次均可以看出对于此领域的研究整体呈逐年上升趋势，但引用频次的上升率要大于发表文献的次数，显示出了近年来此领域研究的整体集中度在逐渐增加。 二、研究的领先国家与期刊分布 对SCI发表文献的国家分布统计，美国是此领域研究领先的国家，发表文献居全球首位（23.11%）。 表1：前10位研究国家分布
从文章的期刊分布上可以看出，PSYCHO-ONCOLOGY是在此领域收录相关文章最多的期刊，但数据也显示相关文章分布较为分散。 表2：前20位发表糖尿病心理精神研究文献期刊
美国Memorial Sloan-Kettering癌症中心和瑞典乌普萨拉大学在此领域较为领先。 表3：前10位发表糖尿病心理精神研究机构
三、产生较大影响的研究
1．Title: The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta analyses
Author(s): Sheard T, Maguire P Source: BRITISH JOURNAL OF CANCER 80 (11):
1770-1780 AUG 1999 Document Type: Article Language: English Cited
References:
68 Times Cited: 101 Abstract: The findings of two meta-analyses of
trials of psychological interventions in patients with cancer are presented:
the first using anxiety and the second depression, as a main outcome measure.
The majority of the trials were preventative, selecting subjects on the basis
of a cancer diagnosis rather than on psychological criteria. For anxiety, 25
trials were identified and six were excluded because of missing data. The
remaining 19 trials (including five unpublished) had a combined effect size of
0.42 standard deviations in favour of treatment against no-treatment controls
(95% confidence interval (CI) 0.08-0.74, total sample size 1023). A most robust
estimate is 9.36 which is based on a subset of trials which were randomized,
scored well on a rating of study quality, had a sample size >40 and in which
the effect of trials with very large-effects were cancelled out. For
depression; 30 trials were identified, but ten were excluded because of missing
data. The remaining 20 trials (including six unpublished) had a combined effect
size of 0.36 standard deviations in favour of treatment against no-treatment
controls (95% CI 0.06-0.66, sample size 1101). This estimate was robust for
publication bias, but not study quality, and was inflated by three trials with
very large effects. A more robust estimate of mean effect is the clinically
weak to negligible value of 0.19. Group therapy is at least as effective as
individual. Only four trials targeted interventions at those identified as-at
risk of, or suffering significant psychological distress, these were associated
with clinically powerful effects (trend) relative to unscreened subjects. The
findings suggest that preventative psychological interventions in cancer
patients may have a moderate clinical effect upon anxiety but not depression.
There are indications that interventions targeted at those at risk of or
suffering significant psychological distress have-strong clinical effects.
Evidence an the effectiveness of such targeted interventions and of the
feasibility and effects of group therapy in a European context is required. 2．Title: does routine screening for breast-cancer raise
anxiety - results from a 3 wave prospective-study in Author(s): SUTTON
S, SAIDI G, BICKLER G, HUNTER J Source: JOURNAL OF
EPIDEMIOLOGY AND COMMUNITY HEALTH 49 (4): 413-418 AUG 1995 Document Type:
Article Language: English Cited References:
22 Times
Cited: 53 Abstract: Objective
- To investigate whether mammography raises anxiety in routinely screened women
who receive a negative result. Design -
Prospective design in which women completed questionnaires at three key points
in the breast screening process: at baseline (before being sent their invitation
for breast screening), at the screening clinic immediately before or after
screening, and at follow up, about nine months after baseline. Information was
obtained from non-attenders as well as from attenders. Setting - Bromelia
District Health Authority, served by the South East London Breast Screening
Service. Participants - Two
overlapping samples were used. Sample A comprised 1500 women aged 50-64 who
were due to be called for first round screening at a mobile screening unit.
Altogether 1021 (68%) returned a usable questionnaire and 795 of these (78%)
also provided adequate information at nine month follow up: there were 695
attenders (including 24 women who received false positive results) and 100
non-attenders. Sample B consisted of 868 women who attended the screening unit
in a three month period, 732 (84%) of whom provided adequate data. A total of
306 attenders (including 10 who received false positive results) occurred in
both samples and provided adequate information on all occasions. The main
analyses were based on these 306 women plus the 100 nonattenders. The analysis
of retrospective anxiety took advantage of the larger sample size of 695
attenders. Main results - On
average, the women were not unduly anxious at any of the three points in the
screening process. Among attenders, there was no difference between anxiety
levels immediately before and immediately after screening. Anxiety was lowest
at the clinic and highest at baseline but the changes were very small in
absolute terms. Anxiety did not predict attendance: there were no differences
in anxiety levels between attenders and non-attenders at baseline. As expected,
women who received false positive results recalled feeling extremely anxious
after they had received the referral letter but their retrospective anxiety was
also higher than in the negative screenees at earlier stages in the breast
screening process. They also reported having experienced more pain and
discomfort during the x ray. Conclusions -
Anxiety does not seem to be an important problem in routinely screened women
who receive a negative result. This finding is very reassuring in relation to a
major criticism of breast screening programmes. Thus, apart from maintaining
current procedures such as keeping waiting times to a minimum, there seems to
be no need to introduce special anxiety reducing interventions into the
national programme. On the other hand, the findings for women who received
false positive results suggest that there are aspects of the experience of being
recalled for assessment after an abnormal mammogram that warrant further
attention. The relationship between contemporaneous and retrospective anxiety
should also be studied. 3．Title: Are we using appropriate self-report
questionnaires for detecting anxiety and depression in women with early breast
cancer? Author(s): Hall A, A'Hern R, Fallowfield L Source: EUROPEAN JOURNAL OF CANCER 35 (1): 79-85 JAN 1999 Document Type: Article Language: English Cited
References: 22 Times Cited:
50 Abstract: The aim of this prospective study was to identify the psychiatric
morbidity associated with the diagnosis and treatment of early breast cancer.
At each of five time points, 269 women were interviewed using a shortened
version of the Present State Examination (PSE) and 266 completed
self-assessment questionnaires, the Hospital and Anxiety Depression Scale
(HADS) and the Rotterdam Symptom Checklist (RSCL). This paper compares the
ability of the questionnaires to detect psychiatric morbidity with that of the
PSE. The majority of women who experienced anxiety and/or depression did so
within 3 months of their initial surgery. The clinical interview identified
anxiety disorder in 132 of 266 women (49.6%) and depressive illness in 99/266
(37.2%) during the first 3 months. Using the recommended threshold of greater
than or equal to 11 for caseness, the sensitivities for both tests were very
low at 24.2% (HADS anxiety) and 14.1% (HADS depression) and 30.6% (RSCL
psychological distress scale). Lowering the threshold value to greater than or
equal to 7 on the HADS improved the sensitivity to 72% for the anxiety
subscale, but it remained low at 37.4% for the depression subscale. A threshold
of greater than or equal to 7 for the RSCL scale raised sensitivity to 66.7%.
Lowering the threshold values raised the sensitivity of both the instruments
but decreased their specificity: the lower the threshold, the greater the
number of women who were identified as false positives which would increase the
work load for clinic staff if used as a screening tool. Given that the HADS was
inadequate in discriminating for depressive illness, it was not surprising that
its use as a unitary scale with a threshold value as low as 12 resulted in a
sensitivity of only 42.7%. In the light of these findings, we question the use
of both the HADS and the RSCL as suitable research or screening instruments for
detection of psychological morbidity in early breast cancer. (C) 1999 Elsevier
Science Ltd. All rights reserved. 4．Title: Prevalence of anxiety and depression in cancer
patients seen at the Author(s): Aass N, Source: EUROPEAN
JOURNAL OF CANCER 33 (10): 1597-1604 SEP 1997 Document Type:
Article Language: English Cited References:
27 Times
Cited: 50 Abstract: The aim
of this study was to investigate the prevalence of anxiety and depression in
cancer patients seen at the 5．Title: Depression, anxiety, and quality of life in
patients with epithelial ovarian cancer Author(s):
Bodurka-Bevers D, Basen-Engquist K, Carmack CL, Fitzgerald MA, Wolf JK, de Moor
C, Gershenson DM Source: GYNECOLOGIC
ONCOLOGY 78 (3): 302-308 Part 1, SEP 2000 Document Type: Article
Language: English Cited References:
25 Times
Cited: 47 Abstract:
Objective. The aims of this study were to evaluate psychological distress and
quality of life (QOL) in patients with epithelial ovarian cancer (EOC) and to
examine the relationship between these problems and health and demographic
variables. Methods. Of 344
consecutive patients identified, 246 completed questionnaires. Four dimensions
of QOL were assessed including physical, functional, emotional, and
social/family well-being, as well as concerns specific to ovarian cancer
patients. Depression was measured with the Center for Epidemiologic
Studies-Depression (CES-D) scale and anxiety was measured by the State Anxiety
Subscale of the Spielberger State-Trait Anxiety Inventory. Performance status
was evaluated by the Zubrod score. Results. Sixty-five
patients (26%) had early stage disease; 181 (74%) had advanced disease. One
hundred twenty-one patients (49%) were under active treatment, while 124 (51%)
were seen for posttherapy surveillance. Forty-eight (21%) met CES-D cutoff
criteria for a clinical evaluation for depression, and 29% scored above the
75th percentile for anxiety. Performance status was related to depression,
anxiety, and QOL problems, except in the domain of social well-being. Conclusions.
Clinically significant depression and anxiety may be more prevalent in patients
with EOC than previously reported. Future studies of screening for and treating
psychological distress are being designed to improve QOL in these women. (C)
2000 Academic Press. 6．Title: Screening for anxiety and depression
in women with breast cancer - Psychiatry and medical oncology gear up for
managed care Author(s): Payne DK, Hoffman RG, Theodoulou
M, Dosik M, Massie MJ Source: PSYCHOSOMATICS 40 (1):
64-69 JAN-FEB 1999 Document Type: Article Language: English Cited References: 14 Times Cited:
47
Abstract: In this study 275 women with breast
cancer attending ambulatory breast cancer clinics in two sites were evaluated
for psychological distress by rising three self-report instruments: a visual
analogue scale for psychological distress, the Hospital Anxiety and Depression
Scale, and the Brief Symptom Inventory. Results suggest that significant
psychological distress exists in ambulatory women with breast cancer; all three
instruments effectively measured that level of distress. Implications for the
use of these instruments in educating oncological staff members, documentations
of psychiatric services are discussed. 7．Title: Anxiety and depression in cancer
patients: relation between the Hospital Anxiety and Depression Scale and the
European Organization for Research and Treatment of Cancer Core Quality of Life
Questionnaire Author(s): Skarstein J, Aass
N, Fossa SD, Skovlund E, Dahl AA Source: JOURNAL OF PSYCHOSOMATIC RESEARCH 49
(1): 27-34 JUL 2000 Document Type: Article Language: English Cited References: 25 Times Cited:
42
Abstract: Background: The emotional
functioning (EF) dimension of the European Organization for Research and
Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C33) and the
Hospital Anxiety and Depression Scale (HADS) evaluate anxiety and depression.
We wanted to compare cancer patients' responses to EF with those to HADS, as
well as the impact of anxiety and depression on the quality of life (QL)
dimensions of the EORTC QLQ C33. Method: A total of 568 cancer patients
completed both the EORTC QLQ C33 and HADS at the same occasion. The association
between the patients' EF scorings and their HADS scores was analyzed by multiple
linear regression. Gender and age were included as covariates. Results:
Statistically significant negative relations were found between EF and HADS-A
(anxiety), HADS-D (depression) and HADS-T (total score), respectively, with the
highest correlation coefficient for HADS-A. Older patients and males reported
less emotional distress assessed by the EF scale than younger ones and females
with comparable HADS-T or HADS-D scores. Both HADS-A and HADS-D were
significantly related to other QL dimensions, and depression was a stronger
predictor for reduced QL than anxiety. Conclusion: The EF dimension of EORTC
QLQ C33 predominantly assesses anxiety, whereas depression is rated to a lesser
degree. Combined with significant age and gender relations, this implies a risk
of underdiagnosed depression, if the EORTC QLQ C33 is used as the only
instrument to screen for psychological distress in cancer patients. As
depression has a stronger impact on global QL of cancer patients than anxiety,
the use of an additional instrument is recommended for assessment of
depression. (C) 2000 Elsevier Science Inc. All rights reserved. 8. Title: The effect of fluoxetine on anxiety
and depression symptoms in cancer patients Author(s): Razavi D, Allilaire JF, Smith M,
Salimpour A, Verra M, Desclaux B, Saltel P, Piollet I, GauvainPiquard A,
Trichard C, Cordier B, Fresco R, Guillibert E, Sechter D, Orth JP, Bouhassira
M, Mesters P, Blin P Source: ACTA PSYCHIATRICA
SCANDINAVICA 94 (3): 205-210 SEP 1996 Document Type: Article Language: English Cited References: 15 Times Cited:
42
Abstract: Little has been done to study the
effectiveness of antidepressants in controlling anxiety/depression in a
population of cancer patients. A double-blind placebo-controlled study was
therefore designed to assess the effectiveness of 20 mg fluoxetine, Of 115
cancer patients who fulfilled entry criteria for levels of distress, 45
patients were randomized to a fluoxetine treatment group (FA) and 46 patients
to a placebo group (PA) after a 1-week placebo period designed to exclude
placebo responders. The Montgomery and Asberg Depression Scale (MADRS), the
Hamilton Anxiety Scale (HAS), the Hospital Anxiety and Depression Scale (HADS),
the Revised Symptom Checklist (SCL90-R) and the Spitzer Quality of Life Index
(SQOLI) were used to assess the efficacy of fluoxetine. The response rate,
defined by a HADS score lower than 8 after 5 weeks of treatment, was not
significantly higher in the FA group (11%) compared to the PA group (7%).
Compared to the PA group, patients in the FA group showed a significantly
greater decrease in SCL90-R mean total score after 5 weeks, but not a greater
decrease in HADS mean score. No difference between the two groups was found in
observer-reported assessments (MADRS, HAS and SQOLI). Significantly more
drop-outs were observed in the FA group (n=15) than in the PA group (n=7),
although the frequencies of side-effects were not significantly different. 9. Title: ASSESSMENT OF PREOPERATIVE ANXIETY -
COMPARISON OF MEASURES IN PATIENTS AWAITING SURGERY FOR BREAST-CANCER Author(s): MILLAR K, JELICIC M, BONKE B,
ASBURY AJ Source: BRITISH JOURNAL OF ANAESTHESIA 74
(2): 180-183 FEB 1995 Document Type: Article Language: English Cited References: 11 Times Cited: 42 Abstract: We have compared three measurements
of anxiety to determine their equivalence in assessing anxiety before surgery.
Forty-four patients awaiting breast cancer surgery completed the state scale of
the state-trait anxiety inventory (STAI), the hospital anxiety and depression
scale (HAD) and a 100-mm visual analogue scale (VAS). Analysis restricted to
correlations between the scales gave the misleading impression that VAS scores
were inconsistent with those of the HAD and STAI. However, when scores were
considered in relation to normative cut-off values to categorize anxiety
levels, the three scales showed good agreement. We conclude that the scales
were equivalent in their assessment of anxiety before surgery, but that
reference to normative data was important in establishing such equivalence and
in determining the patient's state. |
