新疆医科大学学报

目的探讨晚期癌症患者的抑郁和焦虑与症状负担的关系。方法选取2016年5月-2019年7月在广州市暨南大学附属第一医院住院并进行姑息干预的351例晚期癌症患者作为研究对象。患者在入院时(D0)和入院第7天(D7)分别完成1次埃德蒙顿症状评估量表(ESAS)、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评估。比较发生抑郁症和焦虑症(ESAS评分≥4)的患者与无抑郁和焦虑的患者其症状负担的差异,以及发生抑郁症、焦虑症的相关危险因素。结果共回收294例完整问卷,其中患有焦虑症的有120例(40.8%),患有抑郁症的有141例(48.0%)。D0和D7时焦虑和抑郁得分与较高的症状表达水平显著相关(P<0.05)。D0和D7同时出现焦虑和抑郁患者中,无论是在D0还是在D7时,症状负担与未出现焦虑和抑郁的患者相比具有显著的相关性(P<0.05)。T0时与焦虑和焦虑相关变量的多因素分析显示,疼痛[OR(95%CI):1.229(1.102-1.366,P<0.001)]和抑郁[OR(95%CI):1.386(1.242-1.546,P<0.001)]与T0时的焦虑独立相关,嗜睡[OR(95%CI):1.152(1.042-1.281,P=0.006)]、食欲差[OR(95%CI):1.118(1.022-1.234,P=0.023)]和焦虑[OR(95%CI):1.314(1.195-1.452,P<0.001)]与T0时的抑郁独立相关。结论晚期癌症患者焦虑和抑郁与ESAS中大多数症状负担具有相关性。疼痛在焦虑的患者中发生率更高,而抑郁更可能发生在困倦和食欲不振的患者中。即使姑息治疗干预能够显著降低ESAS症状的强度,焦虑和抑郁仍然与较高的症状负担有关。

Objective To explore the relationship between depression and/or anxiety and symptom burden in patients with advanced cancer. Methods A total of 351 patients with advanced cancer who were hospitalized in the First Affilated Hospital of Jinan University from May 2016 to July 2019 were conducted palliative intervention. The Edmonton Symptom Assessment System(ESAS), Hamilton depression scale(HAMD) and Hamilton Anxiety Scale(HAMA) was completed at the time of admission(D0) and on day 7(D7). Demographic and disease data were collected from the patient′s medical records. The difference in symptom burden between patients with depression and/or anxiety(ESAS score ≥4) and those without depression and/or anxiety was compared, and the related risk factors for depression or anxiety were analyzed. Results A total of 284 patients completed questionnaires, including 120 patients(40.8%) with anxiety disorder and 141 patients(48.0%) with depression. At D0 and D7, anxiety and/or depression scores was significantly correlated with higher symptom expression levels(P<0.05). In patients with concurrent anxiety and/or depression, the expression of symptoms was significantly correlated with those without anxiety and/or depression at both D0 and D7(P<0.05). Multivariate analysis of anxiety and anxiety-related variables at T0 showed that pain [OR(95%CI): 1.229(1.102-1.366, P<0.001)] and depression [OR(95%CI): 1.386(1.242-1.546, P<0.001)] were independently correlated. Lethargy [OR(95%CI): 1.152(1.042-1.281, P=0.006)], poor appetite [OR(95%CI): 1.118(1.022-1.234, P=0.023)], and anxiety [OR(95%CI): 1.314(1.195-1.452, P<0.001)] were independently correlated with depression at T0. Conclusion Anxiety and/or depression in patients with advanced cancer were correlated with the expression of most symptoms in ESAS. Pain is highly expressed in patients with anxiety, while depression is more likely to occur in patients with drowsiness and loss of appetite. Even though palliative interventions can significantly reduce the intensity of ESAS symptoms, anxiety and/or depression are still associated with symptom overexpression.