卵巢上皮性癌治疗后血清CA125再升高的治疗选择：积极化疗，抑或是观察等待？

卵巢上皮性癌是恶性程度、病死率极高的卵巢肿瘤,几乎所有的经规范治疗后的卵巢上皮性癌都存在复发风险,复发较大程度上意味着不良预后,甚至死亡。与卵巢癌相关的肿瘤抗原（CA125）是观察、诊断卵巢上皮性癌术后复发的敏感指标,对复发早期无影像学证据,仅单纯 CA125升高的卵巢上皮性癌患者是积极化疗,抑或是观察等待？一直是妇科肿瘤学术界争论的问题。怎样既能通过积极治疗快速缓解病情,又避免过度化疗带来的副作用？本文对此争论作一讨论,以期得出明确的观点,指导临床工作。     

肿瘤化疗相关心脏毒性研究现状及进展

恶性肿瘤与心脏疾病已成为危害人类健康的主要疾病,肿瘤治疗的不断进步使得患者获益于生存期的延长,而肿瘤治疗带来的心血管毒性得到广泛关注。肿瘤心脏病学(cardio-oncology)定位于肿瘤治疗引起的心脏毒性及肿瘤合并心脏疾病。本文对常用化疗药物心脏毒性的研究现状及其监管进行综述,为防治肿瘤化疗相关心脏毒性提供经验。     

肿瘤诊治相关肾损伤的防治决策

肿瘤患者在诊治过程中可能会引起肾脏损伤,如造影剂、化疗和靶向药物的使用等等。如何平衡肿瘤患者在诊治过程中的疗效及安全性,使患者能够接受并完成治疗,延长患者无进展生存和总生存,是肿瘤学界所面临的挑战。     

努力避免肿瘤的过度化疗

化疗是肿瘤治疗的主要手段之一,在临床实践中发挥着十分重要的作用,但是其有明显的毒副作用,避免过度化疗是医疗的基本要求。临床过度化疗的原因与现行医疗管理与流程、医生的诊疗水平有关。近年来,人们对肿瘤生物学行为规律认识不断深入,更加注重个体化治疗,肿瘤治疗领域快速更新,因此对医疗决策水平也提出更高的要求。需要通过规范肿瘤诊疗流程、更新知识、积累经验、临床试验并结合我国国情,权衡利弊,使患者接受恰当治疗。     

告知患者癌症诊断的利弊分析及有效告知的方法

告知患者癌症诊断是肿瘤科的核心问题。法律和医学伦理原则要求医务人员应掌握肿瘤患者的心理和其他方面的特殊性,及时、充分地与患者及家属进行沟通,严格履行肿瘤患者的知情同意原则。本文旨在对告知患者癌症诊断的利弊及有效告知癌症诊断的方法进行分析,以期为临床肿瘤医疗、护理工作提供指导。     

1例晚期肿瘤患者宁养服务浅谈

通过提供居家宁养护理指导和心理疏导的方法,为晚期癌症患者提供身、心、灵全方位的照顾,从而提高晚期癌症患者的生活质量。通过对1例晚期肿瘤患者进行症状控制、护理指导、心理疏导、灵性沟通,该晚期肿瘤患者及家属的自身照顾能力提高,晚期肿瘤患者在生命末期的生活质量有所提高,最终达到善终。身心灵的照顾在宁养服务中起重要作用,有利于患者生活质量的提高,但仍要根据患者的个体特点并掌握一定技巧。     

告知患者癌症诊断的利弊分析及有效告知的方法

告知患者癌症诊断是肿瘤科的核心问题.法律和医学伦理原则要求医务人员应掌握肿瘤患者的心理和其他方面的特殊性,及时、充分地与患者及家属进行沟通,严格履行肿瘤患者的知情同意原则.本文旨在对告知患者癌症诊断的利弊及有效告知癌症诊断的方法进行分析,以期为临床肿瘤医疗、护理工作提供指导.     

肿瘤姑息治疗的全程介入

恶性肿瘤严重威胁人类健康,肿瘤本身以及针对肿瘤的治疗不仅会对患者的生理和心理产生重要影响,同时也会对照顾患者的家人产生各种心理影响。现有医疗条件下短时间内难以提高治愈率,就应更加注重将姑息治疗贯穿于肿瘤治疗的始终,不仅要及早介入,甚至延伸至居丧期。在肿瘤治疗过程中不断对肿瘤患者进行评估和适时调整姑息治疗策略,可有效地提高患者生活质量同时降低医疗成本,最终患者能够在不同阶段和各种治疗手段中获得最大受益。     

克服肿瘤干细胞耐药性的策略和思路

肿瘤干细胞（cancersterncells,CSCs）是肿瘤细胞的祖细胞。已有的研究表明,肿瘤干细胞对多种化疗药物具有耐药性,是导致肿瘤治疗后复发的根源。研究针对肿瘤干细胞的治疗方法,克服肿瘤干细胞耐药性,将给肿瘤治疗模式带来全新的改变,有望彻底改善肿瘤患者的预后。     

血液系统恶性肿瘤患者相关疲劳的生物-心理-社会模式探讨

普遍的疲劳感是引起血液系统恶性肿瘤患者治疗及康复过程中生活质量显著降低的主要因素之一。因此如何减少肿瘤相关疲劳逐渐引起了血液病医生的关注。在医学从传统的"生物"模式向新的"生物-心理-社会"模式转变的背景下,本文就如何利用生物心理社会模式分析血液系统恶性肿瘤相关疲劳的病因、机制、评估、干预进行探讨。     

Retrospective Denial as A Coping Method

Worldwide, gastric cancer is one of the most common and fatal cancers. The majority of patients present with an advanced stage of disease. Even with use of palliative chemotherapy most patients die within 1?year after diagnosis. Medical psychological attention after a diagnosis of incurable cancer is focused on end of life support. This paper presents the care of a patient treated with palliative intent with chemotherapy for an irresectable histologically confirmed gastric cancer. When, unexpectedly prolonged symptom free survival followed, the reaction of the patient came as a surprise to the attending medical team. In this case history we urge those who care for incurable cancer patients, that the rare patient who survives against all odds may require special psychological care.     

癌症病人心理干预的效果及其影响因素

研究的主要目的是探讨对癌症病人实施心理干预的效果及其影响因素。运用病例对照实验设计 ,采用多因素综合分析统计方法 ,对 2 89名放化疗住院病人进行了比较研究。结果为 :干预组病人的生活质量、躯体功能状况比对照组有明显改善。肿瘤临床分期和诊断告知方式是影响干预效果的两个主要因素 ;合并症及其影响、治疗前有无心理准备、病前生活事件在化疗病人中影响明显 ;医疗费、教育水平以及治疗经历对放疗病人影响明显 ;因素间交互作用显著。由此认为 ,影响心理干预效果的因素随治疗方式不同而各有侧重 ,并以综合作用模式为主     

晚期非小细胞肺癌化疗的冷思考

晚期非小细胞肺癌提倡以化疗为主综合治疗,可以延长生存期,提高生存率。但目前化疗取得的疗效虽然较既往有提高,但提高生存期有限,且在药效经济学方面存在争议,缓解症状的作用也有限,联合靶向治疗的疗效也在观望中。临床肿瘤学工作者应正确认识,以循证医学为指导,开展规范化化疗,同时也注重个体化化疗,并期待晚期非小细胞肺癌化疗的新突破。     

Regaining a sense of agency and shared self-reliance: the experience of advanced disease cancer patients participating in a multidimensional exercise intervention while undergoing chemotherapy--analysis of patient diaries

Evidence is emerging that exercise can reduce psychological distress in cancer patients undergoing treatment. The present study aimed to (qualitatively) explore the experiences of advanced disease cancer patients participating in a 6-week, 9-hours weekly, structured, group-based multidimensional exercise intervention while undergoing chemotherapy. Unstructured diaries from a purposive sample of three females and two males (28-52 years old) who participated in the program served as the database. Data were analyzed using a phenomenological, narrative method. The analysis yielded three themes: shifting position, self-surveillance, and negotiated strength. The intervention highlighted situations making it possible for the participants to negate psychological and physical constraints. The concept of structured exercise contains viable psychotherapeutic potentials by allowing the development of alternative bodily and mental realities complying with cancer patients' demands and abilities to regain autonomy and commitment to discover and adopt a sense of agency and shared self-reliance.     

Stress, Coping and Cognitive Deficits in Women After Surgery for Breast Cancer

Research on neuropsychological difficulties among cancer patients has focused on chemotherapy as a primary cause, yet several studies have now shown that some patients evidence cognitive weaknesses prior to chemotherapy. As an alternative to the ‘chemo–brain’ theory, this study examined the hypothesis that stress and coping style may be associated with observed neuropsychological difficulties among female cancer patients. Thirty-six women completed neuropsychological testing and psychological questionnaires following surgery for breast cancer and prior to any subsequent treatments. Twenty-seven percent of participants evidenced deficits on at least one measure of verbal fluency, and 14% of participants were impaired on at least one memory measure. Self-reported stress was correlated with deficits in memory, verbal fluency, and attention. Subsequent mediational analyses indicated that use of passive coping styles may underlie this relationship between stress and neuropsychological deficits. These findings highlight the potential relevance of psychological mechanisms, such as coping style, in cancer patients’ experience of neuropsychological deficits.     

蒽环类耐药转移性乳腺癌的治疗现状与思考

蒽环类药物是治疗乳腺癌最有效的化疗药物之一,但蒽环类耐药后乳腺癌可发生复发或转移,而转移性乳腺癌仍然提倡以化疗为主的综合治疗。肿瘤学工作者应以循证医学为指导,合理选择化疗方案,注重个体化治疗,才能在蒽环类耐药转移性乳腺癌的治疗上取得新突破。     

Anxiety and depression in women with advanced cancer: Implications for counselling

Fifty-three patients with advanced cancer were studied prospectively for 6 months to assess whether the site and method of chemotherapy administration influence levels of anxiety and depression. Patients received chemotherapy either at home or in hospital. Cases of clinical anxiety (36%) and depression (27%) were highest in the hospital treated group during the middle period of therapy. Patients treated at home had a lower psychiatric morbidity for anxiety (21%) and depression (21%) at the same period. There was no statistically significant difference in the mean scores on anxiety and depression between the groups. Overall, anxiety was more prevalent than depression. This study indicates that a minority of patients with advanced cancer treated by chemotherapy experience measureable psychiatric morbidity. Counselling services should be provided for these women throughout treatment, not just at the outset.     

癌症病人的生活质量及心理干预研究

本研究在前期研究的基础上进一步探讨癌症病人的生活质量状况和心理干预的效果。运用病例对照实验设计 ,选用生活质量问卷 (QLQ C3 0 )作为主要测查工具 ,采用两因素混合实验方差分析统计方法 ,对 1 2 0名住院化疗病人进行了比较分析。结果显示 :躯体功能 (PF)、角色功能 (RF)、情绪功能(EF)、认知功能 (CF)和整体生活质量 (QL)得分在治疗前后和实验与对照组之间的交互作用均显著和非常显著 ;症状量表和单项症状中交互作用显著和非常显著的有 :疲乏 (FA)、呼吸困难 (DY)、失眠 (SL)、食欲丧失 (AP)。因此 ,化疗对病人的生活质量有明显的影响 ,经心理干预后癌症病人的各种功能状况和症状得到不同程度的改善。     

关于晚期肿瘤患者临终关怀问题的探讨

分析了晚期肿瘤患者临终关怀的重要意义和特殊性,论述了临终关怀的主要内容,探讨了临终关怀中的伦理问题,特别是对是否告知患者实情和是否应该放弃治疗等问题进行了深入讨论和分析。并提出晚期肿瘤患者的临终关怀,要从生理、心理、社会、伦理等多方面、多角度关爱患者,帮助患者认识生命价值,理解生命意义,提高生存质量。