老年癌症患者疼痛管理

面对日益加剧的人口老龄化趋势,国际肿瘤界逐渐意识到老年肿瘤治疗问题的严重性。老年肿瘤患者在被确诊时多已处于晚期,基础疾病多,各脏器功能下降,姑息治疗对老年肿瘤患者显得非常重要,尤其是疼痛治疗。目前,因为对老年人疼痛的认识不足、评估不够、过分担心药物副作用,使得老年癌痛控制现状不容乐观。本文综述了老年癌痛的特点、评估方法及治疗原则,强调对于老年癌症患者治疗的目标不是重返工作或者延长生命,而是尽最大可能地提高生活质量,让老年癌症患者远离癌痛,真正享受到无痛人生。     

老年癌症患者疼痛管理

面对日益加剧的人口老龄化趋势,国际肿瘤界逐渐意识到老年肿瘤治疗问题的严重性.老年肿瘤患者在被确诊时多已处于晚期,基础疾病多,各脏器功能下降,姑息治疗对老年肿瘤患者显得非常重要,尤其是疼痛治疗.目前,因为对老年人疼痛的认识不足、评估不够、过分担心药物副作用,使得老年癌痛控制现状不容乐观.本文综述了老年癌痛的特点、评估方法及治疗原则,强调对于老年癌症患者治疗的目标不是重返工作或者延长生命,而是尽最大可能地提高生活质量,让老年癌症患者远离癌痛,真正享受到无痛人生.     

亚健康的范畴研究

随着自然科学的进步和哲学思想的演进,与之相适应的医学模式也不断地变化发展;现代生物-心理-社会医学模式下肿瘤综合治疗的策略与观念有了很大的变化,不仅注重提高治愈率,而且注重病人生活质量,从以人为本的哲学思想出发,在肿瘤治疗中视生命的存在与生命的价值同样重要。     

认知行为治疗对老年抑郁症病人的生活质量影响研究

将200例老年抑郁患者随机分为研究组和对照组.研究组认知行为治疗联合药物治疗,对照组单纯药物治疗.治疗前后进行CRI、SDSS、GAF等量表评定.6个月后,两组在大体功能、生活满意度、应对方式等方面有显著性差异(P<0.01).认知行为治疗有效改善老年抑郁症病人的应对方式,提高患者的生活满意度.     

认知行为治疗对老年抑郁症病人的生活质量影响研究

将200例老年抑郁患者随机分为研究组和对照组。研究组认知行为治疗联合药物治疗,对照组单纯药物治疗。治疗前后进行CRI、SDSS、GAF等量表评定。6个月后,两组在大体功能、生活满意度、应对方式等方面有显著性差异（P〈0．01）。认知行为治疗有效改善老年抑郁症病人的应对方式,提高患者的生活满意度。     

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     

如何对待糖尿病教育在其防治中的作用

糖尿病教育是指对医护人员、大众和糖尿病病人进行程度不等的糖尿病知识传授、指导和推广。欧美很早以前就已认识到糖尿病教育的重要性 ,目前 ,波士顿的久斯林糖尿病中心进一步认为糖尿病的病人教育就是治疗。如果把治疗糖尿病的 5种手段包括饮食控制、运动、胰岛素、口服降糖药和教育比做 5匹马拉车 ,则糖尿病教育便是驾辕马。为什么要进行糖尿病教育呢 ?随着生产发展、科技进步、生活水平提高 ,生活模式的现代化及社会的老龄化 ,全球范围内糖尿病发病率急剧增加 ,已成为继肿瘤、心脑血管病之后第三位严重危害人类健康的慢性疾病。我国 199…     

晚期消化道肿瘤患者临床治疗的共同决策

胃癌、结直肠癌是临床较常见的消化道肿瘤,其早中期肿瘤手术治疗效果好,但大部分晚期患者已丧失了手术机会,或者手术效果较差,如何让其主动参与进来选择自己的临床治疗方案,从而使自己相对获益最大,具有很重要的临床意义。晚期肿瘤患者临床治疗以提高晚期生活质量、减轻疾病痛苦、延长生存时间为目的,这一过程需要患者的参与,此类患者的每一项临床治疗的决策,应当是在医生指导下,患者主动参与进来,根据自身的实际情况提出治疗方案,临床医生评估其治疗方案可行性之后配合患者完成临床后期治疗,以此来最大限度提高晚期患者的生活水平。     

肿瘤病人生活质量的临床量表评定

肿瘤临床生活质量评定的组合模式,包括两个基本原则：“核心”问卷用于不受癌症种类限制的癌症病人,便于不同研究之间进行比较;诊断特异和／或治疗特异问卷作为核心问卷的附加问卷用于某一种癌症和／或某一种治疗的癌病人,满足临床特殊问题的研究和运用。在组合模式指导下编制的生活质量核心问卷和肺癌附加问卷已成熟地运用于肿瘤临床。     

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。     

Randomized Controlled Trial of Cognitive–Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting

Standard medical treatments have not been effective for irritable bowel syndrome (IBS) patients. Though individualized cognitive–behavior therapy is an empirically supported treatment option, cognitive–behavioral group therapy (CBGT) has yet to be established as an effective alternative in a randomized controlled trial. This study compared the efficacy of a 10-session CBGT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment for IBS, extending previous quasi-experimental research in this area. Twenty-eight refractory IBS patients, evaluated and referred by gastroenterologists using the Rome criteria, participated in the study. IBS symptoms, psychological functioning, and health-related quality of life were assessed pre- and posttreatment, and at 3-month follow-up. CBGT patients reported significantly more gastrointestinal (GI) symptom improvement than SMTC patients on posttreatment global measures and had significantly reduced daily diary pain scores at 3-month follow-up. Based on MANOVA, there was significant improvement in psychological distress and health-related quality of life for the CBGT patients in comparison to the SMTC patients. These improvements were also maintained at the 3-month follow-up. Reductions in GI symptoms, psychological distress, and improved health related quality of life may contribute to less behavioral avoidance, disability, and health care utilization in refractory IBS patients.     

Spiritual coaching in cancer patients: treating the spirit as well as the disease

Interest in the exploration of spirituality in medical practice has been growing recently due to some studies suggesting its role in the improvement of patient well-being and quality of life. This project examined the feasibility of providing spiritual coaching with patients in an outpatient Radiation Oncology clinic setting. The purpose of spiritual coaching was to provide patients with opportunities to explore their current spiritual lives, increase their involvement in spiritually enhancing activities, and expand their spiritual opportunities. Quality-of-life measurements focused on feelings of hopefulness and distress were used in patients undergoing radiation treatment for cancer. This study suggests that there is a potential benefit for spiritual coaching in the care of cancer patients, and future studies will be done to further el ucidate the ationship of spirituality and quality of life in this population.     

When the Analyst Suffers Illness and Loss

This paper describes my struggle to retain my personal and professional identity while undergoing treatment for breast cancer. It would have been easy to slip into being “the tumor in the left breast.” A circumscribed writing project helped, since writing has always been part of my life. Some interactions with patients in treatment were also crucial to my sense of ongoing personhood.     

老年非小细胞肺癌治疗中存在的问题

肺癌已成为危害人类健康和导致死亡的最主要疾病,其中一半以上发生在老年人,且大部分为确诊时已为晚期,针对这些患者的诊断和治疗还存在很多误区,因多病并发所致的诊断延误、因恐惧所致的逃避、以及因对药物的过度依赖而对患者心理因素的忽视等,致使部分老年肺癌患者不能及时得到合理的治疗,值得引起临床医师的重视。     

手术治疗在晚期乳腺癌中的应用价值

乳腺癌已经成为女性最常见的恶性肿瘤。虽然乳腺癌的早期诊断和治疗水平已经得到了很大水平的提高,但是仍有相当一部分患者在诊断时就已经存在远处转移,或者在术后出现局部复发以及远处转移。对于手术治疗在这些晚期乳腺癌患者中的作用,目前还存在很大的争议。本文对相关内容进行了探讨,认为晚期乳腺癌的治疗需要多学科协作的综合治疗,不应该忽视手术这个重要的治疗手段,从而使晚期的患者也能获得长期生存甚至治愈的机会。     

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。     

Alleviation of Side Effects and Distress in Breast Cancer Patients by Cognitive-Behavioral Interventions: A Systematic Review and Meta-analysis

Cognitive and behavioral interventions (CBI) have been used for breast cancer patients with various stages of the disease or undergoing different treatments. However, no quantitative review has summarized their efficacy on the side effects of treatment, distress, and quality of life in the acute treatment setting after diagnosis. This meta-analysis synthesizes data from 19 randomized clinical trials in order to: (a) provide an estimation of overall effect of CBI in breast cancer patients during treatment for breast cancer, i.e., neo-adjuvant and adjuvant treatment; (b) provide average effect sizes on side effects of treatment, distress, and quality of life; and (c) test possible moderators of effect size. The results show that CBI yielded a small effect size overall, specifically on general side effects of treatment, nausea, vomiting, distress, and quality of life. Individual and behavioral interventions seem to elicit better results on distress and on general side effects of treatment, respectively. While more studies are needed with regard to specific side effects (i.e., fatigue, pain, and sleep disturbance), the overall results clearly support the use of CBI in breast cancer patients during treatment.     

关注晚期癌症患者的生活质量

在强调整体医学的今天,在肿瘤治疗尚未出现理想疗效的前提下,肿瘤治疗目标应遵循生存率与生活质量(QOL)并重的原则。在诊治晚期癌症患者过程中不仅要关心他们的生存期,更要关心他们的生活质量。在诊治过程中要根据他们独特的心理和生理特征给予全方位关怀,减轻痛苦、维持生命质量和保证他们应有的人格尊严。