非小细胞肺癌的综合诊治策略——NCCN肿瘤学临床实践指南（2006第二版）评析

肺癌目前位于世界肿瘤死亡原因的首位。肺癌的治疗应根据临床不同的分期,选择规范化的治疗方案。肺癌规范化综合治疗可使早期肺癌患者5年生存率达50%~70%左右。中晚期达到25%左右。美国NCCN肿瘤学临床实践指南在2006年发布了第二版非小细胞肺癌治疗方案,对于规范化治疗肺癌以及提高肺癌病人生存率和生存质量有着积极的意义。     

癌症患者生存质量研究进展

随着癌症患者生存时间和生存人数的增加,生存者本人和家属更加重视生存质量。本文总结分析近年来国内外癌症患者生存质量的研究状况,以期在癌症治疗过程中,不仅关注躯体功能和疾病本身以及由治疗带来的症状和体征,同时注重心理和社会职能。     

癌症患者家属人格特征、应对方式与消极情绪的关系

为探讨癌症患者家属人格特征、应对方式与消极情绪的关系,对128例癌症患者家属进行调查。结果显示,神经质、消极应对方式、癌症危险认知与消极情绪呈显著正相关;积极应对方式、外向与消极情绪呈显著负相关;外向、神经质、癌症危险认知、消极应对方式均影响癌症患者家属的消极情绪,而消极应对方式为神经质人格特征、癌症危险认知和消极情绪的中间变量。     

癌症患者人格类型及其与应对策略、社会支持的关系

该研究旨在调查和分析癌症患者人格类型及其与应对策略、社会支持的关系。采用艾森克人格问卷简式量表、社会支持评定量表、医用应对问卷等测查工具对205名癌症病人进行调查。结果显示:1.癌症患者可以聚类为两类人格:温和健康型和身心障碍型;2.身心碍型患者的屈服应对显著高于温和健康型患者;3.身心障碍型患者的客观社会支持和主观社会支持都显著低于温和健康型患者。研究表明,癌症患者可分为温和健康型和身心障碍型两种人格类型。身心障碍型患者采用更多的屈服应对,同时获得的社会支持也更少。     

Factors Influencing Perceptions of Breast Cancer Genetic Counseling among Women in an Urban Health Care System

The study assessed perceptions of breast cancer genetic counseling. Focus groups were conducted with twenty women (ages < = 50 years) in a Midwestern, urban health system identified as at above average risk of developing hereditary breast cancer and referred for breast cancer genetic counseling following mammography. All participants associated the words “breast cancer” with fear. African American women who received breast cancer genetic counseling may have channeled their fear into increased vigilance related to breast health. African American women who did not receive breast cancer genetic counseling were most knowledgeable about it. In contrast, Caucasian women who did not receive it reported uncertainty about the role of genetic counseling and testing in assessing breast cancer risk, mistrust in medical professionals, and lack of trust in the accuracy of genetic tests. The results could be used to help develop interventions to improve informed decision-making regarding breast cancer genetic counseling.     

Knowledge and Expectations of Women Undergoing Cancer Genetic Risk Assessment: A Qualitative Analysis of Free-Text Questionnaire Comments

Individuals undergoing cancer genetic risk assessment have been found to have a poor understanding of the process, which may affect how well they cope with learning their risk. This paper reports free-text data from questionnaires completed by women undergoing a randomised controlled trial of a psychological intervention. Of the 268 women undergoing genetic assessment for familial breast/ovarian cancer risk who were invited to take part in the trial, 157 women returned research questionnaires. Of these, 97 women provided free-text comments upon referral to a cancer genetics clinic, 62 provided comments whilst waiting for risk information (average, moderate or high), and 36 women provided comments following notification of risk. This paper reports a thematic analysis of the free-text data. Themes reflected individuals’ poor knowledge and uncertainty about genetic risk assessment. How well individuals responded to learning their risk depended upon whether expectations had been met. Regardless of risk, individuals undergoing cancer genetic risk assessment are likely to benefit from increased information about its process and timescales, and access to increased psychological support. Free-text comments can provide valuable data about individuals’ expectations and knowledge of genetics services.     

Burnout in Mothers and Fathers of Children Surviving Brain Tumour

The aim of this paper was to investigate the occurrence of burnout among parents of brain tumour survivors. Burnout was assessed in 24 mothers and 20 fathers of childhood brain tumour survivors, using the Shirom–Melamed Burnout Questionnaire. Parents of children with no history of chronic or serious diseases served as a reference group. Mothers’ burnout scores were significantly higher compared with reference mothers. For fathers, no relation between burnout and being a parent of a brain tumour survivor was established, despite a nonsignificant tendency in the same direction as for the mothers. In conclusion, the parenting burden after a child’s brain tumour may include chronic strain, and this may be particularly taxing for mothers. The findings encourage further studies of psychological exhaustion among parents of children with special needs.     

Disclosure of Genetics Research Results after the Death of the Patient Participant: A Qualitative Study of the Impact on Relatives

When a gene mutation is identified in a research study following the death of the study participant, it is not clear whether such information should be made available to relatives. We report here an evaluation of the impact on relatives of being informed of study results that detected pathogenic BRCA2 mutations in a male relative, now deceased, who had early onset (under the age of 55) prostate cancer. The breast and ovarian cancer risk was unknown to the living relatives. Qualitative analysis of interviews with thirteen relatives indicated that those who had a higher risk perception, resulting from an awareness of cancer family history or experiential knowledge of cancer in their family, tended to adjust more easily to the results. All participants believed that genetics research results of clinical significance should be fed back to relatives. Those who were fully aware of the BRCA2 results and implications for themselves felt they had benefited from the information, irrespective of whether or not they had elected for genetic testing, because of the consequent availability of surveillance programs. Initial anxiety upon learning about the BRCA2 result was alleviated by genetic counselling. Factors influencing those who have not engaged with the information included scepticism related to the relative who attempted to inform them, young age and fear of cancer. Those who had not sought genetic counselling did not attempt further dissemination, and some were not undergoing regular screening. Implications for informed consent in genetics research programs, and the requirement for genetic counselling when research results are disclosed, are discussed. Names have been changed to protect the privacy of study participants.     

Distress and Family Functioning in Oncogenetic Counselling for Hereditary and Familial Breast and/or Ovarian Cancers

We conducted a psychological assessment during oncogenetic counseling for hereditary breast/ovarian cancer. Anxiety and depression were assessed with the HAD scale, and family functioning and satisfaction with FACES III. HAD was administered at baseline (t ₁)_, at risk communication (t ₂), at genetic test result communication, or at first surveillance in not tested subjects (t ₃); FACES III was administered at baseline only. We analysed a total of 185 questionnaires administered to the 37 subjects studied. Although not pathological, distress was significantly higher at t ₂ and t ₃ (p = 0.027 and p = 0.039, respectively). Health and marital status were significantly associated with distress. In a disease-free condition, anxiety was higher (p = 0.027) at t _2, and for single status, depression increased from t ₁ to t ₂ (p = 0.026). Families were perceived to be well functioning, and subjects were satisfied with their families. The data collected in this analysis could help to improve the quality of oncogenetic counselling in clinical practice.     

心理干预在放疗患者中的应用

探讨通过实施恰当的心理行为治疗,尤其是教育性干预措施,达到改善放疗患者情绪、提高其生活质量以及降低治疗负反应的效果.采用病例对照的临床研究方法,选用生活质量和心境问卷对160名正在进行放射治疗的住院癌症病人进行了心理干预的比较研究.结果表明,干预组患者的总体情绪和总体生活质量状况,比对照组患者有明显的改善,但愤怒、认知功能以及恶心呕吐症状在两组间的差异不显著;干预组组内比较中,角色功能没有显著性差别.其原因有待于进一步研究.