早期肿瘤筛查与例行体检评价

例行体检不同于早期肿瘤筛查。早期肿瘤筛查也称机会筛查,是需要针对不同肿瘤的流行病学与发病特点,进行人群的选择。主要从已发表的文献,目前肿瘤筛查的现状、指南及专家相关建议出发,对早期肿瘤筛查及例行体检的特点做了简单剖析,同时对两者的优缺点等方面做了讨论。在此基础上,突出揭示了如何正确做好肿瘤早期筛查的必要性。结合实际自身情况及现有相关政策的情况下,合理选择筛查方式,将筛查成本效益最大化。     

Conceptual framework from the Paris Psychosomatic School: A clinical psychoanalytic approach to oncology1

This article presents further clinical material from the Paris Psychosomatic School ( Aisenstein, 2006 ). The Freudian foundations of psychosomatics are detailed and post-Freudian developments focusing on the contribution of the Paris Psychosomatic School are outlined, in particular, the somatizing process as a result of regression and the somatizing process as a result of drive unbinding. The authors argue that the latter possibly gives rise to progressive and serious illness leading to death. The relationship of classical psychoanalysis to psychotherapeutic treatment from the angle of the Paris school is commented on. The authors then turn to two clinical presentations of women suffering from breast cancer. The method of evaluating the patients’ capacities for undergoing psychotherapeutic treatment and their mental capacity for healing is discussed. The face-to-face psychoanalytic treatment undertaken with the second case is discussed. Finally, the authors recall Freud’s insistence after 1920 on the opposition of the life drives and the death drives, which placed self-destruction at the centre of psychic functioning. They conclude that current research in biology and medicine, notably research concerning programmed cell death, will converge with psychoanalytic psychosomatics to illuminate somatizing processes and demonstrate the relevance of psychoanalytic treatment to patients who are capable of mental reorganization in the course of their illness and medical treatment.     

Psychological distress and well-being in advanced cancer: The effects of optimism and coping

This study examined the relations among optimism, coping, functional status, and psychological adjustment in 75 adults diagnosed with cancer. Both the positive and the negative aspects of psychological adjustment were assessed. All participants had been diagnosed with advanced stages of cancer (i.e., Stages II, III, and IV). Participants completed three assessments across a 4-month time period. Both optimism and coping were associated with psychological adjustment, even after controlling for functional status and prior adjustment. Additionally, optimism and coping were differentially related to distress and well-being. Optimism was strongly and positively associated with well-being and inversely related to distress. Escape-Avoidance coping was positively associated with distress and Accepting Responsibility coping was negatively associated with well-being. Comparisons between the current and prior studies indicated that individuals who are diagnosed with more advanced stages of cancer or who have survived bone marrow transplantation exhibit higher levels of optimism than do healthy individuals and individuals with early-stage disease.     

Cowden Syndrome

Cowden syndrome is an autosomal dominant inherited cancer syndrome characterized by multiple hamartomas which may develop in any organ. Mucocutaneous papillomas and trichilemmomas are hallmarks of the syndrome. Affected individuals are at high risk of developing both benign and malignant disease of the thyroid and breast. Epithelial thyroid carcinoma occurs in 3–10% of affected individuals while women have a 25–50% lifetime risk of developing adenocarcinoma of the breast. Because of the cancer risk, it is imperative that health care providers recognize Cowden syndrome. The susceptibility gene has been localized to 10q22-23 and preliminary studies demonstrate no genetic heterogeneity.     

EVALUATION OF TWO HEALTH EDUCATION STRATEGIES FOR TESTICULAR SELF-EXAMINATION

We evaluated the effects of two health education teaching methods, a pamphlet based on a task-analyzed checklist and two professionally developed films, on the completeness, accuracy, and maintenance of testicular self-examinations (TSE). Subjects (N = 48) were videotaped while performing a TSE after training and at a follow-up visit. Direct observation of the tapes showed that checklist-based training resulted in more complete and longer TSEs (p < .05). Social validation ratings, however, suggested that physicians were unable to discriminate reliably the performances of subjects taught using the two methods. Accuracy of detection of simulated lesions on plastic models was also similar for the two groups. Adherence to TSE recommendations was high during the study, but declined across the follow-up period. Further study is needed to promote adherence to TSE and to document the effects of early detection on morbidity and mortality of testicular cancer.     

Managing stress and managing illness: Survival and quality of life in chronic disease

Interest has been steadily building in the impact of stress on psychological and physiological functioning, in particular on immune system responses, furthering the concept of a strong connection between the mind and the body. Implications for prevention of disease onset or treatment of stress-induced illness or immunocompromised conditions have been explored through the implementation of stress management techniques. Cognitive behavioral stress management interventions, biofeedback, relaxation, guided imagery, hypnosis, individual and group psychotherapy, aerobic exercise, and guided self-efficacy treatment are briefly reviewed to identify possible treatment mechanisms that may affect immune function and promote quality of life. The application of behavioral techniques to reduce distress and sharpen coping skills has great promise in reducing the costs associated with chronic disease and in enhancing quality of life among those afflicted.Presented at the APA Presidential Miniconvention, To Your Health: Psychology Through the Life Span, Session VIII, Assuring a Healthy Lifestyle: Psychology Delivers. Chair: Diane J. Willis, Ph.D. The third author received partial funding through the Terry Fox Research Fellowship 5257, National Cancer Institute of Canada.     

The interface between physical and mental disorders: The need to dismantle the biopsychosocialneuroimmunological model of disease

This article argues for the necessity of cognitive-behavioral assessment for a thorough understanding of how psychological factors mediate disease process across a wide range of diseases including coronary artery disease, breast cancer, and human immunodeficiency disease. Based on empirical data presented as part of the APA Presidential miniconvention, “To Your Health: Psychology through the Life Span,” the conclusion is that psychological treatment can help extend life. Stress management programs can positively influence adherence to treatment regimens and positively influence the human immune system response during the course of treatment and recovery from illness. Even in the face of life-threatening circumstances such as liver transplantation, Stage II and III breast cancer, and after HIV infection has been diagnosed, the quality of life can be remarkably improved. Physicians and psychologists must work together to produce the beneficial effects of the synergy between mind-body processes.     

Test-retest reliability and concurrent validity of the Morrow Assessment of Nausea and Emesis (MANE) for the assessment of cancer chemotherapy-related nausea and vomiting

The present study evaluated the concurrent validity of two assessment approaches for the measurement of cancer chemotherapy-related nausea and vomiting. The results indicated that the concurrent validity between the Morrow Assessment of Nausea and Emesis (MANE; Morrow, 1984b) and continuous self-monitoring and the reliability on the MANE were moderate. The heterotrait-monomethod and heterotrait-heteromethod matrices demonstrated moderate correlations among the frequency, severity, and duration of anticipatory nausea and vomiting as well as high correlations among the frequency, severity, and duration of posttreatment nausea and vomiting. Additionally, the heterotrait-monomethod matrices show a number of correlations above chance between anticipatory and posttreatment symptoms. The results are discussed in light of future research endeavors.This research was supported in part by Research Grant IN-150 from the American Cancer Society.     

Development and Feasibility of a Group Cognitive-Behavioral Therapy for Fear of Cancer Recurrence

This paper describes the development, content, and preliminary results of a group cognitive-behavioral therapy (CBT) for fear of cancer recurrence (FCR). A manualized CBT intervention was developed and offered to 38 patients with various cancer types and stages in two hospitals. Four weekly group CBT sessions were administered by two licensed psychologists as part of routine care. Patients completed self-report scales before the first treatment session and, a second time, 1 month after the last session.Overall, 33 patients had clinical levels of FCR at baseline. The participants’ satisfaction toward the group CBT for FCR was high. Significant reductions on the total score and most subscales of the Fear of Cancer Recurrence Inventory (FCRI) were observed, as well as significant improvements on most of the other psychological variables measured (i.e., insomnia, anxiety, depression, dysfunctional beliefs about cancer, and intolerance of uncertainty). In addition, 52% of the patients with clinical levels of FCR (FCRI-severity subscale score ≥ 13) at baseline no longer reached this clinical threshold at posttreatment.These preliminary results suggest that our group CBT for FCR is well accepted and feasible, and shows promising efficacy for decreasing FCR and improving other psychological variables among cancer patients. The next step is to investigate the efficacy of this minimal intervention in larger and controlled clinical trials, as well as its usefulness as part of a stepped care approach.This low-cost intervention is easy to implement in various clinical settings and has a strong potential to help large numbers of patients with FCR.