卵巢癌存活者有長期壓力


  【24drs.com】研究者在美國婦產科大會(ACOG)第60屆年會發表指出,卵巢癌存活者在完成治療後5年或更久時,依舊有心理壓力,對於復發之可能性存在有未診斷出的焦慮。
  
  密西根大學的Arvind Bakhru醫師等研究者,調查了在1999-2009年這10年間於密西根大學診斷且治療卵巢癌的女性,所有女性在研究開始前,都進行了6個月以上的治療,有些已經是緩解期達5年以上;每個婦女皆完成「Fear of Cancer Recurrence Inventory (FCRI)」這項問卷,該問卷檢視了對於復發恐懼的誘發因子、恐懼的嚴重度、心理壓力以及應對策略。
  
  研究者比較了調查前接受治療不到3年、治療3-5年,以及調查前已經緩解超過5年婦女等的FCRI結果;結果指出,雖然多數婦女(63.9%)和她們的腫瘤科醫師討論復發風險,只有13.1%表示有寫下有關復發風險的任何事情;雖然復發機會隨著長期緩解顯著降低,存活5年以上的婦女依舊表示會感到心裡壓力。
  
  很少婦女會對她們的家人或朋友吐露有關恐懼的心情,超過59%的調查對象表示她們沒有和其他人談論復發的恐懼,只有6.3%表示參加卵巢癌婦女的支持團體。
  
  參與調查的婦女中,心理壓力、焦慮嚴重度、功能不佳等都隨著時間改善,不過,焦慮誘發因子、有關復發的信心、因應策略等,在緩解不到3年的婦女、調查前治療3-5年者、治療後緩解5年者之間沒有顯著差異。
  
  俄亥俄Summa健康體系婦科專家、婦產科主任Vivian von Gruenigen醫師指出,卵巢癌存活者持續的焦慮和憂鬱情況未獲充分暸解。
  
  Gruenigen醫師表示,密西根大學的研究者對於調查回應率達49%,高出類似研究感到榮幸,但是他們只有使用一種工具測量焦慮,而實際上還有其他方式;當病患在癌症治療後感到焦慮和憂鬱時,她們通常不會向醫師提到這些感覺,醫師們不一定會觸及這些會談。
  
  她指出,值得注意的是,有一部分卵巢癌病患沒有獲得健康照護體系的支持,這些病患看來雖不錯,但是研究指出,這類卵巢癌存活者的心理層面有未被診斷的焦慮和憂鬱。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6826&x_classno=0&x_chkdelpoint=Y
  

Ovarian Cancer Survivors Experience Long-Term Distress

By Barbara Boughton
Medscape Medical News

May 21, 2012 (San Diego, California) — Ovarian cancer survivors continue to have psychological distress even 5 or more years after completing their treatment and have undiagnosed anxiety about the possibility of recurrence, according to researchers here at the American Congress of Obstetricians and Gynecologists (ACOG) 60th Annual Clinical Meeting.

In the study, researchers led by Arvind Bakhru, MD, MPH, University of Michigan, Ann Arbor, surveyed women who had been diagnosed and treated for ovarian cancer at the University of Michigan during a 10-year period (from 1999 to 2009). All the women had been treated more than 6 months before the initiation of the survey, and some had been in remission for more than 5 years. Each woman completed the Fear of Cancer Recurrence Inventory (FCRI), a questionnaire that examines triggers for recurrence fears, severity of fears, psychological distress, and coping strategies.

Researchers compared results from the FCRI for women who had received treatment less than 3 years before the survey, those who had treatment between 3 and 5 years before the survey, and those in remission for more than 5 years.

Results indicated that although most women discussed their recurrence risk with their oncologist (63.9%), only 13.1% reported having anything about recurrence risk written down for them (13.1%). Although the chance of recurrence declines significantly with long-term remission, even women who had survived for 5 years or more years reported experiencing psychological distress years later.

Few women confided even to their family members or friends about their fears. More than 59% of survey respondents said they do not talk with others about their fears of recurrence, and only 6.3% had ever joined a support group for women with ovarian cancer.

Psychological distress, severity of anxiety, and functional impairment all improved with time among the women who took the survey. However, triggers for anxiety, reassurance about recurrence, and coping strategies were not significantly different among those who had been in remission for less than 3 years, those treated between 3 and 5 years before the survey, or even women in remission 5 years after treatment, according to the researchers.

"Ongoing anxiety and depression in our ovarian cancer survivor population is definitely an unmet need," commented Vivian von Gruenigen, MD, chair of obstetrics and gynecology and a specialist in gynecologic oncology at Summa Health System in Akron, Ohio.

"The University of Michigan researchers get kudos for getting such a high response rate to their survey (49%), which is higher than in similar studies. But they also used just one tool for measuring anxiety, when there are others available as well," Dr. von Gruenigen said.

When patients experience anxiety and depression after cancer treatment, they often don't mention these feelings to their doctors, and physicians don't always prompt these conversations, Dr. von Gruenigen said.

"It's worth noting that a subset of the ovarian cancer patients did engage with support in the healthcare system, and these patients tended to do well. But the study points out that there is a psychosocial aspect to ovarian cancer, including undiagnosed anxiety and depression," she added.

Dr. Bakhru and Dr. von Gruenigen have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) 60th Annual Clinical Meeting. Abstract #84. Presented May 8, 2012.

    
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