ASSESSMENT OF DISTRESS DYNAMICS AND QUALITY OF LIFE OF CANCER PATIENTS AT THE STAGE OF RADIATION THERAPY AND POSSIBILITIES OF THEIR CORRECTION.

M V Krasnoselskyi, O O Kyrylova, T V Rublova, A V Svynarenko, S V Artiukh
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The level of anxiety in Group 1 at the pathological and subclinical level was recorded in 54.55 % of patients, the rate of depression at the subclinical level was diagnosed in 18.20 %, and in 9.10 % of patients at the clinical one. In Group 2, the level of anxiety that exceeded the norm was recorded significantly less often (27.25 % vs. 54.55 %, pt < 0.05), and the rate of depression at the subclinical level was diagnosed significantly more often than in Group 1 (54.50 % vs. 18.20 %, pt < 0.05), and in 18.2 % of patients at the clinical level. After radiation, 81.81 % of Group 1 patients showed an increase in distress and anxiety, and depressive symptoms tended to worsen. The level of distress in Group 2 after consulting a psychologist in preparation for RT and undergoing radiation procedures decreased almost twice, the level of anxiety decreased to normal, the indicators of depressive symptoms remained unchanged. According to QOL assessments on the scales of physical and role functioning (PF and RP), general health (GH) and mental health (MH), patients in both groups had significantly lower scores before the RT than in the comparison groups. After the procedures, there was a significant deterioration in the RP scale in Group 1 (18.75 vs. 40.00, pt < 0.05), and an improvement of almost 2 times in Group 2 (35.73 vs. 68.33, pt < 0.06). The indicator of general health (GH) at the end of RT in Group 1 did not change, and in Group 2 it tended to improve (20.93 vs. 47.26, pt < 0.06). Life expectancy (LE) in Group 1 tended to decrease further after treatment, having increased 1.7 times in Group 2.</p><p><strong>Conclusions: </strong>The study showed that cancer patients before the onset of RT experienced a rather strong distress and level of anxiety. 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引用次数: 0

Abstract

Radiation therapy (RT) is the main type of antitumor treatment in inoperable patients. Low awareness and fear of the development of radiation reactions contributes to the destabilization of psycho-emotional state of patients, which can result in withdrawal from treatment and deterioration of their quality of life (QOL). Despite a steady increase in cancer rates in Ukraine, there are currently no studies to develop measures to improve psychological condition of patients undergoing treatment in radiation therapy departments.

Objective: to assess the dynamics of psycho-emotional status and QOL of cancer patients at the stage of radiation therapy.

Materials and methods: The study involved psychodiagnostic examination of 66 cancer patients who underwent radiation treatment in the clinic of the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the NAMS of Ukraine», of whom Group 1 included 44 patients with head and neck cancer, Group 2 comprised 22 patients with colorectal cancer. Comparison group comprised 30 conditionally «healthy» respondents without cancer. All patients had stage III-IV cancer. The study implied the employment of «Distress Thermometer», Hospital Anxiety and Depression Scale (HADS), and the SF-36 Questionnaire (Short Form). The examination was performed before and following the course of radiation therapy. Group 1 patients underwent only psychodiagnostic examination, Group 2 patients apart from psychodiagnostic were accompanied by a psychologist before undergoing radiation procedures. In the comparison group, the survey was conducted once.

Results and discussion: Assessment of the data showed that before the start of RT most subjects (72.73 % in Group 1 and 77.3 % in Group 2) had a high level of distress, they were worried and nervous before the first radiation procedure, had fears about the consequences and side effects. The level of anxiety in Group 1 at the pathological and subclinical level was recorded in 54.55 % of patients, the rate of depression at the subclinical level was diagnosed in 18.20 %, and in 9.10 % of patients at the clinical one. In Group 2, the level of anxiety that exceeded the norm was recorded significantly less often (27.25 % vs. 54.55 %, pt < 0.05), and the rate of depression at the subclinical level was diagnosed significantly more often than in Group 1 (54.50 % vs. 18.20 %, pt < 0.05), and in 18.2 % of patients at the clinical level. After radiation, 81.81 % of Group 1 patients showed an increase in distress and anxiety, and depressive symptoms tended to worsen. The level of distress in Group 2 after consulting a psychologist in preparation for RT and undergoing radiation procedures decreased almost twice, the level of anxiety decreased to normal, the indicators of depressive symptoms remained unchanged. According to QOL assessments on the scales of physical and role functioning (PF and RP), general health (GH) and mental health (MH), patients in both groups had significantly lower scores before the RT than in the comparison groups. After the procedures, there was a significant deterioration in the RP scale in Group 1 (18.75 vs. 40.00, pt < 0.05), and an improvement of almost 2 times in Group 2 (35.73 vs. 68.33, pt < 0.06). The indicator of general health (GH) at the end of RT in Group 1 did not change, and in Group 2 it tended to improve (20.93 vs. 47.26, pt < 0.06). Life expectancy (LE) in Group 1 tended to decrease further after treatment, having increased 1.7 times in Group 2.

Conclusions: The study showed that cancer patients before the onset of RT experienced a rather strong distress and level of anxiety. Psychological correction of the emotional state at the beginning of treatment allowed for a significant improvement in the QOL of patients on the scales of role physical functioning (RF) and vitality (VT). An important area of work of a clinical psychologist at this stage of treatment involved correction of cognitive sphere, support of role functioning and formation of behavior aimed at further treatment.

评估癌症患者在放射治疗阶段的痛苦动态和生活质量,以及矫正的可能性。
放射治疗(RT)是无法手术患者的主要抗肿瘤治疗类型。对辐射反应发展的低意识和恐惧会导致患者心理情绪状态的不稳定,从而导致患者退出治疗并降低生活质量。尽管乌克兰癌症发病率稳步上升,但目前还没有研究制定措施来改善在放射治疗部门接受治疗的患者的心理状况。目的:了解癌症患者放射治疗阶段的心理运动状况及生活质量动态。材料和方法:该研究对66名癌症患者进行了心理诊断检查,这些患者在国家组织“乌克兰NAMS Grigoriev医学放射和肿瘤研究所”的诊所接受了放射治疗,其中第1组包括44名癌症头颈部患者,第2组包括22名癌症患者。对照组由30名无癌症的有条件“健康”受访者组成。所有患者均为癌症III-IV期。该研究采用了“痛苦温度计”、医院焦虑抑郁量表(HADS)和SF-36问卷(简式)。检查在放射治疗前后进行。第1组患者仅接受了心理诊断检查,第2组患者除接受心理诊断外,在接受放射治疗前由心理医生陪同。在对照组中,进行了一次调查。结果和讨论:数据评估显示,在放疗开始前,大多数受试者(第一组72.73%,第二组77.3%)都有高度的痛苦,他们在第一次放疗前感到担忧和紧张,担心后果和副作用。在第1组中,54.55%的患者在病理和亚临床水平上表现出焦虑水平,18.20%的患者在亚临床水平下诊断出抑郁,9.10%的患者在临床水平上诊断出抑郁。在第2组中,超过正常水平的焦虑程度被记录的频率明显较低(27.25%对54.55%,pt<0.05),亚临床水平的抑郁症被诊断的频率明显高于第1组(54.50%对18.20%,pt<0.05)和18.2%的临床水平患者。放射治疗后,81.81%的第1组患者表现出痛苦和焦虑的增加,抑郁症状趋于恶化。在咨询心理医生准备RT和接受放射治疗后,第2组的痛苦程度下降了近两倍,焦虑程度降至正常,抑郁症状指标保持不变。根据对身体和角色功能(PF和RP)、一般健康(GH)和心理健康(MH)量表的生活质量评估,两组患者在RT前的得分均显著低于对照组。手术后,第1组RP量表显著恶化(18.75 vs.40.00,pt<0.05),第2组改善了近2倍(35.73 vs.68.33,pt<0.06)。第1组RT结束时的总体健康指标(GH)没有变化,在第2组中,预期寿命(LE)趋于改善(20.93 vs.47.26,pt<0.06)。第1组的预期寿命在治疗后进一步下降,第2组增加了1.7倍。结论:研究表明,癌症患者在RT发病前经历了相当强烈的痛苦和焦虑。在治疗开始时对情绪状态进行心理矫正,可以显著改善患者在角色-身体功能(RF)和活力(VT)方面的生活质量。临床心理学家在这一治疗阶段的一个重要工作领域涉及认知领域的矫正、角色功能的支持和旨在进一步治疗的行为形成。
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Problemy radiatsiinoi medytsyny ta radiobiolohii
Problemy radiatsiinoi medytsyny ta radiobiolohii Medicine-Radiology, Nuclear Medicine and Imaging
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