为生殖系统恶性肿瘤治疗后康复期间出现神经精神症状的妇女提供综合心理治疗支持的算法

D. V. Blinov, A. G. Solopova, E. E. Achkasov, E. S. Akarachkova, O. V. Kotova, S. A. Akavova, V. N. Galkin, G. K. Bykovshchenko, L. N. Sandzhieva, D. I. Korabelnikov, T. A. Blbulyan, D. A. Petrenko, A. Yu. Vlasina
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The algorithm for the provision of comprehensive psychotherapeutic support included clinical interview, cognitive behavioral therapy, visualization, audio therapy, art therapy, group and individual psychotherapy, family psychotherapy, image therapy. The QoL indicators were determined by questionnaires using the Functional Assessment of Cancer Therapy – General (FACT-G) with nosology-specific extensions (subscales of physical well-being, social/family well-being, emotional wellbeing and functional well-being), Hospital Anxiety and Depression Scale (HADS), Kupperman–Uvarova Modified Menopausal Index (MMI). The follow-up period was 1 year after radical surgical treatment of reproductive system MNs in different localizations. The main group received the algorithm for the provision of comprehensive psychotherapeutic support as part of active medical rehabilitation, the comparison group received basic rehabilitation.Results. The study included 47 women with vulvar cancer (VC): active rehabilitation group (VC-1) – 24 patients and basic rehabilitation group (VC-2) – 23 patients; 61 women with endometrial cancer (EC): active rehabilitation group (EC-1) – 29 patients and basic rehabilitation group (EC-2) – 32 patients; 103 women with cervical cancer (CC): active rehabilitation group (CC-1) – 51 patients and basic rehabilitation group (CC-2) – 52 patients; 62 women with stages I–II ovarian cancer (OC) and low malignant potential tumor (LMPT): active rehabilitation group (LMPT-1) – 29 patients and basic rehabilitation group (LMPT-2) – 33 patients. Differences in physical, social/family and functional well-being (FACT-G) were significant from the 6th month and in emotional well-being – by the end of follow-up. 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引用次数: 0

摘要

背景。女性生殖系统恶性肿瘤(MNs)的根治性治疗往往有严重的后果。慢性疼痛综合征、痛苦、焦虑和抑郁、自尊心下降、性功能障碍和社会适应不良会降低生活质量,需要心理治疗支持。目的:建立生殖系统MNs治疗后康复期间提供综合心理治疗支持的算法,并评估其对女性神经精神障碍患者生活质量指标的影响。材料和方法。提供综合心理治疗支持的算法包括临床访谈、认知行为治疗、可视化、音频治疗、艺术治疗、团体和个人心理治疗、家庭心理治疗、图像治疗。生活质量指标通过问卷调查确定,问卷采用癌症治疗功能评估-一般(FACT-G)和病种特异性扩展(身体健康、社会/家庭健康、情绪健康和功能健康亚量表)、医院焦虑和抑郁量表(HADS)、kupman - uvarova修正绝经指数(MMI)。随访时间为不同部位生殖系统MNs根治性手术后1年。主要组接受算法提供的综合心理治疗支持作为积极医学康复的一部分,对照组接受基础康复。本研究纳入47例女性外阴癌患者:主动康复组(VC-1) 24例,基础康复组(VC-2) 23例;61例女性子宫内膜癌(EC):积极康复组(EC-1) 29例,基础康复组(EC-2) 32例;103例宫颈癌妇女:主动康复组(CC-1) 51例,基础康复组(CC-2) 52例;62例I-II期卵巢癌(OC)合并低恶性潜能肿瘤(LMPT)患者:积极康复组(LMPT-1) 29例,基础康复组(LMPT-2) 33例。从第6个月开始,在身体、社会/家庭和功能健康(FACT-G)方面的差异是显著的,在随访结束时,在情绪健康方面的差异也是显著的。根据kupman - uvarova MMI的评估,神经植物性和心理情绪障碍在接受提供综合心理治疗支持的算法的妇女中显示出显著的积极动态,与对照组相比,这些指标在随访期结束时仍然没有显著的动态或恶化。随访6 - 12个月时,心理治疗支持期间的HADS评分降至正常值,而接受基础康复治疗的患者仍存在亚临床焦虑和抑郁。作为接受生殖系统MNs (VC, EC, CC, OC和LMPT)根治治疗的妇女积极医学康复的一部分,开发的心理治疗支持算法已经证明其有效性,证明其在临床实践中的实施是合理的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Algorithm for the provision of comprehensive psychotherapeutic support to women experiencing neuropsychiatric symptoms during rehabilitation following the treatment of malignant neoplasms of the reproductive system
Background. Radical treatment of malignant neoplasms (MNs) of female reproductive system often has serious consequences. Chronic pain syndrome, distress, anxiety and depression, decreased self-esteem, sexual dysfunction and social maladjustment reduce quality of life (QoL) and require psychotherapeutic support.Objective: to create an algorithm for the provision of comprehensive psychotherapeutic support during rehabilitation following the treatment of reproductive system MNs and to evaluate its effect on QoL indicators in women with neuropsychiatric disorders.Material and methods. The algorithm for the provision of comprehensive psychotherapeutic support included clinical interview, cognitive behavioral therapy, visualization, audio therapy, art therapy, group and individual psychotherapy, family psychotherapy, image therapy. The QoL indicators were determined by questionnaires using the Functional Assessment of Cancer Therapy – General (FACT-G) with nosology-specific extensions (subscales of physical well-being, social/family well-being, emotional wellbeing and functional well-being), Hospital Anxiety and Depression Scale (HADS), Kupperman–Uvarova Modified Menopausal Index (MMI). The follow-up period was 1 year after radical surgical treatment of reproductive system MNs in different localizations. The main group received the algorithm for the provision of comprehensive psychotherapeutic support as part of active medical rehabilitation, the comparison group received basic rehabilitation.Results. The study included 47 women with vulvar cancer (VC): active rehabilitation group (VC-1) – 24 patients and basic rehabilitation group (VC-2) – 23 patients; 61 women with endometrial cancer (EC): active rehabilitation group (EC-1) – 29 patients and basic rehabilitation group (EC-2) – 32 patients; 103 women with cervical cancer (CC): active rehabilitation group (CC-1) – 51 patients and basic rehabilitation group (CC-2) – 52 patients; 62 women with stages I–II ovarian cancer (OC) and low malignant potential tumor (LMPT): active rehabilitation group (LMPT-1) – 29 patients and basic rehabilitation group (LMPT-2) – 33 patients. Differences in physical, social/family and functional well-being (FACT-G) were significant from the 6th month and in emotional well-being – by the end of follow-up. Neurovegetative and psycho-emotional disorders, as assessed by Kupperman–Uvarova MMI, showed significant positive dynamics in women who received the algorithm for the provision of comprehensive psychotherapeutic support, in contrast to the comparison group, where these indicators remained without significant dynamics or worsened by the end of the follow-up period. The HADS scores during psychotherapeutic support decreased to normal values at the 6–12th months of follow-up, while those who received the basic rehabilitation continued to have subclinical anxiety and depression.Conclusion. The developed algorithm for psychotherapeutic support as part of active medical rehabilitation of women who underwent radical treatment for reproductive system MNs (VC, EC, CC, OC, and LMPT) has demonstrated its effectiveness, justifuing its implementation in clinical practice.
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