药学干预结合心理行为干预对接受化疗的结肠癌患者生存质量影响

Effects of pharmaceutical intervention combined with psychological and behavioral intervention on quality of life in colon cancer patients undergoing adjuvant chemotherapy

目的:观察药学干预结合心理行为干预对结肠癌患者辅助化疗期间恶心、呕吐、情绪及生活质量的影响。方法:采用前瞻性研究,184例结肠癌术后患者随机分为干预组(n=92,接受化疗、药学干预结合心理行为干预)和对照组(n=92,接受化疗)。药学干预是针对化疗引起的恶心呕吐,经临床药师优化对症治疗方案和指导用药;心理行为干预由心理医师针对给患者带来压力的因素进行干预。对比两组患者恶心严重程度、呕吐频次、焦虑、抑郁发生率及程度和生活质量。结果:化疗的前3个周期干预组对止吐药物的完全缓解率分别为57.6%、65.2%和67.4%,对照组为34.8%、43.5%和46.7%,明显低于干预组(P=0.002,P=0.0 0 3,P=0.003)。干预组的急性和迟发性恶心症状为Median 4.1和Median 5.3,对照组为Median 8.5和Median 8.8,明显高于干预组(P=0.032,P=0.038);干预组的急性和迟发性呕吐频率(Median 0.4,Median 0.2),对照组为(Median 1.2,Median 0.8),明显高于干预组(P=0.014,P=0.028)。干预组患者在化疗前(基线)时的焦虑自评量表评分(SAS)和抑郁自评量表评分(SDS)总分较对照组差异无统计学意义(P>0.05);干预组患者在化疗前三个周期的SAS和SDS总分较对照组相应周期差异有统计学差异(P<0.05)。生活质量评分:干预组总健康状况评分较对照组高(P=0.031),情绪状况较对照组升高(P=0.023),食欲丧失、恶心和呕吐的症状评分较对照组降低(P=0.025,P=0.029)。结论:心理医师和临床药师对结肠癌患者辅助化疗期间进行心理行为干预及药学干预可减轻患者恶心、呕吐等不良反应,并能改善患者情绪,提高生活质量。

Objective： To investigate the effects of pharmaceutical intervention combined with psychological and behavioral intervention on quality of life in colon cancer patients undergoing adjuvarit chemotherapy. Methods： A co- hort of 184 colon cancer patients, receiving adjuvant chemotherapy were divided into two groups randomly：intervention group（ n=92 ,receiving chemotherapy, pharmaceutical intervention combined with psychological and behavioral inter- vention） and control group （n = 92, receiving chemotherapy）. The pharmaceutical intervention aims at prevent from nausea and vomiting;psychological and behavioral intervention aims at reducing anxiety and depression. Response rate to antiemetics, severity of nausea, frequency of vomiting, prevalence and degree of depression and anxiety and quality of life were compared between the two groups. Results：The complete relief rates of the intervention group to the antemetics were 57.6%, 65.2% and 67.4% in the first three cycle ; those of the control group were 34.8 % ,43.5 % and 46.7 %, which were inferior to those of the intervention group （ P = 0. 002, P = 0.003, P = 0. 003 ）. The symptoms of acute and delayed nausea in the intervention group were Median 4.1 and Median 5.3 ; those in the control group were Median 8.5 and Median 8.8, which were significantly superior to those in the intervention group （ P = 0.032, P = 0.038）. The symptoms of acute and delayed vomiting in the intervention group were Median 0.4 and Median 0.2 ; those in the control group were Median 1.2 and Median 0.8 ,which were significantly superior to those in the interven- tion group（P =0. 014,P =0.028）. There was no statistically difference of the total scores of SAS and SDS between the two groups at baseline（P 〉0.05） ;but there was statistically difference of the total scores of SAS and SDS be- tween the two groups in the first three chemotherapy cycles （P 〈 0.05）. Quality of life evaluation showed that the global health status score and emotion functions score in the intervention group were higher than that in the control group （P = 0.031, P = 0. 023 ）, while the symptom scores in terms of loss of appetite and vomiting/nausea were lower （ P = 0. 025, P = 0. 029）. Conclusion： Pharmaceutical intervention combined with psychological and behavioral inter- vention led by psychologist and clinical pharmacist during adjuvant chemotherapy for colon cancer patients can effec- tively alleviate symptoms including nausea and vomiting, anxiety, depression, and improve the quality of life.