伴有抑郁障碍的晚期癌症住院患者的症状频率及强度调查

A survey on symptom frequency and intensity in hospitalized advanced cancer patients with depressive disorder

目的探讨伴有抑郁障碍的晚期癌症患者的症状频率及强度,并分析抑郁与症状的关系。方法采用埃德蒙顿症状评估量表(ESAS)与抑郁自评量表(SDS)对196例晚期癌症住院患者进行调查。使用卡方检验及秩和检验比较伴有抑郁与无抑郁患者的症状发生频率及症状强度;抑郁与症状间的相关性分析用Spearman相关分析。结果 196例晚期癌症患者中76例(38.8%)伴有抑郁障碍(SDS评分≥53)。与无抑郁患者比较,伴有抑郁障碍的晚期癌症患者发生频率显著增加的症状依次为:自我感觉差(98.7%vs.86.7%,P=0.029)、食欲下降(97.3%vs.74.2%,P=0.002)、疼痛(94.7%vs.63.3%,P<0.001)、焦虑(84.2%vs.49.2%,P<0.001)、气短(84.2%vs.71.7%,P=0.021)、瞌睡(73.7%vs.55.8%;P=0.006)及恶心(61.8%vs.38.3%,P<0.001);而在症状强度(ESAS评分≥1)上则依次为自我感觉差、乏力、食欲下降、焦虑以及气短(P<0.05)。Spearman相关分析显示,SDS与ESAS各症状间呈正相关,其中SDS与抑郁、乏力及焦虑呈高度正相关(相关系数r分别为0.57、0.52及0.51,P均<0.001)。结论伴有抑郁障碍的晚期癌症住院患者普遍存在严重的症状负荷。对症状频率和强度的认识有助于发现抑郁障碍并采取干预措施,从而进一步提高患者的生活质量。

Objective To investigate the frequency and intensity of symptoms in hospitalized advanced cancer patients with de-pressive disorder, then the relationship between these symptoms and depression was analyzed.Methods One hundred ninety-six patientswere surveyed by Edmonton Symptom Assessment System（ ESAS） and Self-Rating Depression Scale（ SDS）. Chi-Square test andWilcoxon rank-sum test were used respectively to compare the incidence and intensity of the patients with and without depressive symp-toms, and Spearman correlation coefficients was used for the analysis of correlation between depression and symptoms.Results In 196 patients, 76（38. 8%） patients had depressive disorder（SDS≥53）. Compared with the patients without depressive symptoms, the highfrequent symptoms expressed by patients with depressive disorder were worse well-being（98. 7%vs.86. 7%,P= 0. 029）, worse appetite（97. 3%vs.74. 2%,P= 0. 002）, pain（94. 7%vs.63. 3%,P〈0.001）, anxiety（84. 2%vs.49. 2%,P〈0.001）, dyspnea（84. 2%vs.71. 7%,P= 0. 021）, drowsiness（73. 7%vs.55. 8%;P= 0. 006） and nausea（61. 8%vs.38. 3%,P〈0.001）, respectively. However, thesepatients with depressive disorder expressed higher intensity of symptoms（ESAS≥1）[median（P25-P75）]including worse well-being[7（5-8）,P〈0.001], fatigue[7（5-8）,P〈0.001], worse appetite[6（4-8）,P= 0. 010], anxiety[5（3-7）,P〈0.001], and dyspnea[5（3-7）,P= 0. 019]. Spearman.s correlation analysis showed that there was a significant association between SDS and other symptoms in theESAS. Correlation coefficients of SDS with depression, fatigue and anxiety were 0. 57, 0. 52 and 0. 51, respectively（P〈0.001）.Conclusion Expression of symptom burdens may be higher and more severe in hospitalized advanced cancer patients with depression. Theawareness of symptom frequency and intensity not only help us to identify depression and make some interventions, but also help us totake more concern about the severe symptoms, so as to improve the quality of life of cancer patients.