早中期肝癌诊断告知与患者应激水平的前瞻性研究

A prospective study on impact of disclosure/concealment of diagnosis on stress level in patients with liver cancer

目的:前瞻性研究告知或隐瞒癌症诊断对患者的应激水平的影响。方法:对300例早中期肝癌住院患者,按是否被告知癌症诊断自然分组为告知组162例、隐瞒组138例,在入院时、出院时、出院后1个月和3个月及6个月时,以创伤后应激障碍筛查量表-居民版进行测评,并检测血清皮质醇浓度。结果:隐瞒组于出院后1个月、6个月时,分别有84.1%、91.3%的患者通过自己的方式获知了癌症诊断。出院后1个月时,创伤后应激症状评分告知组低于隐瞒组[(27.0±7.9)vs.(30.3±7.7),P<0.001],血清皮质醇浓度告知组低于隐瞒组[(682.8±263.8)μmol/L vs.(754.3±218.1)μmol/L,P=0.012]。与入院或出院时相比,告知组出院后1个月时的创伤后应激症状评分降低、血清皮质醇浓度下降(均P<0.001);隐瞒组出院后3个月时上述两项指标的下降有统计学意义(均P<0.001)。结论:被隐瞒癌症诊断者出院后1个月的创伤后应激症状更重、血清皮质醇浓度更高。提示告知诊断更有利于癌症患者从创伤后应激状态中恢复。

Objective:To evaluate the impact of disclosure of cancer diagnosis on the stress level in patients with primary liver cancer(PLC).Methods:In this prospective study,300patients with early or intermediate stage PLC were recruited.According to whether the cancer diagnosis was disclosed to the patient,the participants were classified into the disclosed group(162patients)and the uninformed group(138patients).The patients'post-traumatic stress symptoms(PTSS)were evaluated and serum cortisol concentrations were tested at the time of admission,discharge,at 1month,3months,and 6months after discharge.Results:In the uninformed group,84.1%of patients at 1month and 91.3%at 6months after discharge had known the diagnosis of PLC by their own way.Compared with the uninformed group,patients in the disclosed group had lower PTSS scores[(27.0±7.9)vs.(30.3±7.7),P<0.001]and lower serum cortisol concentration[(682.8±263.8)umol/L vs.(754.3±218.1)umol/L,P=0.012]at 1month after discharge.The PTSS score and the serum cortisol concentration significantly decreased at 1month after discharge compared with that at admission or discharge for patients in the disclosed group(Ps<0.001),whereas these figures were significantly declined at 3months after discharge for patients in the uninformed group.Conclusions:It indicates that disclosure rather than concealment of diagnosis is beneficial for cancer patients to reduce PTSS and serum cortisol concentration.