老年头颈恶性肿瘤患者放疗前后心理痛苦状态分析

Analysis of psychological distress in elderly patients with head and neck cancer receiving radiotherapy

目的评估≥60岁老年头颈部恶性肿瘤患者调强放疗(IMRT)前后的心理痛苦情况。方法采用心理痛苦温度计对85例老年头颈部恶性肿瘤患者进行IMRT前、后心理痛苦程度和痛苦问题前瞻性调查。IMRT前后比较采用配对t检验,采用Logistic回归模型分析相关因素。结果全组中位年龄为66岁(60~85岁)。调查显示IMRT前、后有73%、87%患者出现心理痛苦(P<0.001),显著痛苦分别为6%、35%(P<0.001)。IMRT前主要痛苦问题(>10%发生率)为记忆力下降/注意力不集中、担忧、口腔疼痛、经济问题、紧张、睡眠问题和鼻腔干燥,IMRT后显著增加的痛苦问题为口腔疼痛、便秘、进食、恶心和鼻腔干燥。性别(OR=5.520,95%CI为1.437~21.212,P=0.013),疗前PG-SGA评分(OR=1.220,95%CI为1.048~1.421,P=0.010)和是否有医疗保险(OR=0.230,95%CI为0.053~0.995,P=0.049)是IMRT前显著心理痛苦的相关因素,职业(OR=2.286,95%CI为1.291~4.050,P=0.005)和是否拥有医疗保险(OR=0.089,95%CI为0.029~0.276,P<0.001)是IMRT后显著心理痛苦的相关因素。结论老年头颈部恶性肿瘤患者IMRT前痛苦发生率高,IMRT后痛苦加重,主要为治疗相关的痛苦问题。

Objective To evaluate the psychological pain of patients with head and neck cancer aged≥60 years old before and after intensity-modulated radiotherapy(IMRT).Methods Distress Thermometer(DT)(Chinese version)was used to investigate the degree and problems of psychological pain before and after IMRT for 85 elderly patients with head and neck cancer.The results before and after IMRT were compared by paired t-test.Relevant factors were identified by Logistic regression analysis.Results The median age in the cohort was 66 years old(60-85 years old).The incidence rates of psychological pain were 73%and 87%before and after IMRT(P<0.001).The corresponding incidence rates of severe distress were 6%and 34%(P<0.001).The main distress problems before IMRT were memory loss/attention deficit,worry,oral pain,economic problems,stress,sleep problems,and dry nose.The significantly-increased distress problems after IMRT were oral pain,constipation,eating,nausea,and dry nose.Logistic regression analysis showed gender(OR=5.520,95%CI 1.437-21.212,P=0.013),pre-treatment PG-SGA score(OR=1.220,95%CI 1.048-1.421,P=0.010)and medical insurance(OR=0.230,95%CI 0.053-0.995,P=0.049)were the relevant factors of the severe psychological distress before IMRT.Occupation(OR=2.286,95%CI 1.291-4.050,P=0.005)and medical insurance(OR=0.089,95%CI 0.029-0.276,P<0.001)were the relevant factors of severe psychological distress after IMRT.Conclusion The incidence rate of distress is high in elderly patients with head and neck cancer before IMRT,which can be aggravated after IMRT,primarily the treatment-related physical pain problems.