应对方式对早期肺癌幸存者焦虑情绪的影响

Effect of coping on anxiety in lung cancer survivors of early stage

目的:探索不同应对方式对早期肺癌幸存者焦虑情绪的动态变化趋势。方法:本研究为纵向研究设计,以143例新近确诊的I期肺癌患者为样本,采集一般和临床信息并使用医院焦虑和抑郁量表(HADS)和简明癌症患者心理适应问卷(Mini-MAC)进行测评,在随后12个月、24个月和36个月再次使用HADS量表评估。采取重复测量方差分析探讨不同应对方式下肺癌幸存者焦虑情绪的时间效应。结果:最终共51例患者完成研究。女性、肿瘤分化程度低和术后病理存在不良预后因素的患者焦虑情绪更明显(P<0.05或P<0.01);采取积极情绪应对方式的肺癌幸存者HADS-A评分较低(P=0.001),而采取消极态度者HADS-A评分较高(P<0.01),两者评分均在测评后36个月出现明显下降,采取认知回避者HADS-A评分则在4个时间点内呈持续上升趋势(P<0.05)。多元回归模型结果显示消极情绪、积极态度、认知逃避、性别和肺癌不良预后因素均对焦虑评分差值有影响(P<0.05或P<0.01)。结论:新近确诊的肺癌幸存者,对自身不良预后因素的认识可能和更显著的焦虑情绪有关;采取积极情绪应对方式的肺癌幸存者焦虑情绪较轻微,而认知回避对焦虑情有长期负面影响;为了改善肺癌幸存者的情绪,应采取干预措施以培养患者更为积极的应对方式。

Objective:This study examined the long-term dynamic trends of anxiety in lung cancer survivors of early stage with different coping strategies.Method:General and clinical information were collected from a sample of a hundred and forty three patients with lung cancer in stage I.A longitudinal study was carried out using the Hospital Anxiety and Depression Scale(HADS)and the Mini-Mental Adjustment to Cancer scale(MINI-MAC),and then using the HADS scale again in 12 months,24 months and 36 months later.Repeated measures analysis of variance was used to analysis time effect of the coping strategies to anxiety.Results:In total,fifty-one patients completed all four questionnaires eventually.Lung cancer survivors who were women,with poor tumor differentiation and poor prognostic factors in postoperative pathology were more anxious(P<0.05 or P<0.01).Survivors who adopt positive attitude had lower HADS-A scores(P=0.001),while those who adopt negative emotion had higher HADS-A scores(P<0.01).Both the HADS-A scores of positive attitude and negative emotion decreased significantly at 36 months,and the HADS-A scores of cognitive avoidance showed a continuous upward trend within 4 time Points(P<0.05).A multiple regression model results showed negative emotion,positive attitude,cognitive avoidance,gender and poor prognosis of lung cancer all had an impact on the difference of anxiety scores(P<0.05 or P<0.01).Conclusion:For newly diagnosed lung cancer survivors,their awareness of their own poor prognostic factors may be related to more anxiety.Lung cancer survivors who adopt positive attitude have less anxiety,meanwhile,the anxiety of those who adopt cognitive avoidance continues to increase.Interventions to improve patients'mood should seek to cultivate more adaptive coping strategies.