原发性肝癌患者TACE术后癌症复发恐惧的影响因素及认知行为疗法的治疗效果研究

Study on the Influencing Factors of Fear of Cancer Recurrence in Patients with Primary Liver Cancer After TACE Surgery and the Therapeutic Effect of Cognitive Behavioral Therapy

目的:探讨原发性肝癌(PHC)患者肝动脉化疗栓塞术(TACE)术后癌症复发恐惧(FCR)情的影响因素,同时观察认知行为疗法在FCR患者中的治疗效果。方法:选择上海交通大学医学院附属仁济医院2020年9月-2022年4月期间收治的400例行TACE的PHC患者作为研究对象。根据自制量表获取所有患者的一般资料,采用恐惧疾病进展简化量表(FoP-Q-SF)评估癌症患者FCR,采用单因素和多因素Logistic回归分析FCR发生的影响因素。针对存在FCR的患者,将其按照随机数字表法分为对照组(n=128)和研究组(n=128),对照组接受常规干预,研究组在对照组的基础上接受认知行为疗法干预,观察认知行为疗法在FCR患者中的治疗效果。结果:本院选取的400例PHC患者TACE术后FoP-Q-SF评分为(38.43±5.29)分,其中总分≥34分256例,总分<34分144例。单因素分析结果显示,PHC患者TACE术后FCR与家庭人均月收入、性别、临床病理分期、年龄、术后时间、婚姻状况、TACE治疗次数、疾病应对方式、文化程度、社会支持度有关(P<0.05)。多因素Logistic回归分析显示,TACE治疗次数≥10次、年龄偏低、疾病应对方式为消极应对、文化程度为小学及其以下、社会支持度低、家庭人均月收入<3000元、临床病理分期为Ⅲ期是PHC患者TACE术后FCR发生的危险因素(P<0.05)。干预后,两组FoP-Q-SF、焦虑自评量表(SAS)与抑郁自评量表(SDS)评分均下降,且研究组低于对照组(P<0.05)。结论:年龄偏低、文化程度为小学及其以下、TACE治疗次数≥10次、疾病应对方式为消极应对、社会支持度低、家庭人均月收入<3000元、临床病理分期为Ⅲ期是PHC患者TACE术后FCR发生的危险因素。针对存在TACE术后FCR的PHC患者给予认知行为疗法,可有效减轻FCR程度,减轻抑郁焦虑状况。

Objective:To investigate the influencing factors of fear of cancer recurrence(FCR)after hepatic arterial chemoembolization(TACE)surgery in patients with primary liver cancer(PHC),and to observe the therapeutic effect of cognitive behavioral therapy in patients with FCR.Methods:400 patients with PHC after TACE surgery who were admitted to Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University from September 2020 to April 2022 were selected as research objects.General data of all patients were obtained according to the self-made scale.FCR of cancer patients was evaluated by Fear of Progression Questionnaire-Short Form(FoP-Q-SF),and the influencing factors of FCR occurs were analyzed by univariate and multivariate Logistic regression.Patients with FCR were divided into control group(n=128)and study group(n=128)according to random number table method.The control group received routine intervention,and the study group received cognitive behavioral therapy intervention on the basis of the control group,and the therapeutic effect of cognitive behavioral therapy in patients with FCR was observed.Results:The FoP-Q-SF score of 400patients with PHC after TACE surgery was(38.43±5.29)scores,included 256 cases with total score greater than or equal to 34 scores and 144 cases with total score less than 34 scores.Univariate analysis showed that FCR of PHC patients after TACE is related to the per capita monthly income,gender,clinicopathological stage,age,postoperative time,marital status,TACE treatment times,disease coping style,educational level and social support(P<0.05).Multivariate Logistic regression analysis showed that risk factors for FCR in PHC patients after TACE include≥10 times of TACE treatment,low age,negative coping style of disease,educational level of primary school and below,low social support,per capita monthly income of family<3000 yuan,and clinical pathological stage Ⅲ(P<0.05).After intervention,the scores of FoP-Q-SF,Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)were decreased in the two groups,and the study group was lower than the control group(P<0.05).Conclusion:Lower age,primary school education or below,TACE treatment times greater than or equal to 10 times,negative coping style,low social support,per capita monthly family income less than 3000 yuan,clinicopathological stage Ⅲ are the risk factors for FCR in patients with PHC after TACE surgery.