食管癌放疗患者心理痛苦轨迹及其影响因素研究

Trajectories of psychological distress and influencing factors in patients undergoing radiotherapy for oesophageal cancer

目的探讨食管癌患者心理痛苦轨迹及其影响因素。方法采用便利抽样法,于2022年9月—2023年10月选取河南省某三级甲等医院肿瘤放射治疗中心的食管癌放疗患者226例作为调查对象。采用心理痛苦温度计等分别于首次放疗(T1)、放疗第15次(T2)、放疗结束时(T3)、放疗结束后1个月时(T4)对患者的心理痛苦水平进行调查。基于增长混合模型识别患者心理痛苦轨迹的潜在类别,采用多分类Logistic回归(向后剔除法)分析轨迹类别的影响因素。结果199例食管癌放疗患者完成随访,其心理痛苦轨迹可分为4个潜在类别,分别为“低水平稳定组”(C1,23.6%)、“低水平升降组”(C2,17.1%)、“中水平下降组”(C3,28.6%)和“中高水平稳定组”(C4,30.7%)。以C1为参照,家庭人均月收入<2000元(与≥3000元相比)是C2的保护因素;有食管癌手术史是C4的危险因素;同步放化疗是C2、C4的危险因素;家庭关怀得分高是C2、C3、C4的保护因素;平均症状负担得分高是C2、C3、C4的危险因素;疾病感知得分高是C4的危险因素(P<0.05)。结论食管癌放疗患者的心理痛苦轨迹存在群体异质性,医护团队可根据患者心理痛苦轨迹特征及其影响因素制订精准的干预方案,以降低患者心理痛苦水平。

Objective To explore the trajectories of psychological distress and its influencing factors among esophageal cancer patients undergoing radiotherapy.Methods A total of 226 esophageal cancer patients undergoing radiotherapy in the Oncology Radiotherapy Center of a tertiary hospital in Henan Province were recruited by convenience sampling from September 2022 to October 2023.The Distress Thermometer(DT)and other tools were employed to investigate patients’levels of psychological distress at four time points:before the first radiotherapy session(T1),the 15th radiotherapy session(T2),at the end of radiotherapy(T3),and one month after the completion of radiotherapy(T4).Growth mixture modeling(GMM)was utilized to identify potential classes of psychological distress trajectories,and multinomial logistic regression(backward elimination)was conducted to analyze the factors influencing these trajectory classes.Results A total of 199 esophageal cancer patients completed the follow-up.Their psychological distress trajectories were categorized into four potential classes:“Low-Level Stable Group”(C1,23.6%),“Low-Level Fluctuating Group”(C2,17.1%),“Moderate-Level Declining Group”(C3,28.6%),and“Moderate-to-High-Level Stable Group”(C4,30.7%).Taking C1 as the reference,a monthly family income per capita<2000 yuan compared to≥3000 yuan was a protective factor for C2;a history of surgery was a risk factor for C4;concurrent chemoradiotherapy was a risk factor for both C2 and C4;high family care scores were protective factors for C2,C3,and C4;high average symptom burden scores were risk factors for C2,C3,and C4;and high illness perception scores was a risk factor for C4(P<0.05).Conclusion Heterogeneity exists in the psychological distress trajectories of esophageal cancer patients undergoing radiotherapy.Healthcare teams can develop precise intervention programs based on the characteristics and influencing factors of patients’psychological distress trajectories to reduce their levels of psychological distress.