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背景:负性情绪可直接引起患者体液或细胞免疫功能下降导致肺癌发病,因此在肺癌的防治过程中心理治疗很有必要。目的:观察宣泄和认知疗法对肺癌患者心理状况和近期临床疗效的影响,探讨心理干预的重要性设计:非随机化同期对照,1∶1配对观察。单位:中国医科大学第二附属医院干诊科和解放军沈阳军区总医院干诊科病房。对象:以中国医科大学第二附属医院和解放军沈阳军区总医院1999-02/2002-12收治的肺癌患者124例为观察对象,患者根据自愿原则分别进入治疗组和对照组,治疗结束后统计资料时按相同年龄、性别、UICC-TUM分期和细胞病理分型1∶1配对,配成42对。方法:全部患者均选择同一化疗(足叶乙甙和卡铂)及放疗方案,治疗组在此基础上给予情绪宣泄和认知疗法:治疗开始阶段进行宣泄,每5d1次,需1～3次;然后进行每周一两次的癌症知识认知教育,共计6周。治疗前后应用精神卫生症状自评量表(分为9大症状因子,5级评分:0分为从无,l分为轻度,2分为中度,3分为相当重,4分为严重)评估患者的心理状况;按WHO肺癌评估标准(病灶完全消失4周以上为完全缓解;病灶面积减少50%以上,并持续4周为部分缓解)进行疗效评估。主要观察指标:两组患者治疗前后精神卫生症状自评量表评分及疗效。结果:共配成42对,84例进入结果分析。①精神卫生症状自评量表得分:治疗后两组各项评分均明显低于治疗前(P<0.05),但治疗后治疗组的躯体化、人际关系、抑郁、焦虑和精神病性等项评分均低于对照组(1.64±0.41,1.76±0.34;1.31±0.30,1.67±0.35;1.40±0.29,1.58±0.41;1.23±0.27,1.40±0.39;1.19±0.27,1.24±0.34;t=2.013～2.257,P均<0.05)。②疗效:治疗组总缓解率高于对照组,但无统计学意义(68%,52%,χ2=2.381,P>0.05)。结论:宣泄和认知疗法治疗对肺癌患者的近期临床疗效不明显,但可减轻患者的抑郁、焦虑等负性情绪,对改善其精神心理状态、提高机体免疫调节功能是有帮助的。
Background: Negative emotions may directly cause the decline of humoral or cellular immunity in patients leading to the development of lung cancer. Therefore, psychotherapy is necessary in the prevention and treatment of lung cancer. Objective: To observe the catharsis and cognitive therapy on the psychological status of patients with lung cancer and short-term clinical efficacy of the psychological intervention to explore the importance of design: non-randomized control, 1: 1 paired observation. Unit: Second Affiliated Hospital of China Medical University, Department of Cardiology and PLA Shenyang Military Region General Hospital ward diagnosis and treatment. PARTICIPANTS: A total of 124 patients with lung cancer who were admitted to the Second Affiliated Hospital of China Medical University and Shenyang Military Region General Hospital of PLA from February 1999 to February 2002 were enrolled in the study. The patients entered the treatment group and the control group according to the voluntary principle. After the treatment, According to the same age, sex, UICC-TUM staging and cytopathological type 1: 1 matching, dubbed 42 pairs. Methods: All the patients were treated with the same chemotherapy (etoposide and carboplatin) and radiotherapy regimen. The treatment group was given emotional catharsis and cognitive therapy based on the above treatment: once the treatment started, ; And then once or twice weekly cancer awareness education for a total of 6 weeks. Before and after treatment using mental health self-rating scale (divided into nine major symptoms, grade 5: 0 from no, l was divided into mild, 2 divided into moderate, 3 divided into quite heavy, 4 divided into serious ) To assess the patient’s psychological status; according to the WHO lung cancer evaluation criteria (complete disappearance of lesions over 4 weeks or more; lesion area reduced by 50% or more, and continued for 4 weeks for partial remission) for efficacy evaluation. MAIN OUTCOME MEASURES: The scores and efficacy of mental health self-rating scale before and after treatment in two groups of patients. Results: A total of 42 pairs, 84 cases entered the result analysis. ① Mental health self-rating scale score: After treatment, the score of the two groups were significantly lower than before treatment (P <0.05), but after treatment, the somatization, interpersonal relationship, depression, anxiety and psychosis scores (1.64 ± 0.41,1.76 ± 0.34; 1.31 ± 0.30,1.67 ± 0.35; 1.40 ± 0.29,1.58 ± 0.41; 1.23 ± 0.27,1.40 ± 0.39; 1.19 ± 0.27,1.24 ± 0.34, respectively; t = 2.013 ~ 2.257, P <0.05). ② Efficacy: The overall response rate of the treatment group was higher than that of the control group, but not statistically significant (68%, 52%, χ2 = 2.381, P> 0.05). CONCLUSION: The catharsis and cognitive therapy have no obvious clinical effect on patients with lung cancer, but they can reduce the negative emotions such as depression and anxiety. It is helpful to improve the mental state and improve the immune function.