认知行为干预对晚期癌症疼痛患者影响的临床研究

目的:探讨在临床晚期癌性疼痛患者中,应用认知行为干预的方法,减轻癌痛、改善患者生活质量的可行性。方法:搜集2010年1月至2012年11月间,于哈尔滨医科大学附属第三医院肿瘤内科收治的晚期癌症患者238例,包括晚期的肺癌64例、乳腺癌36例、胃癌33例、肝癌29例、食管癌21例、大肠癌19例、胰腺癌14例、甲状腺癌13例、鼻咽癌6例、骨肉瘤3例,其中发生癌性疼痛的患者214例,肺癌58例、乳腺癌34例、胃癌31例、肝癌28例、食管癌18例、大肠癌17例、胰腺癌13例、甲状腺癌9例、鼻咽癌3例、骨肉瘤1例。对晚期癌症伴发癌痛的患者利用行认知行为干预治疗进行治疗干预,30d为治疗周期,治疗后对晚期癌症患者的生活质量(KPS评分)、癌痛的缓解率的影响。结果:在晚期癌症伴癌痛的患者中,利用认知行为干预后,癌痛总的缓解率为55.6%,其中部分缓解(1~3级)所占比例为49.5%,完全缓解(4级)所占比例为6.1%;在不同级别的疼痛(轻~重)中,程度较轻的疼痛缓解率较高(93.2%),程度为中等的疼痛缓解率为67.3%,而重度疼痛缓解率较低(16.7%);在KPS评分中,238例患者治疗后评分提高率占67.2%;在生活质量评分改善的患者占69.4%。结论:在晚期癌症伴癌痛的患者中,利用认知行为干预的疗法可以对疼痛程度在轻~中度的癌痛有较好的控制作用,并且对患者的生活质量有提高作用。

The Clinical Study on Cognitive Behavior Therapy on Patients with Advanced Cancer Pain

Objective:To investigate feasibility of cognitive behavioral intervention therapy applied in patients with advanced cancer to reduce the cancer pain and improve patient quality of life in the clinic.Methods:238 patients with advanced cancer were collected from January 2010 to November 2012, who accepted therapy in the department of oncology in the third affiliated hospital of Harbin medical university, including 64 lung cancer, 36 breast cacer, 33 gastric cancer, 29 hepatoma, 21 esophageal cancer, 19 colon cancer, 14 pancreatic cancer, 13 thyroid cancer, 6 nasopharynx cancer, 3 osteosarcoma; 214 cases among the 238 patients suffered the cancer pain, including 58 lung cancer, 34 breast cacer, 31 gastric cancer, 28 hepatoma, 18 esophageal cancer, 17 colon cancer, 13 pancreatic cancer, 9 thyroid cancer, 3 nasopharynx cancer, 1 osteosarcoma. Each patient received cognitive behavioral intervention therapy for 30 days. The degree of pain relief and the improvement of quality of life were observed before and after treatment.Results:The results indicated that the total cancer pain relief rate was 55.6%, part relief (degree of 1-3) was 49.5%and entire relief (degree 4) was 6.1%. And the relief rate was 93.2%, 67.3%and 16.7%separately in light, moderate and severe degree of cancer pain. In the KPS, score improved rate accounted for 67.2% in 238 patients after treatment; improvement in quality of life scores accounted for 69.4% of the patients.Conclusion:The study demonstrated that cognitive behavioral intervention therapy is even more effective in light and moderate degree of cancer pain control, and the quality of life was improved in advanced cancer patients after received the therapy.