肝癌术后患者心理弹性水平调查及与生存质量、应对方式和创伤后成长的相关性分析

摘要 目的：调查肝癌术后患者心理弹性水平现状,并探讨其与生存质量、应对方式和创伤后成长的相关性。方法：选取2018年11月-2021年3月我院收治的120例原发性肝癌术后住院患者,采用中文版Conner-Davidson心理弹性量表（CD-RICS）对患者心理弹性水平进行调查,另分别采用肝癌患者生活质量测定量表（QOL-LC）、医学应对方式问卷（MCMQ）、创伤后成长评定量表（PTGI）对患者进行问卷调查。采用Spearman法分析原发性肝癌术后患者心理弹性水平与生存质量、应对方式和创伤后成长的相关性。结果：肝癌术后患者心理弹性总分、乐观、自强、坚韧各维度评分均明显低于中国常模得分（P<0.05）;肝癌术后患者各生存质量维度评分均明显低于中国常模得分（P<0.05）;肝癌术后患者面对应对方式得分较中国常模得分低,回避和屈服应对方式得分较中国常模得分高（P<0.05）;肝癌术后患者创伤后成长总分、各维度评分均明显低于中国常模得分（P<0.05）。肝癌术后患者心理弹性总分与各生存质量维度得分呈正相关（P<0.05）。肝癌术后患者心理弹性总分与回避、屈服应对方式呈负相关,与面对应对方式得分呈正相关（P<0.05）。肝癌术后患者心理弹性总分与创伤后成长总分、各维度得分均呈正相关（P<0.05）。结论：肝癌术后患者具有较低的心理弹性水平,心理弹性水平与积极应对方式、生存质量和创伤后成长呈正相关,应采取针对性措施提高肝癌术后患者心理弹性水平,促进患者术后康复。     

宫颈癌放疗患者生活质量的影响因素及与应对方式的关系研究

目的:探讨宫颈癌放疗患者生活质量的影响因素及与应对方式的关系。方法:选取2018年7月2019年11月期间我院收治的宫颈癌放疗患者139例,收集患者临床资料,采用癌症治疗功能评价系统中的宫颈癌量表(FACT-Cx)对宫颈癌患者的生活质量进行评分,采用Jalowiec的应对量表(JCS)记录并评估所有患者的应对方式,并采用Pearson相关性分析生活质量与应对方式的关系。采用单因素及多因素Logistic回归分析宫颈癌放疗患者生活质量的影响因素。结果:宫颈癌放疗患者的FACT-Cx总分与面对、乐观、姑息、依靠自我应对方式评分呈正相关(P<0.05),与情感宣泄、宿命应对方式评分呈负相关(P<0.05),与逃避、支持应对方式评分无相关性(P>0.05)。不同文化程度、年龄、化疗、肿瘤病理类型情况患者之间FACT-Cx总分比较无统计学差异(P>0.05);不同家庭月收入、肿瘤分期、下肢水肿情况、婚姻状况患者之间FACT-Cx总分比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,家庭月收入、肿瘤分期、下肢水肿情况、婚姻状况均是宫颈癌放疗患者生活质量的影响因素(P<0.05)。结论:宫颈癌放疗患者生活质量与应对方式存在密切联系,且家庭月收入、肿瘤分期、下肢水肿情况、婚姻状况均是其生活质量的影响因素,临床工作者应结合以上因素对患者放疗方案给予针对性调整。     

Coping with cancer

This study examined coping strategies in head and neck cancer patients. The relationships between the use of approach and avoidant coping strategies and the physical and emotional distress of 35 newly diagnosed head and neck cancer patients during the early stages of cancer treatment were evaluated. Patients were categorized on the basis of coping strategy at the time of diagnosis and then evaluated twice during the course of their treatment at four- to six-week intervals. Cancer patients who predominantly employed either approach or avoidant strategies had lower initial levels of emotional distress than patients who did not use either of these strategies. Although symptoms of distress decreased in patients using approach or avoidance, symptoms increased for those patients who did not use these strategies. The level of stress for this cancer population is highest at the point of confirmed diagnosis and recedes during the course of treatment. The theoretical and clinical implications of these findings are discussed.     

Styles of coping with stress of cancer in patients treated with radiotherapy and expectations towards medical staff – Practical implications

Background

It is essential to adjust oncological treatment to medical procedures but also to the expectations of patients themselves. Expectations of patients may depend on the way of coping with the stress of cancer. Many researchers have dealt with this issue. However, it is difficult to find studies concerning relations between the styles of coping and expectations of patients towards medical staff.

Aim

To demonstrate the relationship between the style of coping with stress of cancer shown by patients undergoing radiotherapy at the Greater Poland Cancer Centre and the nature of their expectations towards the medical staff, and to present work of the Clinical Psychology Unit in response to the expectations of patients.

Materials and methods

Questionnaire survey. The respondents filled in a questionnaire consisting of a patient request form (PRF), the mini-mental adjustment to cancer scale (Mini-MAC), and personal data. Obtained results were subjected to statistical analysis.

Results

Significant associations: the expectation to have the disease explained is associated with anxious preoccupation, fighting spirit, helplessness–hopelessness; the expectation of emotional support is associated with anxious preoccupation and helplessness–hopelessness; and the expectation of information on examinations and treatment is associated with anxious preoccupation and helplessness–hopelessness.

Conclusions

Expectations of patients undergoing radiotherapy in the Greater Poland Cancer Centre towards the medical staff depend on their styles of coping with the stress of cancer.     

Coping with Breast Cancer: A Meta-Analysis

Objective

The primary aim of this study was to examine the associations between different types of coping and psychological well-being and physical health among women with breast cancer. A second aim was to explore the potential moderating influences of situational and measurement factors on the associations between coping and psychological well-being and physical health.

Methods

On 14 February 2011, a literature search was made for articles published in the PubMed and PsycINFO databases before January 2010. On 5 September 2013, a repeated literature search was made for articles published before May 2013. In the final analyses, 78 studies with 11 948 participants were included.

Results

Efforts to facilitate adaptation to stress, such as Acceptance and Positive Reappraisal, were related to higher well-being and health. Disengagement and avoidance types of coping were associated with lower well-being and health. The analyses indicated that, in several circumstances, coping effectiveness was dependent on cancer stage, treatment, disease duration, and type of coping measure.

Conclusions

Use of coping targeting adjustment and avoiding use of disengagement forms of coping were related to better psychological well-being and physical health. Adaptive strategies and avoiding disengagement forms of coping seemed particularly beneficial for women undergoing treatment.     

Coping with cancer through self-instruction: a hypothesis.

Because most cancer patients seem to cope well with the stresses of their illness, including the psychosocial ramifications, it is important to understand what good copers manage to do, as opposed to those patients who simply defend themselves against persistent problems. This requires making a radical distinction between coping and defending, as well as between healthy adaptive resources and latent pathological dispositions. A case report is presented to illustrate how one "supercoper" solved problems by self-instruction. While cognitive self-instruction may not be applicable for every cancer patient and all problems, it is a working hypothesis deserving of further investigation, since self-control and personal responsibility are essential elements in rehabilitation on all levels. One intervention model for "high distress" cancer patients is outlined.     

The hormonal basis of reconciliation in humans

Developing effective behavioral and psychological mechanisms for coping with social stress was very important in human evolution because humans evolved as social beings. The aggressive and post-aggressive behavior of 30 boys aged 7-11 years was observed during free play in summer camp with the standard "post-conflict-matched control" method (de Waal and Yoshihara, 1983). The focals were the victims of the conflict. Saliva samples for examination of cortisol and dehydroepiandrosterone sulfate levels were taken from each boy in 5 cases: 10 minutes after a conflict with and without reconciliation, matched-control samples next day and morning samples for the basal level. Every boy filled in a sociometry form, Buss-Durkee Hostility Inventory, Eysenk Personality test and the Revised Children's form for the Manifest Anxiety Scale. The stress-reduction role of peacemaking was supported on the physiological level. The level of stress-related hormones was higher when no reunion occurred.     

The Mediating Role of Mental Adjustment in the Relationship between Perceived Stress and Depressive Symptoms in Hematological Cancer Patients: A Cross-Sectional Study

Background

Depression is a particularly common psychological disorder that affects cancer patients. Diagnosed with hematological malignancies constitute a serious unpredictable and uncontrollable medical stress situation and patients are susceptible to suffer from depressive symptoms. The aims of the study were to explore the correlation between perceived stress and depressive symptoms in patients with hematological malignancies, and assess the mediating role of mental adjustment between these variables.

Methods

A single center, cross-sectional study was performed by convenience sampling between July 2013 and April 2014 in a hospital of China. The Center for Epidemiologic Studies Depression Scale, Perceived Stress Scale, and Mini-Mental Adjustment Scale, as well as questions about demographic and clinical factors was distributed to 300 hematological cancer patients. Completed questionnaires were received from 227 inpatients.

Results

The results showed that perceived stress was positively correlated with depressive symptoms. The mental adjustment significantly mediated the relationship between perceived stress and depressive symptoms.

Conclusions

Among hematological cancer patients perceived stress may be a risk factor for depressive symptoms, whereas positive coping style might be protective against depressive symptoms. Results showed that medical managers could support the development of mental adjustment in the patients to alleviate psychological disorders.     

Self-controllable prodromal symptoms of syncope attributed to carotid sinus syndrome during the end stage of cancer: a case report

Background

Carotid sinus syndrome (CSS) can cause prodromal symptoms of syncope such as dizziness and nausea. Patients with end-stage cancer lose self-efficacy associated with reduced activities of daily life (ADL). Herein, we report a case of end-stage cancer in which self-efficacy was enhanced as the patient gained self-control of prodromal symptoms of syncope.

Case presentation

A 70-year-old patient with end-stage esophageal cancer and enlarged supraclavicular lymph nodes developed CSS. The CSS was a mixed type with both bradycardia and decreased blood pressure, accompanied by prodromal symptoms prior to syncope episodes. The patient incidentally discovered that he could decrease the duration of symptoms by contracting the muscles in his hands and legs. By applying this coping method at the onset of prodromal symptoms, he was also able to reduce the severity and duration of symptoms, which resulted in enhanced self-efficacy. As a result, the frequency of prodromal symptoms also decreased even though ADL improved.

Conclusion

This patient was diagnosed with vasoinhibitory-predominant mixed-type CSS. The coping method the patient developed seemed to avoid the onset of abrupt blood pressure decrease via peripheral vascular constriction action. Achievement of adequate coping such as self-control of prodromal symptoms enabled our patient to improve his self-efficacy even at the end stages of cancer. This case of enhanced self-efficacy could possibly illustrate a placebo effect for prevention of recurrence.

     

The Impact of Coping Flexibility on the Risk of Depressive Symptoms

Objective

According to the dual-process theory, coping flexibility is defined as the ability to produce and implement a new coping strategy in place of an ineffective coping strategy. Specifically, coping flexibility includes two processes: evaluation coping and adaptive coping. Evaluation coping refers to sensitivity to feedback about the efficacy of a coping strategy, and adaptive coping involves the willingness to implement alternative coping strategies. The coping flexibility hypothesis (CFH) postulates that more flexible coping will be associated with more adaptive outcomes; importantly, there are numerous theories and studies that support the CFH. The main purpose of this study was to test the CFH based on dual-process theory.

Methods

A total of 1,770 Japanese college students participated and, completed a set of questionnaires that measured coping flexibility (evaluation coping and adaptive coping) and depressive symptoms. Depressive symptoms were measured via the Center for Epidemiologic Studies Depression Scale.

Results

The proportions of women and men who reported depressive symptoms were 58.69% (95% CIs [55.74, 61.66]) and 54.17% (95% CIs [50.37, 57.95]), respectively when a cut-off score of 16 on the CES-D was used. A multivariable logistic regression analysis revealed that evaluation coping (OR = 0.86, 95% CIs [0.83, 0.0.89]) and adaptive coping (OR = 0.91, 95% CIs [0.88, 0.93]) were significantly associated with lower levels of depressive symptoms.

Conclusion

The results of the present study indicated that the CFH based on dual-process theory was supported in a Japanese sample.     

非小细胞肺癌化疗患者应对方式与生活质量的相关性研究

目的:调查非小细胞肺癌(NSCLC)化疗患者应对方式与生活质量的相关性。方法:选择2016年5月-2018年5月在我院接受化疗的NSCLC患者共110例,分别采用肺癌生命质量量表(EORTC-QLQ.C30)、肺癌患者生活质量调查问卷(EORTC-QLQ.LC13)和医学应对方式问卷(MCMQ)对患者生活质量与应对方式进行调查,分析其相关性,并采用多元逐步回归分析整体生活质量的影响因素。结果:不同化疗阶段,患者功能维度得分和整体生活质量得分显著下降,差异有统计学意义(P0.05),症状维度得分和化疗相关副反应得分显著升高,差异有统计学意义(P0.05)。肺癌表现得分的差异和三种应对方式得分的差异均无统计学意义(P0.05)。患者采取面对方式和回避方式的得分均高于屈服方式(P0.05)。面对方式与患者整体生活质量呈正相关,回避方式、屈服方式与患者整体生活质量呈负相关。多元逐步回归分析显示:年龄、疾病转移及面对方式是NSCLC化疗患者整体生活质量的影响因素(P0.05)。结论:NSCLC化疗患者应对方式与生活质量存在一定的相关性,应有效的发挥积极应对方式对生活质量的促进作用,提高患者生活质量。     

Effects of gender,age, family support,and treatment on perceived stress and coping of patients with type 2 diabetes mellitus

Background

We previously found that the empowerment of patients with type 2 diabetes mellitus can be strongly affected by gender and age in addition to self-managed diet and exercise behaviors and treatment. This study was to examine the effects of gender, age, family support, and treatment on the perceived stress and coping of patients with type 2 diabetes mellitus living with family.

Methods

A survey was conducted of 140 adults with type 2 diabetes mellitus who were living with family. There was no significant difference in hemoglobin A1c (HbA1c) between male and female. Perceived stress and coping were measured with the Japanese version of the Appraisal of Diabetes Scale and the Lazarus Type Stress Coping Inventory. Stepwise regression analysis and path analysis were performed to identify factors that affect the perceived stress and coping of patients.

Results

(1) Perceived stress and coping were strongly affected by gender. (2) Perceived stress and coping were affected by age for males, but perceived stress was not affected by age for females. However, females showed a greater “psychological impact of diabetes” than did males. Females aged between 50 and 69 years engaged in active problem solving, but awareness of diabetes was low. (3) Treatment regimens had an effect on HbA1c for both sexes, and diet therapy affected the awareness of diabetes of males and coping of females. (4) For females, “sense of self-control” was strongly associated with coping, and those who were living with non-spouse family members had a greater psychological impact of diabetes than those living with only their spouse. (5) For males, coping was strongly affected by living with their spouse.

Conclusions

The results suggest that perceived stress, coping, and diet regimen are deeply associated with gender and age and that a male with type 2 diabetes mellitus living with his spouse is strongly dependent on support from the spouse. It is important to take into account gender, age, and family environment to provide patients with an individualized approach to addressing perceived stress and to provide education program for coping that can maximize treatment and maintain better, continuous glycemic control.

     

Effects of heterogeneous habitat use by cattle on nutrient availability and litter decomposition in soils of an Alpine pasture

Grazing by free-ranging cattle on Alpine pastures in southern Switzerland creates sharp contrasts in plant species composition between small camp areas, which are grazed intensely and receive most cattle excreta, and surrounding pasture dominated by Nardus stricta, which is only lightly grazed. We hypothesised that these contrasts are maintained by positive feedbacks related to nutrient availability in soil, in that (a) plant material with rapid decomposition and nutrient release decomposes in camp areas and (b) litter decomposition is further stimulated by enhanced nutrient availability in soil. We compared nutrient availability at three camp areas with that in surrounding Nardus vegetation and investigated how the decomposition of plant material from both vegetation types responds to nutrient availability in soil, both in the field (during 14 weeks) and in the laboratory (during 4, 10, and 16 weeks). At all three field sites P availability was significantly enhanced in camp areas, whereas differences in N availability were inconsistent among the three sites. Laboratory incubations indicated that microbial activity after the addition of labile C (cellulose) was limited by P availability in the Nardus vegetation but not in camp areas. The camp-area plant substrate decomposed much faster (81.5% vs. 27.1% ash-free dry mass loss in the field) and released more N and P than the Nardus substrate, which tended to immobilise soil nutrients. However, the decomposition rate of neither substrate was influenced by nutrient availability in soil, both in the field (comparing camp areas and Nardus vegetation) and in the laboratory (comparing incubations with and without N or P fertilisation). We conclude that the contrasting quality of plant substrates contributes to the greater nutrient availability in camp areas (feedback a) but that the latter does not influence the decomposition of in situ plant material (feedback b) because the latter is not nutrient-limited.     

Faith, hope, and charity: an in-depth interview study of cancer patients' information needs and information-seeking behavior

OBJECTIVE: To explore why cancer patients do not want or seek information about their condition beyond that volunteered by their physicians at times during their illness. DESIGN: Qualitative study based on in-depth interviews. SETTING: Outpatient oncology clinics at a London cancer center. PARTICIPANTS: 17 patients with cancer diagnosed in previous 6 months. Main outcome measures Analysis of patients' narratives to identify key themes and categories. RESULTS: While all patients wanted basic information on diagnosis and treatment, not all wanted further information at all stages of their illness. Three overarching attitudes to their management of cancer limited patients' desire for and subsequent efforts to obtain further information : faith, hope, and charity. Faith in their doctor's medical expertise precluded the need for patients to seek further information themselves. Hope was essential for patients to carry on with life as normal and could be maintained through silence and avoiding information, especially too detailed or "unsafe" information. Charity to fellow patients, especially those seen as more needy than themselves, was expressed in the recognition that scarce resources-including information and explanations-had to be shared and meant that limited information was accepted as inevitable. CONCLUSIONS: Cancer patients' attitudes to cancer and their strategies for coping with their illness can constrain their wish for information and their efforts to obtain it. In developing recommendations, the government's cancer information strategy should attend to variations in patients' desires for information and the reasons for them.     

Psychological status and coping with illness in patients with malignant melanoma

Melanoma patients are subject to different degrees of psychosocial distress. The emotional impact of malignant melanoma can be long lasting and profound, with the most common reactions to melanoma being depression, anxiety and deterioration in quality of life. Coping styles have been shown to have a significant influence on patients' quality of life and their emotional reaction to the illness. The aim of this paper was to investigate the quality of life, emotional status and coping styles in patients with melanoma. 31 patients suffering from malignant melanoma were included in the study. Results of this study show that melanoma has a medium influence on patients' psychological status and quality of life. The most "constructive" coping style--problem focused coping is the mostly used style by the patients, which might be one of the reasons why the illness didn't have a more severe influence on patients' psychological status.     

Evidence for immune defects in breast and lung cancer patients

Immunosuppression is often identified in cancer patients. The aim of this study was to evaluate several immune parameters for patients with breast and lung cancer. Immunophenotyping analysis showed that the cancer patients investigated had significantly lower absolute numbers of peripheral blood lymphocytes than controls. The immunosuppression was more evident for the breast cancer subgroup. The most severe immune defect noticed was the marked impairment of IFN- secretion. A shift toward the Th2 phenotype as revealed by assessment of intracellular level of IFN- and IL-4 was also noticed. The secretion of proinflammatory cytokines IL-1 and TNF- in whole blood cultures was not impaired. Although the proportion of activated cells was slightly lower than in the control group, our results showed that both peripheral T lymphocytes and NK cells of cancer patients could be induced to express early activation marker CD69 after ex vivo mitogen stimulation. In conclusion, our study revealed several immune defects in cancer patients. This suggests that an appropriate immunotherapeutical approach might be used to restore compromised immune functions with beneficial effects on both antitumor and general immunity.     

Changes in immune functions during a peaking period in male university soccer players

The concept of peaking ensures that athletes have trained to attain their absolute peak performance levels prior to a competition. This study investigates the effects of peaking on the functions of neutrophils and lymphocytes in university soccer players during a five‐day soccer training camp followed by two weeks of tapering. The study subjects were 22 soccer players who were members of a university soccer club. We carried out our investigation during a five‐day training camp and two weeks after the training camp (i.e. the tapering period). We measured body composition, immune‐related parameters (leukocyte count, neutrophil count, lymphocyte count, immunoglobulins and complements), myogenic enzymes, superoxide dismutase activity (SOD) and neutrophil functions [reactive oxygen species (ROS) production, phagocytic activity, serum opsonic activity and lymphocyte subtypes]. Leukocyte and neutrophil counts tend to increase after the training camp compared with values before the training camp, and recovered during the conditioning period, although the final values were still lower than those before the training camp. The amount of ROS production per neutrophil and level of SOD decreased significantly during the conditioning period compared with before the training camp (p < 0.05, p < 0.01, respectively). Levels of Th1 cells decreased significantly during the conditioning period compared with the training camp (p < 0.05). In conclusion, the period of two weeks for the tapering period was considered insufficient to allow the athletes’ immune function to recover completely after an intensive training camp. Copyright © 2013 John Wiley & Sons, Ltd.     

A multinomial model for estimating the size of a whale population from incomplete census data

This paper adapts the removal method of population size estimation to the problem of estimating the size of the western Arctic stock of bowhead whales. The whales are counted during their spring migration as they pass two census camps located near Point Barrow, Alaska. Whales seen at the first camp are "removed" from the population of concern to the second camp, where only whales missed by the first camp are counted. If both camps were in operation throughout the migration and if the probability of missing a whale were constant, the removal method would provide a population size estimate based on a trinomial model in which the size of the population would be the number of trials, whales counted by each camp would provide the observed cell totals, and whales missed by both camps would represent an unobserved cell total. Since the probability of missing a whale depends on visibility, we model the population size as the sum of the number of trials of several independent trinomial distributions, each of which represents a particular visibility condition occurring during the census. To account for the fact that watch cannot be maintained at both camps throughout the migration, we derive a confidence interval estimate of the number of trials under a more general model allowing for incomplete observation of totals within particular cells as well as for completely unobserved cells.     

Estrogen receptor concentration and social factors as predictors of natural killer cell activity in early-stage breast cancer patients. Confirmation of a model

Previous work of ours has demonstrated that a significant amount of natural killer (NK) activity variance after surgery in stage I and II breast cancer patients could be accounted for by both the estrogen receptor (ER) status of the tumor and by social factors, namely, perceived social support and seeking social support as a general coping strategy. As considerable evidence has accumulated that social support in both animal and human populations may have survival value, we sought to test the reliability of this regression model, using coping and perceived support factor values obtained at 3 months after surgery to account for concurrent follow-up NK activity in this serially assessed group of patients. It was found that the most significant variable predicting NK activity at follow-up was tumor ER concentration, with higher NK activity associated with ER- status. In addition, seeking social support as a coping strategy, as well as the perceived quality of support, also entered the model to account for a significant amount of NK activity variance (multivariate F = 5.25, p less than 0.001). If, as the literature suggests, NK activity is relevant to breast cancer control, and since ER- tumors have a worse prognosis, we suggest here that perhaps such tumors are resistant to control by NK cells because they lack the ability to attract an accumulation of effector cells to the tumor site, or because blocking factors at the site of the tumor prevent local tumor control at the site of action. The finding related to social support also replicates results from an independent sample of breast cancer patients. This finding, taken together with other evidence that this social variable is associated with longer survival in breast cancer populations, underscores the potential importance of this social support variable. Our findings also suggest one possible immunological variable involved, with potential clinical significance, for this patient population.     

Real-Time Electrocardiogram Transmission from Mount Everest during Continued Ascent

The feasibility of a real-time electrocardiogram (ECG) transmission via satellite phone from Mount Everest to determine a climber’s suitability for continued ascent was examined. Four Taiwanese climbers were enrolled in the 2009 Mount Everest summit program. Physiological measurements were taken at base camp (5300 m), camp 2 (6400 m), camp 3 (7100 m), and camp 4 (7950 m) 1 hour after arrival and following a 10 minute rest period. A total of 3 out of 4 climbers were able to summit Mount Everest successfully. Overall, ECG and global positioning system (GPS) coordinates of climbers were transmitted in real-time via satellite phone successfully from base camp, camp 2, camp 3, and camp 4. At each camp, Resting Heart Rate (RHR) was transmitted and recorded: base camp (54–113 bpm), camp 2 (94–130 bpm), camp 3 (98–115 bpm), and camp 4 (93–111 bpm). Real-time ECG and GPS coordinate transmission via satellite phone is feasible for climbers on Mount Everest. Real-time RHR data can be used to evaluate a climber’s physiological capacity to continue an ascent and to summit.