苏娅丽++王丕琳+刘均娥+韩静+曲更宝++邱彬彬

[摘要] 目的 调查治疗初期乳腺癌患者心理痛苦发生状况并探索其相关因素。 方法 采用描述性研究设计，通过方便抽样的方法选取2016年4～12月在首都医科大学附属北京天坛医院乳腺科治疗，病程在3个月以内的乳腺癌患者122例，采用一般资料问卷和心理痛苦管理筛查工具进行问卷调查。 结果 63.9%的治疗初期乳腺癌患者心理痛苦评分≥4分，心理痛苦相关问题前3位的是担心复发（68.9%）、疲乏（63.1%）、日常生活被打乱（62.3%）。诊断途径显著影响患者的心理痛苦水平，手术中病理确诊的乳腺癌患者心理痛苦得分及中重度心理痛苦的发生率显著高于疑似乳癌，病理穿刺确诊，行新辅助化疗或手术切除的患者。 结论 治疗初期的乳腺癌患者心理痛苦水平较高，诊断途径影响患者的心理痛苦水平。

[关键词] 乳腺癌；治疗初期；心理痛苦；诊断途径；相关因素

[中图分类号] R47 [文献标识码] A [文章编号] 1673-7210（2017）09（b）-0134-05

Analysis of distress and related factors in patients with breast cancer at early stage of treatment

SU Yali1 WANG Pilin1 LIU Jun′e2 HAN Jing2 QU Gengbao1 QIU Binbin1

1.Department of Breast Surgery， Beijing Tiantan Hospital， Capital Medical University， Beijing 100050， China； 2.School of Nursing， Capital Medical University， Beijing 100069， China

[Abstract] Objective To investigate the psychological distress levels of breast cancer patients in their early treatment and explore the related factors. Methods Descriptive research design was used. 122 patients with breast cancer within 3 months collected by convenient sampling method were from Department of Breast Surgery， Beijing Tiantan Hospital， Capital Medical University， during their treatment from April to December in 2016. General questionnaire and psychological pain management screening tools were used for questionnaire survey. Results 63.9% of participants reported moderate or severe distress with scores ≥ 4. Worrying about recurrence （68.9%）， fatigue （63.1%） and daily life being disrupted （62.3%） were the first three related problems. Distress level of participants were significantly affected by diagnostic methods. The distress scores and incidences of severe distress among participants were diagnosed during operation are significantly higher than cases identified by needle biopsy， received neoadjuvant chemotherapy or exairesis. Conclusion Early treatment of breast cancer patients with higher stress levels， diagnostic methods of significant impact on them.

[Key words] Breast cancer； Early stage of treatment； Distress； Diagnostic pathway； Related factors

乳腺癌是女性最常見的恶性肿瘤之一[1]，我国乳腺癌每年新发病例数约为16.9万[2]，发病率以每年3%的增长速度递增[3]，并且乳腺癌发病率有年轻化的趋势[4]。随着诊疗技术的发展，中国乳腺癌患者的5年相对生存率已达到70%以上[5]。在疾病的治疗程中，乳腺癌患者存在抑郁、焦虑、适应不良等心理障碍及负性情绪[6-8]。2010年，美国综合癌症网（NCCN）指出癌症相关的心理问题严重影响患者的治疗依从性、治疗效果以及生活质量，建议采用心理痛苦管理筛查工具（distress management screening measure，DMSM）评估患者的心理痛苦程度及其相关因素，作为进一步干预（疼痛管理、心理治疗、社会支持等）的依据[9]，心理痛苦已被视为癌症患者的第六生命体征[10]。……