肺癌化疗病人心理痛苦轨迹及其影响因素研究

王春华; 朱婉婉; 华丽; 卢峰; 孙永侠

肺癌化疗病人心理痛苦轨迹及其影响因素研究

Study on the trajectory of psychological distress and its influencing factors in lung cancer patients treated with chemotherapy

摘要

摘要:
目的： 探究肺癌化疗病人心理痛苦轨迹及其影响因素。
方法： 选取阜阳市肿瘤医院120例肺癌化疗病人作为研究对象，通过心理痛苦温度计（DT）评分评估病人在化疗开始时（T₁）、化疗2个周期（T₂）、化疗结束时（T₃）和化疗后1个月（T₄）的心理痛苦水平评估。采用潜类别增长分析（LCGA）模型探究肺癌化疗病人心理痛苦轨迹的潜分类特征，并通过多因素logistic回归分析其影响因素。
结果： 病人DT评分在T₁ ~ T₄期间呈先升后降趋势，整体处于中度心理痛苦水平。LCGA模型识别出4个潜在分类：高水平稳定组（C1）、中水平升降组（C2）、中水平稳定组（C3）和低水平稳定组（C4）。多因素logistic回归分析显示，人均月收入在1 000 ~ 3 000元和＞3 000元的OR值分别为0.344（95%CI：0.231 ~ 0.511）和0.162（95%CI：0.093 ~ 0.281）、心理弹性的OR值为0.981（95%CI：0.970 ~ 0.991）和社会支持OR值为0.971（95%CI：0.948 ~ 0.994）对于肺癌化疗病人的心里痛苦轨迹变化属于保护因素；而病人病程在6 ~ 12个月和＞12个月的OR值分别为2.018（95%CI：1.532 ~ 2.658）和5.606（95%CI：3.628 ~ 8.663）以及临床分期的OR值为3.957（95%CI：2.522 ~ 6.207）则属于危险因素。
结论： 在肺癌化疗病人中，心理痛苦轨迹表现出显著的群体异质性。通过评估病人心理痛苦的动态特征及其影响因素，临床医护人员可识别高风险人群并实施针对性干预，从而有效缓解心理痛苦，改善病人整体生存质量。

Abstract:
Objective To investigate the trajectory of psychological distress and its influencing factors in lung cancer patients undergoing chemotherapy.
Methods A total of 120 lung cancer patients treated with chemotherapy in Fuyang Cancer Hospital were selected as the research subjects. The psychological distress levels of the patients were evaluated by the Psychological Distress Thermometer (DT) score at the beginning of chemotherapy (T1), two cycles of chemotherapy (T2), end of chemotherapy (T3) and after 1 month of chemotherapy (T4). The latent category growth analysis (LCGA) model was used to explore the latent classification characteristics of the psychological distress trajectory of lung cancer patients undergoing chemotherapy, and the influencing factors were analyzed through multivariate logistic regression.
Results The DT score of the patients showed a trend of first increasing and then decreasing during the period from T1 to T4, and the overall level was moderate psychological distress. The LCGA model identified four potential classifications: high-level stable group (C1), medium-level rise and fall group (C2), medium-level stable group (C3) and low-level stable group (C4). The results of multivariate logistic regression analysis showed that the OR values for per capita monthly income ranging from 1000 to 3000 yuan and ＞ 3000 yuan were 0.344 (95%CI: 0.231–0.511) and 0.162 (95%CI: 0.093–0.281), respectively, the OR value of psychological resilience was 0.981 (95%CI: 0.970–0.991), and the OR value of social support was 0.971 (95%CI: 0.948–0.994), which were the protective factors for the changes in the psychological distress trajectory of lung cancer patients undergoing chemotherapy. The OR values of patients with a disease course of 6–12 months and ＞12 months were 2.018 (95%CI: 1.532–2.658) and 5.606 (95%CI: 3.628–8.663), respectively, and the OR value of clinical stage was 3.957 (95%CI: 2.522–6.207), which were considered risk factors.
Conclusions Among lung cancer patients undergoing chemotherapy, the trajectory of psychological distress shows significant group heterogeneity. By assessing the dynamic characteristics of psychological distress and its influencing factors, clinical staff can identify high-risk groups and implement targeted interventions to effectively alleviate psychological distress and improve patients' overall quality of life.

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