■罕见的癌症是那些一年中发病率低于6/100,000的癌症。平均而言,罕见癌症患者的5年相对生存率比普通癌症患者差.由于临床证据有限和缺乏知情决策的经验证据,罕见癌症患者的癌症创伤经历可能会进一步加剧。罕见癌症累计占所有癌症的25%,加上全球社会罕见癌症的负担不断上升,有必要确定罕见癌症患者的心理结局。
■这篇PRISMA坚持的系统综述(PROSPERO:CRD42023475748)涉及对PubMed的系统搜索,Embase,Cochrane和PsycINFO自2000年至2024年1月30日发表的所有同行评审的英语语言研究,评估了患病率,抑郁症的发病率和风险,焦虑,自杀,和罕见癌症患者的创伤后应激障碍(PTSD)。两名独立审稿人从已发表的研究中评估并提取了摘要数据。随机效应荟萃分析和荟萃回归用于主要分析。
■我们纳入了32项研究,涉及57,470例罕见癌症患者。荟萃分析表明,与健康对照组相比,罕见癌症患者的抑郁(RR=2.61,95%CI:1.43-4.77,I2=97%)和焦虑(RR=2.66,95%CI:1.27-5.55,I2=92%)的风险比(RR)显着增加。我们确定了高自杀率(每10万人年有315人,95%CI:162-609,I2=95%),抑郁症患病率(17%,95%CI:14-22,I2=88%),焦虑(20%,95%CI:15-25,I2=96%)和创伤后应激障碍(18%,95%CI:9-32,I2=25%)。与常见癌症类型的患者相比,自杀发生率,罕见癌症患者的PTSD患病率明显更高。系统评价发现,患有晚期疾病,化疗治疗,收入较低,社会地位是负面心理结局的危险因素。
■我们强调需要早期识别罕见癌症患者的心理适应不良。此外,确定有效干预措施的研究势在必行。
■这项研究得到了国家医学研究委员会过渡奖的支持,SingHealthDuke-NUS肿瘤学学术临床计划,Khoo飞行员合作奖,国家医学研究委员会临床科学家-个人研究资助-新研究者资助,特里·福克斯·格兰特和KhooBridge基金奖。
UNASSIGNED: Rare cancers are those that exhibit an incidence of less than six per 100,000 in a year. On average, the five-year relative survival for patients with
rare cancers is worse than those with common cancers. The traumatic experience of cancer can be further intensified in patients with
rare cancers due to the limited clinical evidence and the lack of empirical evidence for informed decision-making. With rare cancers cumulatively accounting for up to 25% of all cancers, coupled with the rising burden of rare cancers on societies globally, it is necessary to determine the psychological outcomes of patients with
rare cancers.
UNASSIGNED: This PRISMA-adherent systematic review (PROSPERO: CRD42023475748) involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all peer-reviewed English language studies published since 2000 to 30th January 2024 that evaluated the prevalence, incidence and risk of depression, anxiety, suicide, and post-traumatic stress disorder (PTSD) in patients with
rare cancers. Two independent reviewers appraised and extracted the summary data from published studies. Random effects meta-analyses and meta-regression were used for primary analysis.
UNASSIGNED: We included 32 studies with 57,470 patients with
rare cancers. Meta-analyses indicated a statistically significant increased risk-ratio (RR) of depression (RR = 2.61, 95% CI: 1.43-4.77, I2 = 97%) and anxiety (RR = 2.66, 95% CI: 1.27-5.55, I2 = 92%) in patients with rare cancers compared to healthy controls. We identified a high suicide incidence (315 per 100,000 person-years, 95% CI: 162-609, I2 = 95%), prevalence of depression (17%, 95% CI: 14-22, I2 = 88%), anxiety (20%, 95% CI: 15-25, I2 = 96%) and PTSD (18%, 95% CI: 9-32, I2 = 25%). When compared to patients with common cancer types, suicide incidence, and PTSD prevalence were significantly higher in patients with
rare cancers. Systematic review found that having advanced disease, chemotherapy treatment, lower income, and social status were risk factors for negative psychological outcomes.
UNASSIGNED: We highlight the need for early identification of psychological maladjustment in patients with
rare cancers. Additionally, studies to identify effective interventions are imperative.
UNASSIGNED: This study was supported by the National Medical Research Council Transition Award, SingHealth Duke-NUS Oncology Academic Clinical Programme, the Khoo Pilot Collaborative Award, the National Medical Research Council Clinician Scientist-Individual Research Grant-New Investigator Grant, the Terry Fox Grant and the Khoo Bridge Funding Award.