背景:癌症护理是目前日本最重要的医学问题。癌症患者的总疼痛由四个因素组成:身体,心理,社会困境,和精神上的痛苦。先前的研究表明,与男性患者相比,女性癌症患者要求更多的心理支持,似乎遭受不同类型的痛苦,例如,外观相关症状。然而,与性别相关的其他癌症困扰因素尚未得到全面定义。这项研究的目的是阐明癌症困扰类型的性别差异,以阐明日本应采取的措施,以提高基于性别的医学的整体癌症护理质量。
方法:收集2013年5月至2015年10月期间新就诊于金基大学医院心理肿瘤科门诊的患者资料。回顾性地从患者的病历中提取人口统计学因素和所有评估项目。根据2010年对癌症患者的调查,选择了代表癌症患者“总疼痛”四个因素的每个项目,即,身体上的痛苦(疼痛,外观变化),心理困扰(焦虑,抑郁症),社会困境(家庭问题,与工作相关的问题),和精神上的痛苦;以及性问题,并对答案进行了分析。使用医院焦虑抑郁量表(HADS)评估心理困扰。对癌症困扰类型的性别差异进行卡方检验和Fisher精确检验。对各项目的性别关联进行Pearson分析和多因素logistic回归分析。
结果:分析了101例癌症患者的数据,女性患者多于男性患者(女性:男性比例=71:30)。女性癌症患者更容易遭受心理社会问题,如外表变化,家庭问题和性问题比男性患者多,男性患者更有可能有精神上的痛苦。
结论:癌症患者的痛苦类型存在性别差异。为了提高整个癌症护理的质量,从基于性别的医学和心理肿瘤学的角度来看,需要医疗专业人员和社会支持进行更深入的干预。
BACKGROUND: Cancer care is currently the most important medical issue in Japan. Total pain of cancer patients consists of a combination of four factors: physical, psychological, social distress, and spiritual pain. Previous studies showed female cancer patients ask for more psychological support and seem to suffer different types of distress compared with male patients, for example, appearance-related symptoms. However, other factors of cancer distress related to gender have not been defined comprehensively. The aim of this study is to clarify the gender differences in cancer distress types in order to elucidate the measures that should be taken in Japan to improve the quality of whole cancer care based on gender-based medicine.
METHODS: The data of new patients who had visited the psycho-oncology outpatient service of Kinki University Hospital during the period of May 2013 to October 2015 were collected. Demographic factors and all assessed items were extracted from the patients\' medical charts retrospectively. Based on an inquiry of cancer patients in 2010, each item representing the four factors of \"total pain\" of cancer patients was chosen, i.e., physical distress (pain, changes in appearance), psychological distress (anxiety, depression), social distress (family problems, job-related problems), and spiritual pain; together with sexuality issues, and answers were analyzed. Hospital Anxiety Depression Scale (HADS) was used for the assessment of psychological distress. Chi-square test and Fisher\'s exact test were performed for gender differences in the cancer distress types. Pearson\'s analysis and multiple logistic regression analysis were performed for the association of gender with each item.
RESULTS: The data of 101 cancer patients were analyzed and there were more female patients than male patients (female: male ratio = 71:30). Female cancer patients were more likely to suffer from psycho-social issues such as changes in appearance, family problems and sexuality issues than male patients, and male patients were more likely to have spiritual pain.
CONCLUSIONS: There were gender differences in the distress types of cancer patients. In order to improve the quality of whole cancer care, more intensive intervention by medical professionals and social support is needed from the viewpoint of gender-based medicine and psycho-oncology.