全国多中心老年晚期癌症患者失眠情况调查  

Insomnia in the elderly adults with advanced cancer:a national multi-center survey

作　　者：庞英[1] 何毅[1] 王玉[2] 陆永奎[3] 姜愚 宋丽华[5] 王丽萍[6] 李梓萌[1] 吕晓君 汪艳[1] 姚俊涛 刘晓红[9] 周晓艺[10] 何双智 张叶宁[1] 宋丽莉[1] 王冰梅[1] 苏中格 唐丽丽[1] PANG Ying;HE Yi;WANG Yu;LU Yong-Kui;JIANG Yu;SONG Li-Hua;WANG Li-Ping;LI Zi-Meng;LYU Xiao-Jun;WANG Yan;YAO Jun-Tao;LIU Xiao-Hong;ZHOU Xiao-Yi;HE Shuang-Zhi;ZHANG Ye-Ning;SONG Li-Li;WANG Bing-Mei;SU Zhong-Ge;TANG Li-Li(Department of Rehabilitation Medicine,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research Ministry of Education,Beijing 100142,China;Department of Breast Cancer Radiotherapy,Radiotherapy Center,Shanxi Provincial Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital of Chinese Academy of Medical Sciences,Taiyuan 030013,China;Department of Breast and Soft Tissue Cancer,Affiliated Cancer Hospital of Guangxi Medical University,Nanning 530021,China;Cancer Center,West China School of Medicine,West China Hospital,Sichuan University,Chengdu 610000,China;Department of Breast Medical Oncology,Shandong Cancer Hospital and Institute,Shandong First Medical University,Shandong Academy of Medical Sciences,Jinan 250117,China;Department of Oncology,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of Oncology,Xiamen Humanity Hospital,Xiamen 361016,Fujian Province,China;Department of Integrated Chinese and Western Medicine,Shaanxi Provincial Cancer Hospital Affiliated to Medical College of Xi′an Jiaotong University,Xi′an 710065,China;Department of Clinical Spiritual Care,Hunan Provincial Cancer Hospital,Changsha 410006,China;Department of Radiotherapy,Hubei Provincial Cancer Hospital,Wuhan 430079,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所康复科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]山西省肿瘤医院,中国医学科学院肿瘤医院山西医院放疗中心乳腺放疗科,太原030013 [3]广西医科大学附属肿瘤医院乳腺及软组织肿瘤内科,南宁530021 [4]四川大学华西临床医学院,四川大学华西医院肿瘤中心,成都610000 [5]山东第一医科大学·山东省医学科学院山东省肿瘤防治研究院乳腺内科,济南250117 [6]郑州大学第一附属医院肿瘤科,郑州450052 [7]厦门弘爱医院肿瘤内科,厦门361016 [8]西安交通大学医学院附属陕西省肿瘤医院中西医结合科,西安710065 [9]湖南省肿瘤医院临床心灵关怀部,长沙410006 [10]湖北省肿瘤医院放疗科,武汉430079

出　　处：《中华老年多器官疾病杂志》2022年第11期826-830,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：中国癌症基金会资助。

摘　　要：目的 调查老年晚期癌症患者失眠的发生率,探索失眠人群在症状、情绪和生活质量方面与非失眠人群的差异及失眠的风险因素。方法 2019年7月至2020年12月,使用MD安德森症状问卷(MDASI)、医院焦虑抑郁量表(HADS)、患者健康问卷-9(PHQ-9)、失眠严重指数量表(ISI)及欧洲生活质量五维度五水平问卷(EQ-5D-5L)对全国10个中心的晚期恶性肿瘤患者(≥65岁)进行调查,共计696例患者符合标准而纳入研究。采用SAS 9.4统计软件进行数据分析。根据数据类型,分别采用t检验或χ2检验进行组间比较。使用多元logistic回归分析失眠的风险因素。结果 老年晚期恶性肿瘤患者轻度及以上失眠发生率为31.9%(222/696)。失眠组症状负担、心理痛苦发生率显著高于无失眠组,生活质量显著低于无失眠组,差异均有统计学意义(P<0.001)。抑郁、焦虑是失眠的风险因素(OR=0.254, 95%CI 0.105~0.119,P=0.002;OR=0.286, 95%CI 0.615~0.687,P=0.005)。结论 老年晚期恶性肿瘤患者的失眠值得重视,即便是轻度失眠也会影响患者症状负担、心理痛苦和生活质量。Objective To investigate the prevalence of insomnia in the elderly with advanced cancer, and to explore the differences in their symptoms, emotions and quality of life between those with and without insomnia for the risk factors of insomnia. Methods From July 2019 to December 2020, MD Anderson symptom inventory(MDASI), hospital anxiety and depression scale(HADS), patient health questionnaire-9(PHQ-9), insomnia severity index(ISI), and EuroQol five dimensions questionnaire-5L version(EQ-5D-5L) were used to investigate the patients(aged ≥65 years) with advanced cancer from 10 centers over China. Finally, a total of 696 patients who met the inclusion criteria were enrolled in the study. All data analyses were conducted with SAS 9.4 software. Student′s t test or Chi-square test was used for intergroup comparison depending on different data types. Multivariate logistic regression analysis was employed to explore the risk factors of insomnia. Results The prevalence of mild or more severe insomnia was 31.9%(222/696) in the elderly with advanced cancer. The patients with insomnia had higher incidences of symptom burden and psychological distress, and lower score of quality of life(all P<0.001). Depression and anxiety were risk factors of insomnia(OR=0.254, 95%CI 0.105-0.119, P=0.002;OR=0.286, 95%CI 0.615-0.687, P=0.005). Conclusion Attention should be paid to insomnia among the elderly with advanced cancer. Even mild insomnia can negatively affect symptom burden, psychological distress and quality of life in the patients.

关 键 词：老年人 晚期癌症 失眠 症状管理 多中心 

分 类 号：R749.92[医药卫生—神经病学与精神病学] R730.9[医药卫生—临床医学]