认知行为疗法对化疗癌症患儿治疗依从性及免疫功能的影响
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摘要
目的:探讨认知行为疗法对化疗癌症患儿治疗依从性及免疫功能的影响,为癌症患儿的心理护理提供依据。方法:采用便利抽样方法选取符合标准的癌症患儿50例,并按照癌症类型、分期和年龄进行配对,根据其意愿分为治疗组和对照组各25例。对照组只采用常规心理护理,治疗组采用认知行为疗法,干预时间共5周。干预前后,采用Frankl依从量表(Frankl compliance scale,FCS)、Houpt行为量表(Houpt behavior scale,HBS)和外周血淋巴细胞含量(peripheral blood lymphocyte content,PBLC)评估其治疗依从性及免疫功能,并对结果进行比较分析。结果:干预后,治疗组的治疗依从性(3.20±0.40)、NK细胞含量(natural kill cell,NKC;20.36±10.76)明显高于对照组的治疗依从性(2.72±0.61)及NK细胞含量(16.68±8.44),且差异具有统计学意义(t治疗依从性=3.256,P=0.002;tNK细胞含量=2.356,P=0.024)。T淋巴细胞含量较干预前明显增加(72.26±11.34 vs. 76.33±11.07;t=2.460,P=0.021),但对照组干预前后在治疗依从性及淋巴细胞含量上并无明显差异(均P>0.05)。结论:认知行为疗法通过纠正患儿对患癌事件的歪曲认知,可以增强治疗依从性,对提高免疫调节能力及改善预后有一定的积极作用。
Objective:To investigate the effect of cognitive behavioral therapy on treatment compliance and immune function in children with cancer receiving chemotherapy,and to provide a basis for psychological nursing for children with cancer. Methods:Convenience sampling was used to select 50 children with cancer who met related criteria,and after being matched for type of cancer,stage,and age,they were divided into treatment group and control group according to their preference,with 25 patients in each group. The patients in the control group were given routine psychological nursing,and those in the treatment group were given cognitive behavioral therapy;the course of treatment was 5 weeks for both groups. Before and after intervention,Frankl Compliance Scale(FCS),Houpt Behavior Scale(HBS),and peripheral blood lymphocyte content(PBLC)were used to evaluate treatment compliance and immune function,and the results were analyzed and compared between the two groups. Results:After intervention,compared with the control group,the treatment group had significantly higher treatment compliance(3.20±0.40 vs. 2.72±0.61,t=3.256,P=0.002)and content of natural killer cells(20.36±10.76 vs. 16.68±8.44,t=2.356,P=0.024). The treatment group had a significant increase in T lymphocytes after intervention(72.26±11.34 vs. 76.33±11.07,t=2.460,P=0.021),but in the control group,there were no significant changes in treatment compliance and T lymphocytes after intervention(all P>0.05). Conclusion:In children with cancer,cognitive behavioral therapy can enhance treatment compliance by correcting their distorted understanding of cancer events and thus plays an important role in improving immunoregulation capability and prognosis.
Objective:To investigate the effect of cognitive behavioral therapy on treatment compliance and immune function in children with cancer receiving chemotherapy,and to provide a basis for psychological nursing for children with cancer. Methods:Convenience sampling was used to select 50 children with cancer who met related criteria,and after being matched for type of cancer,stage,and age,they were divided into treatment group and control group according to their preference,with 25 patients in each group. The patients in the control group were given routine psychological nursing,and those in the treatment group were given cognitive behavioral therapy;the course of treatment was 5 weeks for both groups. Before and after intervention,Frankl Compliance Scale(FCS),Houpt Behavior Scale(HBS),and peripheral blood lymphocyte content(PBLC)were used to evaluate treatment compliance and immune function,and the results were analyzed and compared between the two groups. Results:After intervention,compared with the control group,the treatment group had significantly higher treatment compliance(3.20±0.40 vs. 2.72±0.61,t=3.256,P=0.002)and content of natural killer cells(20.36±10.76 vs. 16.68±8.44,t=2.356,P=0.024). The treatment group had a significant increase in T lymphocytes after intervention(72.26±11.34 vs. 76.33±11.07,t=2.460,P=0.021),but in the control group,there were no significant changes in treatment compliance and T lymphocytes after intervention(all P>0.05). Conclusion:In children with cancer,cognitive behavioral therapy can enhance treatment compliance by correcting their distorted understanding of cancer events and thus plays an important role in improving immunoregulation capability and prognosis.
引文
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[25]刘倩,孙爱民,王玮.固有免疫细胞抗肿瘤免疫治疗的研究进展[J].现代肿瘤医学,2018,26(8):1292-1296.
[26] Hirase S,Hasegawa D,Takahashi H,et al. Absolute lymphocyte count at the end of induction therapy is a prognostic factor in childhood acute lymphoblastic leukemia[J]. Int J Hematol,2015,102(5):594-601.
[27]陈莉琼.外周血Th17及T淋巴细胞亚群指标与小儿白血病的关系研究[J].实用癌症杂志,2017,32(11):1171-1173.
[2] Siegel RL,Miller KD,Jemal A. Cancer Statistics,2017[J]. CA Cancer J Clin,2017,67(1):7-30.
[3] Ahmad SS,Reinius MA,Hatcher HM,et al. Anticancer chemotherapy in teenagers and young adults:managing long term side effects[J].BMJ,2016,354(9):i4567.
[4]刘景珍.儿童急性淋巴细胞白血病的预后及相关影响因素分析[J].中国妇幼健,2014,29(1):70-72.
[5] Schrepf A,Thaker PH,Goodheart MJ,et al. Diurnal cortisol and survival in epithelial ovarian cancer[J]. Psychoneuroendocrinology,2015,53(3):256-267.
[6] Qing Y. Biological rhythms and the HPA axis in psychoneuroimmunology[M]. Bern:Springer,2016.
[7] Shin KJ,Lee YJ,Yang YR,et al. Molecular mechanisms underlying psychological stress and cancer[J]. Curr Pharm Des,2016,22(16):2389-2402.
[8] Davis LZ,Slavich GM,Thaker PH,et al. Eudaimonic well-being and tumor norepinephrine in patients with epithelial ovarian cancer[J].Cancer,2015,121(19):3543-3550.
[9]张萍,莫霖,李霞,等.不同心理干预方法对恶性肿瘤患者负性情绪干预效果的网状meta分析[J].重庆医科大学学报,2017,42(9):1208-1212.
[10]杨静静,刘均娥.心理干预对乳腺癌患者免疫功能影响的研究进展[J].中华护理杂志,2014,49(10):1243-1248.
[11] Danese A,J Lewis S. Psychoneuroimmunology of early-life stress:the hidden wounds of childhood trauma?[J]. Neuropsychopharmacology,2017,42(1):99-114.
[12] O’Connor TG,Moynihan JA,Caserta MT. Annual research review:the neuroinflammation hypothesis for stress and psychopathology in children——developmental psychoneuroimmunology[J]. J Child Psychol Psychiatry,2014,55(6):615-631.
[13]沃森,基桑.癌症患者心理治疗手册[M].北京:北京大学医学出版社,2016.
[14]段小燕,周建荣,林双兰,等. Tell-Show-Do法对乳牙正畸患儿治疗依从性的影响[J].检验医学与临床,2015,12(15):2145-2150.
[15] Ding Y,Zhou L,Xia Y,et al. Reference values for peripheral blood lymphocyte subsets of healthy children in China[J]. J Allergy Clin Immunol,2018,142(3):970-973.
[16] Thompson RD,Delaney P,Flores I,Szigethy E. Cognitive-behavioral therapy for children with comorbid physical illness. Child and adolescent psychiatric clinics of North America,2011,20(2):329-48.
[17] Malla HE,Helm NY. Adherence to medication:a nation-wide study from the Children’s Cancer Hospital,Egypt[J]. World J Psychiatry,2013,3(2):25-33.
[18] Buhle JT,Silvers JA,Wager TD,et al. Cognitive reappraisal of emotion:a meta-analysis of human neuroimaging studies[J]. Cereb Cortex,2014,24(11):2981-2990.
[19] Day AL,Whrborg P,Anderssongre B,et al. An evaluation of daily relaxation training and psychosomatic symptoms in young children[J].Health Behav Policy Rev,2016,3(3):198-208.
[20]张萍,莫霖,李霞,等.认知行为疗法对癌症化疗患儿心理弹性及负性情绪的影响[J].护理学杂志,2018,13(11):60-64.
[21]林文娟.心理神经免疫学研究[J].心理科学进展,2006,14(4):511-516.
[22]李光磊,郝济伟,李怡然,等.免疫对神经行为学的影响及机制的最新进展[J].生理科学进展,2017,48(3):216-220.
[23] Reich RR,Lengacher CA,Kip KE,et al. Baseline immune biomarkers as predictors of MBSR(BC)treatment success in off-treatment breast cancer patients[J]. Biol Res Nurs,2014,16(4):429-437.
[24]张瑜,林文娟,王玮文.中枢免疫失衡与认知功能障碍:聚焦TNF-α的作用[J].心理科学进展,2017,25(12):2036-2042.
[25]刘倩,孙爱民,王玮.固有免疫细胞抗肿瘤免疫治疗的研究进展[J].现代肿瘤医学,2018,26(8):1292-1296.
[26] Hirase S,Hasegawa D,Takahashi H,et al. Absolute lymphocyte count at the end of induction therapy is a prognostic factor in childhood acute lymphoblastic leukemia[J]. Int J Hematol,2015,102(5):594-601.
[27]陈莉琼.外周血Th17及T淋巴细胞亚群指标与小儿白血病的关系研究[J].实用癌症杂志,2017,32(11):1171-1173.
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