JAMA子刊 | 年轻时期癌症经历带来的终身心理挑战与精神负担需要引起关注
学术经纬约 5 分钟在数据来源方面，该团队检索了发表自2000年1月1日至2022年11月18日的PubMed、MEDLINE、Embase、PsycINFO、CINAHL和PubMed Central的文献，选择了测量和报告CYACs和非癌症对照组中抑郁症、焦虑症、精神障碍和自杀死亡风险和严重程度的文章。从7319个结果中，研究者共纳入了52项研究（过程如下图），这些研究报告了CYACs相对于无癌症对照组在抑郁症、焦虑症、精神障碍和自杀死亡等心理疾病和心理症状方面的情况。大多数研究招募了健康的、与年龄相匹配的对照组作为对照组，而有13项研究选择了患有癌症的患者的兄弟姐妹作为对照组，另有3项研究选择了患者的父母或护理人员作为对照组。
通过系统性审查和meta分析显示，相对于匹配对照组和他们的兄弟姐妹，CYACs的一生中严重抑郁症状或抑郁症的风险增加（RR，1.57；95% CI，1.29-1.92），焦虑症的风险增加（RR，1.29；95% CI，1.14-1.47），精神障碍的风险增加（RR，1.56；95% CI，1.36-1.80）。
撰文
责编
制作
排版 | Sheila 校对 | uu
*本文由深圳市拾玉儿童公益基金会“儿童肿瘤前沿”团队编译或约稿，文中图表均源引自文献原文。本文著作权归文章作者所有，欢迎个人转发分享，未经允许禁止转载，作者拥有所有法定权利，违者必究。如需转载，请留言或联系[email protected]。本文旨在分享儿童肿瘤科研前沿成果，不是治疗方案推荐。如需获得疾病治疗方案指导，请前往正规医院就诊。
▼滑动查看更多▼
原文摘要（Abstract）
Importance: A cancer diagnosis and treatment may result in highly traumatic periods with lasting psychological consequences for children, adolescent, and young adult patients with cancer (CYACs). Early identification and management may prevent long-term psychological morbidity and suicide.
Objective: To analyze risk, severity, and risk factors for depression, anxiety, psychotic disorders, and suicide in CYACs and noncancer comparators.
Data sources: Literature search of PubMed, MEDLINE, Embase, PsycINFO, CINAHL, and PubMed Central from January 1, 2000, to November 18, 2022.
Study selection: Full-length articles in peer-reviewed journals that measured and reported risk and/or severity of depression, anxiety, psychotic disorders, and suicide mortality in CYACs and a noncancer comparator group.
Data extraction and synthesis: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed with prospective PROSPERO registration.
Main outcomes and measures: Risk ratios (RRs) were used for dichotomous outcomes, and standardized mean differences (SMDs) were used for continuous outcomes. SMDs were defined as follows: 0.2, small; 0.5, medium; and 0.8, large. Sources of heterogeneity and risk factors were investigated using sensitivity, subgroup, and meta-regression analyses.
Results: From 7319 records, 52 studies were included. Meta-analyses revealed that CYACs were at increased lifetime risk of severe symptoms or a disorder of depression (RR, 1.57; 95% CI, 1.29-1.92), anxiety (RR, 1.29; 95% CI, 1.14-1.47), and psychotic disorders (RR, 1.56; 95% CI, 1.36-1.80) relative to both matched controls and their siblings. Overall suicide mortality was not significantly elevated (RR, 1.63; 95% CI, 0.78-3.40). The mean severity of depression was found to be elevated in CYACs receiving treatment (SMD, 0.44; 95% CI, 0.13-0.74) and long-term survivors (SMD, 0.18; 95% CI, 0.02-0.33). The mean severity of anxiety was found to be elevated only during treatment (SMD, 0.16; 95% CI, 0.03-0.20).
Conclusions and relevance: Findings of this systematic review and meta-analysis suggest that CYACs may experience lasting psychological burden long into survivorship. Timely identification, preventive efforts, and psycho-oncological intervention for psychological comorbidity are recommended.
DOI: 10.1001/jamapediatrics.2023.2168