临床时讯 ＞ 临床研究
美国学者报告，Ⅰ期非小细胞肺癌（NSCLC）切除术后1～6年者呼吸困难发生率较高，且与术前呼吸困难、肺弥散量降低、缺乏运动及抑郁相关。见《胸部肿瘤学杂志》（Journal of Thoracic Oncology）。
J Thorac Oncol. 2010 Aug;5(8):1221-6.
Current dyspnea among long-term survivors of early-stage non-small cell lung cancer.
Feinstein MB, Krebs P, Coups EJ, Park BJ, Steingart RM, Burkhalter J, Logue A, Ostroff JS.
Departments of Medicine and daggerPsychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
INTRODUCTION: Dyspnea is common among lung cancer patients. As most studies of dyspnea have reviewed patients with active cancer or immediately after treatment, its prevalence during the longer-term period once treatment has been completed is not well characterized. This study quantifies the prevalence of dyspnea among lung cancer survivors and identifies potential correlates that may be amenable to intervention.
METHODS: Cross-sectional survey of 342 patients with disease-free, stage I, non-small cell lung cancer, assessed 1 to 6 years after surgical resection. Dyspnea was quantified using the Baseline Dyspnea Index. Any moderate/strenuous physical activity was measured using the Godin Leisure-Time Exercise Questionnaire. Mood disorder symptoms were assessed using the Hospital Anxiety and Depression Scale. Multiple regression analyses were used to examine demographic, medical, and health-related correlates of dyspnea.
RESULTS: Mean age was 68.9 years. Average predicted preoperative forced expiratory volume in 1 second was 89.0%. Current dyspnea, defined by a Baseline Dyspnea Index score of 9 or less, existed among 205 (60%) individuals. For 133 (65%) of these patients, dyspnea was absent preoperatively. Multivariate correlates of current dyspnea included preoperative dyspnea (odds ratio [OR] = 5.31), preoperative diffusing capacity (OR = 0.98), lack of moderate/strenuous physical activity (OR = 0.41), and the presence of clinically significant depression symptoms (OR = 4.10).
CONCLUSIONS: Dyspnea is common 1 to 6 years after lung cancer resection, and is associated with the presence of preoperative dyspnea, reduced diffusing capacity, clinically significant depression symptoms, and lack of physical activity. Further research is needed to test whether strategies that identify and treat patients with these conditions attenuate dyspnea among lung cancer survivors.