The chain mediating effect of social alienation and metacognition on symptom distress and fear of cancer recurrence in young and middle-aged patients with cervical cancer
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摘要:
目的 探讨中青年宫颈癌患者社会疏离与元认知在症状困扰与癌症复发恐惧间的链式中介效应,以期为临床癌症复发恐惧的管理及干预提供新视角。 方法 采用便利抽样法,选取2023年2—8月新疆某三级甲等肿瘤专科医院就诊的330例中青年宫颈癌患者作为研究对象,使用一般资料调查表、癌症复发恐惧量表简表(FCRI-SF)、元认知问卷(MCQ-30)、一般疏离感量表(GAS)、安德森症状评估量表(MDASI)进行调查,通过偏差校正的百分位Bootstrap法(Process插件)进行变量间的链式中介效应检验。 结果 中青年宫颈癌患者癌症复发恐惧得分(14.64±6.37)分,57.27%的患者存在较高水平的癌症复发恐惧(FCRI-SF≥13分)。症状困扰与癌症复发恐惧(r=0.495, P<0.01)、社会疏离感(r=0.397, P<0.01)、元认知(r=0.197, P<0.01)均呈正相关关系。中青年宫颈癌患者的症状困扰、社会疏离及元认知能显著正向预测其癌症复发恐惧(β=0.107、0.430、0.156,均P<0.001),中介效应分析显示社会疏离与元认知在症状困扰、癌症复发恐惧之间起链式中介作用,效应量为0.009,总效应占比为4.27%。 结论 中青年宫颈癌患者存在较高水平的癌症复发恐惧,社会疏离感和元认知在症状困扰与癌症复发恐惧之间发挥链式中介作用。 Abstract:Objective The purpose of this study is to explore the mediating effects of social distancing and metacognition between symptom distress and fear of cancer recurrence in young and middle-aged patients with cervical cancer, in order to provide a new perspective for the management and intervention of fear of cancer recurrence. Methods A total of 330 middle-aged and young cervical cancer patients from February to August 2023 in a Grade A cancer hospital in Xinjiang were selected as the study objects by convenience sampling method. The general information questionnaire, the fear of cancer recurrence inventory short form (FCRI-SF), the metacognitive questionnaire (MCQ-30), the general alienation scale (GAS), and the M.D. Anderson symptom inventory (MDASI) were used to conduct the questionnaire survey. The chain mediation effect between variables was tested by percentile Bootstrap method (Process plug-in) with deviation correction. Results The average score of fear of cancer recurrence in young and middle-aged patients with cervical cancer was (14.64±6.37) points, and 57.27% of the patients had a high level of fear of cancer recurrence (FCRI-SF≥13 points). Symptom distress was positively correlated with social alienation (r=0.397, P < 0.01), metacognition (r=0.197, P < 0.01) and fear of cancer recurrence (r=0.495, P < 0.01). Symptom distress, social alienation and metcognition of young and middle-aged patients with cervical cancer could significantly positively predict their fear of cancer recurrence (β=0.107, 0.430, 0.156, P < 0.001). Mediating effect analysis showed that social alienation and metcognition played a chain mediating role between symptom distress and fear of cancer recurrence with an effect size of 0.009. The total effect accounted for 4.27%. Conclusion There is a high level of fear of cancer recurrence in young and middle-aged patients with cervical cancer. Social alienation and metacognition play a chain mediating role between symptom distress and fear of cancer recurrence. -
Key words:
- Cervical cancer /
- Chemotherapy /
- Fear of cancer recurrence /
- Metacognition /
- Social alienation /
- Symptom distress
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表 1 中青年宫颈癌患者FCR与症状困扰、元认知、社会疏离的相关性分析(r值)
Table 1. Correlation analysis of FCRI-SF with symptom distress, metacognition and social distancing in middle-aged and young cervical cancer patients(r value)
变量 癌症复发恐惧 社会疏离 元认知 症状困扰 癌症复发恐惧 1 社会疏离 0.638a 1 元认知 0.454a 0.234a 1 症状困扰 0.495a 0.397a 0.197a 1 注:aP<0.01。 表 2 中青年宫颈癌患者症状困扰与癌症复发恐惧链式中介模型的回归分析
Table 2. Regression analysis of the chain mediation model between symptom distress and fear of cancer recurrence in young and middle-aged cervical cancer patients
结果变量 预测变量 整体拟合指数 回归系数显著性 R R2 F值 β t值 P值 社会疏离 症状困扰 0.397 0.158 61.485 0.186 7.841 0.001 元认知 症状困扰 0.260 0.068 11.884 0.100 2.127 0.034 社会疏离 0.320 3.181 0.002 癌症复发恐惧 症状困扰 0.746 0.557 136.591 0.107 6.179 0.001 社会疏离 0.430 11.520 0.001 元认知 0.156 7.705 0.001 表 3 社会疏离和元认知在症状困扰和癌症复发恐惧间的链式中介效应检验
Table 3. The mediating effects of social distancing and metacognition on symptom distress and fear of cancer recurrence
路径/效应模型 效应值 Boot标准误 Boot标准CI下限 Boot标准CI上限 相对中介效应占比(%) 总效应c 0.211 0.021 0.171 0.252 直接效应c' 0.107 0.017 0.073 0.141 50.71 总中介效应 0.105 0.015 0.077 0.134 49.76 中介效应1 0.080 0.013 0.057 0.107 37.91 中介效应2 0.016 0.008 <0.001 0.033 7.58 中介效应3 0.009 0.004 0.003 0.017 4.27 注:间接效应2中Boot标准CI下限≈0.0002≠0;中介效应1,症状困扰-社会疏离-FCR;中介效应2,症状困扰-元认知-FCR;中介效应3,症状困扰-社会疏离-元认知-FCR。 -
[1] 国家癌症中心, 国家肿瘤质控中心宫颈癌质控专家委员会. 中国宫颈癌规范诊疗质量控制指标(2022版)[J]. 中华肿瘤杂志, 2022, 44(7): 615-622. doi: 10.3760/cma.j.cn112152-20220511-00328National Cancer Center, National Cancer Quality Control Center Cervical Cancer Quality Control Expert Committee. Quality control index of standard diagnosis and treatment of Cervical cancer in China (2022 edition)[J]. Chinese Journal of Cancer, 2022, 44(7): 615-622. doi: 10.3760/cma.j.cn112152-20220511-00328 [2] WANG Z, TANG Y, DANG H W, et al. Analysis of Xinjiang HPV16 L1 gene polymorphisms: a newly developed, low-cost enzyme-linked immunosorbent assay[J]. Int J Clin Exp Pathol, 2022, 15(1): 1-10. [3] 张华, 罗梅, 董银凤, 等. 妇科癌症患者癌症复发恐惧与生活质量的关系及夫妻支持的中介效应[J]. 中华全科医学, 2019, 17(12): 2119-2122, 2130. doi: 10.16766/j.cnki.issn.1674-4152.001142ZHANG H, LUO M, DONG Y F, et al. The relationship between fear of cancer recurrence and quality of life in gynecological cancer patients and the mediating effect of marital support[J]. Chinese Journal of General Practice, 2019, 17(12): 2119-2122, 2130. doi: 10.16766/j.cnki.issn.1674-4152.001142 [4] 李家燕, 杨丽, 张妍欣, 等. 鼻咽癌同步放化疗患者症状困扰纵向调查及影响因素分析[J]. 中国护理管理, 2021, 21(9): 1314-1320. doi: 10.3969/j.issn.1672-1756.2021.09.009LI J y, YANG L, ZHANG Y X, et al. Longitudinal investigation and influencing factors of symptom distress in patients with nasopharyngeal carcinoma with concurrent chemoradiotherapy[J]. Chinese Journal of Nursing Administration, 2021, 21(9): 1314-1320. doi: 10.3969/j.issn.1672-1756.2021.09.009 [5] 郑楹楹, 吕宏英, 陈正飞, 等. 宫颈癌根治术后患者康复期症状体验及心理感受的质性研究[J]. 中华护理杂志, 2020, 55(4): 569-573. doi: 10.3761/j.issn.0254-1769.2020.04.017ZHENG Y Y, LV H Y, CHEN Z F, et al. Qualitative study on symptom experience and psychological feeling of patients with cervical cancer after radical surgery[J]. Chinese Journal of Nursing, 2020, 55(4): 569-573. doi: 10.3761/j.issn.0254-1769.2020.04.017 [6] HONG S J, SHIN N M, JUNG S. A predictive model of fear of cancer recurrence for patients undergoing chemotherapy[J]. Support Care Cancer, 2020, 28(9): 4173-4181. doi: 10.1007/s00520-019-05245-7 [7] 梁亚清, 林艳, 黄林玲, 等. 宫颈癌幸存者社会疏离感现状及影响因素研究[J]. 护理学杂志, 2022, 37(16): 64-67. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202216019.htmLIANG Y Q, LIN Y, HUANG L L, et al. Study on social alienation of cervical cancer survivors and its influencing factors[J]. Journal of Nursing Science, 2022, 37(16): 64-67. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202216019.htm [8] 张爱萍, 段素伟. 社会疏离在康复期乳腺癌患者癌症复发恐惧与睡眠质量间的中介效应[J]. 护理学报, 2022, 29(13): 66-70. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL202213014.htmZHANG A P, DUAN S W. The mediating effect of social distancing on fear of cancer recurrence and sleep quality in convalescent breast cancer patients[J]. Journal of Nursing, 2022, 29(13): 66-70. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL202213014.htm [9] WISŁOWSKA-STANEK A, LEHENR M, TOMCZUK F, et al. The effects of the recurrent social isolation stress on fear extinction and dopamine D2 receptors in the amygdala and the hippocampus[J]. Pharmacol Rep, 2023, 75(1): 119-127. doi: 10.1007/s43440-022-00430-8 [10] 程春燕, 崔盼盼, 郑美琼. 元认知疗法在癌症幸存者中的应用研究进展[J]. 护理研究, 2023, 37(5): 883-886. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202305022.htmCHENG C Y, CUI P P, ZHENG M Q. Research progress of metacognitive therapy in cancer survivors[J]. Chinese Nursing Research, 2023, 37(5): 883-886. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202305022.htm [11] AǦAÇ M, VZAR-ÖZÇE Y S. Psychological resilience, metacognitions, and fear of recurrence among cancer survivors and family caregivers[J]. Cancer Nurs, 2022, 45(2): E454-E462. doi: 10.1097/NCC.0000000000000973 [12] 张榴红, 周婷, 黄峥, 等. 妇科肿瘤患者负性情绪和元认知在躯体症状与恐惧疾病进展间的链式中介作用[J]. 中华行为医学与脑科学杂志, 2022, 31(11): 1002-1007.ZHANG L H, ZHOU T, HUANG Z, et al. The mediating effect of negative emotion and metacognition on physical symptoms and fear of disease progression in gynecological tumor patients[J]. Chinese Journal of Behavioral Medicine and Brain Sciences, 2022, 31(11): 1002-1007. [13] NORDAHL H, ANYAN F, HJEMDAL O, et al. Metacognition, cognition and social anxiety: a test of temporal and reciprocal relationships[J]. J Anxiety Disord, 2022, 86: 102516. DOI: 10.1016/j.janxdis.2021.102516. [14] 彭巧华, 吕卫国. 2022年第1版《NCCN子宫颈癌临床实践指南》解读[J]. 实用肿瘤杂志, 2022, 37(3): 205-214. https://www.cnki.com.cn/Article/CJFDTOTAL-SYZZ202203002.htmPENG Q H, LV W G. Interpretation of the first edition of NCCN Clinical Practice Guidelines for Cervical Cancer in 2022[J]. Journal of Practical Oncology, 2022, 37(3): 205-214. https://www.cnki.com.cn/Article/CJFDTOTAL-SYZZ202203002.htm [15] 翟绍蒲, 王蕾, 邢伟. 宫颈癌根治术患者复发恐惧心理调查及其影响因素分析[J]. 护理实践与研究, 2020, 17(19): 14-16. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202019007.htmZHAI S P, WANG L, XING W. Investigation of fear of recurrence in patients undergoing radical resection of cervical cancer and analysis of its influencing factors[J]. Nursing Practice and Research, 2020, 17(19): 14-16. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202019007.htm [16] 张旭. 癌症幸存者复发恐惧模型的构建与验证研究[D]. 沈阳: 中国医科大学, 2022.ZHANG X. Construction and verification of recurrence fear model in cancer survivors[D]. Shenyang: China Medical University, 2022. [17] 任辉. 乳腺癌患者癌症复发恐惧的影响因素及其发展轨迹研究[D]. 长春: 吉林大学, 2021.REN H. Research on Influencing factors and development trajectory of cancer recurrence fear in breast cancer patients[D]. Changchun: Jilin University, 2021. [18] CLEELAND C S, MENDOZA T R, WANG X S, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory[J]. Cancer, 2000, 89(7): 1634-1646. [19] 黄荣, 刘欢, 曾利红, 等. 宫颈癌患者症状群管理的研究进展[J]. 护理实践与研究, 2023, 20(2): 230-234. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202302014.htmHANG R, LIU H, ZENG L H, et al. Research progress of symptom cluster management in patients with cervical cancer[J]. Nursing Practice and Research, 2023, 20(2): 230-234. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202302014.htm [20] 杨昕宇, 吕利明, 王硕, 等. 癌症幸存者社会疏离的研究进展[J]. 中华护理杂志, 2020, 55(8): 1270-1275. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202008036.htmYANG X Y, LYU L M, WANG S, et al. Research progress of social distancing in cancer survivors[J]. Chinese Journal of Nursing, 2020, 55(8): 1270-1275. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202008036.htm [21] 王晓玲, 贾宁. 焦虑障碍的元认知问卷的编制、变式与应用[J]. 心理技术与应用, 2019, 7(12): 746-755. https://www.cnki.com.cn/Article/CJFDTOTAL-XLJS201912005.htmWANG X L, JIA N. Development, variation and application of metacognitive questionnaire for Anxiety disorder[J]. Psychological Technique and Application, 2019, 7(12): 746-755. https://www.cnki.com.cn/Article/CJFDTOTAL-XLJS201912005.htm [22] BUBIS L D, DAVIS L, MAHAR A, et al. Symptom burden in the first year after cancer diagnosis: an analysis of patient-reported outcomes[J]. J Clin Oncol, 2018, 36(11): 1103-1111. [23] 程颖, 柳菁菁. 《中国肿瘤药物治疗相关恶心呕吐防治专家共识(2022年版)》解读[J]. 临床内科杂志, 2023, 40(5): 351-353. https://www.cnki.com.cn/Article/CJFDTOTAL-LCLZ202305021.htmCHENG Y, LIU J J. Interpretation of Expert Consensus on Prevention and Treatment of nausea and vomiting related to tumor drug Therapy in China (2022 edition)[J]. Journal of Clinical Internal Medicine, 2023, 40(5): 351-353. https://www.cnki.com.cn/Article/CJFDTOTAL-LCLZ202305021.htm [24] SUN Y S, CHEN W L, WU W T, et al. The fact of return to work in cervical cancer survivors and the impact of survival rate: an 11-year follow-up study[J]. Int J Environ Res Public Health, 2021, 18(20): 10703. DOI: 10.3390/ijerph182010703. [25] 周密, 谭严. 重庆市某三甲医院中青年妇科恶性肿瘤患者身心功能状况调查[J]. 现代预防医学, 2018, 45(12): 2158-2162. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201812013.htmZHOU M, TAN Y. Investigation on physical and mental function of young and middle-aged patients with gynecological malignant tumor in a Top three hospital of Chongqing[J]. Modern Preventive Medicine, 2018, 45(12): 2158-2162. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201812013.htm [26] 周娟, 张競, 石卉慧. 预见性护理在预防宫颈癌术后并发症中的应用价值[J]. 中华全科医学, 2022, 20(12): 2168-2171. doi: 10.16766/j.cnki.issn.1674-4152.002795ZHOU J, ZHANG J, SHI H H, Application value of predictive nursing in the prevention of postoperative complications of cervical cancer[J]. Chinese Journal of General Practice, 2022, 20(12): 2168-2171. doi: 10.16766/j.cnki.issn.1674-4152.002795 [27] MARINOVIC D A, HUNTER R L. Examining the interrelationships between mindfulness-based interventions, depression, inflammation, and cancer survival[J]. CA Cancer J Clin, 2022, 72(5): 490-502.