| objective:Bone metastases is one of the frequent complication of cancer.Skeletal-related events(SREs)and the side effects associated with radiotherapy may affect the level of psychological distress in patients with bone metastases.Psychological distress is not only associated with a lower quality of life,but also with lower treatment compliance,higher mortality,and a higher risk of suicide.We screened the level of psychological distress during radiotherapy in patients with bone metastases for the following purpose:(1)to investigate the level of psychological distress and its changes during radiotherapy in patients with bone metastases,and the main problems to cause psychological distress;(2)to analyze the relationship between psychological distress and quality of life,and the relationship between psychological distress and pain in patients with bone metastases;(3)to explore the predictors of a significant decrease in psychological distress after radiotherapy in patients with bone metastases.Methods:This study is a prospective study and our sample was consisted of patients with bone metastases who planned to receive radiotherapy in the department of oncology of Chengdu First People’s Hospital from May 2017 to December 2018.After given informed consent,eligible patients were asked to complete a set of questionnaires containing the Distress Thermometer(DT)with Problem List(PL),the Europe Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Bone Metastases22(EORTC QLQ-BM22),the Numerical Rating Scale(NRS)and a self-designed questionnaire including patient demographic information.Eligible patients with bone metastases were asked to complete the DT,the EORTC QLQ-BM22 and the NRS 4 times:(1)at baseline(before radiotherapy);(2)at the second week of RT;(3)at the fourth week of RT;(4)at the one month after RT.The collected data were analyzed by SPSS 17.0 statistical software.Pearson correlation analysis was used to find out the relationship between DT and EORTC QLQ-BM22,and the relationship between DT and NRS in patients with bone metastases.The chi-square test was used to compare the difference in the prevalence of significant psychological distress during radiotherapy.The univariate and multivariate logistic regression analysis were used to analyze the independent factors of a significant decrease in DT scores of patients with bone metastases after radiotherapy.The nomogram model and the Receiver operating characteristic(ROC)cure were established with R and EmpowerStats software based on the results of the multivariate logistic regression analyses.The ROC cure was used to assess the discrimination of a nomogram model.We set the significance level at P<0.05.Results:(1)The mean score of the DT was 6.07±1.65 at baseline(before radiotherapy),4.81±1.44 at the second week of RT,4.14±1.56 at the fourth week of RT,and 3.77±1.69 at the one month after RT.The mean score of the NRS at the 4 time points was 4,26±2.89,2.28±2.05,1.49±1.12,and 0.96±0,83 in sequence.The mean score of the EORTC QLQ-BM22 at the 4 time points was 41.66±8.81,36.19±7.52,34.36±6.79 and 31.92±5.35 in sequence.The prevalence of significant psychological distress in patients with bone metastases was 91.2%at baseline(before radiotherapy),78.9%at the second week of RT,61.4%at the fourth week of RT;and 45.6%at the one month after RT.Specifically,there was a significant decrease in proportion of patients with significant psychological distress from baseline(before radiotherapy)to the fourth week of RT(X2=14.02,P<0.01),and from baseline(before radiotherapy)to the one month after RT(X2=27.44,P<0.01).(2)The main problems were pain(87.7%),worry(68.4%),sleep(68.4%),financial(59.6%)and eating(57.9%)caused patients with psychological distress before radiotherapy,pain(80.7%),fatigue(66.7%),worry(63.1%),financial(56.1%)and eating(54.4%)at the second week of RT,pain(63.2%),fatigue(61.4%),worry(5 9.6%)and financial(50.9%)at the fourth week of RT and financial(59.6%),worry(59.6%)and sleep(52.6%)at the one month after RT.(3)Pearson correlation analysis showed that the DT was positively related with the EORTC QLQ-BM22 and the NRS(all P<0.05).(4)In the univariate logistic regression analysis,a significant decrease in DT score of patients with bone metastases was found have a statistically significant correlation with age,education,EORTC QLQ-BM22,NRS,financial,worry,and fatigue.However,the multivariate logistic regression analysis confirmed only education(OR= 3.91,9 5%CI:1.97-98.07),EORTC QLQ-BM22 score(OR=20.26,95%CI:2,69-99.9),NRS(OR=12.80,95%CI:1.84-88.7 8),worry(OR=8.10,9 5%CI:1.47-44.42),fatigue(OR=3.77,95%CI:1.01-13.95)and pain(OR=23,54,9 5%CI:1.39-99.9)as independent factors associated with a significant decrease in DT score of patients with bone metastases.(5)The AUC of nomogram for a significant decrease in DT score was 0.877(95%CI:0.78-0.97),indicating considerable predictive accuracy.In the internal validation of the nomograms,the AUC of Bootstrap was 0.873,indicating reliable consistency between the nomogram and the actual observation.Conclusion(1)The prevalence of significant psychological distress is relatively high in patients with bone metastases before radiotherapy.With the progress of radiotherapy,the prevalence of significant psychological distress decrease.The main problems causing psychological distress in patients with bone metastases are emotional and physical problems.(2)The level of psychological distress is positively correlated with the quality of life and the pain.Clinical medical workers can use the quality of life and the pain as one of the evaluation indexs of psychological intervention effects.(3)Education,the quality of life,pain,worry,and fatigue are the predictors of a significant decrease in psychological distress after radiotherapy in patients with bone metastases. |
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