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July 13, 2007 (芝加哥) —最新研究显示，对于要接受根除性前列腺切除术的男性，即使是简短的术前压力管理措施，对他们都有正面的影响。于近期美国临床肿瘤病学第43届年会中所发表的研究报告中，研究人员说明术前的压力管理措施，对于术后生活品质改善的影响能持续6至12个月。休斯顿德州大学安德森治癌中心的研究报告主笔Lorenzo Cohen博士于其简报中提到，先前其研究团队提过短期上的益处，能在术前和术后降低情绪上的干扰。
在其最新的随机型试验中，研究人员观察158名安排要进行根除性前列腺切除术的男性，这些患者被随机分配至三个组别的其中之一，分配至压力管理组的男性，被要求谈论其对于即将接受手术所感受的恐惧及忧虑，并被教导横隔膜呼吸法、意象导引（guided imagery）及良好应对技巧，并在手术当天接受和想像暴露（imaginal exposure）。
分配至支持性注意措施组的男性，则是谈论其即将接受手术所感受的恐惧及忧虑，并做一次半结构式访谈（Semistructured Interview）；该组与压力管理组的男性都在术前和临床心理医师谈两次，并在手术前做另一次较简短的唔谈，最后一次则是在出院前做的。
一般性照护组中的男性则未接受此类介入措施，或是和心理医师唔谈；所有的患者都完成社会心理及生活品质的测量，其中包括苦恼忧伤和直觉想法的额外资讯测量，这些测量在实验一开始时、6个月时和12个月时进行。
【即使是基本的支持性注意措施也有益于患者】
患者主要为白人(78%)、已婚 (85%)且教育程度高(约80%为学院或更高学历)，研究人员控制这些全部的因子，加上年龄、实验开始的前列腺特异抗原、疾病的阶段、格利森评分（Gleason score）及实验开始时的各个量测值。
事后归因分析显示，相较于一般照护组，压力管理组在简表─36角色限制分数（SF-36 Role Physical scores）上明显较高（前者比后者为63比86）；压力管理组和支持性注意措施组之间的差异就没这么大，两组都在简表─36角色限制分数上有不错的表现（前者比后者为86比73）；研究人员提到，混合模型分析显示，在简表─36角色限制上有明显的群组主要效应(P = .01)。
研究人员也观察到疼痛分数上一个最低限度明显群组主要效应(P = .12)，压力管理组在疼痛分数（pain scores）上，明显的较一般照护组来得更佳（前者比后者为80比71），但在疼痛感（pain）上，两组和支持性注意措施组(77)之间的差异就没那么大。
研究人员也提出其中一组在时间效应上的整体健康分数，他们指出，在手术后12个月，压力管理组(74)和支持性注意措施组(76)皆在整体健康分数上较一般照护组(68)来得更高，在其他的术后结果上，则没有差异。
Cohen博士及其研究团队总结，研究结果指出，即使是简短的术前压力管理介入措施，从根除性前列腺切除术后的6及12个月的时间点来看，在改善生活品质的种种面向上是有好处的，采取此类介入措施能对结果有不错的改善。
美国临床肿瘤病第43届年会：会议摘要5148，2007年6月3日发表。
Stress Management Before Prostatectomy Can Improve Outcome
By Allison Gandey
Medscape Medical News
July 13, 2007 (Chicago) — A new study shows that even a brief presurgical stress-management intervention can go a long way in helping men undergoing radical prostatectomy. Reporting at the recent American Society of Clinical Oncology 43rd Annual Meeting, researchers demonstrated that intervention improved quality of life 6 and 12 months after the procedure. "We previously reported on the short-term benefits in reducing mood disturbances before and after surgery," lead author Lorenzo Cohen, PhD, from the University of Texas MD Anderson Cancer Center, in Houston, noted during his presentation.
In this latest randomized trial, the group looked at 158 men scheduled for radical prostatectomy. Patients were randomly assigned to 1 of 3 groups. Men in the stress-management group were asked to discuss their fears and concerns about the upcoming surgery and were taught diaphragmatic breathing, guided imagery, and adaptive coping skills and were given imaginal exposure to the day of surgery.
Men in the supportive-attention group discussed their fears and concerns about the upcoming surgery and underwent a semistructured interview. Men in this group as well as the stress-management group met with a clinical psychologist twice before surgery and were given another brief session just prior to their operation and again before they were discharged from hospital.
Men in the usual-care group had no such interventions or meetings with a psychologist. All patients completed psychosocial and quality-of-life measures, which included additional information on distress and intrusive thoughts. These measures were taken at baseline, 6 months, and 12 months.
Even Basic Supportive Attention Helped Patients
Patients were primarily white (78%), married (85%), and highly educated (about 80% college or higher). The researchers controlled for all of these factors as well as age, baseline prostate-specific antigen, stage of disease, Gleason score, and baseline measures.
Post hoc analyses revealed significantly higher SF-36 Role Physical scores for the stress-management group compared with the usual-care patients (86 vs 63). The comparison between the stress-management patients and the supportive-attention group was less dramatic, but there was benefit for both (86 vs 73). The researchers reported that mixed model analyses revealed a significant group main effect for SF-36 Role Physical (P = .01).
They also observed a marginally significant group main effect for pain scores (P = .12), with the stress-management group reporting significantly better pain scores than the usual-care group (80 vs 71). But neither group differed much from the supportive-attention group (77) when it came to pain.
The investigators also reported a group by time effect for general health scores. They showed that by 12 months after surgery the stress-management (74) and the supportive-attention (76) groups both reported higher general health scores than the usual-care group (68). There were no group differences on any of the other outcomes.
"Results suggest that even a brief presurgical stress-management intervention is beneficial in terms of improving aspects of quality of life 6 and 12 months after radical prostatectomy," Dr. Cohen and his team conclude. They suggest that adopting such interventions may well improve outcomes.
American Society of Clinical Oncology 43rd Annual Meeting: Abstract 5148. Presented June 3, 2007.