Purpose The early integration of oncology and palliative care (EIPC) improves quality of life (QOL) and mood for patients with advanced cancer. However, the mechanisms by which EIPC benefits these outcomes remain unclear. We therefore examined whether EIPC improved patients' coping strategies and if changes in coping accounted for intervention effects on QOL and depressive symptoms. Patients and Methods For this secondary analysis of an EIPC trial, we examined data from 350 patients with newly diagnosed incurable lung or GI cancer. Participants completed assessments of QOL (Functional Assessment of Cancer Therapy-General), depressive symptoms (Patient Health Questionnaire-9), and coping (Brief COPE) at baseline and 24 weeks. We used linear regression to test intervention effects on use of coping strategies and mediation regression models with bias-corrected bootstrapping to examine whether improvements in coping mediated the effects of early palliative care on patient-reported outcomes. Results Compared with usual oncology care, EIPC significantly increased patient use of approach-oriented coping strategies ( B = 1.09; SE = 0.44; P = .01) and slightly reduced use of avoidant strategies ( B = -0.44; SE = 0.23; P = .06) from baseline to 24 weeks. Also, the increased use of approach-oriented coping and reduction in avoidant coping were associated with higher QOL and lower depressive symptoms at 24 weeks. The positive changes in approach-oriented coping, but not avoidant coping, significantly mediated the effects of EIPC on QOL (indirect effect, 1.27; 95% CI, 0.33 to 2.86) and depressive symptoms (indirect effect, -0.39; 95% CI, -0.87 to -0.08). Conclusion Patients with incurable cancer who received EIPC showed increased use of approach-oriented coping, which was associated with higher QOL and reduced depressive symptoms. Palliative care may improve these outcomes by providing patients with the skills to cope effectively with life-threatening illness.

中文翻译：

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患者应对策略在了解早期姑息治疗对生活质量和情绪的影响中的作用

目的 肿瘤学和姑息治疗 (EIPC) 的早期整合可改善晚期癌症患者的生活质量 (QOL) 和情绪。然而，EIPC 使这些结果受益的机制仍不清楚。因此，我们检查了 EIPC 是否改善了患者的应对策略，以及应对的变化是否可以解释干预对 QOL 和抑郁症状的影响。患者和方法 对于 EIPC 试验的二次分析，我们检查了 350 名新诊断为无法治愈的肺癌或胃肠道癌患者的数据。参与者在基线和 24 周时完成了 QOL（癌症治疗功能评估 - 一般）、抑郁症状（患者健康问卷 - 9）和应对（Brief COPE）的评估。我们使用线性回归来测试对使用应对策略和中介回归模型的干预效果，以及偏差校正引导法，以检查应对的改善是否介导了早期姑息治疗对患者报告结果的影响。结果 与通常的肿瘤护理相比，EIPC 显着增加了患者对方法导向的应对策略的使用（B = 1.09；SE = 0.44；P = .01）并略微减少了回避策略的使用（B = -0.44；SE = 0.23；P = .06) 从基线到 24 周。此外，方法导向应对的使用增加和回避应对的减少与 24 周时更高的 QOL 和更低的抑郁症状相关。以方法为导向的应对而非回避应对的积极变化显着介导了 EIPC 对 QOL 的影响（间接影响，1.27；95% CI，0.33 至 2。86）和抑郁症状（间接影响，-0.39；95% CI，-0.87 至 -0.08）。结论 接受 EIPC 的无法治愈的癌症患者更多地使用方法导向的应对方式，这与更高的 QOL 和减少的抑郁症状相关。姑息治疗可以通过为患者提供有效应对危及生命的疾病的技能来改善这些结果。