乳がん専門医による乳がん患者に対するうつ病診療の実態調査 [in Japanese] Survey of medical care by oncologists for depression in breast cancer patients [in Japanese]
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<b>【目的】</b>乳がん専門医によるうつ病診療の実態調査 <b>【方法】</b>乳がん専門医352名に, うつ病診療状況に関する調査票を郵送した. <b>【結果】</b>110名(31.3％)から回答を得た. 乳がん患者のうつ病罹患割合は, 90％の医師が20％以下, 約半数が5％以下と回答した. 第一選択薬はベンゾジアゼピン系抗不安薬(BZD)が最多で(41.5%), 次が選択的セロトニン再取り込み阻害薬(SSRI)だった(30.9%). BZD使用の医師は, 使用経験の豊富さ(オッズ比[OR] 8.20), 安全性(OR 6.27)で選んでおり, SSRIは, 効果の高さ(OR 7.07)で選ばれていた. <b>【結論】</b>乳がん専門医の乳がん患者のうつ病診療では, 調査票に基づく診断や薬物療法等において高い水準の医療が均しく行われているとは言い難く, 精神科系専門家との連携も含め, 診療環境整備の必要性が示唆された.
<b>Objective:</b> To investigate the perception of the prevalence of mental diseases in breast cancer patients and the therapeutic approach to depression undertaken by oncologists. <b>Method:</b> Self-reported questionnaires were sent to 352 breast cancer specialists. The survey contains 11 categories to elicit the perception and identification of mental illnesses in patients, diagnostic procedure, and details of antidepressant prescribed. Logistic regression was used to explore the association of oncologists' characteristics and management of depression in breast cancer patients. <b>Results:</b> Survey response rate was 31.3%. Ninety percent of the oncologists perceived the prevalence of depression to be less than 20%, while half believed that the proportion was less than 5%. The most commonly-used medication for the treatment of depression was BZDs (41.5% [<i>n</i>=39]), followed by Selective Serotonin Reuptake Inhibitors (SSRIs) (30.9% [<i>n</i>=29]). Benzodiazepines (BZDs) were most frequently prescribed (41.5%) despite its known ineligible dependency, followed by Selective Serotonin Reuptake Inhibitors (SSRIs) (30.9%). Choice of BZDs was significantly associated with the career length of oncologists (Odds Ratio [OR]=8.20), and safety of drug (OR=5.57). Contrarily, prescription of SSRIs was associated with efficiency of drug (OR=7.07). Conclusion: Relative to anxiety and insomnia, a lower awareness regarding depression was common among study oncologists. In addition, the quality of care varied among these oncologists. It is necessary to improve both the awareness and management of mental illnesses in order to enhance the total clinical care of breast cancer patients.
- Palliative Care Research
Palliative Care Research 9(3), 132-139, 2014
Japanese Society for Palliative Medicine