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结直肠癌晚期化疗患者心理问题特征、影响机制及干预策略的系统综述

Psychological Problems in Patients with Advanced Colorectal Cancer Undergoing Chemotherapy: A Systematic Review of Characteristics, Influencing Mechanisms, and Intervention Strategies

Psychology of China / 2026,8(1): 139-146 / 2026-01-30 16 8

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• Authors: 孙艺媛 鲍文卿 韩佳佳
• Information:

  上海健康医学院附属浦东公利医院，上海

• Keywords:
  Colorectal cancer; Advanced stage; Chemotherapy; Psychological problems; Cancer-related fatigue; Psychological intervention; Family involvement; Resilience; Precision medicine
  结直肠癌; 晚期; 化疗; 心理问题; 癌因性疲乏; 心理干预; 家属参与; 复原力; 精准医学
• Abstract: Objective: To systematically review the core characteristics, multi-dimensional influencing factors, and mechanisms of psychological problems in patients with advanced colorectal cancer undergoing chemotherapy. This study aims to comprehensively summarize the efficacy differences of existing psychological intervention programs, thereby providing evidence-based support for clinical precision psychological management and future research. Methods: Guided by a conceptual framework encompassing “Problem–Influencing Factors–Mechanisms– Interventions–Future Directions”. We searched 9 databases (including PubMed, The Cochrane Library, CINAHL, and CNKI) for relevant Chinese and English literature published in the past three years. Information from the literature was qualitatively synthesized and quantitatively analyzed based on inclusion and exclusion criteria. Key conclusions were extracted, and cross-study comparative perspectives were supplemented. Results: Psychological problems in patients with advanced colorectal cancer undergoing chemotherapy presented a “three primary and three secondary” characteristic profile. The primary problems included cancer-related fatigue (CRF, incidence 62%~78%), anxiety (38%~55%), and depression (32%~48%). The secondary problems were sleep disorders (45%~60%), spiritual distress (28%~35%), and body image disturbance (25%~32%). Their development is interactively influenced by four categories of factors: patient-specific factors (resilience, self-compassion), treatment-related factors (severity of side effects), social support (family involvement), and disease-related factors (progression rate). These problems are further exacerbated through a four-stage vicious cycle: “physical discomfort→cognitive bias→emotional deterioration→treatment nonadherence.” Among existing interventions, the combined program of “family-participatory cognitive-behavioral nursing + precision nutrition intervention” demonstrated the optimal efficacy, reducing anxiety scores by 15.2 points, CRF scores by 18.6 points, and improving chemotherapy adherence to 96.3%. Conclusion: Psychological problems in patients with advanced colorectal cancer undergoing chemotherapy are complex and diverse. There is a need to select targeted, precision interventions based on “population heterogeneity.” Future research should conduct large-sample, multi-center studies to establish a long-term evidence chain linking “psychological intervention to survival benefit.” 目的：系统梳理晚期结直肠癌化疗患者心理问题的核心特征，多维度影响因素与作用机制，全面总结现有心理干预方案的效果差异，为临床精准心理管理与后续研究提供循证依据。方法：采用“问题—影响因素—机制—干预—展望”的逻辑框架，通过检索PubMed、TheCochraneLibrary、CINAHL、中国知网等9个数据库中近3年相关中英文文献，依据纳排标准对文献中信息进行定性整合与定量分析，提炼关键结论并补充跨研究对比观点。结果：晚期结直肠癌化疗患者心理问题呈现“三主三辅”特征——以癌因性疲乏（发生率62%～78%）、焦虑（38%～55%）、抑郁（32%～48%）为主要问题，以睡眠障碍（45%～60%）、灵性痛苦（28%～35%）、自我形象紊乱（25%～32%）为辅助问题。其形成受患者自身（复原力自我关怀）、治疗（副作用严重程度）、社会支持（家属参与度）、疾病（进展速度）四类因素交互影响。并通过“生理不适—认知偏差—情绪恶化—治疗不依从”的四阶段恶性循环持续加重。现有干预方案中“家属参与式认知行为护理+精准营养干预”联合方案效果最优，可使焦虑评分降低15.2分，癌因性疲乏评分降低18.6分，化疗依从性提升至96.3%。结论：晚期结直肠癌化疗患者心理问题具有复杂性与多样性，需基于“人群异质性”选择靶点精准的干预方案，未来需开展多中心大样本研究，建立“心理干预—生存获益”的长期证据链。
• DOI: https://doi.org/10.35534/pc.0801022 (registering DOI)
• Cite: 孙艺媛, 鲍文卿, 韩佳佳. (2026). 结直肠癌晚期化疗患者心理问题特征、影响机制及干预策略的系统综述. 中国心理学前沿, 8 (1), 139-146.