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№ 3 (2026)

ОБЩИЕ ВОПРОСЫ ТЕРАПИИ И ОБЗОРЫ

Тревожные расстройства у пациентов с раком поджелудочной железы: от эпидемиологии к клиническим исходам и стратегиям лечения

https://doi.org/10.48612/psyph/8m17-m792-hrku

Опубликован 2026-10-02

  • В.И. Егоров
    • ,
  • К.К. Яхин

В.И. Егоров
Казанский государственный медицинский университет; Республиканский клинический онкологический диспансер имени профессора М.З. Сигала

К.К. Яхин
Казанский государственный медицинский университет

Аннотация

Актуальность. Рак поджелудочной железы (РПЖ) отличается крайне агрессивным течением и высокой частотой возникновения тревожных
расстройств (от 20 до 44 %), которые ухудшают качество жизни, снижают приверженность лечению, увеличивают риск послеоперационных
осложнений и негативно влияют на выживаемость.

Цель — анализ распространенности тревожных расстройств у больных РПЖ, их влияния на ближайшие и отдаленные результаты лечения,
а также анализ сравнительной эффективности инструментов скрининга и подходов к коррекции тревожных состояний.

Материалы и методы. Выполнен обзор литературы в базах PubMed, Cochrane Library, еLibrary, а также клинических руководств NCCN,
RUSSCO и ASCO за 2004–2026 гг. В обзор включены проспективные и ретроспективные когортные, популяционные исследования, рандомизированные контролируемые исследования и метаанализы; исключены описания клинических случаев и тезисы конференций. Всего для
обзора отобрана 71 публикация.

Результаты. Распространенность тревожных расстройств при РПЖ составляет от 14,5 до 44 % в зависимости от применяемого способа
оценки и дизайна исследования. Тревожное расстройство ассоциируется со снижением приверженности химио- и хирургическому лечению,
повышением частоты послеоперационных осложнений (включая гастростаз) и, согласно большинству данных, ухудшением выживаемости. Биологическими механизмами служат активация гипоталамо-гипофизарно-надпочечниковой оси, выброс катехоламинов и глюкокортикоидов,
стимулирующих пролиферацию, ангиогенез и иммуносупрессию. Оптимальная стратегия скрининга тревожных расстройств при РПЖ — двухэтапная: шкала дистресса (порог ≥ 4) с последующим тестированием по шкалам GAD-7 (порог 7–8) или HADS-A (порог 7–8). Коррекция
включает когнитивно-поведенческую терапию, релаксационные техники и при необходимости прием антидепрессантов (СИОЗС/СИОЗСН).
Однако лишь около 25 % пациентов получают своевременную помощь, необходимую для снижения явлений тревожных расстройств.

Заключение. Тревожное расстройство при РПЖ служит модифицируемым фактором неблагоприятных клинических исходов. Приоритетной
задачей является интеграция систематического скрининга и мультимодальной коррекции тревожных расстройств в рутинные алгоритмы ведения пациентов для улучшения прогноза и онкологических результатов лечения.

Ключевые слова

тревожность, депрессия, рак поджелудочной железы, качество жизни, скрининг тревоги, выживаемость

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