Chinese Expert Consensus on Clinical Management of the Psychosomatic Symptoms in Patients with Cancer

doi:10.12114/j.issn.1007-9572.2024.0575

Chinese General Practice ›› 2025, Vol. 28 ›› Issue (15): 1809-1822.DOI: 10.12114/j.issn.1007-9572.2024.0575

Special Issue: 指南/共识最新文章合辑；肿瘤最新文章合辑

• Guidelines·Consensus·Interpretation • Next Articles

Chinese Expert Consensus on Clinical Management of the Psychosomatic Symptoms in Patients with Cancer

1. Department of Psychiatry and Psychosomatics, Zhongda Hospital, School of Medicine, Jiangsu Provincial Key Laboratory of Brain Science and Medicine, Southeast University, Nanjing 210009, China
2. Department of Psychological Medicine, Fudan University Shanghai Cancer Center/Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
3. Department of Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
4. Department of Breast Surgery, Fudan University Shanghai Cancer Center/Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
5. Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China
6. Department of Psychology, the First Medical Center of the PLA General Hospital, Beijing 100853, China
7. Department of Psychology, Drum Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing 210008, China
8. The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
9. Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
10. Department of Oncology, Sichuan Provincial People's Hospital, Chengdu 610072, China
11. Department of Psychiatry, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
12. Department of Psychological Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
13. Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai 200065, China
14. Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha 410011, China
15. Department of Oncology, the First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China
16. Department of Psychology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China
17. Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China

Received:2024-09-10 Revised:2025-01-10 Published:2025-05-20 Online:2025-03-21
Contact: FENG Wei, YUAN Yonggui
About author:
YIN Yingying and ZHAO Kuan are co-first authors

肿瘤患者心身症状临床管理中国专家共识

1．210009　江苏省南京市，东南大学附属中大医院心身医学科
2．200032　上海市，复旦大学附属肿瘤医院心理医学科　复旦大学上海医学院肿瘤学系
3．210009　江苏省南京市，东南大学附属中大医院肿瘤科
4．200032　上海市，复旦大学附属肿瘤医院乳腺外科　复旦大学上海医学院肿瘤学系
5．510000　广东省广州市，南方医科大学附属广东省人民医院（广东省医学科学院）广东省精神卫生中心
6．100853　北京市，解放军总医院第一医学中心医学心理科
7．210008　江苏省南京市，南京大学医学院附属鼓楼医院医学心理科
8．210008　江苏省南京市，南京大学医学院附属鼓楼医院肿瘤中心
9．610072　四川省成都市，四川省医学科学院·四川省人民医院（电子科技大学附属医院）四川省精神医学中心
10．610072　四川省成都市，四川省人民医院肿瘤中心
11．310009　浙江省杭州市，浙江大学医学院附属第二医院精神科
12．200127　上海市，上海交通大学医学院附属仁济医院心理医学科
13．200065　上海市，同济大学附属同济医院精神医学中心
14．410011　湖南省长沙市，中南大学湘雅二医院精神卫生研究所精神病学科
15．610500　四川省成都市，成都医学院第一附属医院肿瘤科
16．830000　新疆维吾尔自治区乌鲁木齐市，新疆维吾尔自治区人民医院临床心理科
17．100730　北京市，中国医学科学院北京协和医院心理医学科

通讯作者: 冯威, 袁勇贵
作者简介:
尹营营和赵宽为共同第一作者
作者贡献：
袁勇贵、冯威负责设计共识、组织专家讨论；尹营营、赵宽负责检索文献、总结专家意见、撰写初稿；其余作者负责对文章知识性内容的审阅、初稿修订。
基金资助:
江苏省重点研发计划(BE2019748); 上海市加强公共卫生体系建设三年行动计划学科带头人项目(GWVI-11.2-XD23)

Abstract

Abstract:

Cancer patients are often accompanied by serious psychosomatic symptoms such as depression, anxiety, insomnia and pain, which seriously affect the quality of life and prognosis of patients. However, these symptoms are often under-appreciated and poorly treated. At present, the domestic consensus on the management of cancer lacks the content of psychosomatic symptoms. Therefore, this consensus systematically describes the clinical management methods of psychosomatic symptoms related to cancer patients, combining relevant literature and integrating practical management tools. It comprehensively answers the important questions of physician-patient communication, diagnosis and evaluation, psychological intervention, drug treatment, and how to establish the physician-nurse-patient-family alliance of cancer-related psychosomatic symptoms. Aim at raising awareness of cancer-related psychosomatic symptoms among non-psychiatrists, and selecting effective communication, treatment and management of psychosomatic symptoms with the help of psycho-psychological and other multidisciplinary teams.

Key words: Cancer, Psychosomatic symptoms, Psychosomatic medicine, Clinical management, Expert consensus

摘要： 肿廇患者常伴有严重的抑郁、焦虑、失眠、疼痛等心身症状，严重影响患者生活质量及预后。该类症状目前在我国临床中容易被医患忽视或未有效转诊治疗。目前国内肿瘤管理相关共识对心身症状处理内容较少，鉴于此，本共识系统阐述了肿瘤患者相关心身症状的临床管理建议，结合相关文献，整合实用管理工具，全面回答了肿瘤相关心身症状的医患沟通、诊断评估、心理干预、药物治疗以及如何建立医-护-患-家属同盟等重要问题，旨在提高非精神专科医生对肿瘤相关心身症状的识别、转诊，并在精神心理科及其他多学科团队的互助下有效沟通、开展治疗及管理心身症状。

关键词: 肿瘤, 心身症状, 心身医学, 临床管理, 专家共识

YIN Yingying,ZHAO Kuan,WANG Cailian, et al. Chinese Expert Consensus on Clinical Management of the Psychosomatic Symptoms in Patients with Cancer[J]. Chinese General Practice, 2025, 28(15): 1809-1822. DOI: 10.12114/j.issn.1007-9572.2024.0575.
尹营营,赵宽,王彩莲等. 肿瘤患者心身症状临床管理中国专家共识[J]. 中国全科医学, 2025, 28(15): 1809-1822. DOI: 10.12114/j.issn.1007-9572.2024.0575.

Figures/Tables 2

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常见心身障碍	症状标准	病程标准	严重程度标准	排除标准
广泛性焦虑障碍	1.担心、害怕；2.紧张、坐立不安；3.疲倦；4.注意力不集中，心神恍惚；5.易激惹；6.肌肉紧张、不能放松；7.失眠；8.思虑过多	≥6个月或经常出现上述症状	1.出现≥4种症状；2.无法自控；3.影响日常生活功能	药物或其他疾病（如甲状腺功能亢进等）所致
惊恐障碍	1.心慌、心悸；2.多汗；3.震颤、发抖；4.气短；5.胸闷；6.胸口不适；7.恶心；8.头晕；9.忽冷忽热；10.刺痛、麻木等感觉异常；11.非真实感、人格解体；12.失控；13.濒死感	1.发作>1次；2.担心再发	发作时因为恐惧常求助急诊，发作间期因担心发作无人帮助而感到害怕，需要他人陪伴	左房室瓣脱垂、肾上腺嗜铬细胞瘤等躯体疾病所致
抑郁障碍	1.情绪低落；2.快感缺失、兴趣减退；3.食欲或体重下降；4.睡眠紊乱（失眠或嗜睡）；5.精神运动迟滞或激越；6.疲乏、精力下降；7.内疚、无价值感；8.感无望、绝望；9.注意力不集中、犹豫不决；10.自杀观念或行为	1.≥2周；2.经常出现上述症状；3.几乎每天都出现上述症状	1.出现≥5种症状；2.影响日常生活功能；3.临床确诊疾病或失能后的反应过度	药物或其他疾病（如甲状腺功能减退等）所致
睡眠障碍	入睡困难、眠浅易醒、多梦、梦魇、早醒，睡眠节律紊乱	1.慢性失眠障碍：每周发生3次或以上，持续3个月或以上；2.短期失眠障碍：病程短于3个月	白天疲倦、注意力不集中、认知减退，影响日常工作学习及社交活动，甚至导致各种差错或者事故	其他精神、躯体疾病所致
谵妄	定向障碍、感知觉障碍（包括幻觉、视空间感知障碍等）、思维障碍、情绪障碍、记忆障碍、言行紊乱、睡眠节律紊乱等表现，具有昼轻夜重的特点	病程快速波动、与躯体疾病密切相关，并可随躯体疾病的好转而逐渐恢复	影响日常生活功能	脑器质性疾病及精神分裂症等其他精神障碍

常见心身障碍	症状标准	病程标准	严重程度标准	排除标准
广泛性焦虑障碍	1.担心、害怕；2.紧张、坐立不安；3.疲倦；4.注意力不集中，心神恍惚；5.易激惹；6.肌肉紧张、不能放松；7.失眠；8.思虑过多	≥6个月或经常出现上述症状	1.出现≥4种症状；2.无法自控；3.影响日常生活功能	药物或其他疾病（如甲状腺功能亢进等）所致
惊恐障碍	1.心慌、心悸；2.多汗；3.震颤、发抖；4.气短；5.胸闷；6.胸口不适；7.恶心；8.头晕；9.忽冷忽热；10.刺痛、麻木等感觉异常；11.非真实感、人格解体；12.失控；13.濒死感	1.发作>1次；2.担心再发	发作时因为恐惧常求助急诊，发作间期因担心发作无人帮助而感到害怕，需要他人陪伴	左房室瓣脱垂、肾上腺嗜铬细胞瘤等躯体疾病所致
抑郁障碍	1.情绪低落；2.快感缺失、兴趣减退；3.食欲或体重下降；4.睡眠紊乱（失眠或嗜睡）；5.精神运动迟滞或激越；6.疲乏、精力下降；7.内疚、无价值感；8.感无望、绝望；9.注意力不集中、犹豫不决；10.自杀观念或行为	1.≥2周；2.经常出现上述症状；3.几乎每天都出现上述症状	1.出现≥5种症状；2.影响日常生活功能；3.临床确诊疾病或失能后的反应过度	药物或其他疾病（如甲状腺功能减退等）所致
睡眠障碍	入睡困难、眠浅易醒、多梦、梦魇、早醒，睡眠节律紊乱	1.慢性失眠障碍：每周发生3次或以上，持续3个月或以上；2.短期失眠障碍：病程短于3个月	白天疲倦、注意力不集中、认知减退，影响日常工作学习及社交活动，甚至导致各种差错或者事故	其他精神、躯体疾病所致
谵妄	定向障碍、感知觉障碍（包括幻觉、视空间感知障碍等）、思维障碍、情绪障碍、记忆障碍、言行紊乱、睡眠节律紊乱等表现，具有昼轻夜重的特点	病程快速波动、与躯体疾病密切相关，并可随躯体疾病的好转而逐渐恢复	影响日常生活功能	脑器质性疾病及精神分裂症等其他精神障碍

药物种类	药物名称	初始剂量	维持剂量	不良反应及注意事项
选择性5-羟色胺再摄取抑制剂（SSRIs）	艾司西酞普兰	5~10 mg/d	10~20 mg/d	氟西汀、帕罗西汀、高剂量舍曲林为CYP2D6酶抑制剂，影响他莫昔芬代谢；SSRIs不良反应常见胃肠道反应、抗胆碱能反应和性功能障碍等，其中艾司西酞普兰耐受性相对较好
	氟西汀	10~20 mg/d	20~60 mg/d
	帕罗西汀	10~20 mg/d	20~60 mg/d
	舍曲林	25~50 mg/d	50~200 mg/d
	西酞普兰	10~20 mg/d	20~40 mg/d
5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）	度洛西汀	20~30 mg/d	60~120 mg/d	可改善神经病理性疼痛，CYP2D6酶抑制剂，可能影响他莫昔芬代谢
5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）	文拉法辛	37.5~75.0 mg/d	75~225 mg/d	高血压患者慎用，可改善神经病理性疼痛、潮热等躯体症状
其他抗抑郁药	阿米替林	6.25~12.50 mg/d	12.50~25.00 mg/d	可改善神经病理性疼痛，但需注意药物不良反应。
	安非他酮	50~75 mg/d	150~450 mg/d	癫痫禁用，CYP2D6酶抑制剂，可能影响他莫昔芬代谢。可改善癌症相关性疲乏
	伏硫西汀	5~10 mg/d	10~20 mg/d	不影响CYP450酶代谢
	米氮平	7.5~15.0 mg /d	15~45 mg/d	镇静作用，改善食欲
	曲唑酮	25~50 mg/d	50~200 mg/d	镇静作用
	托鲁地文拉法辛	40 mg/d	80~160 mg/d	不经过CYP450酶代谢
抗焦虑药	丁螺环酮	10~15 mg/d	15~60 mg/d	可能引起嗜睡、困倦、眩晕等不适
抗焦虑药	坦度螺酮	20~30 mg/d	20~60 mg/d	可能引起嗜睡、困倦、眩晕等不适
镇静催眠药	阿普唑仑	0.2~1.0 mg/次	每次最少间隔6 h	存在日间困倦、认知功能减退、停药戒断反应、呼吸抑制等，老年患者应注意肌松作用和跌倒风险。与阿片类药物联用可能增加上述风险，需更加谨慎
	艾司唑仑	0.5~2.0 mg/次	每次最少间隔8 h
	奥沙西泮	7.5~15.0 mg/次	每次最少间隔8 h
	劳拉西泮	0.25~2.0 mg/次	每次最少间隔4 h
	右佐匹克隆	1~3 mg/d		常见不良反应包括头晕、嗜睡、遗忘等，严重呼吸功能不全、呼吸睡眠暂停综合征患者禁用
	佐匹克隆	3.75~7.5 mg/d
	唑吡坦	5~10 mg/d
抗精神病药	阿立哌唑	2.5~5.0 mg/d	5.0~10.0 mg/d	常见不良反应包括体质量增加、代谢综合征、抗胆碱能反应、锥体外系不良反应等。合并酪氨酸激酶抑制剂时需监测QTc间期，警惕心律失常风险
	奥氮平	2.5~5.0 mg/d	5.0~10.0 mg/d
	氟哌啶醇	1~2 mg/次	3次/d，最少间隔4 h，可口服、肌肉注射、静脉注射
	喹硫平	12.5~25.0 mg/d	50.0~200.0 mg/d

药物种类	药物名称	初始剂量	维持剂量	不良反应及注意事项
选择性5-羟色胺再摄取抑制剂（SSRIs）	艾司西酞普兰	5~10 mg/d	10~20 mg/d	氟西汀、帕罗西汀、高剂量舍曲林为CYP2D6酶抑制剂，影响他莫昔芬代谢；SSRIs不良反应常见胃肠道反应、抗胆碱能反应和性功能障碍等，其中艾司西酞普兰耐受性相对较好
	氟西汀	10~20 mg/d	20~60 mg/d
	帕罗西汀	10~20 mg/d	20~60 mg/d
	舍曲林	25~50 mg/d	50~200 mg/d
	西酞普兰	10~20 mg/d	20~40 mg/d
5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）	度洛西汀	20~30 mg/d	60~120 mg/d	可改善神经病理性疼痛，CYP2D6酶抑制剂，可能影响他莫昔芬代谢
5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）	文拉法辛	37.5~75.0 mg/d	75~225 mg/d	高血压患者慎用，可改善神经病理性疼痛、潮热等躯体症状
其他抗抑郁药	阿米替林	6.25~12.50 mg/d	12.50~25.00 mg/d	可改善神经病理性疼痛，但需注意药物不良反应。
	安非他酮	50~75 mg/d	150~450 mg/d	癫痫禁用，CYP2D6酶抑制剂，可能影响他莫昔芬代谢。可改善癌症相关性疲乏
	伏硫西汀	5~10 mg/d	10~20 mg/d	不影响CYP450酶代谢
	米氮平	7.5~15.0 mg /d	15~45 mg/d	镇静作用，改善食欲
	曲唑酮	25~50 mg/d	50~200 mg/d	镇静作用
	托鲁地文拉法辛	40 mg/d	80~160 mg/d	不经过CYP450酶代谢
抗焦虑药	丁螺环酮	10~15 mg/d	15~60 mg/d	可能引起嗜睡、困倦、眩晕等不适
抗焦虑药	坦度螺酮	20~30 mg/d	20~60 mg/d	可能引起嗜睡、困倦、眩晕等不适
镇静催眠药	阿普唑仑	0.2~1.0 mg/次	每次最少间隔6 h	存在日间困倦、认知功能减退、停药戒断反应、呼吸抑制等，老年患者应注意肌松作用和跌倒风险。与阿片类药物联用可能增加上述风险，需更加谨慎
	艾司唑仑	0.5~2.0 mg/次	每次最少间隔8 h
	奥沙西泮	7.5~15.0 mg/次	每次最少间隔8 h
	劳拉西泮	0.25~2.0 mg/次	每次最少间隔4 h
	右佐匹克隆	1~3 mg/d		常见不良反应包括头晕、嗜睡、遗忘等，严重呼吸功能不全、呼吸睡眠暂停综合征患者禁用
	佐匹克隆	3.75~7.5 mg/d
	唑吡坦	5~10 mg/d
抗精神病药	阿立哌唑	2.5~5.0 mg/d	5.0~10.0 mg/d	常见不良反应包括体质量增加、代谢综合征、抗胆碱能反应、锥体外系不良反应等。合并酪氨酸激酶抑制剂时需监测QTc间期，警惕心律失常风险
	奥氮平	2.5~5.0 mg/d	5.0~10.0 mg/d
	氟哌啶醇	1~2 mg/次	3次/d，最少间隔4 h，可口服、肌肉注射、静脉注射
	喹硫平	12.5~25.0 mg/d	50.0~200.0 mg/d

Chinese Expert Consensus on Clinical Management of the Psychosomatic Symptoms in Patients with Cancer

肿瘤患者心身症状临床管理中国专家共识

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