乳腺癌患者的生命质量研究

乳腺癌严重威胁女性的生命健康,并严重影响患者的生命质量.近年来,乳腺癌患者的生命质量愈来愈倍受人们的关注.从生命质量的内容、测量工具以及影响因素等方面介绍乳腺癌患者生命质量的研究现状.     

不同TNM分期乳腺癌患者规范化治疗后生存期生命质量评价

目的 评价规范化治疗后不同TNM分期乳腺癌患者的生命质量,以及欧洲五维健康量表(EQ-5D)在中国乳腺癌患者生命质量测评中的应用价值.方法 采用国内乳腺癌患者生命质量测定调查量表(QLICP-BR)和EQ-5D中文版,分别测量于6个月前完成规范化治疗(内分泌治疗除外)的乳腺癌患者生命质量.采用x2检验、单因素方差分析、协方差分析等统计学方法分析影响乳腺癌患者生命质量的因素.以QLICP-BR量表中共性模块(QLICP-GM)的得分和QLICP-BR总分为标准,采用Pearson相关分析评价EQ-5D量表的应用价值.结果 2010年3-9月共收集符合纳入排除标准的女性乳腺癌患者178例,其中0期和Ⅰ期47例,Ⅱ期81例,Ⅲ期和Ⅳ期50例.控制年龄、文化程度、职业、出生地(城市和农村)、家庭月收入、医保支付情况后,0期和Ⅰ期患者调整QLICP-BR总分为(72.55±3.10)分,Ⅱ期患者为(64.09±2.69)分,Ⅲ期和Ⅳ期患者为(58.21 ±3.00)分,不同TNM分期患者调整QLICP-BR总分差异有统计学意义(P =0.002).0期和Ⅰ期患者的QLICP-BR总分和社会功能调整生命质量得分均高于Ⅱ期患者(均P＜0.05);0期和Ⅰ期患者的QLICP-BR总分、特异模块、心理功能、社会功能和躯体功能调整生命质量得分均高于Ⅲ期和Ⅳ期患者(均P ＜0.05).不同TNM分期乳腺癌患者EQ-5D效用得分与相应的QLICP-GM得分和QLICP-BR总分均呈正相关(均P＜0.05).结论 TNM分期早的患者生命质量较好,早诊早治可以提高乳腺癌患者的生命质量.EQ-5D量表对不同TNM分期患者生命质量的测定有良好的区分度,可用于中国女性乳腺癌患者生命质量的评价.     

乳腺癌患者生命质量测定量表的条目筛选及方法

[目的]研制乳腺癌患者生命质量测定量表。[方法]采用选题小组和专题小组的程序化决策方式研制乳腺癌患者生命质量测定量表,并通过随机抽取临床165例女性乳腺癌患者进行的生命质量测定资料对量表进行再筛选。所用的统计学方法包括相关分析、因子分析、逐渐回归分析和t检验。[结果]研制出含36个条目并加上自我评价的总体健康状况一个条目形成最终的含四个领域／维度,36＋1个条目的正式量表,称为癌症病人生命质量测定量表体系－乳腺癌量表,简称为QLICP－BR（V1．0）。其中,躯体功能维度（PH）6条,心理功能维度（PS）12条,症状及副作用维度（ST）8条,社会功能维度（SO）10条。[结论]QLICP－BR（V1．0）是由有关的各方面人员参与选题与讨论,所提出的条目池反映了WHO关于生命质量的内涵及乳腺癌患者的特殊问题,并按程序化方式进行条目筛选,因此可以认为具有较好的内容效度。     

乳腺癌的术中放疗

乳腺癌是全球女性最高发的恶性肿瘤,不仅威胁患者生命,同时也影响患者的生存质量和生理功能。因此,采用优化的综合治疗策略,延长患者生命,改善患者生存质量,是目前乳腺癌治疗的趋势。放射治疗是乳腺癌综合治疗的重要组成部分,近年来,乳腺癌放射治疗具有照射范围缩小,分割次数减少两大趋势。术中放疗(intraoperative radiotherapy,IORT)由于在手术中直视下给予单次大剂量照射,具有缩短疗程,有效保护正常组织的优势。目前IORT对接受保乳术的乳腺癌患者可作为外照射的局部剂量追加技术方法,或作为替代术后外照射的技术方法。现就IORT技术的优缺点及其临床适应证、疗效和不良反应进行系统回顾,为指导临床开展IORT提供依据。     

乳腺癌患者术后的规范化康复护理及其效果评价

目的:评价规范化康复护理对乳腺癌术后患者的康复效果。方法:选取2011年7月~2012年6月在我院及四川大学华西医院行乳腺癌改良根治术的患者58例作为试验组,2010年7月~2011年6月接受同样手术的乳腺癌患者54例作为历史对照组,试验组在康复专科护士指导下开展规范化康复护理,对照组由普通护士做健康指导,比较两组研究对象的患肢功能和生命质量。结果:试验组肩关节运动幅度(χ~2=6.0496,P=0.014)、肌力(χ~2=3.8621,P=0.049)、精细运动功能(χ~2=4.9509,P=0.026)均优于对照组,生命质量评分增速高于对照组(F=11.77,P=0.001)。结论:乳腺癌患者术后进行规范化康复护理是促进患肢功能恢复的重要环节,对提高患者的生命质量有着十分重要的意义。     

多样性心理干预对乳腺癌患者负性情绪、心理弹性和生存质量的影响

目的 探讨多样性心理干预对乳腺癌患者负性情绪、心理弹性和生存质量的影响.方法 采用随机数字表法将120例乳腺癌患者分为干预组和对照组,各60例.两组患者均给予常规的健康教育及治疗指导,干预组同时给予多样性心理干预.比较两组患者干预前后的心理弹性水平、负性情绪和生存质量.结果 干预后,干预组患者的心理弹性水平总评分为(75.27±9.41)分,高于对照组患者的(71.04±9.06)分(P﹤0.05).干预后,干预组患者中文版乳腺癌患者生命质量测定量表(QLICP-BR)中社会能力、心理状态、特异模块、共性症状维度的评分及总分均高于对照组患者(P﹤0.05).干预后,干预组患者焦虑抑郁量表中的焦虑亚量表(HADS-A)和抑郁亚量表(HADS-D)评分均明显低于对照组患者(P﹤0.01).结论 多样心理干预对乳腺癌患者的心理功能、负性情绪均具有明显的调节作用,可改善患者的生命质量.     

乳腺癌患者生命质量测定量表的考评

[目的]考评乳腺癌患者生命质量测定量表。[方法]通过随机抽取临床165例女性乳腺癌患者进行的生命质量测定资料对癌症病人生命质量测定量表体系-乳腺癌量表,简称为QLICP-BR（V1.0)进行考评。所用的统计学方法包括相关分析、因子分析,逐步回归分析的t检验。[结果]（1）躯体、心理、症状及副作用、社会功能四个领域和量表总分的重测相关系数分别为因子分析、逐步回归分析和t检验。[结果]（1）躯体、心理、症状及副作用、社会功能四个领域和量表总分的重测相关系数分别为0.86、0.84、0.87、0.85和0.89;分半信度为0.88;躯体、心理、症状及副作用、社会功能四个领域的克朗巴赫系数α分别为0.74、0.80、0.75和0.62。（2）量表的结构与设计时的概念构想吻合,以美国的FAFCT-B量表为效标进行评价,其效标效度为0.85。（3）量表能够反应治疗前后生命质量的变化。[结论]本文研究的量表具有较好的效度,信度和反应度,可作为我国乳腺癌患者生命质量的测评工具。     

癌症患者生命质量测定量表体系中各量表的测量学特性分析

目的:分析癌症患者生命质量测定量表体系(Quality of Life Instruments for Cancer Patients, QLICP)中,已研制的用于测定肺癌、乳腺癌、头颈癌、胃癌、结直肠癌和宫颈癌等6种癌症患者的量表构成及信度、效度和反应度。方法:采用量表开发的程序化方法研制各量表,然后对692例恶性肿瘤(包括85例肺癌、186例乳腺癌、133例头颈癌、86例胃癌、110例结直肠癌和92例宫颈癌)患者进行生命质量测定,通过计算总量表及各领域的克朗巴赫系数α和重测相关系数,应用探索性因子以及采用配对t检验等分析方法,考评研制量表的信度和效度。结果:6种癌症患者的生命质量测定量表均有较好的结构和符合要求的测量学特性,即有较好的信度、效度和一定的反应度。结论:肺癌、乳腺癌、头颈癌、胃癌、结直肠癌和宫颈癌等6种癌症的特异模块与QLICP体系中的共性模块结合后,可用于临床上相应癌症患者生命质量的测定。     

癌症患者生命质量测定量表体系之乳腺癌量表QLICP-BR的研制

背景与目的:我们已经研制了癌症患者生命质量测定量表体系的共性模块(quality of life instruments for cancer patients-general module,QLICP-GM).本研究在此基础上再研制乳腺癌患者生命质量测定量表(QLICP-BR),并对其进行评价.方法:采用量表开发的程序化决策方式研制适合中国文化的QLICP-BR,并通过对186例乳腺癌患者进行的生存质量测定对量表进行评价.结果:总量表及各个领域的重测相关系数均在0.75以上;各领域内部一致性信度的α值除社会功能领域为0.58外,其余均在0.65以上;各条目与其领域的相关性均大于与其它领域的相关性,相关系数r值大多都在0.6以上;总量表、共性模块、躯体功能、心理功能及社会功能领域得分均显示治疗前后差异有统计学意义.结论:QLICP-BR具有较好的信度、效度和一定的反应度,可作为我国乳腺癌患者生命质量的测评工具.     

乳腺癌患者生命质量测定量表FACT-B中文版介绍

全文介绍美国著名的生命质量测定量表FACT－B的中文版。重点是其计分方法和应用效果评价。结果表明FACT－B中文版具有较好的信度、效度及反应度，可用于中国乳腺癌患者的生命质量测定。     

Measuring Quality of Life in Thai Women with Breast Cancer

Breast cancer has become a commonly diagnosed disease among Thai women in the last decade, despite thefact that Thai women generally have a lower rates than their Western counterparts. With the rising incidenceand survival rates, it is crucial for nurses to look at the long term quality of life of these patients. A broad rangeof instruments have been used in clinical trials among breast cancer patients in oncology, like the EORTCquestionnaire including the general quality of life questions (QLQ-C30) and the breast cancer module (QLQBR23),and the FACT-B questionnaire consisting of both a generic part (FACT-G) and a breast cancer specificmodule. They have been shown to have good validity and reliability properties both for the English original andtranslations into various languages including Thai. A few studies on quality of life in Thai context exist, coveringquality of life in women with breast cancer. Therefore, the purpose of this study was to find which standardmeasure of common Western quality of life scales is appropriate to assess quality of life in Thai women withbreast cancer. Results revealed the Thai version of EORTC QLQ-C30 and FACT-G questionnaires to be reliableand valid to assess quality of life in general. The best fit for measuring quality of life in Thai women with breastcancer during adjuvant treatment should be the EORTC QLQ-C30/-BR23.     

术后乳腺癌患者焦虑、抑郁及生活质量分析

[目的]评价术后乳腺癌患者焦虑、抑郁和生活质量状况。[方法]采用一般调查问卷、生活质量测定量表、焦虑自评量表和抑郁自评量表对116例术后乳腺癌患者进行问卷调查。[结果]术后乳腺癌患者生活质量偏低,社会状况、情感状况、关注状况和生理状况得分均偏低。年龄、教育程度、婚姻状况、职业、家庭收入、病程、医疗费用等均与乳腺癌患者生活质量总分呈正相关,而肿瘤分期、焦虑总分、抑郁总分等与乳腺癌患者生活质量总分呈负相关。[结论]乳腺癌患者术后焦虑、抑郁情绪越严重,其生活质量越差。建议医护人员对乳腺癌患者加强疾病宣教、情绪疏导,促进其社会支持、提高乳腺癌患者的生活质量。     

Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery?

Women with a breast cancer diagnosis often are given a choice between breast conservation or mastectomy as the primary treatment for their cancer. Despite the high frequency of this cancer, there is little systemic information about the effect of surgical treatment on the quality of life or psychological adjustment of the patient. In this study, the authors prospectively evaluated quality of life, performance status, and psychological adjustment in 109 women who had primary breast cancer treatment. During the year of follow-up, no statistically significant differences in quality of life, mood disturbance, performance status, or global adjustment were found between the two surgical groups, and both groups of patients improved significantly during the year of observation (P = 0.0001). As was predicted, patients receiving mastectomy reported more difficulties with clothing and body image; however, these results apparently did not affect the assessment of mood or quality of life. The authors conclude that patients receiving breast conservation therapy do not experience significantly better quality of life or mood than patients having mastectomy; however, patients having breast conservation surgery have fewer problems with clothing and body image. Women receiving breast conservation therapy may require more intensive psychosocial intervention in the postoperative period because of the added burden of primary radiation therapy.     

Comparison of breast and rectal cancer patients' quality of life: results of a four year prospective field study

This paper compares quality of life in breast and rectal cancer patients. The Munich Cancer Registry records clinical details of all cancer patients in the region. Over a 2-year period, cooperating clinicians recruited patients who were sent quality of life questionnaires, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – C30 over 4 years. Breast cancer patients were compared to both male and female rectal cancer patients. A total of 1315 patients returned questionnaires (988 breast cancer, 327 rectal cancer). More breast cancer patients were under 70 years old, received adjuvant therapy, had a good prognosis, took medication and rated psychological support as important. Breast cancer patients reported poorer quality of life than rectal cancer patients in more than half the variables. In particular, they suffered significantly worse emotional functioning, fatigue, pain and sleeplessness. Female rectal cancer patients did not suffer the same problems. Both age groups and those with or without adjuvant therapy indicated the same trend, with breast cancer patients reporting lower scores. Breast cancer patients, despite better prognoses, appear to suffer more psychological problems than rectal cancer patients. Gender, age and therapy did not seem to explain these differences. The negative public perception of breast cancer may play a role.     

The effect of supportive pamidronate treatment on aspects of quality of life of patients with advanced breast cancer

Selective aspects of quality of life during supportive pamidronate (APD) treatment were assessed in breast cancer patients with osteolytic metastases. 144 patients were randomised to a pamidronate group (n = 76) or a control group (n = 68). A questionnaire measuring mobility impairment, bone pain, fatigue and gastrointestinal toxicity was administered at 3-monthly intervals. The analysis focused on changes in these quality of life domains over time. The median follow-up for both groups was 18 months. Mobility impairment and bone pain were significantly less in the pamidronate group as compared with the control group, due primarily to a rapid improvement shortly after initiation of pamidronate treatment. Thereafter, a gradual increase in these symptoms was noted in both groups. Gastrointestinal complaints and fatigue levels were similar over time in the two groups, suggesting that these symptoms are more dependent on disease-related events and cytotoxic treatment than on pamidronate treatment. The results indicate that reduced skeletal morbidity in breast cancer patients during pamidronate treatment is associated with an improvement in selective aspects of quality of life.     

External locus of control and quality of life among Malaysian breast cancer patients: The mediating role of coping strategies

This study aimed to investigate the mediating role of coping strategies in the relationship between external locus of control and quality of life among breast cancer patients. A convenience sample of 130 Malaysian breast cancer patients participated in this study. Using a multiple mediation model analysis, we found a negative relationship between powerful others and patients' quality of life and the mediation of active-emotional coping between powerful others and quality of life. The findings indicated the need for early, targeted psychological interventions seeking to encourage externally oriented cancer patients to use more active emotional coping strategies as it may improve their quality of life.     

乳腺癌患者术后生活质量评估的现状及进展

乳腺癌是严重影响以女性为主患者身心健康的常见恶性肿瘤,目前发病率仍呈逐年上升的趋势。手术及术后进一步治疗在乳腺癌患者的生理、心理及社会功能等方面引起的巨大变化逐渐引起了人们的关注,对其生活质量的相关研究也就越发显得迫切。作为评价乳腺癌患者术后生活质量必不可少的测量工具——量表的研制与应用方面的研究也显得尤为重要。本文对乳腺癌患者术后生活质量评测工具的现状及面临的问题加以综述,并分析影响乳腺癌患者生活质量的相关因素,有助于提高乳腺癌患者的生活质量。     

Qualité de vie dans les cancers gynécologiques : actualités

The evaluation of quality of life has become essential in gynecological oncology. Recent guidelines have been published to improve the collection, analysis and publication of the data quality of life that will make them more reliable, reproducible and integrate them into the final treatment decision. This year at ASCO, in breast cancer, the benefit of sentinel lymph node dissection compared to the quality of life has been demonstrated. New data on cognitive function in patients treated for breast cancer show the importance of the evaluation of these disorders especially among elderly patients who are at-risk populations. Medical strategies including targeted therapies can improve survival without impairing the quality of life, also with improved gastrointestinal symptoms in case of combination chemotherapy with bevacizumab in patients with ovarian cancer in a situation early recurrence. Similarly, the addition of a pathway inhibitor M- Tor (everolimus) with hormonal therapy does not induce degradation of the quality of life in women with metastatic breast cancer.     

A method for assessing the quality of life of cancer patients: replication of the factor structure.

The psychometric properties of a method of measuring the quality of life of cancer patients based on multiple linear analogue scales have been assessed in a group of 294 patients with breast cancer attending one clinical unit. The method was found to be readily managed by patients although a small number of scales presented difficulties of understanding to patients and difficulties of analysis. The scales distinguished readily between patients of different disease and treatment status. Factor analysis revealed a 5 factor structure which we interpret as relating to physical activities of everyday living, emotional disturbance, alimentary disturbances, appearance and cosmetic problems and a fifth factor which is more difficult to interpret and includes impairment of speech, writing and concentration. We feel the essential factors determining quality of life in cancer patients have been demonstrated in this and our earlier studies and there is now a substantial level of agreement in the factors that have been identified by groups taking quite different approaches. The major factors determining quality of life in cancer patients are now known and should be assessed in clinical research and clinical trials. The method by which they should be assessed is not as yet so clear.