江苏省通州地区肿瘤患者生存质量的影响因素研究

[目的]探讨江苏省通州地区肿瘤患者生存质量的相关影响因素。[方法]采用E-ORTCQLQ-C30量表测评不同癌种的肿瘤生存者的生存质量。[结果]性别、年龄、婚姻状态、文化程度、是否参与群体抗癌、家庭支持程度、社会支持程度、收入水平、医疗形式都对生存质量的某些方面产生不同程度的影响,而收入水平、年龄、社会支持程度三者是影响整体生存质量的独立预测变量。[结论]提示人口学、社会性因素对肿瘤生存者的生存质量具有不同程度的影响作用,该结果对于临床肿瘤康复综合措施的采取具有一定的参考意义。     

生存质量评价在乳腺癌治疗中的应用

生存质量(quality oflife,QOL)是一个多维的概念,包括生理、心理、社会的满意程度,以及疾病或治疗有关的症状.在肿瘤治疗领域中,QOL评价被广泛应用于·临床治疗决策、治疗效果评价、疾病严重程度评定、肿瘤药物效应评价等方面,成为肿瘤治疗研究终点之一.乳腺癌患者由于其发病率高、生存期长、病损部位特殊等原因,QOLL往往严重下降.本文综述了常用的乳腺癌患者QOL评价工具,如线性模拟自我评价量表、癌症患者生活功能指标、乳腺癌化疗问卷、癌症生存者生存质量量表、欧洲癌症研究与治疗组织生存质量量表、肿瘤治疗功能评价量表、国际乳腺癌协作组生存质量量表、癌症患者生存质量测定量表等,并分析影响乳腺癌患者QOL的主要因素,这将有助于乳腺癌患者的-临床治疗决策和QOL的提高.     

生存质量在食管癌中的研究现状

随着临床肿瘤学以及人文医学的发展,肿瘤医学模式由重视癌症患者的生命数量转向提高患者的生命质量。随着对生存质量的深入研究,其在癌症的治疗方案选择、疗效评价、预后评估等方面具有重要意义。食管癌是消化道肿瘤中最常见的恶性肿瘤,我国食管癌的发病率和死亡率居世界首位,提高食管癌患者的生存质量是食管癌治疗的重要目标之一。近年来关于食管癌患者的生存质量的研究蓬勃发展,本文就生存质量在食管癌中的研究现状作一综述。     

不同部位肝外胆管癌特点和手术治疗预后效果观察

目的探讨不同部位肝外胆管癌的特点和手术治疗预后效果。方法选取2007年1月至2017年1月间葫芦岛市中心医院龙湾院区收治的435例肝外胆管癌患者,根据胆管癌部位分为肝门胆管癌组290例和胆总管下端癌组145例。对两组患者的胆管条件、血管情况和功能性肝实质充分保留情况进行评估,对具备行根治性切除的可能性进行判断,肝门胆管癌组Ⅰ型、Ⅱ型、Ⅲa和Ⅲb型及Ⅳ型患者分别接受单纯胆管骨骼化切除、骨骼化切除附加尾叶切除、肿瘤联合尾状叶及左右半肝切除及联合半肝切除治疗,胆总管下端癌组患者均接受胰十二指肠切除术治疗。治疗后,比较两组患者的术后肿瘤复发转移时间、最终死亡时间、无瘤生存时间及总生存时间。结果肝门胆管癌组165例患者术后并发症:感染55例,胆汁瘘15例,胆管炎15例,肝衰竭5例。1年生存率为62.2%,2年生存率为35.1%,3年生存率为27.0%。肿瘤直径≥3cm者总生存时间短于<3cm者;有淋巴结转移、肝脏侵犯和血管侵犯患者的总生存时间短于无淋巴结转移、肝脏侵犯和血管侵犯患者;随着Bismuth分型、改良T分期和AJCC分期的提升,患者总生存时间逐渐缩短,差异均有统计学意义(均P<0.05)。不同糖类抗原CA19-9水平和病理类型患者的总生存时间比较,差异无统计学意义(P>0.05)。肿瘤直径≥3cm患者的无瘤生存时间显著短于<3cm患者,有淋巴结转移和肝脏侵犯患者的无瘤生存时间均短于无淋巴结转移和肝脏侵犯的患者,随着Bismuth分型、改良T分期和AJCC分期的提升,患者的无瘤生存时间均逐渐缩短,差异均有统计学意义(均P<0.05)。不同CA19-9水平、病理类型和血管侵犯患者的无瘤生存时间比较,差异无统计学意义(P>0.05)。胆总管下端癌组70例患者术后并发症:感染55例,胰瘘15例,1年生存率为37.5%。随着AJCC分期提升,患者总生存时间逐渐缩短(P<0.05);不同肿瘤直径、CA19-9水平、病理类型和胰腺侵犯患者的总生存时间比较,差异无统计学意义(P>0.05)。不同肿瘤直径、CA19-9水平、病理类型、AJCC分期和胰腺侵犯患者的无瘤生存时间比较,差异无统计学意义(P>0.05)。两组患者根治术后总生存时间、根治术后无瘤生存时间、非手术治疗总生存时间和总生存时间比较,差异均无统计学意义(P>0.05)。结论不同部位肝外胆管癌根治性切除手术治疗,效果均较好,预后可用AJCC分期评估。     

关注癌症生存者

抗癌治疗达到肿瘤完全控制后,癌症患者成为癌症生存者。癌症生存者是在艰难抗癌治疗后的幸存者,因此又被称为癌症幸存者。李先生和张女士就是这样的癌症幸存者。6年前李先生患大肠癌,治疗后反复检查无任何肿瘤复发征象。     

癌症脊柱转移的微创治疗进展

近年来临床检测手段的提高以及癌症综合治疗水平的提升使得越来越多的癌症患者得以较长时间地生存,但发生骨转移的患者也呈上升趋势.脊柱是最常受累的骨骼之一,癌症脊柱转移的患者将产生严重的疼痛,肿瘤的生长有可能压迫神经,导致神经功能障碍,患者的生活质量严重下降.一方面这些患者迫切需要通过治疗来缓解症状,提高生活质量,另一方面这些患者预期生存时间较短,体质虚弱,高龄及伴有基础疾病,对骨科大手术的耐受性较差.此外,这些患者在术后短期内将可能接受进一步的放疗或化疗.近年来随着以椎体成形术为代表的脊柱肿瘤微创治疗技术的发展,使得这些晚期肿瘤的患者在姑息治疗方面有了更多的选择.     

肢体骨转移癌的诊断与外科治疗

骨转移癌是骨骼系统中最常见的肿瘤.随着对原发癌的诊治水平的不断提高,转移癌患者的生存较既往有了延长.骨转移癌的外科治疗的主要目的是提高患者的生活质量.本文就肢体长骨转移癌的诊断、外科治疗的目的、术前评估、适应证及影响肢体骨转移癌外科治疗疗效的因素等进行阐述,希望为肿瘤内科、放疗科医师对癌症患者随诊时发现肢体骨转移是否行外科治疗提供参考,为肿瘤骨科医师对肢体骨转移患者选择手术方法提供依据.     

非小细胞肺癌纵隔淋巴结转移(N2)的外科治疗选择

目的 探讨有纵隔淋巴结转移（N2）的非小细胞肺癌（NSCLC）的外科治疗选择。方法 回顾性分析总结325例N2 NSCLC的外科治疗效果和经验。结果 全组5年生存率为19．6％,其中根治性切除者高于姑息性切除者,鳞癌高于腺癌,行袖式肺叶切除和全肺切除者高于常规肺叶切除者,纵隔淋巴结转移1～3枚者高于〉3枚者,术后综合治疗者高于单一外科治疗者,上述差异均有统计学意义。所有T3、T4以及M1患者均无5年生存者。结论 对于N2 NSCLC肿瘤为Tl或T2、病理类型为非腺癌以及纵隔转移淋巴结〈4枚者,外科治疗是最好的选择。对于肿瘤为T3的患者,外科治疗可能并非良策,肿瘤的根治性切除以及肺门和纵隔的系统淋巴结清扫,是病变分期和生存率提高的关键所在,术后综合治疗有助于患者的远期生存,尤其适用于有肿瘤残留和（或）纵隔转移淋巴结〉3枚的患者。     

脊柱转移肿瘤手术治疗风险和预后分析

目的　探讨脊柱转移肿瘤的手术治疗风险和预后。方法　 1992年 6月至 2 0 0 2年 6月手术治疗脊柱转移肿瘤 6 3例 ,其中前路椎体全部或部分切除脊髓减压、内固定 4 1例 ,后路椎板切除脊髓减压加内固定 8例 ,一期前后路肿瘤切除固定 14例。手术后随访 6个月以上。结果　术后X线显示所有患者均取得脊柱的稳定。除 1例术后 3d死亡外 ,有 5 7例 (91.9% )患者疼痛有显著的缓解或消失 ,4 1例 (6 6 .1% )患者的神经系统症状和体征有较大的改善。手术中无严重并发症发生。本组术后平均生存时间 13.5 9个月 ,肺癌和肝癌转移组的平均生存时间为 6个月 ,乳腺、胃肠道、前列腺癌和其他肿瘤转移组的平均生存时间为 15个月 ,甲状腺和肾癌的平均生存时间为 2 8个月 ,3组间差异有显著性 (P <0 .0 1)。结论　脊柱转移肿瘤手术能够缓解患者的疼痛 ,改善患者的生存质量。患者生存时间与原发肿瘤类型有关 ,肺癌和肝癌脊柱转移者生存时间较短 ,甲状腺癌和肾癌生存时间最长。     

生存质量与中医肿瘤疗效评价

癌症患者的生存质量是国内外都十分关注的问题.随着社会的发展,人们生活水平的提高,大家更关注患者生存质量的好坏,越来越多的学者们在研究它,制定各种量表,以期更加准确而全面地评估人们的生活情况及治疗疾病的效果.中医治疗肿瘤的优势不在于迅速缩小瘤体,而在于提高患者生存质量和延长患者生存时间,因此如何恰当地评价中医药对肿瘤患者生存质量的影响是十分重要的.     

Effect of cigarette smoking on quality of life in small cell lung cancer patients

BackgroundContinued cigarette smoking after small cell lung cancer (SCLC) diagnosis has been shown to shorten patients’ survival, but little is known about the impact of smoking and cessation on quality of life (QOL) profile (e.g., overall QOL, pain, fatigue, cough, dyspnea, appetite change, and performance status) in SCLC survivors (who survived at least 6 months post initial diagnosis). In this study, we sought to evaluate the relationship between cigarette smoking and QOL profiles in SCLC patients.MethodsA total of 223 survivors were classified into five groups: never smokers, former smokers (quit more than 1 year prior to diagnosis), recent quitters (quit within 1 year surrounding diagnosis), late quitters (quit after 1 year post diagnosis) and never quitters. One hundred and sixty-eight of these survivors were matched with 334 lung-cancer-free controls on age, gender, and smoking status for comparative analysis. QOL scales were scored from 0 (worse) to 100 (best). Conditional logistic regression, linear mixed-effect models, and Wilcoxon signed rank tests were used.ResultsSCLC survivors consistently showed a significant deficit in QOL profile; e.g., mean overall QOL in patients was 17.5 points worse than the controls (p < 0.0001). Among all smokers, former smokers reported the best QOL profile, while late or never quitters reported the worst. The recent quitters showed an improving trend in QOL profile and lower percent of reduced appetite (an average of 43%) compared to the late or never quitters (58%).ConclusionsOur study confirmed the negative impact of smoking on SCLC survivors’ QOL and found that smoking cessation surrounding the time of diagnosis could improve overall QOL and symptoms. The findings of this study provide evidence for oncologists to recommend smoking cessation to their SCLC patients.     

Associations between Quality of Life and Marital Status in Cancer Patients and Survivors

Background: The cancer survival rate in Korea has substantially increased, necessitating the management of not only patients with cancer but also longer term survivors. Although the divorce rate has drastically increased in Korea, there is not sufficient research regarding the relationship between changes in marital status and quality of life (QOL) in cancer patients and survivors. Thus, we aimed to examine the relationship between marital status and QOL in such cases. Materials and Methods: This study was performed using the Community HealthSurvey of 2008 administered by the Korea Centers for Disease Control and Prevention (N=169,328). We used t-tests and Chi-square tests to compare demographic variables between men and women, and analysis of variance(ANOVA) to compare QOL scores among comparison groups. We also performed a multilevel analysis on the relationship between QOL and marital status while accounting for provincial differences. Results: Decline of EuroQOL five dimensions (EQ-5D) in single patients with cancer was greater than in any other marital status group, but there was no statistically significant decline in survivors of cancer with regard to marital status. In the general population, the decline of EQ-5D was higher among single people than married people. Using the EuroQOL visual analog scale (EQ-VAS), single people had higher values than those of other marital status among both patients with cancer and survivors of cancer. In the general population, EQ-VAS values were higher for single people compared to married people. Conclusions: There may be a significant relationship betweenmarital status and QOL in cancer patients and survivors. Policy interventions to manage patients with cancer who experience a decline in QOL as well as marital problems should be conducted.     

Influence of Offspring on Quality of Life among Cancer Patients and Survivors: Results from the Korean Longitudinal Study of Aging (KLoSA), 2008-2011

Background: To examine whether offspring improve or reduce quality of life (QOL) among cancer patientsand survivors. Materials and Methods: We used data from the Korean Longitudinal Study of Aging (KLoSA)from 2008 to 2011. There were 490 research subjects in our study: 245 cancer patients and survivors and 245controls matched using propensity scores. Results: For cancer patients and survivors with no offspring, the QOLestimate was -2.831 lower (SE: 5.508, p-value: 0.623) than that of those with two offspring, while for those withfive or more offspring, the QOL estimate was 7.336 higher (SE: 2.840, p-value: 0.036). For non-cancer patientsand survivors with one child, the QOL estimate was -11.258 lower (SE: 2.430, p-value: 0.002) than that of thosewith two offspring, while for those with five or more offspring, the QOL estimate was -4.881 lower (SE: 2.484,p-value: 0.090). Conclusions: This article provides evidence for a beneficial effect of offspring upon QOL incancer patients and survivors, indicating that offspring are important for them.     

An exploratory model of the relationships between cancer-related trauma outcomes on quality of life in non-Hodgkin lymphoma survivors

Given that more than one third of some cohorts of cancer survivors exhibit post-traumatic stress disorder (PTSD) symptomatology, this study examines how trauma outcomes might relate to quality of life (QOL). Eight hundred thirty survivors of adult lymphoma were assessed for PTSD, post-traumatic growth (PTG) and QOL. Structural equation modeling revealed that QOL was best explained by the model in which stressors (e.g., co-morbidities) were mediated by PTSD and PTG. Trauma outcomes mediated the relationship between specific stressors and QOL. These findings support using PTSD and PTG as a diagnostic framework in understanding symptomatology in survivors.     

An Exploratory Model of the Relationships Between Cancer-Related Trauma Outcomes on Quality of Life in Non-Hodgkin Lymphoma Survivors

Given that more than one third of some cohorts of cancer survivors exhibit post-traumatic stress disorder (PTSD) symptomatology, this study examines how trauma outcomes might relate to quality of life (QOL). Eight hundred thirty survivors of adult lymphoma were assessed for PTSD, post-traumatic growth (PTG) and QOL. Structural equation modeling revealed that QOL was best explained by the model in which stressors (e.g., co-morbidities) were mediated by PTSD and PTG. Trauma outcomes mediated the relationship between specific stressors and QOL. These findings support using PTSD and PTG as a diagnostic framework in understanding symptomatology in survivors.     

Quality of Life Differences between Younger and Older Breast Cancer Patients

Purpose

This study was designed to investigate quality of life (QOL) differences between younger (<50 years) and older (≥50 years) breast cancer survivors and to determine the unique effect of age on QOL after adjusting age-correlated variables.

Methods

One thousand two hundred fifty patients were enrolled. Clinicopatholgical and social parameters were reviewed and Functional Assessment of Cancer Therapy-Breast cancer instrument (FACT-B) and the Ladder of Life scale were used to measure the QOL. Among 1,250 eligible patients, 1,094 patients completed the questionnaire and were used for analysis. Chi-square test, t-test and a series of multiple regression analyses were conducted to verify age-related differences in QOL between two groups and to evaluate the unique contribution of age variable on QOL of breast cancer patients.

Results

Significant socio-demographic and clinical differences existed based on age categories, including education, job, time since surgery, chemotherapy and daily activity. Also, there were significant age-related differences in FACT-B total, physical well-being, social/family well-being, functional well-being and breast cancer subscale and in subjective QOL. Older patients ≥50 years showed significantly lower QOL than younger patients <50 years. However, after controlling for age-correlated variables including job, education, time since surgery, chemotherapy, and daily activity, there was no unique age difference in QOL among breast cancer survivors.

Conclusion

Our study results suggest that older women with breast carcinoma suffered significantly lower QOL, even though the unique age effect was not found. Therefore, various interventions for enhancing QOL for women with breast carcinoma should be provided to older age group.     

Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors

Survival from cancer has improved over the past decade resulting in more long-term survivors. The literature on multi-dimensional quality of life (QOL) among long-term (5+ years) adult survivors is reviewed for each of seven cancer sites (i.e. breast, ovarian, cervical, prostate, colorectal, head and neck, and Hodgkin's disease survivors). Overall, long-term survivors experience good to excellent QOL. Physical domain QOL was the most frequently measured while spiritual domain QOL was the least frequently measured. QOL varies according to treatment received and by age for all groups with older persons (excepting head and neck and Hodgkin's disease survivors) reporting better QOL. QOL improves with time for breast cancer survivors and tends to decrease over time for prostate cancer survivors. Issues regarding sexual functioning affected the social domain-especially for breast and prostate cancer survivors. Social support improves psychological domain QOL for breast, cervical, and colorectal survivors. Review of findings may assist researchers and clinicians wishing to enhance the QOL of the long-term survivor population by identifying the most pressing and widely experienced concerns and by providing directions for future research.     

The meaning of quality of life in cancer survivorship

PURPOSE/OBJECTIVES: To describe the meaning of quality of life (QOL) in long-term cancer survivors, to validate inductively derived QOL themes, and to identify and cluster over-arching themes across long-term cancer survivors. DESIGN: Qualitative study that was part of a larger, cross-sectional survey. SETTING/SAMPLE: 687 (57% response) cancer survivors at an average of 6.7 years after diagnosis. In the sample, 81% were female (with a mean age of 49.6 years), 72% were college educated, 63% were married, and 49% worked full time. METHODS: Mailed survey of three open-ended questions and standard QOL tools. A QOL conceptual model was used to frame the research study, describe the QOL responses of the participants, and explore the meaning of cancer survivorship. Content analysis was used to answer the research questions. Data collection and analysis occurred sequentially. MAIN RESEARCH CONCEPTS: Meaning, QOL cancer survivorship. FINDINGS: 25 of 30 inductively derived QOL themes were validated in this study of long-term cancer survivors; 107 additional QOL themes were identified and clustered into 11 over-arching themes across the entire data set. Over-arching themes included struggle between independence-dependence, balance, wholeness, life purpose, reclaiming life, multiple losses, having control, altered meaning of health, and surviving cancer from a family perspective. IMPLICATIONS FOR NURSING PRACTICE: The meaning of QOL in long-term cancer survivors is multifaceted and complex. CONCLUSIONS: Nurses can use this broader conception of QOL in breast cancer survivors to help patients prepare for and cope with adjustments.     

Factors Affecting the Quality of Life of Korean Cancer Survivors Who Return to the Workplace

Background: Although the prevalence of cancer is increasing, it is no longer synonymous with death. Thenumber of cancer survivors is estimated to be increasing due to development in medical treatments and socialprograms; cancer survivors are increasingly returning to work after long-term unemployment. Thus, we examinedthe quality of life (QOL) and the factors associated with return of cancer survivors to the workplace. Materialsand Methods: This study was performed using the 2008 Community Health Survey administered by the KoreaCenters for Disease Control and Prevention (N= 548). We used Chi-square tests to compare demographic variablesbased on self-perceived health status, and analysis of variance (ANOVA) to compare QOL scores among groups.We also performed a mixed-model analysis of the relationship between QOL and factors at the workplaces ofcancer survivors. Results: Based on the results of our study, the overall QOL of cancer survivors was associatedwith ‘mutual respect’, ‘free emotional expression’, occupation, and age. Moreover, different trends of QOLaccording to self-perceived health were identified on additional analysis. In the ‘bad’ self-perceived health group,QOL was significantly different according to income. The QOL of cancer survivors in the low-income group waslower than in the other groups. Conversely, the ‘normal’ group had a lower QOL caused by ‘no mutual respect’and “no free emotional expression” in the workplace. The QOL in the ‘good’ group based on self-perceivedhealth was higher in the younger age group. Conclusions: There may be a significant relationship between QOLand workplace factors for cancer survivors, although further study is needed to investigate this relationship indetail. This may facilitate formulation of policy and efforts to prevent and manage the decline in the QOL ofcancer survivors returning to work.