激素受体阳性乳腺癌患者在不同内分泌治疗用药时间的类更年期症状及生命质量

目的探讨激素受体阳性(HR+)乳腺癌患者在不同内分泌治疗时间的类更年期症状和生命质量状况。方法采用横断面研究设计,收集2011—2017年就诊于四川省肿瘤医院经病理确诊的167例HR+乳腺癌患者,按内分泌治疗时间分为<12个月组、12~36个月组、>36个月组。应用改良Kupperman量表和乳腺癌生命质量测定量表(FACT-B)测量类更年期症状和生命质量。采用方差分析及χ2检验比较不同用药时间及用药类型患者的类更年期症状差异,采用协方差分析和多重线性回归分析不同用药时间患者的生命质量得分差异和类更年期症状对生命质量的影响。结果167例乳腺癌患者的类更年期症状得分为(14.5±7.6)分,现患率为87.4%(146/167),以失眠率最高(73.7%,123/167)。除失眠易激动外,选择性雌激素受体调节剂(SERM)使用者以潮热症状最多(64.8%,79/122),芳香化酶抑制剂使用者以骨关节痛症状最多(62.2%,28/45)。患者的FACT-B总得分为(104.5±15.5)分,达标率高达89.8%(150/167),但各维度状况参差不齐,以社会家庭及功能维度达标率最低,分别为73.0%(122/167)和50.9%(85/167)。<12个月组、12~36个月组和>36个月组患者的Kupperman总分分别为(15.0±1.3)分、(14.0±6.9)分和(14.5±7.4)分;FACT-B总得分分别为(102.7±17.8)分、(105.0±12.9)分和(105.6±16.7)分,差异均无统计学意义(均P>0.05)。多重线性回归分析结果显示,患者服用SERM类药物期间类更年期症状对生命质量存在负向影响,<12个月组、12~36个月组和>36个月组患者的标准偏回归系数分别为-0.67、-0.30和-0.50,影响程度在12~36个月组中最小。结论HR+乳腺癌患者回归社会、家庭和功能恢复情况较差,应重点关注。类更年期症状在内分泌治疗期间普遍存在,应积极处理以改善生命质量。

Menopausal symptoms and quality of life of hormone receptor positive breast cancer patients at different endocrine therapy time

Objective To explore the menopausal symptoms and quality of life of hormone receptor positive(HR+)breast cancer patients at different endocrine therapy time.Methods The HR+breast cancer patients who were pathologically confirmed from 2011 to 2017 in the Sichuan Cancer Hospital were divided into three groups according to endocrine therapy time(<12 months,12~36 months,>36 months)and analyzed by a cross-sectional study.The Menopausal symptoms and quality of life of these patients were measured using the modified Kupperman scale and the functional assessment of cancer therapy-breast cancer(FACT-B)scale.The differences of menopausal symptoms among different time groups and drug groups were analyzed by Chi-square test.The differences of quality of life and the effects of menopausal symptoms on quality of life were tested by covariance and multiple linear regression analyses.Results The average score of menopausal symptom of 167 patients was 14.5±7.6 and the prevalence rate was 87.4%(146/167).Among all of the menopausal symptoms,the prevalence rate of insomnia was the highest(73.7%,123/167).Besides insomnia and excitement,hot flashes was more prevalent in selective estrogen receptor modulator(SERM)users(64.8%,79/122),while osteoarthritis was more prevalent in aromatase inhibitor(AI)users(62.2%,28/45).The total score of FACT-B of Patients was 104.5±15.5,and the compliance rate was up to 89.8%(150/167).However,the condition of each dimension was different,the compliance rates of social/family and functional dimension were lowest,which were 73.0%(122/167)and 50.9%(85/167),respectively.The menopausal symptoms of patients at different time groups were 15.0±1.3,14.0±6.9,14.5±7.4,respectively,and the total score of FACT-B of patients at different time groups were 102.7±17.8,105.0±12.9,105.6±16.7,respectively,without significant differences(both P>0.05).Multiple linear regression analysis showed that menopausal symptoms impaired the quality of life of SERM users during the endocrine therapeutic period.The standardized regression coefficients of three time groups were-0.67,-0.30,-0.50,respectively,with the lowest effect on 12~36 months group.Conclusion HR+breast cancer patients will have a poor function recovery and social/family return,who need more attention.Menopausal symptoms are common problems during endocrine therapy,and active measures should be taken to improve patients′quality of life.