家庭护理干预对早期宫颈癌患者术后家庭功能和生活质量的影响

目的探讨家庭护理干预对早期宫颈癌患者术后家庭功能和生活的影响。方法选取2010年6月至2015年6月间重庆市红十字会医院收治的90例宫颈癌患者,按入院时间先后分为干预组(50例)和对照组(40例)。干预组患者给予家庭护理干预,对照组患者给予常规护理。在两组患者术后6个月时,采用家庭亲密度和适应性量表、女性性功能测量量表、医院自制的调查问卷和世界卫生组织(WHO)简明生活质量测定量表,分别评估患者的家庭亲密度及适应性、患者的性功能、患者的自护能力和生活质量,比较两组患者的各项指标。结果经家庭护理干预后,干预组患者家庭亲密度及适应性、女性性功能、自护能力和生活质量均明显高于对照组,差异有统计学意义(P<0.05)。结论家庭护理干预有助于提高早期宫颈癌患者术后家庭功能和生活质量。     

保乳手术与改良根治术对早期乳腺癌患者生活质量的影响

目的 探讨保乳手术与改良根治术对早期乳腺癌患者生活质量的影响。方法 回顾性分析2013年1月至2015年1月在本院确诊住院治疗的早期乳腺癌患者276例,其中保乳手术组138例,改良根治术组138例。采用患者满意度、抑郁自评量表（SDS）及焦虑自评量表（SAS）对采用两种手术方式的患者生活质量进行评价;采用Rosenberg自尊量表、家庭亲密度适应性量表及生命质量测量表（FA CT-B）对276例患者进行问卷调查分析。结果 保乳手术组患者的SAS及SDS评分均低于改良根治术组,差异有统计学意义（P＜0.05）。保乳手术组在患者满意度方面较改良根治术组有明显提高,两组比较差异有统计学意义（P＜0.05）;保乳手术组患者在Rosenberg自尊量表和FA CT-B中的测定结果均优于改良根治术组（P=0.03,P=0.04）;保乳手术组在家庭亲密度和适应性方面优于改良根治术组,两组比较差异均有统计学意义（P＜0.05）。结论 实施保乳手术能有效提高早期乳腺癌患者的生活质量,缓解患者心理和生理上的各种不适,促进患者康复。     

围手术期舒适护理对乳腺癌患者心理状态及疼痛程度的影响

目的探讨围手术期舒适护理对乳腺癌患者心理状态及疼痛程度的影响。方法选择2013年1月至2015年1月间收治的女性乳腺癌患者68例,随机数表法分为观察组和对照组,每组34例。观察组患者在常规护理基础上给予舒适护理干预,对照组患者给予常规护理。比较两组患者的心理状态、疼痛程度、生活质量及护理满意度情况。结果观察组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均显著低于对照组(P<0.05),术后疼痛程度明显轻于对照组(P<0.05),生活质量各维度评分明显高于对照组(P<0.05)。观察组患者的护理满意度为97.1%,显著高于对照组的76.5%(P<0.05)。结论围手术期舒适护理可有效地改善乳腺癌患者的心理状态,降低疼痛程度,并提高生活质量,有利于患者康复。     

乳腺癌患者围手术期的应对方式及其对生活质量的影响

目的探讨乳腺癌患者围手术期应对方式对生活质量的影响。方法选取2013年3月至2014年9月间手术治疗的乳腺癌患者80例,应用医学应对问卷(MCMQ)及生活质量量表(FACT-B)对患者术前、术后进行调查,探讨手术前后患者应对方式对生活质量的影响。结果 (1)3种应对方式中,面对和回避维度从术前至出院前是递增的,与出院前差异有统计学意义(P<0.05);而屈服维度呈递减趋势,与出院前差异有统计学意义(P<0.05)。生活质量方面,患者术前生存质量明显低于出院前,差异有统计学意义(P<0.05),其中5个相关维度中,社会家庭状况术前明显低于出院前,差异有统计学意义(P<0.05),其他4个维度差异无统计学意义(P>0.05)。(2)总体生活质量与面对维度和回避维度呈正相关(P<0.05),与屈服维度呈负相关(P<0.05);面对维度与社会/家庭状况、功能状况均呈正相关(P<0.05);回避维度与社会/家庭状况,功能状况呈正相关(P<0.05)。屈服维度与生理状况、情感状况、功能状况、附加关注呈负相关(P<0.05)。结论乳腺癌患者围手术期应对方式与生活质量相关,患者在不同时期可能表现出不同的应对方式。     

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。     

保乳术治疗早期乳腺癌患者的临床疗效及对生活质量的改善作用

目的探讨保乳术治疗早期乳腺癌临床疗效,并观察其对患者生活质量的影响。方法 70例乳腺癌患者,其中35例采用改良根治术治疗者为对照组;另35例采用保乳术治疗,为观察组。两组术后均采用CMF化疗方案治疗,雌激素受体或孕激素受体(ER/EP)阳性者行内分泌治疗,观察组术后行全乳放疗及瘤床加量放疗。于术后2个月统计两组术后并发症及乳房美容情况,随访3年,统计两组局部复发、生存率、远处转移情况,并采用乳腺癌生命质量测定量表调查两组生活质量。结果观察组术后2个月并发症发生率2.86%,明显低于对照组(17.14%),χ~2=3.96,P=0.04;观察组术后2个月乳房美容优良率91.43%,明显高于对照组(0),χ~2=58.94,P=0.00。观察组与对照组患者3年生存率[94.29%vs97.14%]、局部复发率[2.86%vs5.71%]及远处转移率[8.57%vs11.43%]比较,差异均无统计学意义,P>0.05。观察组生理功能、躯体疼痛、生理职能、活力、总体健康、社会功能、情感职能及精神健康得分明显高于对照组相比,P<0.05。结论采用保乳术与改良根治术治疗早期乳腺癌均可取得较好疗效,但前者术后并发症少且具有较好的乳房外形,从而有利于改善患者生活质量。     

系统化干预联合微视频健康宣教在早期胃癌患者内镜治疗中的应用效果

目的 探讨系统化干预联合微视频健康宣教在早期胃癌患者内镜治疗中的应用效果.方法 按照护理方式不同将80例早期胃癌患者分为观察组和对照组,每组40例,两组患者均给予常规内镜治疗,对照组患者在此基础上给予系统化护理干预,观察组患者联合微视频健康宣教.采用抑郁自评量表(SDS)和焦虑自评量表(SAS)评估两组患者的心理状态,采用视觉模拟评分法(VAS)评估疼痛程度,采用简明健康调查表(SF-36)评估生活质量,比较两组患者的胃肠功能改善情况.结果 术后1天,两组患者SDS、SAS评分均低于本组术前(P<0.05),VAS评分均高于本组术前(P<0.05);术后2天,两组患者SDS、SAS评分均低于本组术后1天(P<0.05),观察组患者的VAS评分低于本组术前(P<0.05),但对照组患者的VAS评分仍高于本组术前(P<0.05);且观察组患者术后1、2天的SDS、SAS、VAS评分均低于对照组(P<0.05).观察组患者术后排气时间、肠鸣音恢复时间均明显短于对照组(P<0.01),腹胀发生率低于对照组,腹胀程度轻于对照组(P<0.05).干预后,两组患者SF-36量表各维度评分均高于本组干预前(P<0.05),且观察组患者SF-36量表各维度评分均高于对照组(P<0.05).结论 早期胃癌内镜治疗术后患者应用系统化干预联合微视频健康宣教,可明显改善患者的焦虑、抑郁等负性情绪,促进患者术后胃肠功能的改善,减少腹胀发生风险,明显提高患者的生活质量.     

叙事疗法对肺癌患者疼痛应激、心理弹性和生活质量的影响

目的 探讨叙事疗法对肺癌患者疼痛应激、心理弹性和生活质量的影响.方法 依据干预方法将120例肺癌患者分为观察组(n=65)和对照组(n=55),对照组患者给予常规宣教心理疏导,观察组患者在此基础上给予五步式叙事疗法干预.干预前后,比较两组患者的疼痛应激因子[血清P物质、去甲肾上腺素(NE)、皮质醇、前列腺素E2(PGE2)]水平、情绪状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)和正负性情绪量表(PANAS)]、心理弹性[心理弹性量表(CD-RISC)]、生活质量[简明健康状况调查问卷(SF-36)].结果 干预后,两组患者P物质、NE、皮质醇、PGE2水平均明显低于本组干预前(P﹤0.01),且观察组患者P物质、NE、皮质醇、PGE2水平均明显低于对照组(P﹤0.01).干预后,两组患者PA分量表评分均明显高于本组干预前(P﹤0.01),SAS、SDS和NA分量表评分均明显低于本组干预前(P﹤0.01),且观察组患者PA分量表评分明显高于对照组(P﹤0.01),SAS、SDS和NA分量表评分均明显低于对照组(P﹤0.01).干预后,两组患者SF-36量表各维度评分、CD-RISC量表各维度评分及总分均明显高于本组干预前(P﹤0.01),且观察组患者SF-36量表各维度评分、CD-RISC量表各维度评分及总分均明显高于对照组(P﹤0.01).结论 叙事疗法可有效降低肺癌患者的疼痛应激水平,减轻焦虑、抑郁等负性情绪,增强心理弹性,提高生活质量.     

心理干预对乳腺癌患者术后辅助化疗期间抑郁和生活质量的影响

摘 要：［目的］ 探讨心理干预对乳腺癌患者术后辅助化疗期间抑郁和生活质量的影响。［方法］ 119例乳腺癌术后患者在接受辅助化疗前随机分为干预组（n=58）和对照组(n=61),干预组在进行常规化疗的同时给予心理干预,对照组仅接受常规化疗。分别于干预前后采用贝克抑郁量表(Beck Depression Inventory,BDI)和乳腺癌患者生活质量测评量表（Functional Assessment of Cancer Therapy-Breast,FACT-B)测评。［结果］ 干预前两组人口学特征、临床病理、抑郁评分和生活质量评分差异均无统计学意义（P均>0.05）。干预后,干预组患者的抑郁评分较对照组明显降低(15.20±3.01 vs 22.63±3.98,t=6.822,P<0.001),干预组患者的生活质量总评分及社会/家庭状况、情感状况和功能状况评分均高于对照组（P均<0.05）。［结论］ 心理干预可明显改善乳腺癌患者辅助化疗期间的抑郁和生活质量,专业心理医师对患者进行心理治疗值得在临床推广。     

结构式家庭护理指导对乳腺癌根治术患者术后生活质量的影响

目的探讨结构式家庭护理指导对乳腺癌根治术患者术后心理弹性、社会功能及生活质量的影响。方法选取2011年1月至2015年6月间四川广元市中心医院收治的70例乳腺癌根治术患者,按住院顺序编号,单号分为对照组,双号分为观察组,每组35例。对照组患者给予常规护理及出院指导,观察组患者给予结构式家庭护理指导,采用心理弹性量表(CD-RICS)与乳腺癌生活质量量表(FACT-B)测定干预前和干预6个月后,两组患者心理弹性及生活质量的变化,采用自我护理能力测定表(ESCA)测定患者健康行为及自我效能的变化,采用社会功能评定表(SFRS)测定干预前和干预6个月两组患者社会功能的改善情况。结果干预前,两组患者FACTB量表各维度评分对比,差异无统计学意义(P>0.05);干预后,两组患者各维度评分均上升,且观察组患者上升幅度均高于对照组,差异均有统计学意义(均P<0.05)。干预前,两组患者CD-RICS量表各维度评分对比,差异无统计学意义(P>0.05);干预后,两组患者CD-RICS量表各维度评分均上升,且观察组评分上升幅度高于对照组,差异均有统计学意义(均P<0.05)。干预前,两组患者ESCA量表各维度评分对比,差异无统计学意义(P>0.05);干预后,两组患者自我效能量表各维度评分均明显上升,且观察组上升幅度高于对照组,差异均有统计学意义(均P<0.05)。干预前,两组患者SFRS量表各维度评分对比,差异无统计学意义(P>0.05);干预后,两组患者量表各维度评分均显著降低,且观察组患者降低幅度高于对照组,差异均有统计学意义(均P<0.05)。结论结构式家庭护理指导可改善乳腺癌患者根治术后生活质量,提升其心理弹性与自护能力,改善其社会功能。     

Quality of life over time in women diagnosed with ductal carcinoma in situ, early-stage invasive breast cancer, and age-matched controls

Little is known about quality-of-life (QOL) differences over time between incident ductal carcinoma in situ (DCIS) and early-stage invasive breast cancer (EIBC) cases as compared with same-aged women without breast cancer (controls). We prospectively recruited and interviewed 1,096 women [16.8% DCIS, 33.3% EIBC (25.7% Stage I; and 7.6% Stage IIA), 49.9% controls; mean age 58; 23.7% non-white] at mean 6.7 weeks (T1), and 6.2 (T2), 12.3 (T3), and 24.4 months (T4) after surgery (patients) or screening mammogram (controls). We tested two hypotheses: (1) DCIS patients would report lower levels of QOL compared with controls but would report similar QOL compared with EIBC patients at baseline; and (2) DCIS patients' QOL would improve during 2-year follow-up and approach levels similar to that of controls faster than EIBC patients. We tested hypothesis 1 using separate general linear regression models for each of the eight subscales on the RAND 36-item Health Survey, controlling for variables associated with at least one subscale at T1. Both DCIS and EIBC patients reported lower QOL at T1 than controls on all subscales (each P<0.05). We tested hypothesis 2 using generalized estimating equations to examine change in each QOL subscale over time across the three diagnostic groups adjusting for covariates. By T3, physical functioning, role limitations due to physical problems, energy/fatigue, and general health each differed significantly by diagnostic group at P<0.05, because of larger differences between EIBC patients and controls; but DCIS patients no longer differed significantly from controls on any of the QOL subscales. At T4, EIBC patients still reported worse physical functioning (P=0.0001) and general health (P=0.0017) than controls, possibly because of lingering treatment effects. DCIS patients' QOL was similar to that of controls two years after diagnosis, but some aspects of EIBC patients' QOL remained lower.     

233例癌症病人生活质量的调查研究

［目的］研究影响癌症病人生活质量的因素。［方法］采用自编的癌症病人生活质量的调查表对杭州市233名肺癌、胃癌、乳腺癌病人的生活质量进行问卷调查,用生活质量综合得分作为生活质量评价指标,并用生活质量综合得分的P10、P25、P75、P90制定评价标准。［结果］Pearsons相关分析结果表明本调查表的各项目对生活质量鉴别能力较好,该样本癌症病人生活质量综合得分处于中等水平,病人生活质量与年龄、性别、文化程度、婚姻、经济状况关系密切,有统计学意义（P＜0．01）。［结论］用本调查问卷及所制订的评价标准找出生活质量较差者,特别是对于男性、60岁以上老年人、文化程度低、婚姻状况不佳、家庭经济状况较差的这部分重点人群应予以健康教育,缓解他们的心理压力,并采取一些措施,以求提高其生活质量。     

Meta-analysis of tumour burden in pre-operative axillary ultrasound positive and negative breast cancer patients

Purpose

Radiotherapy (RT) after breast-conserving surgery for early-stage breast cancer patients has similar survival benefits with whole breast RT (WBRT) or accelerated partial breast irradiation (APBI). However, the impact of RT type and side-effects severity on change in quality of life (QOL) is unknown. We examined changes in RT side-effects severity and QOL by RT type.

Methods

We analyzed data from a cohort of 285 newly diagnosed early-stage breast cancer patients with tumor size ≤3.0 cm and lymph node-negative disease. Patients (93 [32.6%] stage 0; 49 [17.2%] non-white; mean age = 59.3 years) completed four interviews (6 weeks, 6, 12, and 24 months) after definitive surgical treatment. We measured severity of RT side effects, fatigue and skin irritation, using a 5-point scale (1 “not at all” to 5 “all the time”) and measured QOL using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and RAND 36-item Health Survey Vitality subscale. Repeated-measures analysis of covariance of each outcome controlled for demographic, clinical/treatment, and psychosocial factors.

Results

Patients initiated RT by 6 months (113 received APBI; 172 received WBRT) and completed RT by 12 months. Patients receiving WBRT (vs. APBI) reported greater increase in fatigue and skin irritation severity from 6-week to 6-month interviews (each P < 0.001). Improvement in neither total FACT-B nor Vitality differed significantly by RT type over 2-year follow-up.

Conclusions

Findings suggest that early-stage breast cancer patients can benefit from less-severe, short-term side effects of APBI with no differential impact on QOL change within 2-year follow-up.

     

Five-Year Overall Survival of Interval Breast Cancers is Better than Non- Interval Cancers from Korean Breast Cancer Registry

Objective: Interval breast cancer (IC) is a limitation of breast cancer screening. We investigated data from alarge scaled breast cancer dataset of patients with breast cancer who underwent breast cancer screening in order torecapitulate the overall survival (OS) of patients with ICs compared to those with non-ICs. Methods: A total of 27,141patients in the Korean breast cancer registry with breast cancer who had ever participated in biannual national breastcancer screening programs between 2009 and 2013 were enrolled. We compared the social, pregnancy-associated, andpathologic characteristics between the IC and non-IC groups and identified the significant prognostic factors for OS.Results: The proportion of ICs was 1.3% (370/27,141) in this study population. ICs were correlated with age 45-55years at diagnosis, higher levels of education, early menopause (provinces (Kangwon, Kyungnam, Jeju, and Dae-jeon), and family history of breast cancer. Low-to-intermediate nucleargrade, early stage (stage 0-I), and low Ki-67 level were also correlated with IC proportion. Non-ICs were associatedwith an increased risk of five-year mortality (hazard ratio [HR] 7.4; 95% confidence interval [CI]:1.85-29.66; p = 0.005)compared to ICs. Lymph node metastasis, residence (Kyung-nam province), low education status, high histologic grade,and asymptomatic cancers increased the HR of five-year OS. Conclusion: ICs occurred unequally in specific provinceand relatively high-educated women in Korea. They were also diagnosed with early-stage breast cancer with a favorablerecurrence risk, and their outcome was better than those of patients with other breast cancers in breast cancer screening.     

Symptom Communication in Breast Cancer: Relationships of Holding Back and Self-Efficacy for Communication to Symptoms and Adjustment

Adjuvant endocrine therapy improves overall survival for women with breast cancer. However, side effects may compromise patients’ quality of life (QOL). This study examined how two communication variables (self-efficacy for symptom communication [SE] and holding back from discussing cancer-related concerns [HB]) relate to QOL, pain and menopausal symptoms. Participants with breast cancer (N = 61) completed questionnaires regarding symptoms, communication, and QOL. SE was positively related to QOL and negatively related to pain interference. HB from discussing cancer-related concerns was related negatively to QOL and positively to pain interference. HB mediated the relationship between SE and QOL as well as between SE and pain interference. Increased SE is beneficial among women on endocrine therapy for breast cancer. Future research should determine if interventions to improve SE are feasible and can improve QOL and symptom tolerability.     

Quality of life in women with advanced breast cancer treated with docetaxel

A survey was conducted to address the question of whether overall quality of life (QOL) in women with advanced breast cancer is significantly impaired by treatment with docetaxel in routine clinical practice. Health-related QOL (HRQOL) measured by the European Organisation for Research and Treatment of Cancer QOL Questionnaire C30, as well as performance status (PS) and tumor response, were assessed at baseline, then after every 2 cycles of treatment. The 209 evaluable patients received a median of 5 treatment cycles (range, 2-9), with a response rate of 35% (95% CI, 28.5%-41.4%). There were significant adverse changes in fatigue (P = 0.002) and diarrhea (P = 0.0002). However, HRQOL scores for emotional function (P < 0.0001), pain (P = 0.0001), constipation (P = 0.01), and nausea and vomiting (P = 0.03) all showed significant beneficial changes. Several QOL parameters improved during docetaxel therapy even in patients who did not have an objective tumor response. Overall, PS was maintained during docetaxel treatment. Following the encouraging QOL data from clinical trials of docetaxel in breast cancer, the authors conclude that, in actual clinical practice, docetaxel does not have an overall detrimental effect on QOL.     

肺癌患者生存质量影响因素的研究

[目的]反映肺癌患者的整体健康或功能状态,分析肺癌患者生存质量的影响因素.[方法]采用由世界家庭医生学会(WONCA)所推荐的COOP/WONCA功能状态量表中文版,于2002年对武汉市184例肺癌住院病人的生存质量状况进行了调查分析.[结果]影响肺癌患者生存质量的因素主要为年龄、体育锻炼和精神创伤.并且,这些因素均对病人的社会交往活动产生显著的影响.[结论]要重视肺癌患者的社会关注,以提高肺癌患者生存质量.     

上海市闵行区“六癌”早发现效果及影响因素分析

[目的]了解闵行区＂六癌＂（大肠癌、胃癌、肝癌、肺癌、乳腺癌、宫颈癌）早发现效果及其影响因素。[方法]对1999~2011年早发现登记队列中确诊的＂六癌＂与肿瘤登记系统中同期非队列人群确诊的＂六癌＂确诊期别、生存率及生存质量进行比较。[结果]＂六癌＂早期率,1年、3年、5年生存率和生存质量队列组均优于非队列组。基于社区的早发现模式效果好于基于医疗机构的早发现模式。影响患者生存的因素为：发病年龄、性别、家族史、手术性质、转移、患≥2个肿瘤、未经早发现干预,OR分别为：1.03、1.13、2.17、1.21、1.88、1.76、1.71。粘液性囊性肿瘤风险较高（OR=1.22,P=0.02）,腺癌、导管癌及鳞癌与上皮肿瘤相比死亡风险相当。患肠癌、胃癌、肝癌及肺癌较宫颈癌的死亡风险分别为：1.55、2.55、3.99、4.07,乳腺癌为宫颈癌死亡风险的0.66倍。[结论]两种早发现模式均有一定成效,基于社区的肿瘤早发现模式效果较优。＂六癌＂早发现、早诊断、早治疗,提高根治率是降低死亡风险的关键,尤其需要加强肝癌及肺癌的早诊早治工作。