Effect of peri-operative chemotherapy on the quality of life of patients with early breast cancer

Since chemotherapy is assumed to have a negative impact on quality of life, the impact of peri-operative chemotherapy on physical, psychological and social well-being and on the activity level of patients with early stage breast cancer was investigated. 24 women received peri-operative chemotherapy and 29 did not. They were interviewed 2 months and at a mean of 12 months post-surgery. Although the treated group reported more fatigue and considered hair loss a severe side-effect, no differences were found in overall physical and psychological well-being, perceived social interaction and activity level at 2 months. 1 year after surgery no differences were found between the two groups. Although no substantial effects of peri-operative chemotherapy on quality of life were demonstrated, patients almost unanimously considered peri-operative chemotherapy the most burdensome aspect of the treatment because of alopecia.     

Two simple indexes used to evaluate the impact of therapy on the quality of life of patients receiving primary chemotherapy for operable breast cancer.

The psychometric characteristics of two indexes used to evaluate the subjective morbidity of chemotherapy regimens were analyzed. Both indexes assessed the duration of discomfort as perceived by the patient throughout therapy. The first index asked patients to state the number of days spent with 'discomfort', and the second index asked them which days they would like to eliminate altogether because of the unbearable symptoms experienced on those days. While the first index gives some idea of the duration of suffering, without defining it, the second highlights a specific time when the quality of her life was unacceptable to the patient. We studied these indexes in the form of a questionnaire completed by 168 women who had entered a cancer clinical trial. This trial evaluated the efficacy of primary chemotherapy in rendering conservative surgery feasible in women with operable breast cancer, but whose tumor size was greater than 3 cm. Four different treatment regimens were used: CMF, FAC, FEC, FNC (C = cyclophosphamide, M = methotrexate, F = fluorouracil, A = adriamycin, E = epirubicin, N = mitoxantrone). Seventy-nine patients were interviewed during chemotherapy and 89 during follow-up visits. Initial assessment of the reliability, discriminant and concurrent validity of the two indexes produced satisfactory results. Finally, we analyzed the responses given by 168 patients for a total of 600 treatment cycles. The average value of 'discomfort' was 3 days, whereas the average value of days 'to be eliminated' was 1. The range of subjective morbidity (for every cycle of treatment: 'discomfort = 0-30 days; 'to be eliminated' = 0-20 days) was very broad.(ABSTRACT TRUNCATED AT 250 WORDS)     

乳腺癌初次与再次化疗患者生活质量调查

目的评估乳腺癌患者初次化疗与再次化疗时的生活质量。方法采用欧洲癌症研究与治疗组织（EORTC）开发的QLQ-BR53来测定初次与再次乳腺癌化疗患者的生活质量,所得资料用统计学方法进行配对t检验。结果①在一般生存状况中（QLQ-C30）,两组患者相比,再次化疗患者在物理症状、认知功能、情绪功能、社会功能及总体健康状况上与化疗前相比差异有显著性（P〈0.05或P〈0.01）。②乳腺癌特定生活质量比较中,再次化疗患者在性功能、性乐趣、系统疗法副作用、手臂症状及脱发引起的烦恼方面与初次化疗相比差异有显著性（P〈0.05或P〈0.01）。结论乳腺癌患者再次化疗时生命质量低于初次化疗时,再次化疗患者生活质量降低并非不可避免,提高手术质量,选择合适的化疗药物,改善化疗支持治疗,适当的心理治疗可以避免上述情况的发生。     

乳腺癌化疗患者生存质量及影响因素分析

目的 调查和了解乳腺癌化疗患者的生存质量及其影响因素。方法 以欧洲研究和治疗协会的QLQ-C30和QLQ-BR23组成EORTC-BR53量表为主要依据设计调查问卷,对乳腺癌化疗患者的生存质量进行调查,应用秩和检验评价乳腺癌化疗患者的生存质量,应用等级Logistic回归分析影响预后生存质量的因素。结果 诊断与调查时间间隔小于35个月,36~59个月和大于60个月三组中QLQ-BR23量表的性乐趣得分中位数分别为0,0和66.67(P＜0.05),症状量表脱发引起烦恼得分中位数分别为33.33,33.33和10.33(P＜0.05)。改良根治术、区段加前哨和保乳患者的QLQ-C30量表躯体功能得分中位数分别为66.67,66.67和73.33(P＜0.05);改良根治术的恶心呕吐得分为16.67,其他组为0分(P＜0.05);QLQ-BR23三组体形得分中位数分别为91.67,100和100(P＜0.05);性功能得分分别为0,16.67和50(P＜0.05);性乐趣得分中位数分别为0,33.33和66.67(P＜0.05)。对生存质量总症状进行分析,因病借钱和病理分类是化疗的乳腺癌患者生存质量总症状的影响因素(P＜0.05)。结论 化疗的乳腺癌患者生存质量主要与患者的病理分期、是否有经济压力密切相关。     

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。     

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.     

乳腺癌患者化疗后的心理痛苦与其生活质量之间的关系分析

目的 探讨乳腺癌患者化疗后不同程度的心理痛苦与其生活质量之间的关系。方法以本院2015年3月至2016年3月62例完成6个周期标准化疗的乳腺癌术后患者为研究对象,在化疗后分别完成心理痛苦温度计（DT）及乳腺癌生活质量量表（FACT-B）的测查,根据DT是否≥4分分为高分组和低分组,比较两组间生活质量的差异,同时分析心理痛苦与生活质量的相关性。结果 62例患者中有2例未完成问卷调查剔除。60例低分组和高分组患者生活质量的评分分别为（124.3±11.2）分和（89.5±15.6）分,组间的差异有统计学意义（t=10.06,P＜0.05）。60例患者的心理痛苦评分与生活质量评分呈显著负相关（r=-0.949,P＜0.05）。结论 乳腺癌患者化疗后存在不同程度心理痛苦,且心理痛苦的评分与其生活质量密切相关。     

居家护理指导对乳腺癌化疗患者化疗依从性和生活质量的影响

目的探讨居家护理指导对乳腺癌化疗患者的应用效果。方法选取2014年5月至2015年5月南京医科大学附属南京医院收治的160例乳腺癌化疗患者,采用随机数字表法随机分为观察组和对照组,每组80例。两组患者住院时护理方法相同。出院后对照组患者不进行院外指导,观察组患者给予居家护理指导,比较两组患者化疗3个月的化疗依从性、化疗效果和生活质量。结果观察组患者的化疗依从性的优良率和客观缓解率高于对照组患者,差异均有统计学意义(均P<0.05)。观察组患者干预后3个月时,生理状况、社会/家庭状况和情感状况等生活质量评分均高于对照组,差异均有统计学意义(均P<0.05)。结论居家护理指导能够提高乳腺癌患者化疗的依从性和化疗效果,改善患者生活质量。     

Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients

Late effects of adjuvant treatment on perceived health and quality of life were assessed through a questionnaire mailed to 448 premenopausal and postmenopausal breast cancer patients, free from recurrence 2–10 years after primary therapy. The patients had been randomised to postoperative radiotherapy or adjuvant chemotherapy as adjuncts to primary surgery. The differences between the two treatments were generally small. However, the radiotherapy patients had significantly greater problems with decreased stamina, symptoms related to the operation scar and anxiety. The chemotherapy patients had significantly more problems with smell aversion. Activity level inside and outside the home, anxiousness and depressive symptoms were similar in both groups. The chemotherapy patients scored their overall quality of life higher than the radiotherapy patients.     

个体化用药教育对乳腺癌化疗患者生命质量的影响

目的探讨个体化用药教育对乳腺癌化疗患者生命质量的影响。方法选择从2010年1月至2011年7月在本院首次乳腺癌化疗患者90例,年龄35～60岁,分为干预A组,干预B组和对照组各30例,各组基本情况比较差异无统计学意义。首次化疗前1周分别测定各组生命质量。对照组进行常规治疗和护理,化疗过程中不做干预,首次化疗前1周对干预A组,首次化疗后l周对干预B组进行个体化用药教育。对各组末次化疗结束后1周用乳腺癌生存质量测评量表（FACT—B）对生命质量评分,比较各干预组与对照组之间的生命质量差异。结果化疗后干预A组、B组在对自身疾病的了解程度、正确用药、合理饮食等方面均显著高于对照组（P〈0．017）,而A组与B组间差异无统计学意义（P〉0．017）。化疗完成并随访结束后对其生命质量进行比较,干预A组、B组在生理状况、情感状况、功能状况、附加关注及总的质量评分（总分）等方面显著高于对照组（P〈0．050）,而A组与B组问除生理状况质量评分差异无统计学意义外,其余四项差异均有统计学意义。化疗前后比较：对照组在生理状况、情感状况、功能状况和总分方面化疗前后差异有统计学意义（P〈0．050）;干预A组、B组在生理状况、情感状况、功能状况、附加关注及总分等方面化疗前后差异有统计学意义（P〈0．050）。结论个体化用药教育对乳腺癌化疗患者生命质量的改善具有积极意义。     

The impact of a second breast cancer diagnosis on health related quality of life

Summary A growing of research documents the negative impact of recurrent breast cancer on quality of life (QOL), however few prospective investigations are available that compare QOL outcomes across different types of second cancer events (e.g., local/regional recurrence (LR) versus distant/metastatic recurrence (DR) versus a new primary breast cancer (NP)). In addition, although participant attrition is a major issue in this group of cancer patients, the potential impact of attrition or response bias on QOL outcomes is not typically examined. To address these issues, we prospectively examined QOL data obtained from a sample of women (n=140) participating in the Women’s Healthy Eating and Living (WHEL) Study who experienced a second cancer event (LR, DR or NP). Women in our study reported significant worsening in most areas of QOL, except for emotional wellbeing, from pre- to post-second cancer event. Although the patterns of change to QOL differed slightly within each category (LR versus DR versus NP), participants were more similar than different in their QOL ratings. However, the perceived health status of women with DR was significantly lower than women with LR or NP. We also identify important sources of response bias that should be considered when interpreting findings. Specifically, women diagnosed with DR (a) were more likely to decline to complete the post-recurrence QOL questionnaire (27% refusal rate versus 14% LR and 13% NP), and (b) had higher death rates (28% death rate versus 4% LR and 6% NP) after agreeing to but before completing the post-second diagnosis QOL questionnaire.     

The impact of recurrent rectal cancer on quality of life.

AIMS: To determine, in patients operated upon for rectal cancer, the impact that tumour recurrence has on quality of life. METHODS: Twenty-five patients, who had curative surgery for rectal cancer from 1992 to 1997, and who subsequently developed tumour recurrence, participated. Each patient was individually matched with two patients who also had rectal cancer surgery during the same period of time but were considered to be free of cancer. The patients were matched for age, gender, type of operation and socioeconomic status. They answered the European Organization for the Research and Treatment of Cancer (EORTC) QLQ-C30 and CR38 quality of life questionnaires, as well as the SF36 II questionnaire, at least 1 year after surgery. RESULTS: Patients with recurrent rectal cancer had significantly lower quality of life scores than cured patients in most dimensions, as measured by the three questionnaires. A significant difference was also seen in the global quality of life score on the QLQ-C30 (median scores 50 vs 75, z = 4.015, P = 0.0001). CONCLUSION: Recurrence of rectal cancer has a profound effect on quality of life, affecting most measurable dimensions. Treatment of recurrent cancer should not only be directed at the physical aspect of the disease, but also at its psychological and social aspects. Copyright Harcourt Publishers Limited.     

The impact of hyperbaric oxygen therapy on late radiation toxicity and quality of life in breast cancer patients

Breast Cancer Research and Treatment - To evaluate symptoms of late radiation toxicity, side effects, and quality of life in breast cancer patients treated with hyperbaric oxygen therapy (HBOT)....     

The impact of hemoglobin levels on fatigue and quality of life in cancer patients.

BACKGROUND: Although fatigue is a commonly reported symptom in cancer patients its etiology is still poorly understood. The objective of the present study was to investigate the relationship between hemoglobin (Hb) levels and the subjective experience of fatigue and quality of life in cancer patients with mild or no anemia undergoing chemotherapy. PATIENTS AND METHODS: Sixty-eight cancer patients (25 colorectal, 26 lung and 17 ovarian cancer) presently undergoing chemotherapy participated in the study. Fatigue was measured with the Multidimesional Fatigue Inventory (MFI-20), quality of life with The European Organization for Research and Treatment of Cancer QLQ-C30. In order to provide normative data for fatigue levels, the MFI-20 was also completed by a sex- and age-matched sample of 120 healthy controls. RESULTS: Compared with healthy subjects, cancer patients experienced significantly higher levels of subjective fatigue. Correlations between Hb values and subscales of the MFI-20 were moderate with a tendency to increase during chemotherapy. Hb values alone, however, do not fully account for the observed fatigue. Other symptoms, especially pain, dyspnea and sleep disturbances, also showed an association with perceived fatigue. CONCLUSIONS: Despite significant correlations, these results indicate that Hb values only partially explain subjectively experienced fatigue and quality of life in cancer patients. It is suggested therefore that the treatment of fatigue must be multidimensional and involve all areas which contribute to the syndrome.     

The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review

In recent years, doubt has been shed on the necessity of mastectomy for women with early-stage breast cancer. Apart from purely medical studies comparing (radical) mastectomy to less intruding surgical treatment, a number of studies (N = 18) have been published investigating the impact of breast-conserving treatment versus mastectomy on quality of life. We review these studies with respect to medical issues (treatment modality, stage of disease), methodologic issues (design, measurement moment, sample size), and results (psychologic discomfort, changes in life patterns, fears and concerns). It is concluded that there is no solid proof of a better psychologic adjustment after breast-conserving treatment and that there are no substantial differences between the different treatment modalities in changes of life patterns and fears and concerns. However, the results with respect to body image and sexual functioning favor the use of breast-conserving treatment.     

健康素养对乳腺癌术后患者生存质量影响的路径分析

目的:探讨乳腺癌改良根治术后患者的健康素养对功能锻炼依从性、生存质量的影响及相关性。方法:以2016年3月至2017年4月在我院进行治疗的318例乳腺癌改良根治术后患者作为研究对象,以慢性病患者健康素养量表、乳腺癌患者功能锻炼依从性量表、癌症治疗功能评价系统—乳腺癌生存质量量表为评价工具,采用Pearson分析和Spearman分析探讨健康素养对功能锻炼依从性、生存质量有无影响及相关性。结果:乳腺癌改良根治术后,318例患者的健康素养评分、功能锻炼依从性评分及生存质量评分均值分别为(92.86±13.71)分、(49.77±9.18)分、(82.31±17.76)分;健康素养、功能锻炼依从性、生存质量及其各维度之间相互呈显著性正相关（P＜0.05);健康素养对功能锻炼依从性的影响为0.773、对生存质量的总影响为0.702,功能锻炼依从性对生存质量的影响为0.662,功能锻炼依从性中介作用的影响为0.512;改善互动能力对健康素养的影响最大(0.853);主动寻求建议依从性对功能锻炼依从性的影响最大(0.875);社会/家庭状况对生存质量的影响最大(0.882)。结论:健康素养与功能锻炼依从性均可直接正向预测生存质量,健康素养还可通过功能锻炼依从性间接正向预测生存质量。     

系统化护理对乳腺癌患者化疗期间负性情绪和生活质量的影响

目的探讨系统化护理对乳腺癌患者化疗期间负性情绪和生活质量的影响。方法选取2010年8月至2015年8月间青岛市肿瘤医院收治的104例乳腺癌化疗患者为研究对象,采用随机数表法分成观察组和对照组,每组52例。观察组患者在常规护理基础上予以系统化护理,对照组患者仅采用常规护理。观察并比较护理前后两组患者生活质量量表简表评分、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、简易癌因性疲乏量表(BFI)评分和匹兹堡睡眠质量指数量表(PSQI)相关指标的变化情况。结果两组患者护理前生活质量、HAMA、HAMD、FBI和PSQI评分比较,差异均无统计学意义(均P>0.05),护理后,对照组患者生理、心理、社会和环境评分分别为(9.11±1.78)分、(8.12±1.32)分、(9.94±1.23)分和(9.84±1.33)分,观察组患者上述指标分别为(11.11±1.47)分、(9.97±1.47)分、(11.53±1.54)分和(11.12±1.44)分,差异均有统计学意义(均P<0.05)。对照组患者护理后睡眠效率、入睡时间、睡眠质量、睡眠时间、睡眠障碍、日间功能和催眠药物评分分别为(2.52±0.63)分、(2.22±0.46)分、(2.36±0.31)分、(2.24±0.29)分、(2.02±0.24)分、(2.25±0.25)分和(2.39±0.47)分,观察组患者上述评分分别为(2.22±0.47)分、(1.78±0.34)分、(1.83±0.25)分、(1.15±0.24)分、(1.46±0.16)分、(1.74±0.23)分和(1.72±0.34)分,观察组显著优于对照组,差异均有统计学意义(均P<0.05)。对照组患者护理后HAMA、HAMD和BFI评分分别为(17.83±4.12)分、(18.24±3.16)分和(69.57±5.14)分,观察组患者上述评分相对应分别为(9.35±3.15)分、(9.25±1.58)分和(20.45±3.16)分,观察组显著优于对照组,差异均有统计学意义(均P<0.05)。结论系统化护理可降低乳腺癌患者化疗期间负性情绪,提高生活质量。     

Predictors of quality of life of breast cancer patients

Research has indicated that several demographic and clinical factors may affect the quality of life of breast cancer patients. Few studies, however, have sufficient sample sizes for multivariate analyses to be tested. Furthermore, several important factors, such as arm morbidity, communication and comorbid illness, have not been included in quality of life models. The aim of this study was to predict the simultaneous effect of these factors on long-term quality of life. Breast cancer patients (n=990) completed a quality of life survey, including the EORTC QLQ-C30, over five years. Clinical details were registered in the Munich Cancer Registry. Eleven predictors across eight quality of life domains were analyzed over a period of five years using a logistic regression model. Arm problems, communication, comorbidity, age, surgery, and, to a lesser extent, marital, educational and employment status were significantly associated with quality of life. Adjuvant therapy, medical insurance and pT category were not significant predictors. This study is the first to demonstrate the consistency and strength of arm dysfunction and doctor-patient communication on breast cancer patients' quality of life. These important factors in breast cancer care can be improved and should be regarded as a priority.