死亡教育对老年末期癌症患者生死观、情绪状态及生活质量的影响

目的探讨死亡教育对老年末期癌症患者生死观、情绪状态及生活质量的影响。方法采用随机分组法将197例患者分成教育组(n=92)和对照组(n=105),2组患者均接受常规基础护理及症状控制。教育组还给予个体化死亡教育,每周1～2次,持续4周,教育前后均接受自编问卷、简明心境量表(POMS)和欧洲癌症研究治疗组织生活质量测定表(EORTCQLQ-C30)测评。结果死亡教育后病人对死亡及人生观均得到显著地改善(P0.01);死亡教育后患者的抑郁-沮丧、紧张-焦虑、愤怒-敌意等情绪因子分值有显著降低,测评结果差异有统计学意义(P0.01);教育后患者情绪功能、认知功能、社会功能及总体生存质量均有显著提高(P0.01)。结论死亡教育改变了老年末期癌症患者对生死观及价值观的认识,改善了患者对死亡的不良认知及行为,解除了患者对死亡的恐惧、担忧和悲观情绪,提高其生活质量。     

心理干预对老年癌症患者生命质量的影响

目的探讨心理干预对老年癌症患者生命质量的影响。方法将唐山市人民医院肿瘤专科医院收治的73例老年癌症患者随机分为干预组和对照组,干预组患者接受系统心理干预,对照组患者仅接受常规护理和一般支持性心理护理。干预前后对干预组和对照组患者均采用EORTC生命质量测定量表QLQ-C30(V3.0)中文版进行问卷调查。结果干预后干预组老年癌症患者的躯体功能、角色功能、情绪功能、认知功能等功能领域以及总体健康状况得分显著高于对照组(t=2.322,2.602,3.879,4.223,2.616;P<0.05或P<0.001),而干预组干预后症状领域中的疲倦得分显著低于对照组(t=-2.397,P<0.05)。结论心理干预可以显著提高老年癌症患者的生命质量。     

死亡教育对头颈外科末期肿瘤患者生死观、不良情绪及生活质量的影响

目的探讨死亡教育对头颈外科末期肿瘤患者生死观、不良情绪及生活质量的影响。方法将134例晚期头颈部肿瘤患者分为观察组和对照组,每组67例,对照组采用常规的健康教育及护理干预,观察组在对照组的基础上实施死亡教育。干预1个月后,比较两组干预前后生死观、不良情绪及生活质量。结果干预前,两组生死观各项指标、抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分及生活质量各项评分差异均无统计学意义(均P0. 05)。干预后,两组上述指标均明显改善,且观察组改善较对照组更显著(P0. 05)。结论死亡教育能使头颈外科末期肿瘤患者勇敢面对死亡,建立积极的人生态度,显著改善患者焦虑、抑郁情绪,生活质量得到明显提高。     

综合护理干预对老年冠心病患者生活质量的影响

目的评价综合护理干预对老年冠心病患者生活质量的影响。方法本次观察对象为2014年7月至2015年9月在我院就诊的60例老年冠心病患者,入院后均实施综合护理干预措施,于护理前后,观察患者生活质量及负面情绪变化情况。结果与护理前相比,患者护理后活力、躯体角色、情绪角色、社会功能、躯体功能及总体健康评分均明显提升,差异有统计学意义(P0.05);与护理前相比,患者护理后SDS及SAS评分均显著降低,差异有统计学意义(P0.05)。结论给予老年冠心病患者综合护理干预,可明显提高生活质量,消除负面情绪,促进身体康复。     

全国多中心老年晚期癌症患者失眠情况调查

目的 调查老年晚期癌症患者失眠的发生率,探索失眠人群在症状、情绪和生活质量方面与非失眠人群的差异及失眠的风险因素。方法 2019年7月至2020年12月,使用MD安德森症状问卷(MDASI)、医院焦虑抑郁量表(HADS)、患者健康问卷-9(PHQ-9)、失眠严重指数量表(ISI)及欧洲生活质量五维度五水平问卷(EQ-5D-5L)对全国10个中心的晚期恶性肿瘤患者(≥65岁)进行调查,共计696例患者符合标准而纳入研究。采用SAS 9.4统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。使用多元logistic回归分析失眠的风险因素。结果 老年晚期恶性肿瘤患者轻度及以上失眠发生率为31.9%(222/696)。失眠组症状负担、心理痛苦发生率显著高于无失眠组,生活质量显著低于无失眠组,差异均有统计学意义(P<0.001)。抑郁、焦虑是失眠的风险因素(OR=0.254, 95%CI 0.105～0.119,P=0.002;OR=0.286, 95%CI 0.615～0.687,P=0.005)。结论 老年晚期恶性肿瘤患者的失眠值得重视,即便...     

老年肺癌住院患者应对方式与健康相关生活质量

目的探讨老年肺癌住院期间的应对方式与健康相关生活质量及二者之间的关系。方法采用欧洲癌症研究与治疗组织(EORTC)研发的健康相关生活质量问卷核心卷(QLQ-C30)中文版和医学应对方式问卷(MCMQ)对117例老年住院肺癌患者开展调查研究。结果老年肺癌患者住院期间总体健康状况得分为(56.34±15.68)分;患者多采用回避的应对方式(P0.05);肺癌患者总体生活质量、角色功能、情绪功能、社会功能与屈服应对呈显著负相关(P0.01)。结论老年肺癌患者多采用消极应对方式,并对患者的健康相关生活质量有影响。     

心理干预联合健康教育对老年肺癌患者生存质量和负性情绪的影响

目的探讨心理干预联合健康教育对老年肺癌患者生存质量和负性情绪的影响。方法选取2014年1月至2015年1月收治的老年肺癌患者110例,按照随机数字表法分为研究组和对照组,每组55例,对照组给予常规干预措施,研究组在对照组的基础上给予心理干预联合健康教育,应用焦虑自评量表(SAS)评价患者焦虑情况,采用抑郁自评量表(SDS)评价患者抑郁情况,并应用生存质量评分来评价患者生存质量。结果干预前两组SDS评分和SAS评分比较均无统计学意义(P0.05),干预后研究组SDS评分和SAS评分均显著优于干预前,且显著优于对照组(P0.05),对照组干预前后SDS评分和SAS评分无显著变化(P0.05);干预后研究组角色功能、情绪功能、躯体功能、认知功能以及整体功能均显著优于对照组(P0.05)。结论心理干预联合健康教育对老年肺癌患者具有较好效果,能显著改善患者的负性情绪,提高患者的生存质量。     

老年维持性血液透析患者家庭支持和生活质量相关性分析

目的 探讨老年维持性血液透析患者家庭支持和生活质量相关性.方法 采用健康状况调查问卷(SF-36中文版)、家庭支持自评量表和生活质量自评量表,对230例老年维持性血液透析患者进行问卷调查,并进行相关分析及回归分析.结果 老年维持性血液透析患者在生理机能、生理职能、躯体疼痛、总体健康、精力、社会功能、情感职能7个维度的得分均显著低于中国一般人群(P＜0.001),精神健康维度得分也低于中国一般人群(P＜0.01).老年维持性血液透析患者的家庭支持与生活质量呈显著正相关(r＝0.702,P＜0.001),其中家庭支持对维持性血液透析患者的生活满意度、健康与功能、自我概念呈显著正相关(P＜0.001),而与社会、经济因素无相关性(P＞0.05).结论 护理工作中应注重调动老年维持性血液透析患者家庭成员的主观能动性,提高家庭支持水平,提高患者的生活质量.     

姑息化疗联合家庭预后意识对晚期肺癌患者免疫功能、生活质量及生存的影响

目的 分析姑息化疗联合家庭预后意识对晚期肺癌患者免疫功能、生活质量及生存的影响。方法 选取老年晚期肺癌患者76例，根据干预方式分为对照组和研究组各38例。对照组接受姑息化疗；研究组在姑息化疗基础上联合家庭预后护理。比较两组各项指标。结果 治疗后研究组CD4⁺/CD8⁺T细胞比值显著高于对照组，免疫细胞相关因子[白细胞介素(IL)-2、IL-6、IL-8和肿瘤坏死因子(TNF)-α]水平明显优于对照组(P<0.05)。治疗后，研究组疲乏量表(PFS)评分显著低于对照组(P<0.001),生活质量测定量(QLQ-C30)各项评分明显优于对照组(P<0.05)。治疗后两组焦虑自评量表(SAS)及抑郁自评量表(SDS)评分显著降低，且研究组显著低于对照组(P<0.05)。两组生存率无显著差异(P=0.456)。结论 姑息化疗联合家庭预后护理能改善晚期肺癌患者细胞免疫功能，缓解癌症疲乏，调节身心状态。     

生物信息反馈疗法对中晚期原发性肝癌患者生活质量的影响

目的:观察分析生物信息反馈疗法对原发性肝癌(HCC)中、晚期患者心理和生存质量的影响。方法:将88例HCC患者随机分为两组。对照组42例,采用常规治疗;干预组46例在常规治疗基础上加用生物信息反馈疗法。运用欧洲生活质量协作组癌症核心量表(QLQ-C30)评价患者生活质量,分析生物信息反馈疗法对患者的影响。结果:干预组患者QLQ-C30量表功能领域及生活整体质量评分均显著高于对照组(P0.05),疲乏、恶心呕吐、疼痛、呼吸困难、睡眠障碍、腹泻等症状得分显著低于对照组(P0.05)。结论:生物信息反馈疗法在一定程度上能改善中、晚期HCC患者绝望、紧张、抑郁、痛苦等情绪,进而改善由这些负面情绪所导致的症状,提高其生活、生存质量。     

Cardiovascular health-related quality of life in cancer: a prospective study comparing the ESC HeartQoL and EORTC QLQ-C30 questionnaire

Aims

Health-related quality of life (HRQoL) is highly relevant in cancer and often assessed with the EORTC QLQ-C30. Cardiovascular HRQoL in cancer can be measured with the ESC HeartQoL questionnaire. We compared these instruments and examined their prognostic value.

Methods and results

Summary scores for EORTC QLQ-C30 (0–100 points) and ESC HeartQoL (0–3 points) questionnaires were prospectively assessed in 290 patients with mostly advanced cancer (stage 3/4: 81%, 1-year mortality: 36%) and 50 healthy controls (similar age and sex). Additionally, physical function and activity assessments were performed. Both questionnaires demonstrated reduced HRQoL in patients with cancer versus controls (EORTC QLQ-C30: 67 ± 20 vs. 91 ± 11, p < 0.001; ESC HeartQoL: 1.8 ± 0.8 vs. 2.7 ± 0.4, p < 0.001). The instruments were strongly correlated with each other (summary scores [r = 0.76], physical [r = 0.81], and emotional subscales [r = 0.75, all p < 0.001]) and independently associated with all-cause mortality (best cut-offs: EORTC QLQ-C30 <82.69: hazard ratio [HR] 2.33, p = 0.004; ESC HeartQoL <1.50: HR 1.85, p = 0.004 – adjusted for sex, age, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin T, cancer stage/type), with no differences in the strength of the association by sex (p-interaction > 0.9). Combining both questionnaires identified three risk groups with highest mortality in patients below both cut-offs (vs. patients above both cut-offs: HR 3.60, p < 0.001). Patients with results below both cut-offs, showed higher NT-proBNP and reduced physical function and activity.

Conclusions

The EORTC QLQ-C30 and ESC HeartQoL – assessing cancer and cardiovascular HRQoL – are both associated with increased mortality in cancer patients, with even greater stratification by combing both. Reduced HRQoL scores were associated with elevated cardiovascular biomarkers and decreased functional status.     

上海市某中心社区癌症患者生活质量评估与影响因素分析

目的通过对某中心城区158例癌症患者的调查分析,对社区癌症患者的生活质量进行评估并对相关影响因素进行分析。方法对158例癌症患者采用欧洲癌症研究与治疗组织生活质量核心评定量表（EORTCQLQ—C30．V3．0）及自设一般情况调查表进行问卷调查。结果癌症患者的躯体功能、角色功能、认知功能、社会功能低于Norwegian常模,另外在症状和单项比较中呼吸困难、失眠、便秘、经济困难评分也高于Norwegian常模。患者性别、学历和经济收入对生存质量影响差异无统计学意义,但患病时间和年龄的影响差异有统计学意义（P〈0．05）。结论癌症患者的生活质量受到患病时间和年龄的影响,社区医护人员在对社区肿瘤患者的随访过程中,不但要重视患者躯体症状的改善,还要加强心理、社会功能的改善,积极做好患者及家属的健康教育、心理疏导和行为干预等指导工作,以提高和促进社区肿瘤患者的生活质量。     

Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema

The aim of this study was to assess disability, psychological distress and quality of life in Polish breast cancer survivors with arm lymphedema. One thousand sets of questionnaires consisting of WHO-DAS II, GHQ-30, EORTC QLQ-C30 and QLQ-BR23 were sent to members of the Polish Federation of Breast Cancer Survivors Clubs "Amazonki." The response rate was 28.3% of whom 31.70% reported arm lymphedema. The WHO-DAS II survey showed that patients with arm lymphedema had a higher overall disability score (45.04 versus 38.80 in group without arm lymphedema; p=0.01) and higher mean values in the scales of understanding and communicating, getting around, life activities at home, getting along with people, participating in society. The EORTC QLQ-C30 survey showed that patients with lymphedema had lower mean values in physical (0.55 versus 0.65; p=0.001), emotional (0.47 versus 0.57; p=0.01), social (0.59 versus 0. 73; p=0.002), cognitive and role functioning, increased fatigue, pain, insomnia, dyspnea, nausealvomiting and financial problems. The EORTC QLQ-BR23 data demonstrated worse future perspectives and an increase in breast and arm symptoms, and the GHQ-30 survey produced higher psychological distress (scores 15.18 versus 11.24; p=0.004). In conclusion, breast cancer survivors with arm lymphedema were more disabled, experienced a poorer quality of life and had increased psychological distress in comparison to survivors without this condition.     

Quality of life and social integration after allogeneic hematopoietic SCT

In total, 124 adult patients in remission after allogeneic hematopoietic SCT (HSCT) participated in a cross-sectional study to assess health-related quality of life (HRQL). Assessment of HRQL was carried out using two questionnaires: the (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy (FACT) with specific modules for BMT (FACT-BMT). Transplanted patients differed from healthy controls in many HRQL-related dimensions in the EORTC QLQ-C30: social functioning 73.4 versus 85.8, P<0.0001; role functioning 74.6 versus 83.3, P<0.004; physical functioning 83.9 versus 89.9, P<0.001; emotional functioning 72.2 versus 82.8, P<0.0001 but were not significant for global HRQL 71.2 versus 75.3, P<0.03. In total, 60% of the patients returned to work after HSCT; 31% part time and 29% full time. Age at HSCT and employment status were significantly associated with HRQL. Other factors such as disease and disease stage and especially the occurrence of late complications did not impact the perception of HRQL. This study suggests that the perception of HRQL after HSCT differs from the general population. Issues to increase work-related capabilities and improve social support need to be addressed.     

The prognostic value of quality of life scores during treatment for oesophageal cancer

BACKGROUND: Quality of life (QL) data are useful to evaluate the effectiveness of treatment. Accumulating evidence suggests that QL data may predict survival. AIMS: In this study we investigated if baseline QL scores and changes in QL scores before and after intervention are prognostic for patients with oesophageal cancer. PATIENTS: Between 1993 and 1995, 92 consecutive new patients with oesophageal cancer were studied; 89 were followed until death or the end of the study period (survival of seven patients was censored in May 1999). METHODS: All patients completed the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire (EORTC QLQ-C30) and the dysphagia scale of the oesophageal module (EORTC QLQ-OES24) before treatment and at regular intervals throughout the study. Cox's proportional hazards models assessed the impact of baseline QL variables and changes in QL scores on survival. RESULTS: Cox's proportional hazards models, adjusting for associations between QL scores, age, and TNM stage, found that physical function at baseline was significantly associated with survival (p=0.002). An increase in physical function score of 10 points corresponded to a 12% reduction in the likelihood of death at any given time (95% confidence intervals 4--18%). Further exploratory multivariable analyses suggested that improvement in emotional function six months after treatment was significantly related to longer survival (p<0.0001). CONCLUSIONS: These data provide evidence to support a relationship between patient rated scores of QL and survival. Further understanding of the associations between QL and clinical variables is needed.     

Quality of life in elderly patients with acute myeloid leukemia: patients may be more accurate than physicians

Background

The aim of this study was to evaluate changes in quality of life scores and their association with therapy and survival in unselected elderly patients with acute myeloid leukemia.

Design and Methods

From February 2003 to February 2007, 113 patients aged more than 60 years with de novo acute myeloid leukemia were enrolled in a prospective observational study. Two different quality of life instruments were employed: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – C30 (EORTC QLQ-C30) and a health-related quality of life questionnaire for patients with hematologic diseases (QOL-E).

Results

Forty-eight patients (42.4%) received intensive chemotherapy and 65 (57.6%) were given palliative treatments. Age greater than 70 years (P=0.007) and concomitant diseases (P=0.019) had a significant impact on treatment allocation. At diagnosis, general quality of life was affected [median QOL-E standardized score 54, interquartile range 46–70; median EORTC global score 50, interquartile range 41–66]. Most patients were given a good ECOG Performance Status (< 2), which did not correlate with the patients’ perception of quality of life. At multivariate analysis, palliative approaches (P=0.016), age more than 70 years (P=0.013) and concomitant diseases (P=0.035) each had an independent negative impact on survival. In a multivariate model corrected for age, concomitant diseases and treatment option, survival was independently predicted by QOL-E functional (P=0.002) and EORTC QLQ-C30 physical function (P=0.030) scores.

Conclusions

Quality of life could have an important role in elderly acute myeloid leukemia patients at diagnosis as a prognostic factor for survival and a potential factor for treatment decisions.     

EORTC QLQ-C30 and FACT-BMT for the measurement of quality of life in bone marrow transplant recipients: a comparison

The purpose of the study was to compare two different quality-of-life self-rating instruments, namely the EORTC QLQ-C30, developed by the quality-of-life study group of the European Organisation for Research and Treatment of Cancer, and the FACT-BMT (version 3), the Functional Assessment of Cancer Therapy - Bone Marrow Transplantation scale, which is the FACT-G(eneral measure) in combination with a module developed specifically for evaluating quality of life of bone marrow transplant (BMT) patients. Fifty-six BMT recipients completed both the EORTC QLQ-C30 and the FACT-BMT (German language version) during the same session. Questionnaire data were analyzed on a subscale basis using correlation analysis and multiple linear regression. Correlations between corresponding subscales of EORTC QLQ-C30 and the FACT-BMT ranged from r=0.30 for the emotional domain (poor agreement) to r=0.77 for global QOL (good agreement). This suggests that the instruments, despite considerable overlap, possibly focus on different aspects of QOL, in particular in addressing emotional and social issues of BMT patients. It appears that the FACT-BMT gives a more comprehensive overview regarding the multidimensional construct of quality of life. The EORTC QLQ-C30 gives more insight into the physical aspects of quality of life and helps to identify symptoms which effectively decrease quality of life from the patient's perspective. The QLQ-C30 might be improved by the incorporation of a BMT-specific module currently under development. We therefore conclude that neither of the two instruments can be replaced by the other in the assessment of QOL of BMT patients and that a direct comparison of results obtained with the two instruments is likely to be misleading.     

Functional outcome and quality of life at least 6 months after pneumonectomy--effect of operation, adjuvant therapy, tumor stage, sex, type of pneumonia and recurrence

This study reports on the results of a checkup carried out on 38 patients subjected to an extended cancer aftercare examination at least 6 months after pneumectomy because of bronchial carcinoma, 12 of these patients receiving adjuvant chemotherapy and/or radiotherapy. Lung function data determined by body plethysmography were measured, as well as the quality of life, using the Karnofsky and Spitzer indices as well as QLQ-C30 of the EORTC. In addition, anamnestic data and postoperative ECG and blood gas analysis results were recorded. The most important findings concern restricted lung function due to pneumectomy, an IVC decrease by 33.3%, a drop in FEV1 by 27.3% and a reduction of the total lung capacity (TLC) by 14%. Moreover, a distinctly increased right heart load was seen in 23.4% of all patients. The quality of life tests revealed a slightly reduced quality of life in the external assessment indices according to Karnofsky (86 +/- 11%) and Spitzer (8.6 +/- 1.2). Self-assessment by QLQ-C30 of the EORTC, however, evidenced a clear reduction of the global quality of life (54.2 +/- 15.6) and role function, a moderate decrease of physical, emotional, cognitive and social functioning as well as a greatly increased incidence of the symptoms fatigue, dyspnea, sleep disturbances and pain after surgery. Adjuvant therapy applied in 12 patients had no significant influence, neither on lung function parameters nor on the quality of life. A more advanced tumour stage or a relapse, however, will adversely affect the quality of life.     

Effect of thalidomide with melphalan and prednisone on health-related quality of life (HRQoL) in elderly patients with newly diagnosed multiple myeloma: a prospective analysis in a randomized trial

Thalidomide with melphalan/prednisone (MPT) was defined as standard treatment in elderly patients with multiple myeloma (MM) based on five randomized trials. In one of these trials, HOVON49, a prospective health-related quality-of-life (HRQoL) study was initiated in order to assess the impact of thalidomide on QoL. Patients aged >65 years with newly diagnosed MM were randomized to receive melphalan plus prednisone (MP) or MPT, followed by thalidomide maintenance in the MPT arm. Two hundred eighty-four patients were included in this side study (MP, n=149; MPT n=135). HRQoL was assessed with the EORTC Core QoL Questionnaire (QLQ-C30) and the myeloma-specific module (QLQ-MY24) at baseline and at predetermined intervals during treatment. The QLQ-C30 subscales physical function (P=0.044) and constipation (P<0.001) showed an improvement during induction in favour of the MP arm. During thalidomide maintenance, the scores for the QLQ-MY24 paraesthesia became significantly higher in the MPT arm (P<0.001). The QLQ-C30 subscales pain (P=0.12), insomnia (P=0.068), appetite loss (P=0.074) and the QLQ-MY24 item sick (P=0.086) scored marginally better during thalidomide maintenance. The overall QoL-scale QLQ-C30-HRQoL showed a significant time trend towards more favourable mean values during protocol treatment without differences between MP and MPT. For the QLQ-C30 subscales emotional function and future perspectives, difference in favour of the MPT arm from the start of treatment was observed (P=0.018 and P=0.045, respectively) with no significant 'time × arm' interaction, indicating a persistent better patient perspective with MPT treatment. This study shows that the higher frequency of toxicity associated with MPT does not translate into a negative effect on HRQoL and that MPT holds a better patient perspective.     

Do patients who are treated with stem cell transplantation have a health-related quality of life comparable to the general population after 1 year?

Health-related quality of life (HRQOL) in leukemia and lymphoma patients treated with high-dose chemotherapy followed by allogeneic (SCT) and autologous (ASCT) stem cell transplantation or receiving combination chemotherapy (CT) was prospectively assessed by the EORTC QLQ-C30 and compared with reference data from a general population sample. One year after transplant, the SCT group had functional scores which were close to population values except for lower social (P < 0.0001) and role function (P = 0.0004). More symptoms and problems were reported, especially appetite loss (P = 0. 001) and financial difficulties (P = 0.0001). The ASCT patients reported a less than optimal HRQOL relative to the population 1 year post transplant. Cognitive, physical, role, and social function, dyspnoea, financial difficulties and global quality of life were most impaired (P < 0.001). In the CT group, physical, role and social function, dyspnoea and financial difficulties were impaired 1 year after start of chemotherapy, compared with the general population (P < 0.001). The EORTC QLQ-C30 was supplemented by a high-dose chemotherapy module, the HDC-19, at the 1-year assessment, but no consistent differences were found across groups. Fifteen to 34% of the patients expressed fears of relapse and worries about future health, while 24-30% indicated no participation in sexual activities.