Shimozuma K, Ganz P A, Petersen L, Hirji K
Department of Surgery, Kawasaki Medical School, Kurashiki-City, Japan.
Breast Cancer Res Treat. 1999 Jul;56(1):45-57. doi: 10.1023/a:1006214830854.
Although mortality rates from breast cancer are declining, many breast cancer survivors will experience physical and psychological sequelae that affect their everyday lives. Few prospective studies have examined the rehabilitation needs of newly diagnosed breast cancer patients, and little is known about the predictors of health-related quality of life (QOL) in this population.
Between 1987 and 1990, 227 women with early stage breast cancer participated in a prospective longitudinal study in which detailed information was collected through interviews, standardized measures of QOL and psychological distress, and clinical evaluation. Comparisons of physical and treatment-related problems were made according to type of surgical treatment. Multivariate regression analysis was performed to examine the predictors of QOL at one year after surgery.
Physical and treatment-related problems were reported frequently one month after breast cancer surgery, and occurred with equal frequency in women receiving modified radical mastectomy or breast conservation treatment. There were no significant differences in problems reported at one year by type of surgery; however, frequently reported problems include 'numbness in the chest wall or axilla,' 'tightness, pulling or stretching in the arm or axilla,' 'less energy or fatigue,' 'difficulty in sleeping,' and 'hot flashes'. There was no relationship between the type of surgery and mood or QOL. Poorer QOL one year after surgery was significantly associated with greater mood disturbance and body image discomfort one month after surgery, as well as positive lymph node involvement. Although the majority of patients experienced substantial disruptions in the physical and psychosocial dimensions of QOL post-operatively, most women recovered during the year after surgery, with only a minority (<10%) significantly worsening during that time.
At one year after surgery, most women report high levels of functioning and QOL, with no relationship between the type of surgery and QOL. Women who reported lower levels of QOL at one year after diagnosis had greater mood disturbance and poorer body image one month after surgery, as well as lower income and positive axillary nodes.
尽管乳腺癌死亡率在下降，但许多乳腺癌幸存者会经历影响其日常生活的身体和心理后遗症。很少有前瞻性研究调查新诊断乳腺癌患者的康复需求，对于该人群健康相关生活质量（QOL）的预测因素知之甚少。
1987年至1990年间，227名早期乳腺癌女性参与了一项前瞻性纵向研究，通过访谈、QOL和心理困扰的标准化测量以及临床评估收集详细信息。根据手术治疗类型对身体和治疗相关问题进行比较。进行多变量回归分析以检查术后一年QOL的预测因素。
乳腺癌手术后一个月，身体和治疗相关问题经常被报告，接受改良根治性乳房切除术或保乳治疗的女性中出现频率相同。手术类型在一年时报告的问题上无显著差异；然而，经常报告的问题包括“胸壁或腋窝麻木”、“手臂或腋窝紧绷、拉扯或伸展”、“精力不足或疲劳”、“睡眠困难”和“潮热”。手术类型与情绪或QOL之间没有关系。术后一年较差的QOL与术后一个月更大的情绪障碍和身体形象不适以及阳性淋巴结受累显著相关。尽管大多数患者术后在QOL的身体和心理社会维度经历了重大干扰，但大多数女性在术后一年内康复，在此期间只有少数（<10%）显著恶化。
术后一年，大多数女性报告功能水平和QOL较高，手术类型与QOL之间没有关系。诊断后一年报告QOL较低的女性在术后一个月情绪障碍更大、身体形象更差，以及收入较低和腋窝淋巴结阳性。
