Mosconi Paola, Apolone Giovanni, Barni Sandro, Secondino Simona, Sbanotto Alberto, Filiberti Antonio
Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Tumori. 2002 Mar-Apr;88(2):110-6. doi: 10.1177/030089160208800206.
Although the long-term survival of cancer patients has risen during the last decades, little is known about their quality of life. Assessment of the long-term effect of disease and treatments on subjective qualitative aspects of life that are related to health may be important for identifying specific long-term sequelae of cancer and treatments. In order to better understand the outcomes on a long-term survivor population, a sample of breast and colon cancer patients was evaluated using state-of-the-art health-related quality of life (HRQoL) approaches and instruments
EORTC OLQ-C30 and SF-36 HS questionnaires were mailed to a sample of subjects with a diagnosis of breast or colon cancer recruited in two randomized clinical trials with a median follow-up of 65 and 100 months, respectively. Data obtained with the SF-36 HS questionnaire were compared with data from a representative sample of the Italian population, whereas the EORTC QLQ-C30 data were evaluated across relevant subgroups.
Out of 2208 subjects, 1772 were randomized to receive the different types of questionnaires and 921 answered (52%). According to the findings, if no serious comorbidity or relapse appeared, long-term cancer survivors reported having a substantially satisfying HRQoL, not much different from (age and sex) comparable controls. The most intriguing findings were those obtained from breast cancer patients. They reported a somewhat higher level than comparable Italian women of limitations in activities, when describing their role, as due to physical problems. In addition, breast cancer patients also reported lower scores (worse health perception) in two EORTC scales describing activities of daily living than colon cancer patients. When data were plotted according to the type of medical therapy, hormone therapy versus chemotherapy, a higher HRQoL was reported by the former than the latter group.
Our study supports the hypotheses that the impact of cancer on quality of life over a period of time is not necessarily devastating in survivors. As regards the impact of different medical strategies, although our data are consistent with other research supporting the hypotheses that hormone therapy does not cause a decrease in long-term quality of life, differences we observed between hormone and chemotherapy might be caused by the action of confounds we were not able to control for or by the distortion introduced by the design of the present study.
尽管在过去几十年中癌症患者的长期生存率有所提高，但对他们的生活质量却知之甚少。评估疾病和治疗对与健康相关的生活主观质量方面的长期影响，对于确定癌症和治疗的特定长期后遗症可能很重要。为了更好地了解长期存活人群的结果，我们使用了最先进的健康相关生活质量（HRQoL）方法和工具，对一组乳腺癌和结肠癌患者进行了评估。
将欧洲癌症研究与治疗组织（EORTC）的QLQ-C30问卷和SF-36健康调查简表邮寄给在两项随机临床试验中招募的乳腺癌或结肠癌患者样本，这两项试验的中位随访时间分别为65个月和100个月。将SF-36健康调查简表获得的数据与意大利人群代表性样本的数据进行比较，而EORTC QLQ-C30数据则在相关亚组中进行评估。
在2208名受试者中，1772名被随机分配接受不同类型的问卷，921人进行了回答（52%）。根据研究结果，如果没有出现严重的合并症或复发，长期癌症幸存者报告其HRQoL基本令人满意，与（年龄和性别）相当的对照组没有太大差异。最有趣的发现来自乳腺癌患者。他们在描述自己的角色时，由于身体问题，报告的活动受限程度比意大利同龄女性略高。此外，在描述日常生活活动的两个EORTC量表中，乳腺癌患者的得分也低于结肠癌患者（健康感知较差）。当根据药物治疗类型（激素治疗与化疗）绘制数据时，前者报告的HRQoL高于后者。
我们的研究支持以下假设：一段时间内癌症对生活质量的影响对幸存者来说不一定是毁灭性的。关于不同医疗策略的影响，虽然我们的数据与其他支持激素治疗不会导致长期生活质量下降这一假设的研究一致，但我们观察到的激素治疗和化疗之间的差异可能是由我们无法控制的混杂因素的作用或本研究设计引入的偏差造成的。
