Härtl K, Janni W, Kästner R, Sommer H, Strobl B, Rack B, Stauber M
I. Frauenklinik, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Ann Oncol. 2003 Jul;14(7):1064-71. doi: 10.1093/annonc/mdg289.
The impact of various medical and demographic factors on the quality of life (QoL) of breast cancer patients has been discussed controversially. We investigated the influence of six different factors on long-term QoL and body image of women with primary breast cancer.
Two-hundred and seventy-four breast cancer patients were administered the QoL questionnaire following a mean interval of 4.2 years after primary diagnosis. All women had been primarily treated for stage I to III breast cancer without evidence of distant metastases. QoL was evaluated by using the QLQ-C30 questionnaire Version 2.0. Supplementary scales included body image, satisfaction with surgical treatment, cosmetic result and fear of recurrence. We analyzed the impact of tumor stage, surgical treatment, adjuvant radiotherapy, adjuvant cytotoxic therapy, age and length of follow-up period on the examined outcome parameters.
At the time of the follow-up examination, patients showed minor impairment of QoL (mean 67.8) and body image (mean 24.8), but more fear of recurrence (mean 60.7). None of the studied factors had a significant impact on overall QoL (P >0.05) according to the QLQ-C30 questionnaire. In contrast, with the exception of the factors 'cytotoxic therapy' and 'radiotherapy' all investigated variables influenced at least one of the additional psychological scales (P <0.05). The primary surgical treatment modality had the strongest impact and affected all four scales. Patients treated with breast conservation reported a more favorable body image, compared to those treated with mastectomy (17.2 versus 37.5, P <0.01), more satisfaction with surgical treatment (4.0 versus 10.7, P = 0.01), rated a better cosmetic result (75.5 versus 57.1, P <0.01), but presented more fear of recurrence (63.9 versus 55.3, P = 0.04).
Current QoL questionnaires do not sufficiently cover all relevant aspects of QoL, but might be complemented by breast cancer specific aspects such as body image and fear.
各种医学和人口统计学因素对乳腺癌患者生活质量（QoL）的影响一直存在争议。我们研究了六种不同因素对原发性乳腺癌女性长期生活质量和身体形象的影响。
274例乳腺癌患者在初次诊断后平均4.2年接受生活质量问卷调查。所有女性均主要接受了I至III期乳腺癌的治疗，且无远处转移证据。使用QLQ-C30问卷2.0版评估生活质量。补充量表包括身体形象、对手术治疗的满意度、美容效果和对复发的恐惧。我们分析了肿瘤分期、手术治疗、辅助放疗、辅助细胞毒性治疗、年龄和随访期长度对所检查的结局参数的影响。
在随访检查时，患者的生活质量（平均67.8）和身体形象（平均24.8）有轻微损害，但对复发的恐惧更大（平均60.7）。根据QLQ-C30问卷，所研究的因素均未对总体生活质量产生显著影响（P>0.05）。相比之下，除了“细胞毒性治疗”和“放疗”因素外，所有调查变量至少影响了一个额外的心理量表（P<0.05）。主要手术治疗方式的影响最强，影响了所有四个量表。与接受乳房切除术的患者相比，接受保乳治疗的患者报告的身体形象更良好（17.2对37.5，P<0.01），对手术治疗更满意（4.0对10.7，P = 0.01），美容效果评分更高（75.5对57.1，P<0.01），但对复发的恐惧更多（63.9对55.3，P = 0.04）。
目前的生活质量问卷没有充分涵盖生活质量的所有相关方面，但可能需要补充乳腺癌特定的方面，如身体形象和恐惧。
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