Pearman Timothy
Tulane University Medical Center, 1415 Tulane Avenue, Box HC-62 New Orleans, LA 70112, USA.
Health Qual Life Outcomes. 2003 Aug 20;1:33. doi: 10.1186/1477-7525-1-33.
Gynecologic malignancies occur in approximately 1 in 20 women in the United States. Until recently, clinical management of these cancers has focused almost exclusively on prolonging the survival of patients. A recent literature search using MEDLINE revealed relatively few research studies that reported data on quality of life (QOL) in a gynecologic cancer population. Reports in the literature have been conflicting, with some studies finding deterioration in QOL and some finding stability or improvement in QOL over time. Until recently, the impact of various treatments (surgery, radiation, chemotherapy) on QOL in this population was unknown. Recently, the QOL of women with gynecologic cancer has been compared to that of women with other types of cancer. Also, risk factors for poor adjustment in gynecologic cancer are beginning to be investigated. This presentation will attempt to 1) summarize the relevant literature on QOL in a gynecologic cancer population, 2) compare QOL in this population to other types of cancer, 3) examine risk factors for poor adjustment and 4) describe the limitations of the literature and future research directions. Overall, it appears that QOL is most negatively affected from time of diagnosis through completion of treatment. Following treatment, QOL appears to improve over the course of 6-12 months, but then appears to remain stable from that time through two years post-treatment. Compared to breast cancer patients, it appears that gynecologic cancer patients experience poorer QOL on several domains during active treatment, but that after completion of treatment, overall QOL is similar between groups. Risk factors for maladjustment include treatment with radiotherapy or multi-modality treatment, increased length of treatment, younger age, and coping using a disengaged style. Other risk factors include lower education, poor social support and lower levels of religious belief. The significance of these findings and future research directions will be discussed.
在美国，约每20名女性中就有1人会发生妇科恶性肿瘤。直到最近，这些癌症的临床管理几乎完全集中在延长患者生存期上。最近使用MEDLINE进行的文献检索显示，相对较少有研究报告妇科癌症患者的生活质量（QOL）数据。文献中的报告相互矛盾，一些研究发现生活质量下降，而另一些研究则发现随着时间推移生活质量保持稳定或有所改善。直到最近，各种治疗方法（手术、放疗、化疗）对该人群生活质量的影响尚不清楚。最近，已将妇科癌症女性的生活质量与其他类型癌症女性的生活质量进行了比较。此外，妇科癌症患者适应不良的风险因素也开始得到研究。本报告将试图：1）总结妇科癌症人群生活质量的相关文献；2）将该人群的生活质量与其他类型癌症进行比较；3）研究适应不良的风险因素；4）描述文献的局限性和未来研究方向。总体而言，从诊断到治疗结束这段时间，生活质量似乎受到的负面影响最大。治疗后，生活质量在6至12个月的过程中似乎有所改善，但从那时起直到治疗后两年似乎保持稳定。与乳腺癌患者相比，妇科癌症患者在积极治疗期间在几个方面的生活质量似乎较差，但治疗结束后，两组的总体生活质量相似。适应不良的风险因素包括接受放疗或多模式治疗、治疗时间延长、年龄较小以及采用脱离式应对方式。其他风险因素包括教育程度较低、社会支持不足和宗教信仰水平较低。将讨论这些发现的意义和未来的研究方向。
