Holloway Richard L, Hellewell James L, Marbella Anne M, Layde Peter M, Myers Katherine B, Campbell Bruce H
Department of Family & Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
Head Neck. 2005 Apr;27(4):281-8. doi: 10.1002/hed.20147.
BACKGROUND: To identify and rate the importance of several psychosocial and physiologic influences on quality of life (QOL) among a cohort of 5-year head and neck cancer survivors, we conducted a cross-sectional study of a convenience sample that used both questionnaires and physiologic evaluations. METHODS: QOL was assessed by the Functional Assessment of Cancer Therapy (FACT) and the FACT Head and Neck additional concerns (FACT-H&N) questionnaires. Psychosocial characteristics (or risk factors) potentially influencing QOL were measured by the Millon Behavioral Health Inventory (MBHI) and the Social Support Questionnaire (SSQSR). Physiologic risk factors were measured in examinations that included shoulder and neck range of motion, whole and stimulated saliva measurements, and oropharyngeal swallowing efficiency. We evaluated the association of selected QOL measures with three groups of potential risk factors: psychosocial factors, consisting of selected MBHI and SSQSR scales; physiologic factors, consisting of selected physical ability measures; and a combination of psychosocial/physiologic factors. RESULTS: The entire study population of 105 subjects completed the FACT and FACT-H&N questionnaires; 86 of these completed the physiologic tests as well. Combined psychosocial/physiologic models best predicted all QOL measures considered. Psychosocial models alone, compared with physiologic models alone, better predicted FACT physical and social/family well-being measures. Physiologic models alone, compared with psychosocial models alone, better predicted FACT-H&N additional concerns measures. Premorbid pessimism (MBHI) was consistently the best predictor of QOL measures. CONCLUSIONS: Both psychosocial and physiologic factors influence QOL in patients with head and neck cancer, but many QOL measures are most strongly influenced by psychosocial considerations. Physicians and surgeons caring for long-term head and neck cancer survivors should be cognizant of the importance of psychosocial risk factors in the QOL of their patients.
背景：为了识别并评估多种心理社会因素和生理因素对一组5年头颈部癌症幸存者生活质量（QOL）的重要性，我们对一个便利样本进行了横断面研究，该研究同时使用了问卷调查和生理评估。 方法：通过癌症治疗功能评估（FACT）问卷和FACT头颈附加问题（FACT-H&N）问卷评估生活质量。使用米隆行为健康量表（MBHI）和社会支持问卷（SSQSR）测量可能影响生活质量的心理社会特征（或风险因素）。在包括肩部和颈部活动范围、全唾液和刺激唾液测量以及口咽吞咽效率的检查中测量生理风险因素。我们评估了选定的生活质量测量指标与三组潜在风险因素之间的关联：心理社会因素，由选定的MBHI和SSQSR量表组成；生理因素，由选定的身体能力测量指标组成；以及心理社会/生理因素的组合。 结果：105名受试者的整个研究人群完成了FACT和FACT-H&N问卷；其中86人还完成了生理测试。心理社会/生理因素组合模型对所有考虑的生活质量测量指标的预测效果最佳。单独的心理社会模型比单独的生理模型能更好地预测FACT身体和社会/家庭幸福感测量指标。单独的生理模型比单独的心理社会模型能更好地预测FACT-H&N附加问题测量指标。病前悲观情绪（MBHI）一直是生活质量测量指标的最佳预测因素。 结论：心理社会因素和生理因素均影响头颈部癌症患者的生活质量，但许多生活质量测量指标受心理社会因素的影响最为强烈。照顾长期头颈部癌症幸存者的内科医生和外科医生应认识到心理社会风险因素对其患者生活质量的重要性。
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