Blaauwbroek R, Stant A D, Groenier K H, Kamps W A, Meyboom B, Postma A
University Medical Center Groningen, Department of Paediatrics, Division of Paediatric Oncology, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Eur J Cancer. 2007 Jan;43(1):122-30. doi: 10.1016/j.ejca.2006.08.003. Epub 2006 Sep 20.
The RAND-36 was used to assess HRQoL in all adult (> or =18 years) survivors who had attended the long-term follow-up clinic since 1995. The survivors were divided into two groups based on the length of follow-up: Group LF (long term follow-up, follow-up > or =20 years, n=129) and Group VLF (very long-term follow-up, follow-up >20 years, n=184). Data on diagnosis, treatment and complications were obtained from medical records. Late effects were graded using the CTCAEv3.
The RAND-36 was completed by 313 (86.2%) out of 363 eligible patients. Except for higher scores on the subscale Bodily pain, LF patients did not differ significantly on the RAND-36 subscales from the population sample; VLF patients had significant lower scores on the subscales Physical functioning (P=0.003), Social functioning, Vitality and General health perception (P<0.001). Significantly more VLF patients (P<0.001) had severe (grade 3 and 4) late effects (47.8%) compared to LF patients (27.9%). Female gender and especially psycho-social late effects were inversely related to HRQoL.
Childhood cancer survivors who were diagnosed more than 20 years ago have lower scores on the RAND 36, and have significantly more severe late effects than those diagnosed more recently. Patients with longer follow-up are more likely to become lost to follow-up. Time has come to establish new models of care for adult childhood cancer survivors, which are more flexible and appropriate to the needs of adult childhood cancer survivors.
采用兰德36项健康调查量表（RAND-36）对自1995年以来在长期随访门诊就诊的所有成年（≥18岁）幸存者的健康相关生活质量（HRQoL）进行评估。根据随访时间长短将幸存者分为两组：LF组（长期随访，随访时间≥20年，n = 129）和VLF组（超长期随访，随访时间>20年，n = 184）。从医疗记录中获取诊断、治疗及并发症的数据。采用美国国立综合癌症网络（NCCN）不良事件通用术语标准第3版（CTCAEv3）对迟发效应进行分级。
363例符合条件的患者中，313例（86.2%）完成了兰德36项健康调查量表评估。除了在躯体疼痛分量表上得分较高外，LF组患者在兰德36项健康调查量表各分量表上与总体样本相比无显著差异；VLF组患者在生理功能、社会功能、活力和总体健康感知分量表上得分显著更低（生理功能：P = 0.003；社会功能、活力和总体健康感知：P<0.001）。与LF组患者（27.9%）相比，VLF组患者出现严重（3级和4级）迟发效应的比例显著更高（47.8%，P<0.001）。女性性别，尤其是心理社会迟发效应与健康相关生活质量呈负相关。
20多年前被诊断为儿童癌症的幸存者在兰德36项健康调查量表上得分较低，且与近期诊断的患者相比，出现严重迟发效应的比例显著更高。随访时间较长的患者更有可能失访。现在是时候建立新的成年期儿童癌症幸存者护理模式了，这种模式应更灵活且更符合成年期儿童癌症幸存者的需求。
