Hopwood Penelope, Haviland Joanne, Mills Judith, Sumo Georges, M Bliss Judith
Christie Hospital NHS Trust, Wilmslow road, Withington, Manchester M20 4BX, UK.
Breast. 2007 Jun;16(3):241-51. doi: 10.1016/j.breast.2006.11.003. Epub 2007 Jan 19.
Quality of life (QOL) assessments of women entering a UK randomised trial of adjuvant radiotherapy (START) were investigated to estimate the independent effects on QOL of age, time since surgery, type of breast surgery, chemotherapy and endocrine therapy. QOL was evaluated using the EORTC general cancer QOL scale (EORTC QLQ-C30), breast cancer module (BR23), the Body Image Scale (BIS) and the Hospital Anxiety and Depression Scale (HADS). Independent effects of age and clinical factors were tested using multiple regression analysis. A total of 2208 (mean age 56.9 years, range 26-87) consented to the QOL study prior to radiotherapy; 17.1% had undergone mastectomy (Mx) and the remainder had undergone a wide local excision (WLE). 33.3% had received adjuvant chemotherapy (CT) and 56.7% were taking endocrine therapy (ET). Age had significant effects on QOL with older and younger subgroups predicting poorer QOL for different domains. CT affected most QOL domains and resulted in worse body image, sexual functioning, breast and arm symptoms (<0.001). Mx was associated with greater body image concerns (p<0.001), and WLE with more arm symptoms (p=0.01). There were no effects of ET on QOL. Women <50 years (proxy pre-menopausal) had worse QOL in respect of anxiety, body image and breast symptoms but age and clinical factors had no effect on depression. Overall, QOL and mental health were favourable for most women about to start RT, but younger age and receiving CT were significant risk factors for poorer QOL, and so patients in these subgroups warrant further monitoring. Surgery had a limited impact and ET had no effect on QOL.
对参加英国辅助放疗随机试验（START）的女性进行生活质量（QOL）评估，以估计年龄、术后时间、乳房手术类型、化疗和内分泌治疗对生活质量的独立影响。使用欧洲癌症研究与治疗组织通用癌症生活质量量表（EORTC QLQ-C30）、乳腺癌模块（BR23）、身体意象量表（BIS）和医院焦虑抑郁量表（HADS）对生活质量进行评估。使用多元回归分析测试年龄和临床因素的独立影响。共有2208名女性（平均年龄56.9岁，范围26 - 87岁）在放疗前同意参加生活质量研究；17.1%的女性接受了乳房切除术（Mx），其余女性接受了广泛局部切除（WLE）。33.3%的女性接受了辅助化疗（CT），56.7%的女性正在接受内分泌治疗（ET）。年龄对生活质量有显著影响，年龄较大和较小的亚组在不同领域预测生活质量较差。化疗影响了大多数生活质量领域，导致身体意象、性功能、乳房和手臂症状更差（<0.001）。乳房切除术与更大的身体意象担忧相关（p<0.001），广泛局部切除与更多的手臂症状相关（p = 0.01）。内分泌治疗对生活质量没有影响。年龄小于50岁（绝经前替代）的女性在焦虑、身体意象和乳房症状方面生活质量较差，但年龄和临床因素对抑郁没有影响。总体而言，大多数即将开始放疗的女性的生活质量和心理健康状况良好，但年龄较小和接受化疗是生活质量较差的显著风险因素，因此这些亚组的患者需要进一步监测。手术对生活质量的影响有限，内分泌治疗对生活质量没有影响。
