Murphy Barbara A, Ridner Sheila, Wells Nancy, Dietrich Mary
Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, 777 Preston Research Building, Nashville, TN 37215, USA.
Crit Rev Oncol Hematol. 2007 Jun;62(3):251-67. doi: 10.1016/j.critrevonc.2006.07.005. Epub 2007 Apr 3.
Quality of life (QOL) has become an increasingly important outcome measure for patient's undergoing treatment for a wide array of illnesses. QOL is a global construct that reflects a patient's general sense of well being. It is by definition multi-dimensional and reflective of the patient's point of view. Health related issues are among the many factors that may influence QOL. Since head and neck cancer (HNC) affects structures that are critical for normal functions such as speech and swallowing, and treatment may lead to deformities that adversely impact psychosocial functioning, there is particular interest in assessing QOL in this cohort of patients. In order to interpret the HN QOL literature, it is important to have an understanding of the significance and limitations of QOL assessments in the head and neck patient population as well as an appreciation for the currently available measurement tools. Unfortunately, the HNC QOL literature has many limitations including: small sample size, lack of prospective data and poor study design. None-the-less, important insights can be obtained by review of the current literature. First, it is important that QOL studies be reported in such a way as to provide clinically meaningful data to clinicians. Linking measurements with clinical benchmarks is one way to accomplish this goal. In addition, both general and HNC specific measures are needed in order to provide a comprehensive assessment of global health and tumor specific issues. In general, QOL declines immediately after therapy and returns toward baseline by 1 year. Several factors have been identified that may predict for worse QOL outcomes including: the presence of a feeding tube, co-morbid disease, tracheotomy, site and stage. Data correlating QOL with functional outcome and symptom burden fails to demonstrate a consistent relationship. This may be attributed to methodological issues in study design or the patient's ability to adapt to functional and symptom control problems. Whether routine use of QOL measures in the clinical setting is beneficial to patients has yet to be determined. Further studies are warranted as currently available instruments may not be valid for repeated clinical use.
生活质量（QOL）已成为众多疾病患者治疗效果评估中日益重要的一项指标。生活质量是一个综合概念，反映患者的总体幸福感。从定义上讲，它具有多维度性，且反映患者的观点。与健康相关的问题是可能影响生活质量的众多因素之一。由于头颈癌（HNC）会影响对正常功能（如言语和吞咽）至关重要的结构，且治疗可能导致畸形，进而对心理社会功能产生不利影响，因此对该类患者群体的生活质量评估格外受关注。为了解读头颈癌生活质量相关文献，重要的是要理解生活质量评估在头颈癌患者群体中的意义和局限性，以及了解当前可用的测量工具。不幸的是，头颈癌生活质量相关文献存在许多局限性，包括：样本量小、缺乏前瞻性数据以及研究设计不佳。尽管如此，通过回顾当前文献仍可获得重要见解。首先，生活质量研究应以能为临床医生提供具有临床意义的数据的方式进行报告。将测量结果与临床基准相联系是实现这一目标的一种方法。此外，为了全面评估整体健康状况和肿瘤特异性问题，既需要通用测量方法，也需要头颈癌特异性测量方法。一般来说，治疗后生活质量立即下降，并在1年后恢复到基线水平。已确定了几个可能预示生活质量较差结果的因素，包括：是否存在饲管、合并症、气管切开术、肿瘤部位和分期。将生活质量与功能结果和症状负担相关联的数据未能显示出一致的关系。这可能归因于研究设计中的方法学问题或患者适应功能和症状控制问题的能力。在临床环境中常规使用生活质量测量方法对患者是否有益尚未确定。鉴于目前可用的工具可能不适用于重复临床使用，有必要进行进一步研究。
