Zeltzer Lonnie K, Recklitis Christopher, Buchbinder David, Zebrack Bradley, Casillas Jacqueline, Tsao Jennie C I, Lu Qian, Krull Kevin
Department of Pediatrics, Division of Cancer Prevention and Control Research, David Geffen School of Medicine at University of California-Los Angeles, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-1752, USA.
J Clin Oncol. 2009 May 10;27(14):2396-404. doi: 10.1200/JCO.2008.21.1433. Epub 2009 Mar 2.
Psychological quality of life (QOL), health-related QOL (HRQOL), and life satisfaction outcomes and their associated risk factors are reviewed for the large cohort of survivors and siblings in the Childhood Cancer Survivor Study (CCSS). This review includes previously published manuscripts that used CCSS data focused on psychological outcome measures, including the Brief Symptom Inventory (BSI-18), the Medical Outcomes Survey Short Form-36 (SF-36), the Cantril Ladder of Life, and other self-report questionnaires. Comparisons and contrasts are made between siblings and survivors, and to normative data when available, in light of demographic/health information and abstracted data from the medical record. These studies demonstrate that a significant proportion of survivors report more symptoms of global distress and poorer physical, but not emotional, domains of HRQOL. Other than brain tumor survivors, most survivors report both good present and expected future life satisfaction. Risk factors for psychological distress and poor HRQOL are female sex, lower educational attainment, unmarried status, annual household income less than $20,000, unemployment, lack of health insurance, presence of a major medical condition, and treatment with cranial radiation and/or surgery. Cranial irradiation impacted neurocognitive outcomes, especially in brain tumor survivors. Psychological distress also predicted poor health behaviors, including smoking, alcohol use, fatigue, and altered sleep. Psychological distress and pain predicted use of complementary and alternative medicine. Overall, most survivors are psychologically healthy and report satisfaction with their lives. However, certain groups of childhood cancer survivors are at high risk for psychological distress, neurocognitive dysfunction, and poor HRQOL, especially in physical domains. These findings suggest targeting interventions for groups at highest risk for adverse outcomes and examining the positive growth that remains despite the trauma of childhood cancer.
针对儿童癌症幸存者研究（CCSS）中的大量幸存者和同胞队列，回顾了心理生活质量（QOL）、健康相关生活质量（HRQOL）、生活满意度结果及其相关风险因素。本综述纳入了先前发表的使用CCSS数据聚焦心理结果测量的手稿，包括简明症状量表（BSI - 18）、医学结局调查简表36（SF - 36）、坎特里尔生活阶梯以及其他自我报告问卷。根据人口统计学/健康信息和病历摘要数据，对同胞和幸存者进行了比较和对比，并与可用的规范数据进行比较。这些研究表明，相当一部分幸存者报告有更多的总体痛苦症状，且HRQOL的身体领域较差，但情感领域并非如此。除脑肿瘤幸存者外，大多数幸存者报告当前和预期未来的生活满意度都良好。心理困扰和HRQOL差的风险因素包括女性、教育程度较低、未婚、家庭年收入低于20,000美元、失业、缺乏医疗保险、存在重大医疗状况以及接受颅脑放疗和/或手术治疗。颅脑照射影响神经认知结果，尤其是在脑肿瘤幸存者中。心理困扰还预示着不良的健康行为，包括吸烟、饮酒、疲劳和睡眠改变。心理困扰和疼痛预示着会使用补充和替代医学。总体而言，大多数幸存者心理健康并对自己的生活感到满意。然而，某些儿童癌症幸存者群体面临心理困扰、神经认知功能障碍和HRQOL差的高风险，尤其是在身体领域。这些发现表明，应针对不良结局风险最高的群体进行干预，并研究尽管经历了儿童癌症的创伤但仍留存的积极成长。
