Rolke Heidi Berg, Bakke Per Sigvald, Gallefoss Frode
Department of Pulmonary Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway.
Clin Respir J. 2010 Jul;4(3):168-75. doi: 10.1111/j.1752-699X.2009.00171.x.
This study intended to explore the impact of the first treatment modality on health-related quality of life (HRQoL), mood disorders and mastery in an unselected population of patients with primary lung cancer and to judge patient satisfaction with treatment.
An unselected group of 479 patients with newly diagnosed lung cancer in Southern Norway (Agder counties) were included prospectively from June 2002 to June 2005, collecting data on histology, treatment options, HRQoL, mood disorders and mastery at baseline as well as satisfaction with treatment, and changes in HRQoL and mood disorders after finishing the first treatment modality.
After finishing the first treatment modality, patients experienced a worsening of nine HRQoL parameters and an improvement in one. Patients in good performance status experienced reduced physical and role function, and if in reduced performance, improved emotional and role function. Patients with mood disorders experienced reduced anxiety and depression, anxious patients experienced reduced neuropathies, and depressed patients experienced improved social functioning and appetite. Half of the patients treated actively were definitely positive to repeat the same treatment again compared with only 15% in the best supportive care group. Surgery was associated with reduced role function and increased dyspnoea, radiation was associated with increased fatigue, and chemotherapy in small cell lung cancer (SCLC), to a larger extent, was associated with alopecia than in non-SCLC (NSCLC).
The development of many HRQoL parameters after the first treatment modality in an unselected population of patients with primary lung cancer seemed, at large, well correlated to general disease progression and to well-known treatment side effects. However, reduced role function after lung surgery, and reduced anxiety and depression in patients with mood disorders at baseline might be surprising. Patient satisfaction with treatment was surprisingly good. Several findings in this study may help clinicians to improve their handling of patients with lung cancer.
本研究旨在探讨在未经挑选的原发性肺癌患者群体中，首次治疗方式对健康相关生活质量（HRQoL）、情绪障碍和掌控感的影响，并评判患者对治疗的满意度。
前瞻性纳入了挪威南部（阿格德尔郡）479例新诊断肺癌患者，这些患者在2002年6月至2005年6月期间未经挑选。收集了组织学、治疗方案、基线时的HRQoL、情绪障碍和掌控感以及治疗满意度的数据，以及完成首次治疗方式后HRQoL和情绪障碍的变化。
完成首次治疗方式后，患者的9个HRQoL参数恶化，1个改善。身体状况良好的患者身体和角色功能下降，而身体状况较差的患者情绪和角色功能改善。有情绪障碍的患者焦虑和抑郁减轻，焦虑患者神经病变减轻，抑郁患者社会功能和食欲改善。与最佳支持治疗组中仅15%的患者相比，接受积极治疗的患者中有一半肯定愿意再次接受相同治疗。手术与角色功能下降和呼吸困难增加有关，放疗与疲劳增加有关，小细胞肺癌（SCLC）的化疗比非小细胞肺癌（NSCLC）在更大程度上与脱发有关。
在未经挑选的原发性肺癌患者群体中，首次治疗方式后许多HRQoL参数的变化似乎在很大程度上与一般疾病进展和众所周知的治疗副作用密切相关。然而，肺手术后角色功能下降以及基线时有情绪障碍的患者焦虑和抑郁减轻可能令人惊讶。患者对治疗的满意度出奇地好。本研究中的几个发现可能有助于临床医生改善对肺癌患者的治疗。
