Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 9, Boston, Massachusetts 02215, USA.
Oncologist. 2011;16(1):121-32. doi: 10.1634/theoncologist.2010-0183. Epub 2011 Jan 6.
Potentially debilitating, osteonecrosis of the jaw (ONJ) is an emerging complication of bisphosphonates. However, its effect on quality of life (QoL) is unknown. We determined the ONJ-related QoL decline in a cancer patient cohort.
Thirty-four cancer patients with bisphosphonate-associated ONJ completed a telephone survey (October 2007 through May 2008). The Oral Health Impact Profile 14 (OHIP) retrospectively assessed participant oral health-related QoL before and after ONJ. Standardized ONJ descriptions were developed in a multidisciplinary, iterative process and were evaluated with three frequently used preference-based QoL measurement methods on a 0 (death) to 1 (perfect health) scale: Visual Analogue Scale (VAS), Time Trade-Off (TTO), and EQ-5D.
ONJ significantly (p < .001) increased OHIP scores (worse QoL) for additive (3.56-16.53) and weighted (7.0-17.5) methods. Seven individual OHIP items significantly increased (Bonferroni correction p < .0035): pain, eating discomfort, self-consciousness, unsatisfactory diet, interrupted meals, irritability, and decreased life satisfaction. Mean preference-based QoL values significantly decreased (p < .001) with worsening ONJ stage (VAS, TTO, and EQ-5D): no ONJ (0.76, 0.86, 0.82), ONJ stage 1 (0.69, 0.82, 0.78), ONJ stage 2 (0.51, 0.67, 0.55), and ONJ stage 3 (0.37, 0.61, 0.32). As ONJ worsened, EQ-5D domain scores significantly increased (p < .001). Pain/discomfort and anxiety/depression contributed most to declining QoL.
ONJ significantly affects QoL, a detriment that increases with worsening ONJ. QoL impairments for ONJ stages 2 and 3 are similar to other treatment side effects that influence decision-making. Bisphosphonate-associated ONJ QoL is an important consideration for patients, clinicians, and policy makers.
颌骨坏死（ONJ）是双膦酸盐类药物的一种新出现的潜在致残并发症。但是，其对生活质量（QoL）的影响尚不清楚。我们确定了癌症患者人群中与 ONJ 相关的 QoL 下降。
34 例接受双膦酸盐类药物治疗的癌症患者完成了一项电话调查（2007 年 10 月至 2008 年 5 月）。使用 14 项口腔健康影响简表（OHIP-14），回顾性评估患者在发生 ONJ 前后的口腔健康相关 QoL。采用多学科、迭代方法制定了标准化的 ONJ 描述，并使用三种常用的基于偏好的 QoL 测量方法进行评估，采用 0（死亡）到 1（完美健康）的量表：视觉模拟量表（VAS）、时间权衡法（TTO）和 EQ-5D。
ONJ 显著增加（p＜0.001）OHIP 评分（QoL 更差），采用附加（3.56-16.53）和加权（7.0-17.5）方法。7 项 OHIP 单项评分显著增加（Bonferroni 校正 p＜0.0035）：疼痛、进食不适、自我意识、饮食不满意、中断进餐、烦躁和生活满意度下降。随着 ONJ 阶段的恶化，基于偏好的 QoL 均值显著降低（p＜0.001）（VAS、TTO 和 EQ-5D）：无 ONJ（0.76、0.86、0.82）、ONJ 1 期（0.69、0.82、0.78）、ONJ 2 期（0.51、0.67、0.55）和 ONJ 3 期（0.37、0.61、0.32）。随着 ONJ 恶化，EQ-5D 域评分显著增加（p＜0.001）。疼痛/不适和焦虑/抑郁对 QoL 的下降影响最大。
ONJ 显著影响 QoL，随着 ONJ 的恶化，这种影响会加剧。ONJ 2 期和 3 期的 QoL 损伤与影响决策的其他治疗副作用相似。双膦酸盐类药物相关的 ONJ QoL 是患者、临床医生和决策者的一个重要考虑因素。
