Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Phys Med Rehabil. 2011 May;90(5 Suppl 1):S27-37. doi: 10.1097/PHM.0b013e31820be3be.
To outline the potential reasons for the persistent underutilization of rehabilitation services in the care of patients with advanced cancer, a literature review and post hoc analysis of data collected from 163 patients with stage IV breast cancer are used to examine the role of accumulated physical impairments and adverse symptoms in cancer-related disablement. Univariate and multivariate regression analyses were used to estimate the variance in functional outcomes (as measured by the Physical Function-10, Functional Independence Measure, and the Older Americans Resource Study subscales) explained by the presence and interaction of physical impairments, pain (Brief Pain Inventory scores), and exertional limitations (6-min walk test performance). A majority of patients had more than three impairments. Potentially catastrophic impairments, for example, paraparesis and hemiparesis, occurred in only 15% of patients. Although most specific impairments explained less than 5% of the variance in functional outcomes, a participant's total number of impairments was strongly correlated with his/her performance status and explained between 36% and 52% of the variance in functional outcomes. Brief Pain Inventory scores and exertional intolerance explained a greater proportion of the variance in functional outcomes than did the presence of impairments. Multivariate models using total number of impairments, Brief Pain Inventory scores, exertional intolerance, and their interactions accounted for up to 65% of the variance in functional outcomes. The disablement process in metastatic breast cancer is driven by the accrual of multiple physical impairments, adverse symptoms, and their interactions rather than by discrete and functionally catastrophic impairments. Without systematic disability screening, the detection of functional decline may remain challenging.
为了概述导致晚期癌症患者康复服务持续未得到充分利用的潜在原因，我们对 163 例 IV 期乳腺癌患者的数据进行了文献回顾和事后分析，以研究累积的身体损伤和不良症状在癌症相关残疾中的作用。我们使用单变量和多变量回归分析来估计功能结局（通过 Physical Function-10、功能独立性测量和 Older Americans Resource Study 子量表测量）的方差，这些功能结局由身体损伤、疼痛（简明疼痛量表评分）和劳累限制（6 分钟步行试验表现）的存在和相互作用来解释。大多数患者存在三种以上的损伤。虽然只有 15%的患者存在截瘫和偏瘫等潜在灾难性损伤，但大多数患者存在三种以上的损伤。虽然大多数特定损伤解释的功能结局的方差不到 5%，但参与者的损伤总数与其表现状态强烈相关，解释了功能结局方差的 36%至 52%。简明疼痛量表评分和劳累不耐受解释的功能结局方差比例大于损伤的存在。使用损伤总数、简明疼痛量表评分、劳累不耐受及其相互作用的多变量模型可以解释高达 65%的功能结局方差。转移性乳腺癌的残疾过程是由多种身体损伤、不良症状及其相互作用累积驱动的，而不是由离散的、具有功能破坏性的损伤驱动的。如果没有系统的残疾筛查，功能下降的检测可能仍然具有挑战性。
