Centre for Psycho-Oncology Research & Training, Department of Community Medicine & Unit for Behavioural Sciences, School of Public Health, The University of Hong Kong, 5/F, WMW Mong Block, Faculty of Medicine Building, 21 Sassoon Road, Pokulam, Hong Kong.
Breast Cancer Res Treat. 2012 Feb;131(3):957-67. doi: 10.1007/s10549-011-1798-2. Epub 2011 Oct 5.
We examined degree and determinants of change in body image and sexuality over the first year following breast cancer diagnosis to differentiate body image and sexuality trajectories, and then explored if differences in trajectories predicted 6 years' psychosocial outcomes. 363/405 (90%) Chinese women receiving surgery for BC were assessed at 5-days (Baseline), 1-month, 4-months, and 8-months post-surgery. Psychological distress, treatment decision making (TDM) difficulties, satisfaction with treatment outcome, optimism, and self-efficacy were assessed at Baseline. Self-image and sexuality were recorded at each follow-up assessment. Latent growth mixture modeling identified trajectories of self-image and sexuality. Multinominal logistic regression identified factors predicting trajectory patterns. Six years later 211/363 (58%) of the original patients were successfully traced and their psychosocial status assessed. Three distinct trajectories of self-image and sexuality were identified: high-stable, recovery, and high-deteriorating. Most women (64% self-image; 58% sexuality) showed stable levels of self-image and sexuality scores. TDM difficulties, satisfaction with treatment outcomes, physical symptom and psychological distress predicted trajectory patterns. Self-image trajectories over the first year diagnosis predicted 6-years psychosocial outcomes. Women with high-stable level of self-image had the best 6-year self-image and sexuality; women with initial low level of self-image had significantly greater long-term psychological distress. Low TDM difficulties and high treatment outcome satisfaction predicted high and stable self-image and sexuality. Type of surgery showed little impacts on self-image and sexuality. Self-image during acute illness phase predicted long-term outcomes. Interventions should focus on minimizing self-image decrement.
我们研究了乳腺癌诊断后第一年身体意象和性的变化程度和决定因素，以区分身体意象和性轨迹，然后探讨轨迹差异是否预测 6 年的心理社会结局。对 405 名接受乳腺癌手术的中国女性中的 363 名在术后 5 天（基线）、1 个月、4 个月和 8 个月进行评估。在基线时评估心理困扰、治疗决策困难、治疗结果满意度、乐观主义和自我效能感。自我形象和性在每次随访评估时记录。潜在增长混合模型确定了自我形象和性的轨迹。多项逻辑回归确定了预测轨迹模式的因素。六年后，对 363 名原始患者中的 211 名（58%）进行了成功追踪，并评估了他们的心理社会状况。确定了自我形象和性的三种不同轨迹：高稳定、恢复和高恶化。大多数女性（64%的自我形象；58%的性行为）表现出稳定的自我形象和性行为评分。治疗决策困难、对治疗结果的满意度、身体症状和心理困扰预测了轨迹模式。诊断后第一年的自我形象轨迹预测了 6 年的心理社会结局。具有高稳定自我形象水平的女性具有最佳的 6 年自我形象和性行为；初始自我形象水平较低的女性在长期内具有显著更大的心理困扰。低治疗决策困难和高治疗结果满意度预测了高且稳定的自我形象和性行为。手术类型对自我形象和性行为的影响不大。急性疾病阶段的自我形象预测长期结局。干预措施应侧重于最大限度地减少自我形象下降。
