I-Chan Huang, Kelly Kenzik, and Elizabeth Shenkman, University of Florida, Gainesville, FL; and Tara M. Brinkman, James G. Gurney, Kirsten K. Ness, Jennifer Lanctot, Leslie L. Robison, Melissa M. Hudson, and Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN.
J Clin Oncol. 2013 Nov 20;31(33):4242-51. doi: 10.1200/JCO.2012.47.8867. Epub 2013 Oct 14.
We investigated the association between prevalence of symptoms and health-related quality of life (HRQOL) in adult survivors of childhood cancer enrolled in the St Jude Lifetime Cohort study.
Eligibility criteria include childhood malignancy treated at St Jude, survival ≥ 10 years from diagnosis, and current age ≥ 18 years. Study participants were 1,667 survivors (response rate = 65%). Symptoms were self-reported by using a comprehensive health questionnaire and categorized into 12 classes: cardiac; pulmonary; motor/movement; pain in head; pain in back/neck; pain involving sites other than head, neck, and back; sensation abnormalities; disfigurement; learning/memory; anxiety; depression; and somatization. HRQOL was measured by using physical/mental component summary (PCS/MCS) and six domain scores of the Medical Outcomes Study 36-Item Short-Form Health Survey. Multivariable regression analysis was performed to investigate associations between symptom classes and HRQOL. Cumulative prevalence of symptom classes in relation to time from diagnosis was estimated.
Pain involving sites other than head, neck and back, and disfigurement represented the most frequent symptom classes, endorsed by 58.7% and 56.3% of survivors, respectively. Approximately 87% of survivors reported multiple symptom classes. Greater symptom prevalence was associated with poorer HRQOL. In multivariable analysis, symptom classes explained up to 60% of the variance in PCS and 56% of the variance in MCS; demographic and clinical variables explained up to 15% of the variance in PCS and 10% of the variance in MCS. Longer time since diagnosis was associated with higher cumulative prevalence in all symptom classes.
A large proportion of survivors suffered from many symptom classes, which was associated with HRQOL impairment.
我们研究了儿童癌症成年幸存者中症状的流行程度与健康相关生活质量（HRQOL）之间的关系，这些幸存者参加了圣裘德终身队列研究。
入选标准包括在圣裘德接受过儿童恶性肿瘤治疗、诊断后生存时间≥ 10 年且当前年龄≥ 18 岁的患者。本研究纳入了 1667 名幸存者（应答率=65%）。症状通过一份全面的健康问卷进行自我报告，并分为 12 类：心脏；肺部；运动/移动；头部疼痛；背部/颈部疼痛；头部、颈部和背部以外部位的疼痛；感觉异常；毁容；学习/记忆；焦虑；抑郁；和躯体化。HRQOL 通过身体/心理成分综合（PCS/MCS）和医疗结局研究 36 项简短健康调查问卷六个领域的评分进行测量。采用多变量回归分析调查症状类别与 HRQOL 之间的关系。根据诊断后时间估计症状类别的累积流行率。
除头部、颈部和背部以外部位的疼痛和毁容是最常见的症状类别，分别有 58.7%和 56.3%的幸存者报告了这些症状。约 87%的幸存者报告了多种症状类别。症状的流行程度越高，HRQOL 越差。多变量分析显示，症状类别可以解释 PCS 变化的 60%和 MCS 变化的 56%；人口统计学和临床变量可以解释 PCS 变化的 15%和 MCS 变化的 10%。诊断后时间越长，所有症状类别的累积流行率越高。
很大一部分幸存者患有多种症状类别，这与 HRQOL 受损有关。
