Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan.
Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Value Health. 2014 Jun;17(4):482-6. doi: 10.1016/j.jval.2014.02.006. Epub 2014 Apr 24.
To estimate the lifetime gain in the health-related quality of life (HRQOL) from early detection of cervical cancer.
A consecutive, cross-sectional sample of 421 patients with cervical cancer was administered the World Health Organization Quality of Life-brief version questionnaires. A nationwide sample of 22,543 patients with invasive cervical cancer (ICC) was collected from the national cancer registry for estimation of lifetime survival function from 1998 to 2007, which was further multiplied by the ratio of HRQOL score functions for patients with ICC and patients with carcinoma in situ (CIS), and summed up over lifetime to obtain expected relative-quality-adjusted survival. The difference between lifetime survival and the expected relative-quality-adjusted survival gives the expected total dissatisfied time during the life course.
In comparison with patients with CIS postconization, patients with ICC showed consistently lower scores in the physical and psychological domains and that of sexual life after adjustment for other risk factors. The expected years of life lost for an invasive cancer was 6.48 years using the general population as the reference cohort, while the durations of equivalent to living with a very dissatisfied HRQOL were 1.71 and 0.25 for the physical and psychological domains, respectively, and 1.47 years for sexual life. Validation of the extrapolation method based on a subcohort followed from the 6th to the 13th year shows a relative bias of 0.4%. Sensitivity analysis with 37,000 CIS cases as the reference cohort yields a similar result.
Early detection of cervical cancer not only avoids premature mortality but also prevents long-term living under lower HRQOL scores, including sexual life.
评估早期宫颈癌检测对健康相关生命质量（HRQOL）的终身获益。
对 421 例宫颈癌患者进行连续横断面样本调查，并使用世界卫生组织生命质量简表进行问卷调查。通过全国癌症登记处收集了 1998 年至 2007 年全国范围内 22543 例浸润性宫颈癌（ICC）患者的生存数据，以估计生存函数。进一步将 ICC 患者与原位癌（CIS）患者的 HRQOL 评分函数相乘，并对其进行终生求和，以获得预期相对质量调整后的生存。将终生生存与预期相对质量调整后的生存之间的差异作为生命过程中预期的总不满意时间。
与 CIS 锥切术后患者相比，ICC 患者在调整其他危险因素后，其身体和心理领域以及性生活的评分均较低。以普通人群为参考队列，浸润性癌症患者的预期寿命损失为 6.48 年，而相当于生活在非常不满意的 HRQOL 状态下的时间分别为身体和心理领域的 1.71 年和 0.25 年，性生活为 1.47 年。基于第 6 至第 13 年随访的亚组对推断方法进行验证，相对偏差为 0.4%。以 37000 例 CIS 病例作为参考队列的敏感性分析得到了类似的结果。
早期宫颈癌检测不仅避免了过早死亡，还避免了长期处于较低 HRQOL 评分（包括性生活）的状态。
