Hart Vicki, Sprague Brian L, Lakoski Susan G, Hampton John M, Newcomb Polly A, Gangnon Ronald E, Trentham-Dietz Amy
Vicki Hart, Brian L. Sprague, and Susan G. Lakoski, University of Vermont; Brian L. Sprague and Susan G. Lakoski, University of Vermont Cancer Center, Burlington, VT; John M. Hampton, Ronald E. Gangnon, and Amy Trentham-Dietz, University of Wisconsin, Madison, WI; and Polly A. Newcomb, Fred Hutchinson Cancer Research Center, Seattle, WA.
J Clin Oncol. 2016 Apr 20;34(12):1323-9. doi: 10.1200/JCO.2015.62.7281. Epub 2016 Feb 16.
Studies of quality of life (QoL) are scarce among survivors of ductal carcinoma in situ (DCIS). The objective of this study was to assess long-term QoL in DCIS survivors in relation to age at diagnosis, time since diagnosis, and treatments received.
We assessed physical and mental measures of health-related QoL in 1,604 patients with DCIS diagnosed in 1997 to 2006 with up to four follow-up interviews. We further compared baseline QoL to 1,055 control patients without DCIS. QoL was measured using the validated Medical Outcomes Study Short Form 36 Health Status Survey questionnaire. Among patients with DCIS, we examined trends in QoL over time since diagnosis using generalized linear regression models, adjusting for confounders. We tested for effect modification by surgical treatment choice, post-treatment endocrine therapy use, and age at diagnosis.
Both physical and mental measures of QoL among DCIS survivors at fewer than 2 years after diagnosis were comparable to controls. Mental measures of QoL among patients with DCIS declined at ≥ 10 years after diagnosis and were significantly lower than at less than 2 years after diagnosis (47.4 v 52.0; P < .01). In the first 5 years after a DCIS diagnosis, mental QoL was significantly higher among women diagnosed at ages 50 to 74 years compared with those diagnosed at ages 28 to 49 years, although this difference was not sustained in later time periods.
QoL after a DCIS diagnosis was generally comparable to that of women of similar age without a personal history of DCIS. Our findings suggest that DCIS survivors, and particularly those diagnosed at a younger age, may benefit from support for mental QoL.
关于导管原位癌(DCIS)幸存者生活质量(QoL)的研究较少。本研究的目的是评估DCIS幸存者的长期生活质量,及其与诊断时年龄、诊断后的时间以及所接受治疗的关系。
我们对1997年至2006年诊断为DCIS的1604例患者进行了与健康相关的生活质量的身体和心理指标评估,随访访谈最多达4次。我们还将基线生活质量与1055例无DCIS的对照患者进行了比较。使用经过验证的医疗结果研究简明健康状况调查问卷36项版本来测量生活质量。在DCIS患者中,我们使用广义线性回归模型,对混杂因素进行调整,研究自诊断以来生活质量随时间的变化趋势。我们检验了手术治疗选择、治疗后内分泌治疗的使用以及诊断时年龄对结果的影响。
诊断后不到2年的DCIS幸存者的身体和心理生活质量指标与对照组相当。DCIS患者的心理生活质量指标在诊断后≥10年下降,且显著低于诊断后不到2年时(47.4对52.0;P<.01)。在DCIS诊断后的前5年,50至74岁诊断的女性的心理生活质量显著高于28至49岁诊断的女性,尽管在后期这个差异没有持续存在。
DCIS诊断后的生活质量总体上与无DCIS个人史的同龄女性相当。我们的研究结果表明,DCIS幸存者,尤其是那些诊断时年龄较小的患者,可能会从心理生活质量支持中受益。