肺癌手术对患者及其家庭照顾者生活质量轨迹的影响。
The impact of lung cancer surgery on quality of life trajectories in patients and family caregivers.
作者信息
Kim Jae Y, Sun Virginia, Raz Dan J, Williams Anna Cathy, Fujinami Rebecca, Reckamp Karen, Koczywas Marianna, Cristea Mihaela, Hurria Arti, Ferrell Betty
机构信息
Division of Thoracic Surgery, Department of Surgery, United States.
Division of Nursing Research and Education, Department of Population Sciences, United States.
出版信息
Lung Cancer. 2016 Nov;101:35-39. doi: 10.1016/j.lungcan.2016.08.011. Epub 2016 Aug 30.
OBJECTIVES
Family caregivers (FCGs) play an important role in the quality of life (QOL) of lung cancer patients. FCGs experience significant psychological distress related to their caregiving role, but there is relatively little data about FCG QOL after cancer surgery. We sought to describe QOL trajectories for patients and their FCGs after lung cancer surgery.
METHODS
This is a secondary analysis of a larger, prospective QOL study, testing the effectiveness of an interdisciplinary palliative care intervention for lung cancer patients and FCGs in a single institution. The intervention included interdisciplinary care planning and formal education sessions for both patients and FCGs. This subset analysis included patients who underwent surgery and had a matching FCG with complete QOL data (41 pairs of patients and caregivers out of 112 surgical patients). Patient QOL was assessed with the Functional Assessment of Cancer Therapy-Lung tool. FCG QOL was assessed with the FCG version of the City of Hope QOL tool. Psychological distress was assessed using the Distress Thermometer.
RESULTS
Psychological distress levels were highest for patients (3.8/10) and FCGs (5.1/10) before surgery. Distress levels decreased among patients at six (2.9/10) and 12 weeks (2.2/10, p=0.001) later, but remained elevated among FCGs (4.2/10 and 4.4/10, p=0.157). Compared with usual care, patients in the intervention group reported improved physical and functional QOL outcomes at 12 weeks (p<0.01), but there was no significant benefit seen for FCGs in any domain (p>0.05).
CONCLUSIONS
FCGs of lung cancer patients experience significant psychological distress. FCGs continue to have impaired QOL 3 months after surgery. The trajectory of QOL for FCGs does not mirror that of patients. Our palliative care intervention showed improved QOL outcomes for this subset of patients but was not effective for their FCGs.
TRIAL REGISTRATION
NCI sponsored, trial identifier NCT00823667 https://clinicaltrials.gov/show/NCT00823667.
目的
家庭照顾者在肺癌患者的生活质量中起着重要作用。家庭照顾者因照顾角色而经历显著的心理困扰，但关于癌症手术后家庭照顾者生活质量的数据相对较少。我们试图描述肺癌手术后患者及其家庭照顾者的生活质量轨迹。
方法
这是一项对一项更大规模的前瞻性生活质量研究的二次分析，该研究在单一机构测试了一种跨学科姑息治疗干预对肺癌患者及其家庭照顾者的有效性。干预措施包括为患者和家庭照顾者进行跨学科护理规划和正式教育课程。该亚组分析纳入了接受手术且有匹配的家庭照顾者且拥有完整生活质量数据的患者（112名手术患者中的41对患者和照顾者）。使用癌症治疗功能评估-肺癌工具评估患者的生活质量。使用希望之城生活质量工具的家庭照顾者版本评估家庭照顾者的生活质量。使用痛苦温度计评估心理困扰。
结果
手术前患者（3.8/10）和家庭照顾者（5.1/10）的心理困扰水平最高。六周后患者的困扰水平下降（2.9/10），12周时进一步下降（2.2/10，p=0.001），但家庭照顾者的困扰水平仍居高不下（4.2/10和4.4/10，p=0.157）。与常规护理相比，干预组患者在12周时报告身体和功能生活质量结果有所改善（p<0.01），但在任何领域家庭照顾者均未观察到显著益处（p>0.05）。
结论
肺癌患者的家庭照顾者经历显著的心理困扰。家庭照顾者在手术后3个月生活质量仍受损。家庭照顾者的生活质量轨迹与患者不同。我们的姑息治疗干预对该亚组患者显示出生活质量改善，但对其家庭照顾者无效。
试验注册
由美国国立癌症研究所资助，试验标识符NCT00823667 https://clinicaltrials.gov/show/NCT00823667 。
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