Arndt Volker, Koch-Gallenkamp Lena, Jansen Lina, Bertram Heike, Eberle Andrea, Holleczek Bernd, Schmid-Höpfner Sieglinde, Waldmann Annika, Zeissig Sylke Ruth, Brenner Hermann
a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany.
b German Cancer Research Center (DKFZ), Office of Cancer Survivorship Research , Heidelberg , Germany.
Acta Oncol. 2017 Feb;56(2):190-197. doi: 10.1080/0284186X.2016.1266089. Epub 2017 Jan 5.
With the increasing number and diversity of cancer survivors, studies of survivors' physical, emotional, and social health are of growing importance. While there is a growing body of literature on the quality of life (QoL) of cancer patients during the early years past diagnosis, less is known regarding QoL in long-term survivors (LTS) (5 + years past diagnosis) and particularly in very long-term survivors (VLTS) (10 + years past diagnosis). The objective of our study is to: (1) compare QoL of long-term cancer survivors and population norms; and (2) assess whether any deficits in QoL of survivors observed 5-10 years past diagnosis persist beyond the 10th year past diagnosis.
In total 6952 long-term cancer survivors (5-16 years past diagnosis of breast, colorectal, or prostate cancer) from Germany recruited in the context of the population-based CAESAR + study were compared with 1878 population-based controls without a history of cancer. QoL was assessed with the EORTC QLQ-C30. Differences in QoL between survivors and controls were assessed via multiple regression while controlling for age, gender, education, and case mix for survivors 5-9 years and 10 + years past diagnosis separately.
Overall QoL in long-term cancer survivors was comparable to population norms but specific deficits in social, role, emotional, cognitive, and physical functioning and symptoms such as insomnia, fatigue, dyspnea, constipation, diarrhea, and financial difficulties were more prevalent in LTSs. Detriments in QoL persisted during the observation period and affected particularly cancer survivors at younger ages (<50 years). Non-significant aggravations in QoL with longer time since diagnosis were observed in very young and very old cancer survivors.
Detriments in health-related quality of life persist over more than a decade and affect predominantly younger patients. Improvements both in early and long-term follow-up care of cancer survivors seem warranted.
随着癌症幸存者数量的增加和多样性的提升，对幸存者身体、情感和社会健康的研究愈发重要。虽然关于癌症患者确诊后早期生活质量（QoL）的文献越来越多，但对于长期幸存者（确诊后5年以上），尤其是极长期幸存者（确诊后10年以上）的生活质量了解较少。我们研究的目的是：（1）比较长期癌症幸存者的生活质量与总体人群标准；（2）评估确诊后5至10年观察到的幸存者生活质量缺陷在确诊后第10年之后是否依然存在。
在基于人群的CAESAR +研究中招募了6952名来自德国的长期癌症幸存者（确诊乳腺癌、结直肠癌或前列腺癌后5至16年），并与1878名无癌症病史的基于人群的对照者进行比较。使用欧洲癌症研究与治疗组织生活质量核心问卷（EORTC QLQ-C30）评估生活质量。分别针对确诊后5至9年和10年以上的幸存者，在控制年龄、性别、教育程度和病例组合的情况下，通过多元回归评估幸存者与对照者之间生活质量的差异。
长期癌症幸存者的总体生活质量与总体人群标准相当，但社会、角色、情感、认知和身体功能以及失眠、疲劳、呼吸困难、便秘、腹泻和经济困难等症状方面的特定缺陷在长期幸存者中更为普遍。生活质量的损害在观察期内持续存在，尤其影响年龄较小（<50岁）的癌症幸存者。在非常年轻和非常年老的癌症幸存者中，观察到确诊时间越长生活质量有非显著加重的情况。
与健康相关的生活质量损害持续超过十年，主要影响年轻患者。癌症幸存者的早期和长期随访护理似乎都有必要改善。
