BMC Med. 2017 Jan 13;15(1):10. doi: 10.1186/s12916-016-0768-2.
A better understanding of health-related quality of life (HRQoL) and psychological distress in cancer survivors can raise awareness, promote the development of policies in cancer survivorship care, and facilitate better targeted use of limited resources in low- and middle-income countries (LMICs). The main objectives of this paper were therefore to assess HRQoL and the prevalence of psychological distress amongst cancer survivors in Southeast Asia and identify risk factors of these outcomes.
The ACTION study was a longitudinal study in eight LMICs in Southeast Asia with 5249 first time cancer survivors followed up at 1 year after diagnosis. HRQoL was assessed using the EORTC QLQ-C30 and EQ-5D. Psychological distress (anxiety and depression) was assessed using the Hospital Anxiety and Depression Scale. General linear models and multiple logistic regression were used to identify independent predictors of HRQoL and psychological distress.
One year after diagnosis, the mean EORTC QLQ-C30 global health score for survivors was 66.2 out of 100 (SD 22.0), the mean index score on the EQ-5D was 0.74 (SD 0.23), 37% of survivors had at least mild levels of anxiety, and 46% showed at least mild levels of depression. Poorest HRQoL and highest prevalence of anxiety and depression were seen in patients with lung cancer and lymphomas, while highest scores and least psychological distress were seen in female patients with breast and cervical cancer. The most significant predictor of poor HRQoL and psychological distress outcomes was cancer stage at diagnosis. Age, co-morbidities, treatment, and several socioeconomic factors were associated with HRQoL and psychological distress.
Cancer survivors in LMICs in Southeast Asia have impaired HRQoL and substantial proportions have psychological distress. Patients with advanced cancer stages at diagnosis and those in a poor socioeconomic position were most at risk of such poor outcomes. Supportive interventions for cancer patients that address wider aspects of patient wellbeing are needed, as well as policies that address financial and other barriers to timely treatment.
更好地了解癌症幸存者的健康相关生活质量（HRQoL）和心理困扰，可提高认识，促进癌症生存护理政策的制定，并有助于在低收入和中等收入国家（LMICs）更有针对性地利用有限资源。因此，本文的主要目的是评估东南亚癌症幸存者的HRQoL和心理困扰患病率，并确定这些结果的风险因素。
ACTION研究是一项在东南亚八个LMICs进行的纵向研究，对5249名首次患癌幸存者在诊断后1年进行随访。使用欧洲癌症研究与治疗组织核心问卷（EORTC QLQ-C30）和欧洲五维度健康量表（EQ-5D）评估HRQoL。使用医院焦虑抑郁量表评估心理困扰（焦虑和抑郁）。采用一般线性模型和多元逻辑回归来确定HRQoL和心理困扰的独立预测因素。
诊断后1年，幸存者的EORTC QLQ-C30全球健康平均得分为66.2（满分100分，标准差22.0），EQ-5D的平均指数得分为0.74（标准差0.23），37%的幸存者至少有轻度焦虑，46%至少有轻度抑郁。肺癌和淋巴瘤患者的HRQoL最差，焦虑和抑郁患病率最高，而乳腺癌和宫颈癌女性患者得分最高，心理困扰最少。HRQoL差和心理困扰结果的最显著预测因素是诊断时的癌症分期。年龄、合并症、治疗以及一些社会经济因素与HRQoL和心理困扰有关。
东南亚LMICs的癌症幸存者HRQoL受损，相当一部分人有心理困扰。诊断时癌症分期较晚的患者和社会经济地位较差的患者出现此类不良结果的风险最高。需要针对癌症患者的支持性干预措施，以解决患者福祉的更广泛方面，以及解决及时治疗的财务和其他障碍的政策。
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