Olga Husson, Radboud University Medical Center, Nijmegen, Netherlands; Brad J. Zebrack, University of Michigan School of Social Work, Ann Arbor, MI; Rebecca Block, MNR Analytics; Brandon Hayes-Lattin, Oregon Health and Sciences University, Portland, OR; Leanne Embry and Christine Aguilar, University of Texas Health Science Center at San Antonio, San Antonio, TX; and Steve Cole, HopeLab Foundation, Redwood City, CA.
J Clin Oncol. 2017 Feb 20;35(6):652-659. doi: 10.1200/JCO.2016.69.7946. Epub 2017 Jan 17.
Purpose To examine changes in health-related quality of life (HRQoL) and its predictors during the first 2 years after initial cancer diagnosis in adolescent and young adult (AYA) patients with cancer. Patients and Methods A multicenter, longitudinal, prospective study was conducted among a diverse sample of AYA patients with cancer ages 15 to 39 years. One hundred seventy-six patients (75% response) completed a self-report measure of HRQoL (Short Form-36 [SF-36]) within the first 4 months after diagnosis and again 12 and 24 months later. Linear mixed models with random intercepts and slopes estimated changes in QoL. Results Recently diagnosed AYA patients with cancer had significantly worse physical component scale (PCS) scores (38.7 v 52.8; P < .001) and mental component scale (MCS) scores (42.9 v 48.9; P < .001) when compared with population norms. Significant improvements in PCS and MCS scores from baseline to 24-month follow-up were observed; however, these increases were largest during the first 12 months. At the 24-month follow-up, AYA patients still had significantly lower PCS scores (48.0 v 52.8; P < .001) and MCS scores (45.8 v 48.9; P = .002) when compared with population norms. Multivariable analyses revealed that improvements in PCS and MCS scores were primarily a function of being off-treatment and being involved in school or work. PCS but not MCS scores were worse for AYA patients diagnosed with cancers with poorer prognoses. Conclusion Although HRQoL improved over time, it was still compromised 24 months after primary diagnosis. Given relatively little observed improvement in HRQoL during the 12- to 24-month period after diagnosis, AYA patients may benefit from supportive care interventions administered during the second year after diagnosis.
研究青少年和年轻成人（AYA）癌症患者在确诊后最初 2 年内健康相关生活质量（HRQoL）的变化及其预测因素。
对年龄在 15 至 39 岁的多种癌症 AYA 患者进行了一项多中心、纵向、前瞻性研究。176 例患者（75%的应答率）在诊断后 4 个月内完成了健康调查问卷（SF-36），并在 12 个月和 24 个月后再次完成。线性混合模型具有随机截距和斜率，用于评估 QoL 的变化。
与人群标准相比，新诊断的 AYA 癌症患者的身体成分量表（PCS）评分（38.7 分比 52.8 分；P <.001）和精神成分量表（MCS）评分（42.9 分比 48.9 分；P <.001）明显较差。从基线到 24 个月随访，PCS 和 MCS 评分均有显著改善；然而，这些增加在最初的 12 个月最大。在 24 个月的随访中，与人群标准相比，AYA 患者的 PCS 评分（48.0 分比 52.8 分；P <.001）和 MCS 评分（45.8 分比 48.9 分；P =.002）仍然较低。多变量分析显示，PCS 和 MCS 评分的改善主要是治疗结束和上学或工作的结果。与预后较差的癌症相比，AYA 患者的 PCS 评分而不是 MCS 评分较差。
尽管 HRQoL 随时间改善，但在原发性诊断后 24 个月仍受到损害。鉴于在诊断后 12 至 24 个月期间 HRQoL 观察到的改善相对较少，AYA 患者可能受益于诊断后第二年进行的支持性护理干预。
