Klernäs Pia, Johnsson Aina, Horstmann Vibeke, Johansson Karin
Department of Health Sciences, Division of Physiotherapy, Lund University, Sweden.
Bräcke diakoni, Rehabcenter Sfären, Solna, Sweden.
Scand J Caring Sci. 2018 Jun;32(2):634-644. doi: 10.1111/scs.12488. Epub 2017 Sep 11.
Lymphoedema may cause complex problems that can strongly influence patients' health-related quality of life (HRQoL). The main purpose of this study was to investigate the impact of lymphoedema on HRQoL in patients with varying forms of lymphoedema.
The Lymphoedema Quality of Life Inventory (LyQLI), measuring three domains, physical, psychosocial and practical, and the Short Form 36 Health Survey Questionnaire (SF-36), measuring eight health domains, were sent to 200 lymphoedema patients. Out of those who answered both questionnaires, 88 patients had lymphoedema secondary to cancer treatment and they additionally received the Functional Assessment of Cancer Therapy Scale-General (FACT-G). The relation between continuous variables and the three domains were analysed by Spearman's correlation coefficients, and Kruskal-Wallis test was used to analyse categorical variables.
Altogether 129 patients completed the LyQLI and SF-36 and 79 of them also completed FACT-G. Twenty per cent had a high mean score (≥2.0) in at least one domain of the LyQLI, thus having a low HRQoL. Lower HRQoL was found in the practical domain of LyQLI in patients with lower limb lymphoedema compared to patient with lymphoedema in upper limb or head/neck (p = 0.002) and in patients working part-time compared to patients working full-time (p = 0.005). The impact on HRQoL tended to decrease with age, with a significant correlation in the psychosocial domain (r = 0.194, p = 0.028). Compared with the general Swedish population, patients with lymphoedema scored significantly lower in general health (p = 0.006), vitality (p = 0.002) and social functioning (p = 0.025) assessed by the SF-36. From a cancer-specific view, HRQoL was similar to other Swedish studies using the FACT-G.
This study indicates that about 20% of the patients with lymphoedema had major impact on their HRQoL. More effort and research is needed to identify, understand and support groups of patients with severe lymphoedema-related problems.
淋巴水肿可能引发复杂问题，对患者的健康相关生活质量（HRQoL）产生重大影响。本研究的主要目的是调查不同类型淋巴水肿患者中淋巴水肿对HRQoL的影响。
向200名淋巴水肿患者发放了测量身体、心理社会和实际三个领域的淋巴水肿生活质量量表（LyQLI）以及测量八个健康领域的简短健康调查36项问卷（SF-36）。在回答了两份问卷的患者中，88名患者的淋巴水肿继发于癌症治疗，他们还额外接受了癌症治疗功能评估量表通用版（FACT-G）。连续变量与三个领域之间的关系通过Spearman相关系数进行分析，分类变量则采用Kruskal-Wallis检验进行分析。
共有129名患者完成了LyQLI和SF-36，其中79名患者还完成了FACT-G。20%的患者在LyQLI的至少一个领域中平均得分较高（≥2.0），因此其HRQoL较低。与上肢或头/颈部淋巴水肿患者相比，下肢淋巴水肿患者在LyQLI的实际领域中HRQoL较低（p = 0.002）；与全职工作的患者相比，兼职工作的患者HRQoL较低（p = 0.005）。随着年龄增长，对HRQoL的影响趋于降低，在心理社会领域存在显著相关性（r = 0.194，p = 0.028）。通过SF-36评估，与瑞典普通人群相比，淋巴水肿患者在总体健康（p = 0.006）、活力（p = 0.002）和社会功能（p = 0.025）方面得分显著较低。从癌症特异性角度来看，HRQoL与瑞典其他使用FACT-G进行的研究相似。
本研究表明，约20%的淋巴水肿患者对其HRQoL有重大影响。需要付出更多努力并开展研究，以识别、理解和支持存在严重淋巴水肿相关问题的患者群体。
