a Department of Plastic Surgery , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
b Department of Public Health , University of Helsinki , Helsinki , Finland.
Acta Oncol. 2018 May;57(5):622-628. doi: 10.1080/0284186X.2017.1400683. Epub 2017 Nov 15.
The prognosis of breast cancer has improved significantly during the last few decades increasing the interest in health-related quality of life (HRQoL). The aim of this study was to compare the HRQoL scores produced by different instruments and to shed light on their validity in various states of breast cancer by studying the association of cancer-related symptoms with HRQoL.
An observational, cross-sectional study of breast cancer patients treated in the Helsinki and Uusimaa Hospital District from September 2009 to April 2011. A total of 840 patients completed three HRQoL questionnaires: the EQ-5D-3L (including VAS), 15D and EORTC QLQ-30 and a questionnaire concerning sociodemographic factors. Patients were divided into five mutually exclusive groups: primary treatment (n = 118), recovery (6-18 months from diagnosis) (n = 150), remission (>18 months) (n = 382), metastatic disease (n = 176) and palliative care (n = 14). The association of HRQoL with sociodemographic and clinical factors and cancer-related symptoms, screened by the EORTC QLQ-30, was studied by multivariate modeling using stepwise linear regression analysis.
HRQoL scores were the best at the time closest to diagnosis and deteriorated with disease progression. The EQ-5D had a pronounced ceiling effect with 40.8% of the respondents scoring 1 (perfect health) compared to 6% for the 15D and 5.6% for VAS. In regression analyses, pain, fatigue and financial difficulties were the most important predictors of lower HRQoL. The 15D showed better discriminatory power and content validity. The EORTC QLQ-C30 functioning deteriorated in advanced states of the disease with physical, social and role functioning being the most affected. Insomnia, fatigue and pain were the most commonly reported symptoms in all groups.
Different HRQoL instruments produce notably different HRQoL scores. The EQ-5D has a pronounced ceiling effect. Pain and fatigue are the most common symptoms associated with poor HRQoL in all disease states.
在过去几十年中，乳腺癌的预后有了显著改善，这提高了人们对健康相关生活质量（HRQoL）的兴趣。本研究的目的是比较不同工具产生的 HRQoL 评分，并通过研究与癌症相关症状与 HRQoL 的关联，揭示它们在乳腺癌不同状态下的有效性。
这是一项观察性、横断面研究，纳入了 2009 年 9 月至 2011 年 4 月在赫尔辛基和乌西玛地区医院接受治疗的乳腺癌患者。共有 840 名患者完成了三种 HRQoL 问卷：EQ-5D-3L（包括 VAS）、15D 和 EORTC QLQ-30，以及一份关于社会人口因素的问卷。患者被分为五个互斥组：初始治疗（n=118）、恢复期（诊断后 6-18 个月）（n=150）、缓解期（>18 个月）（n=382）、转移性疾病（n=176）和姑息治疗（n=14）。通过逐步线性回归分析，使用多元建模研究 HRQoL 与社会人口和临床因素以及 EORTC QLQ-30 筛查出的与癌症相关症状之间的关联。
HRQoL 评分在最接近诊断时最佳，随着疾病进展而恶化。EQ-5D 具有明显的天花板效应，40.8%的受访者得分为 1（完全健康），而 15D 为 6%，VAS 为 5.6%。在回归分析中，疼痛、疲劳和经济困难是 HRQoL 较低的最重要预测因素。15D 具有更好的区分能力和内容效度。EORTC QLQ-C30 的功能在疾病的晚期状态恶化，身体、社会和角色功能受影响最大。失眠、疲劳和疼痛是所有组中最常见的报告症状。
不同的 HRQoL 工具产生的 HRQoL 评分明显不同。EQ-5D 具有明显的天花板效应。疼痛和疲劳是所有疾病状态下与较差 HRQoL 相关的最常见症状。
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