Hoole J, Mitchell D A, Smith A B, Kanatas A
Calderdale and Huddersfield NHS Foundation Trust, United Kingdom.
York Health Economics Consortium, University of York, York, United Kingdom.
Br J Oral Maxillofac Surg. 2018 Dec;56(10):910-917. doi: 10.1016/j.bjoms.2018.11.005. Epub 2018 Nov 22.
Patient-reported outcomes are increasingly used by clinical teams as indicators of quality when assessing treatment after a diagnosis of head and neck cancer. About a third of patients report reduced sexual interest or enjoyment after such treatment but, despite that, there is no questionnaire about intimacy that has been developed specifically for them. The aim of this study was to develop such a questionnaire, to gain an indication of the relative incidence of individual items, and to compare characteristics such as age, stage, treatment, time since treatment for an established head and neck cancer, and a health-related quality of life (QoL) measure (European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30 with the Head and Neck 35 module). The development of the new instrument was based on an exploratory observational study that included quantitative and qualitative methods. The qualitative element was achieved by the generation of items - from published studies, the comments of patients and carers, and a cross-sectional survey of patients with head and neck cancer who were alive and free of disease. The quantitative element comprised analysis of exploratory and confirmatory factors, internal reliability assessment (Cronbach's alpha), and a correlation analysis. Forty-two patients were included in the focus groups, and 101 patients participated in the cross-sectional survey (both male and female, in a relationship and single, age range 30-70 years for the focus group, and 62-117 in the cross-sectional survey). All treatments were included. We found that the ability to enjoy a sex life had been adversely affected in about half the sample and that this had significantly changed from before their cancer in a third. The qualitative part of the study resulted in 22 items that covered a range of domains from dry mouth and thick saliva to loss of sensation (lips, fingertips), restricted head/neck movement, fatigue, and pain. The exploratory analysis covered four domains (physical, sensation, movement, and communication) from 12 of 22 items. Cronbach's alphas ranged from 0.62 to 0.84, and the correlation analysis indicated "good fit" statistics for these domains. In terms of the EORTC QoL Questionnnaire - Head and Neck 35, the four MHK domains showed good levels of association with anticipated domains. Head and neck cancer and its associated treatments significantly adversely affect intimacy and sexuality in half the population sampled. The MHK tool may be used to identify specific issues related to intimacy in patients with a history of diagnosis and treatment of head and neck cancer. Further work is essential to identify its precise role and to help develop specific interventions.
在评估头颈癌诊断后的治疗质量时，临床团队越来越多地将患者报告的结果用作质量指标。约三分之一的患者报告称，此类治疗后性兴趣或性快感降低，尽管如此，尚未专门为他们开发关于亲密关系的问卷。本研究的目的是开发这样一份问卷，以了解各个项目的相对发生率，并比较年龄、分期、治疗方式、确诊头颈癌后的治疗时间以及健康相关生活质量（QoL）测量指标（欧洲癌症研究与治疗组织（EORTC）生活质量问卷-C30及头颈35模块）等特征。新工具的开发基于一项探索性观察研究，该研究包括定量和定性方法。定性部分通过生成项目来实现——这些项目来自已发表的研究、患者及其护理人员的意见，以及对存活且无疾病的头颈癌患者的横断面调查。定量部分包括探索性和验证性因素分析、内部信度评估（克朗巴哈系数）以及相关性分析。42名患者参加了焦点小组，101名患者参与了横断面调查（包括男性和女性，有伴侣和单身，焦点小组年龄范围为30 - 70岁，横断面调查为62 - 117岁）。所有治疗方式均涵盖在内。我们发现，约一半的样本中享受性生活的能力受到了不利影响，其中三分之一的人与患癌前相比有显著变化。研究的定性部分产生了22个项目，涵盖了从口干、唾液浓稠到感觉丧失（嘴唇、指尖）、头颈活动受限、疲劳和疼痛等一系列领域。探索性分析涵盖了22个项目中12个项目的四个领域（身体、感觉、活动和沟通）。克朗巴哈系数范围为0.62至0.84，相关性分析表明这些领域的统计数据“拟合良好”。就EORTC生活质量问卷-头颈35而言，四个MHK领域与预期领域显示出良好的关联水平。头颈癌及其相关治疗对抽样人群中一半人的亲密关系和性功能有显著不利影响。MHK工具可用于识别有头颈癌诊断和治疗史患者中与亲密关系相关的具体问题。进一步的工作对于确定其确切作用并帮助制定具体干预措施至关重要。
