评估持续性化疗后脱发患者的生活质量和治疗结果。
Assessment of Quality of Life and Treatment Outcomes of Patients With Persistent Postchemotherapy Alopecia.
机构信息
Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Dermatology Service, Hospital Vithas Santa Catalina, Gran Canaria, Canary Islands, Spain.
出版信息
JAMA Dermatol. 2019 Jun 1;155(6):724-728. doi: 10.1001/jamadermatol.2018.5071.
IMPORTANCE
Persistent alopecia occurs in a subset of patients undergoing chemotherapy, yet the quality of life (QOL) of these patients and their response to therapy have not been described in a large patient cohort.
OBJECTIVE
To characterize the clinical presentation of patients with persistent chemotherapy-induced alopecia (pCIA) or endocrine therapy-induced alopecia after chemotherapy (EIAC) and their QOL and treatment outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective multicenter cohort of 192 women with cancer treated with cytotoxic agents who received a clinical diagnosis of persistent alopecia (98 with pCIA and 94 with EIAC) between January 1, 2009, and July 31, 2017, was analyzed. All patients were from the dermatology service in 2 comprehensive cancer centers and 1 tertiary-care hospital. Data on demographics, chemotherapy regimens, severity, clinical patterns, and response to hair-growth promoting agents were assessed. Data from the Hairdex questionnaire were used to assess the QOL of patients with alopecia.
MAIN OUTCOMES AND MEASURES
The clinical presentation, response to dermatologic therapy, and QOL of patients with pCIA were assessed and compared with those of patients with EIAC.
RESULTS
A total of 98 women with pCIA (median age, 56.5 years [range, 18-83 years]) and 94 women with EIAC (median age, 56 years [range, 29-84 years]) were included. The most common agents associated with pCIA were taxanes for 80 patients (82%); the most common agents associated with EIAC were aromatase inhibitors for 58 patients (62%). Diffuse alopecia was predominant in patients with pCIA compared with patients with EIAC (31 of 75 [41%] vs 23 of 92 [25%]; P = .04), with greater severity (Common Terminology Criteria for Adverse Events, version 4.0, grade 2) among patients with pCIA (29 of 75 [39%] vs 12 of 92 [13%]; P < .001). A negative emotional effect was reported by both groups. After treatment with topical minoxidil or spironolactone, moderate to significant improvement was observed for 36 of 54 patients with pCIA (67%) and for 32 of 42 patients with EIAC (76%).
CONCLUSIONS AND RELEVANCE
Persistent chemotherapy-induced alopecia is frequently more severe and diffuse when compared with EIAC, and both groups of patients experienced a negative effect. A modest benefit was observed with dermatologic therapy. Additional studies are warranted to develop effective strategies for prevention and effective therapy for pCIA and EIAC.
重要性
在接受化疗的患者中，有一部分会出现持续性脱发，但大量患者的生活质量（QOL）及其对治疗的反应尚未在大型患者队列中进行描述。
目的
描述持续性化疗诱导性脱发（pCIA）或化疗后内分泌治疗诱导性脱发（EIAC）患者的临床特征及其 QOL 和治疗结局。
设计、地点和参与者：回顾性分析了 2009 年 1 月 1 日至 2017 年 7 月 31 日期间，在 2 家综合癌症中心和 1 家三级保健医院皮肤科就诊的 192 名接受细胞毒性药物治疗的癌症患者的临床诊断为持续性脱发（98 例 pCIA 和 94 例 EIAC）的多中心队列。所有患者均来自皮肤科服务。评估了人口统计学数据、化疗方案、严重程度、临床模式以及对毛发生长促进剂的反应。使用 Hairdex 问卷评估脱发患者的 QOL。
主要结果和测量
评估了 pCIA 患者的临床特征、对皮肤科治疗的反应和 QOL，并与 EIAC 患者进行了比较。
结果
共纳入 98 例 pCIA 患者（中位年龄 56.5 岁[范围 18-83 岁]）和 94 例 EIAC 患者（中位年龄 56 岁[范围 29-84 岁]）。与 pCIA 相关的最常见药物为紫杉醇 80 例（82%）；与 EIAC 相关的最常见药物为芳香酶抑制剂 58 例（62%）。与 EIAC 相比，pCIA 患者中弥漫性脱发更为常见（75 例中有 31 例[41%]，92 例中有 23 例[25%]；P = .04），且脱发程度更严重（通用术语标准不良事件，版本 4.0，等级 2）（75 例中有 29 例[39%]，92 例中有 12 例[13%]；P < .001）。两组患者均报告有负面情绪影响。在接受局部米诺地尔或螺内酯治疗后，54 例 pCIA 患者中有 36 例（67%）和 42 例 EIAC 患者中有 32 例（76%）观察到中度至显著改善。
结论和相关性
与 EIAC 相比，持续性化疗诱导性脱发通常更为严重且更为弥漫性，两组患者均经历了负面情绪。皮肤科治疗观察到适度获益。需要进一步研究以制定预防和治疗 pCIA 和 EIAC 的有效策略。
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