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使用欧洲五维健康量表 5 级效用值评估门诊癌症化疗患者的生活质量与不良事件的真实世界数据。

Real-world data of the association between quality of life using the EuroQol 5 Dimension 5 Level utility value and adverse events for outpatient cancer chemotherapy.

机构信息

Department of Pharmacy, Gifu University Hospital, Gifu, Japan.

Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan.

出版信息

Support Care Cancer. 2020 Dec;28(12):5943-5952. doi: 10.1007/s00520-020-05443-8. Epub 2020 Apr 12.

Abstract

BACKGROUND

Outpatient cancer chemotherapy may lead to improved quality of life (QOL) by allowing treatment to continue without impairing the social lives of patients compared with hospitalization. However, the occurrence of serious adverse events may cause a decline in QOL. We investigated the relationship between outpatient chemotherapy-induced adverse events and QOL.

METHODS

A single-center retrospective descriptive study was conducted in patients who received outpatient chemotherapy at Gifu University Hospital (Gifu, Japan) between September 2017 and December 2018. The utility values of QOL, type and severity of adverse events, type of cancer, chemotherapy regimen, and other patient demographics were analyzed. Adverse events were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. QOL was evaluated using the Japanese version of the EuroQol 5 Dimension 5 Level (EQ-5D-5L). Associations between the EQ-5D-5L utility value and serious adverse events were assessed using adjusted (age and sex) odds ratios obtained with a proportional odds logistic regression model.

RESULTS

Data from 1008 patients who received 4695 chemotherapy cycles were analyzed. According to proportional odds logistic regression, the adverse events that significantly correlated with a decreased EQ-5D-5L utility value were malaise, edema of the limbs, peripheral neuropathy, pruritus, and dry skin. Based on the proportional odds logistic analysis, neither cancer type nor anticancer drugs were significantly correlated with the EQ-5D-5L utility value in patients who received chemotherapy. Pharmaceutical care for peripheral neuropathy significantly improved patients' EQ-5D-5L utility value from 0.747 to 0.776 (P < 0.01).

CONCLUSIONS

Adverse events (i.e., peripheral neuropathy, malaise, and edema of the limbs) are significantly correlated with a decrease in QOL, regardless of the type of cancer or anticancer drugs used. Pharmaceutical care provided by pharmacists in collaboration with physicians may improve QOL.

摘要

背景

与住院相比,门诊癌症化疗可继续治疗而不影响患者的社会生活,从而提高生活质量(QOL)。但是,严重不良事件的发生可能会导致 QOL 下降。我们调查了门诊化疗引起的不良事件与 QOL 之间的关系。

方法

对 2017 年 9 月至 2018 年 12 月在岐阜大学医院(岐阜,日本)接受门诊化疗的患者进行了一项单中心回顾性描述性研究。分析了 QOL 的效用值、不良事件的类型和严重程度、癌症类型、化疗方案以及其他患者人口统计学特征。根据不良事件通用术语标准,第 4.0 版对不良事件进行分级。使用日本版 EuroQol 5 维度 5 级量表(EQ-5D-5L)评估 QOL。使用比例优势逻辑回归模型获得的调整(年龄和性别)优势比评估 EQ-5D-5L 效用值与严重不良事件之间的关联。

结果

对接受 4695 个化疗周期的 1008 名患者的数据进行了分析。根据比例优势逻辑回归,与 EQ-5D-5L 效用值降低显著相关的不良事件是不适、四肢水肿、周围神经病、瘙痒和皮肤干燥。根据比例优势逻辑分析,癌症类型和抗癌药物均与接受化疗的患者的 EQ-5D-5L 效用值无显著相关性。周围神经病的药学护理可使患者的 EQ-5D-5L 效用值从 0.747 提高到 0.776(P<0.01)。

结论

无论癌症类型或抗癌药物如何,不良事件(即周围神经病、不适和四肢水肿)与 QOL 下降显著相关。药剂师与医生合作提供的药学护理可能会改善 QOL。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f2cb/7686000/bb6759278f89/520_2020_5443_Fig1_HTML.jpg

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