Edinburgh Napier University, Sighthill campus, School Health & Social Care, Edinburgh, EH11 4BN, Scotland.
BMC Cancer. 2020 Jun 5;20(1):528. doi: 10.1186/s12885-020-07022-w.
Cancer impacts on patients and their families across a range of different domains. For that reason, optimal cancer care has moved away from a disease-centric focus to a more holistic approach in order to proactively support people with their individual needs and concerns. While international policy clearly advocates this agenda, implementation into routine care is limited. Therefore, relevant interventions that measurably improve patient outcomes are essential to understand if this ideal is to become routine multidisciplinary practice. The aim of this study was to analyse the impact of a proactive, holistic, community-based intervention on health-related quality of life in a cohort of people diagnosed with cancer. Secondary aim was to explore the relationship between changes in health status and: cancer type, cancer stage, number of concerns expressed and change in severity of concerns pre and post intervention.
Prospective observational cohort study. A convenience sample of 437 individuals were referred to the service 'Improving the Cancer Journey (ICJ) in the UK. Each completed the Euroqol EQ-5D-3 L and visual analogue scale (VAS) and a Holistic Needs Assessment (HNA) during initial visit to the service and again at follow-up review, median 84 days later. Change between scores was tested with paired t-tests and relationships between variables with multiple regression models with heteroscedasticity-consistent standard errors.
Participants were White British with median age between 50 and 64 years. Cancer type and stage were varied. EQ-5D utility scores improved at follow-up by 0.121 [0.0891-0.153], p < .001, and VAS scores improved by 7.81 [5.88-9.74], p < .001. The strongest predictor of change was a decrease in severity of concerns. Cancer stage 'palliative care' contributed to a reduction in health status.
This study is the first to show that a holistic community intervention dedicated to supporting the individual concerns of participants had both a statistically significant and clinically meaningful impact on participants' health-related quality of life. The mean change in EQ-5D scores was more than the 'minimally important clinical difference' described in the literature. This is important because while quality of life has multiple determinants, this study has shown for the first time that it is possible to capture a clinically meaningful improvement as a function of reducing someone's personally identified concerns.
癌症在多个不同领域影响着患者及其家庭。因此，为了主动支持人们的个人需求和关切，最佳的癌症护理已从以疾病为中心的治疗方法转变为更全面的治疗方法。尽管国际政策明确倡导这一议程，但在常规护理中的实施却有限。因此，了解如果将这一理想转化为常规多学科实践，哪些相关干预措施可以显著改善患者的预后是至关重要的。本研究的目的是分析一项积极主动的、全面的、基于社区的干预措施对一组确诊癌症患者的健康相关生活质量的影响。次要目的是探讨健康状况的变化与以下因素之间的关系：癌症类型、癌症分期、表达的关注数量以及干预前后关注严重程度的变化。
前瞻性观察性队列研究。对 437 名患者进行了方便抽样，他们被转介到英国的“改善癌症之旅（ICJ）”服务。每位患者在服务初始访问时和 84 天的随访审查时完成了 Euroqol EQ-5D-3L 和视觉模拟量表（VAS）以及全面需求评估（HNA）。通过配对 t 检验测试评分之间的变化，并用异方差一致标准误差的多元回归模型来测试变量之间的关系。
参与者为白种英国裔，年龄在 50 至 64 岁之间。癌症类型和分期各不相同。EQ-5D 效用评分在随访时提高了 0.121[0.0891-0.153]，p<.001，VAS 评分提高了 7.81[5.88-9.74]，p<.001。变化的最强预测因素是关注严重程度的降低。癌症分期“姑息治疗”有助于改善健康状况。
本研究首次表明，专门用于支持参与者个人关注的全面社区干预措施对参与者的健康相关生活质量具有统计学意义和临床意义上的影响。EQ-5D 评分的平均变化大于文献中描述的“最小临床重要差异”。这很重要，因为尽管生活质量有多个决定因素，但本研究首次表明，通过减少某人个人确定的关注点，可以实现有临床意义的改善。
