Department of Surgery, University of Melbourne, Melbourne, Australia.
The Royal Melbourne Hospital, Melbourne, Australia.
Qual Life Res. 2021 Feb;30(2):385-394. doi: 10.1007/s11136-020-02652-w. Epub 2020 Sep 30.
The burden of treatment toxicities in breast cancer requires longitudinal assessment of patient-centered outcomes. The current study aimed to assess the feasibility of collecting general and breast cancer-specific quality of life (QoL), ongoing symptoms and unmet needs, in patients identified from a population-based cancer registry, and to assess the contribution of demographic, disease, and care-related factors.
Eligible patients were identified from the Victorian Cancer Registry (Victoria, Australia) using the ICD-10 code C50, diagnosed during 2013, 2011, and 2009. Data included age, area of residence, cancer diagnosis, date of diagnosis, treatment modality, and staging. Patients completed a number of validated tools including the EQ-5D-5L and FACT-B, symptom items, and unmet needs.
Of 1006 eligible patients, the overall response rate was 45.6%. Survivors 1 year post-diagnosis had significantly greater problems with pain or discomfort (59.2%) and with anxiety or depression (51.3%) compared with survivors 5 years post-diagnosis (45.1% with pain or discomfort, p < 0.05, and 32.7% with anxiety or depression, p < 0.01). For the 5 years group, pain or discomfort and anxiety or depression were significantly higher than for the general population (32.2% and 21.6%, respectively). Improved quality of life was found in those who did not receive chemotherapy (coefficient = 0.2269, p = 0.0409) and those who did not have a longstanding health condition (coefficient = 0.6342, p < 0.001). Poorer quality of life was associated with those who were not certain what was happening with their breast cancer (coefficient = - 0.3674, p = 0.0094) and those whose cancer had not been treated, had been treated but was still present, or had returned after treatment (coefficient = - 0.5314, p = 0.0136). Across the total cohort, women were bothered by changes in weight (21.3%) and concerned about the effects of stress on their cancer (19.6%). Fear of cancer recurrence was commonly reported and did not diminish over time (60.7%, 52.2%, and 56.9% at 1, 3, and 5 years, respectively).
Collecting patient-reported outcomes from a population-based sample of breast cancer survivors was feasible. Physical symptoms and psychosocial issues are common and are persistent. Use of chemotherapy was the only treatment modality that significantly impacted on QoL.
乳腺癌治疗毒性的负担需要对以患者为中心的结局进行纵向评估。本研究旨在评估从基于人群的癌症登记处中识别的患者中收集一般和乳腺癌特异性生活质量（QoL）、持续症状和未满足的需求的可行性，并评估人口统计学、疾病和护理相关因素的贡献。
使用 ICD-10 代码 C50 从维多利亚癌症登记处（澳大利亚维多利亚州）确定符合条件的患者，这些患者于 2013 年、2011 年和 2009 年诊断。数据包括年龄、居住地区、癌症诊断、诊断日期、治疗方式和分期。患者完成了多项经过验证的工具，包括 EQ-5D-5L 和 FACT-B、症状项目和未满足的需求。
在 1006 名符合条件的患者中，总体响应率为 45.6%。诊断后 1 年的幸存者在疼痛或不适（59.2%）和焦虑或抑郁（51.3%）方面的问题明显多于诊断后 5 年的幸存者（疼痛或不适分别为 45.1%，p<0.05 和 32.7%，焦虑或抑郁，p<0.01）。对于 5 年组，疼痛或不适和焦虑或抑郁明显高于一般人群（分别为 32.2%和 21.6%）。未接受化疗（系数=0.2269，p=0.0409）和没有长期健康状况（系数=0.6342，p<0.001）的患者生活质量得到改善。生活质量较差的患者与那些不确定乳腺癌进展情况的患者（系数=-0.3674，p=0.0094）和那些癌症未得到治疗、已治疗但仍存在或治疗后复发的患者（系数=-0.5314，p=0.0136）相关。在总队列中，女性对体重变化（21.3%）感到困扰，并担心压力对癌症的影响（19.6%）。对癌症复发的恐惧经常被报告，且随着时间的推移并未减少（分别为 60.7%、52.2%和 56.9%，在 1、3 和 5 年时）。
从基于人群的乳腺癌幸存者样本中收集患者报告的结果是可行的。身体症状和心理社会问题很常见且持续存在。使用化疗是唯一对 QoL 有显著影响的治疗方式。
