Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Gynecol Oncol. 2021 Jan;160(1):252-259. doi: 10.1016/j.ygyno.2020.10.022. Epub 2020 Nov 1.
Our goal was to pragmatically describe patient reported outcomes (PROs) in a typical clinic population of vulvar cancer patients, as prior studies of vulvar cancer PROs have examined clinical trial participants.
A prospective PRO program was implemented in the Gynecologic Oncology clinic of a tertiary academic institution in January 2018. Vulvar cancer patients through September 2019 were administered the European Organization for the Research and Treatment of Cancer Quality of life Questionnaire, the Patient Reported Outcome Measurement Information System Instrumental and Emotional Support Scales, and the Functional Assessment of Cancer Therapy-Vulvar questionnaire. Binary logistic regressions were performed to determine adjusted odds ratios for adverse responses to individual questions by insurance, stage, age, time since diagnosis, recurrence, radiation, and surgical radicality.
Seventy vulvar cancer patients responded to PROs (85.4% response rate). Seventy-one percent were > 1 year since diagnosis, 61.4% had stage I disease, and 28.6% recurred. Publicly insured women had less support and worse quality of life (QOL, aOR 4.15, 95% CI 1.00-17.32, p = 0.05). Women who recurred noted more interference with social activities (aOR 4.45, 95% CI 1.28-15.41, p = 0.019) and poorer QOL (aOR 5.22 95% CI 1.51-18.10, p = 0.009). There were no major differences by surgical radicality. Those >1 year since diagnosis experienced less worry (aOR 0.17, 95% CI 0.04-0.63, p = 0.008).
Surgical radicality does not affect symptoms or QOL in vulvar cancer patients, whereas insurance, recurrence, and time since diagnosis do. This data can improve counseling and awareness of patient characteristics that would benefit from social services referral.
我们的目标是在典型的外阴癌患者临床人群中务实描述患者报告的结局（PROs），因为之前关于外阴癌 PROs 的研究仅检查了临床试验参与者。
2018 年 1 月，在一家三级学术机构的妇科肿瘤诊所实施了前瞻性 PRO 计划。通过 2019 年 9 月，为外阴癌患者提供了欧洲癌症研究与治疗组织生活质量问卷、患者报告结局测量信息系统工具和情绪支持量表以及癌症治疗功能评估-外阴问卷。进行二元逻辑回归，以确定按保险、分期、年龄、诊断后时间、复发、放疗和手术根治性等因素调整对个别问题的不良反应的调整比值比。
70 名外阴癌患者对 PROs 做出了回应（85.4%的回应率）。71%的患者诊断后时间>1 年，61.4%的患者为 I 期疾病，28.6%的患者复发。有公共保险的女性获得的支持较少，生活质量较差（aOR 4.15，95%CI 1.00-17.32，p=0.05）。复发的女性注意到更多的社交活动受到干扰（aOR 4.45，95%CI 1.28-15.41，p=0.019）和较差的生活质量（aOR 5.22 95%CI 1.51-18.10，p=0.009）。手术根治性无明显差异。诊断后时间>1 年的患者，忧虑程度较低（aOR 0.17，95%CI 0.04-0.63，p=0.008）。
手术根治性并不影响外阴癌患者的症状或生活质量，而保险、复发和诊断后时间会影响。这些数据可以改善咨询和患者特征的认识，这将有利于社会服务转介。
