残疾、心理困扰与癌症诊断和癌症类型相关的生活质量：基于人群的 22505 例癌症幸存者和 244000 例无癌症人群的澳大利亚研究。

BACKGROUND: Improved survival means that cancer is increasingly becoming a chronic disease. Understanding and improving functional outcomes are critical to optimising survivorship. We quantified physical and mental health-related outcomes in people with versus without cancer, according to cancer type. METHODS: Questionnaire data from an Australian population-based cohort study (45 and Up Study (n = 267,153)) were linked to cancer registration data to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes-severe physical functional limitations (disability), moderate/high psychological distress and fair/poor quality of life (QoL)-in participants with versus without cancer, for 13 cancer types. RESULTS: Compared to participants without cancer (n = 244,000), cancer survivors (n = 22,505) had greater disability (20.6% versus 12.6%, respectively, PR = 1.28, 95%CI = (1.25-1.32)), psychological (22.2% versus 23.5%, 1.05 (1.02-1.08)) and poor/fair QoL (15.2% versus 10.2%; 1.28 (1.24-1.32)). The outcomes varied by cancer type, being worse for multiple myeloma (PRs versus participants without cancer for disability 3.10, 2.56-3.77; distress 1.53, 1.20-1.96; poor/fair QoL 2.40, 1.87-3.07), lung cancer (disability 2.81, 2.50-3.15; distress 1.67, 1.46-1.92; poor/fair QoL 2.53, 2.21-2.91) and non-Hodgkin's lymphoma (disability 1.56, 1.37-1.78; distress 1.20, 1.05-1.36; poor/fair QoL 1.66, 1.44-1.92) and closer to those in people without cancer for breast cancer (disability 1.23, 1.16-1.32; distress 0.95, 0.90-1.01; poor/fair QoL 1.15, 1.05-1.25), prostate cancer (disability 1.11, 1.04-1.19; distress 1.09, 1.02-1.15; poor/fair QoL 1.15, 1.08-1.23) and melanoma (disability 1.02, 0.94-1.10; distress 0.96, 0.89-1.03; poor/fair QoL 0.92, 0.83-1.01). Outcomes were worse with recent diagnosis and treatment and advanced stage. Physical disability in cancer survivors was greater in all population subgroups examined and was a major contributor to adverse distress and QoL outcomes. CONCLUSIONS: Physical disability, distress and reduced QoL are common after cancer and vary according to cancer type suggesting priority areas for research, and care and support.

背景：随着癌症患者生存率的提高，癌症逐渐成为一种慢性病。了解并改善癌症患者的功能预后对改善患者的生存质量至关重要。本研究旨在评估不同癌症类型对癌症患者和非癌症患者的身心健康相关结局的影响。

方法：本研究利用澳大利亚人群队列研究（45 and Up Study）的数据（共纳入 267153 名参与者），通过与癌症登记数据进行链接，确定了参与者在入组前的癌症诊断情况。采用改良泊松回归估计了癌症患者与非癌症患者在 13 种癌症类型中的不良个体为中心结局（严重的身体功能障碍、中度/重度心理困扰和较差/极差的生活质量）的年龄和性别调整患病率比（PR）。

结果：与非癌症患者（n=244000）相比，癌症幸存者（n=22505）的残疾发生率更高（20.6% vs. 12.6%，PR=1.28，95%CI=1.25-1.32），心理困扰发生率（22.2% vs. 23.5%，PR=1.05，95%CI=1.02-1.08）和较差/极差的生活质量发生率（15.2% vs. 10.2%，PR=1.28，95%CI=1.24-1.32）也更高。癌症类型的不同也会导致不同的结局，多发性骨髓瘤（残疾 PR 3.10，2.56-3.77；心理困扰 PR 1.53，1.20-1.96；较差/极差的生活质量 PR 2.40，1.87-3.07）、肺癌（残疾 PR 2.81，2.50-3.15；心理困扰 PR 1.67，1.46-1.92；较差/极差的生活质量 PR 2.53，2.21-2.91）和非霍奇金淋巴瘤（残疾 PR 1.56，1.37-1.78；心理困扰 PR 1.20，1.05-1.36；较差/极差的生活质量 PR 1.66，1.44-1.92）患者的结局比非癌症患者更差，而乳腺癌（残疾 PR 1.23，1.16-1.32；心理困扰 PR 0.95，0.90-1.01；较差/极差的生活质量 PR 1.15，1.05-1.25）、前列腺癌（残疾 PR 1.11，1.04-1.19；心理困扰 PR 1.09，1.02-1.15；较差/极差的生活质量 PR 1.15，1.08-1.23）和黑色素瘤（残疾 PR 1.02，0.94-1.10；心理困扰 PR 0.96，0.89-1.03；较差/极差的生活质量 PR 0.92，0.83-1.01）患者的结局则更接近非癌症患者。近期诊断和治疗以及晚期癌症患者的身心健康结局更差。癌症幸存者的身体残疾在所有研究的人群亚组中都更为普遍，是导致不良心理困扰和生活质量结局的主要原因之一。

结论：癌症患者的身体残疾、心理困扰和生活质量下降较为常见，且因癌症类型而异，这提示我们需要优先开展相关研究，为癌症患者提供更好的护理和支持。