检查老年癌症幸存者的个体和多种合并症及与健康相关的生活质量。
Examination of individual and multiple comorbid conditions and health-related quality of life in older cancer survivors.
机构信息
Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
Cancer Prevention Fellowship Program, National Cancer Institute, Rockville, MD, USA.
出版信息
Qual Life Res. 2021 Apr;30(4):1119-1129. doi: 10.1007/s11136-020-02713-0. Epub 2021 Jan 14.
PURPOSE
Older cancer survivors (≥ 65 years at diagnosis) are at high-risk for multimorbidity (2 + comorbid conditions). However, few studies have utilized a generalizable sample of older cancer survivors to understand how individual comorbid conditions, as opposed to total comorbidity burden, are associated with health-related quality of life (HRQOL). We examined associations between HRQOL outcomes (pain, fatigue, physical function), individual comorbidities (cardiovascular disease [CVD], lung disease, diabetes, arthritis) and total comorbidity (cancer-only, cancer + 1 condition, cancer + 2 or more conditions).
METHODS
Utilizing a population-based sample of 2019 older cancer survivors, we tested associations between comorbid conditions and the HRQOL outcomes using generalized linear models. HRQOL domains were assessed using Patient-Reported Outcome Measurement Information System (PROMIS) measures. Comorbidity was assessed via self-report.
RESULTS
Cancer survivors with lung disease reported significantly worse physical functioning (β = - 4.96, p < 0.001), survivors with arthritis reported significantly higher pain (β = 4.37, p < 0.001), and survivors with CVD reported significantly higher fatigue (β = 3.45, p < 0.001) compared to survivors without each condition. Having cancer + 1 condition was not as strongly associated with all outcomes as when individual conditions were tested (e.g. pain: β = 3.09, p < 0.001). Having 2+ comorbidities had a stronger association with all outcomes (e.g. physical function: β = - 7.51, p < 0.001) than examining conditions individually.
CONCLUSIONS
Knowing the specific comorbid condition profile of an older cancer survivor provides insight into specific HRQOL outcomes that may be impaired in cancer survivorship, but understanding total comorbidity burden, regardless of the specific conditions, sheds light on survivors at-risk for multiple impairments in HRQOL. This information, taken together, can inform risk-stratified survivorship care.
目的
老年癌症幸存者（诊断时年龄≥65 岁）患有多种疾病（≥2 种合并症）的风险很高。然而，很少有研究利用具有代表性的老年癌症幸存者样本来了解个体合并症与健康相关生活质量（HRQOL）之间的关系，而不是总合并症负担。我们研究了 HRQOL 结局（疼痛、疲劳、身体功能）、个体合并症（心血管疾病[CVD]、肺部疾病、糖尿病、关节炎）与总合并症（仅癌症、癌症+1 种疾病、癌症+2 种或更多疾病）之间的关联。
方法
利用 2019 年老年癌症幸存者的基于人群的样本，我们使用广义线性模型检验了合并症与 HRQOL 结局之间的关联。HRQOL 领域使用患者报告的结果测量信息系统（PROMIS）措施进行评估。合并症通过自我报告进行评估。
结果
患有肺部疾病的癌症幸存者报告的身体功能明显更差（β=-4.96，p<0.001），患有关节炎的幸存者报告的疼痛明显更高（β=4.37，p<0.001），患有 CVD 的幸存者报告的疲劳明显更高（β=3.45，p<0.001），而没有这些疾病的幸存者。患有癌症+1 种疾病与所有结局的相关性并不像单独测试个体疾病时那样强（例如疼痛：β=3.09，p<0.001）。患有 2 种或更多合并症与所有结局的相关性更强（例如身体功能：β=-7.51，p<0.001），而单独检查疾病时则较弱。
结论
了解老年癌症幸存者的具体合并症情况可以深入了解癌症生存中可能受损的特定 HRQOL 结局，但了解总合并症负担，无论具体情况如何，都可以了解 HRQOL 受损风险较高的幸存者。这些信息结合在一起，可以为风险分层的生存护理提供信息。
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