食管癌手术后 2 年内的心理困扰和健康相关生活质量：全国范围内基于人群的研究。
Psychological distress and health-related quality of life up to 2 years after oesophageal cancer surgery: nationwide population-based study.
机构信息
Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.
出版信息
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa038.
BACKGROUND
Patients are at higher risk of suffering from psychological distress and reduced health-related quality of life (HRQoL) after oesophageal cancer surgery. This Swedish nationwide population-based longitudinal study aimed to evaluate the association between psychological distress and HRQoL up to 2 years after oesophageal cancer surgery.
METHODS
The study included patients with oesophageal cancer who had survived for 1 year after oesophageal cancer surgery. The exposure was psychological distress measured using the Hospital Anxiety and Depression Scale. Patients scoring at least 8 on either the anxiety or the depression subscale were classified as having psychological distress. The outcome was HRQoL assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire generic and disease-specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Exposure and outcome were measured at 1, 1.5, and 2 years after operation. Fixed-effects models with adjustment for all time-invariant confounding and potential time-varying confounders were used to examine the mean score difference in HRQoL between patients with and without psychological distress.
RESULTS
In total, 180 patients were analysed. Clinically relevant, statistically significant and time-constant mean score differences were found in emotional function, social function, dyspnoea, anxiety, eating difficulty, eating in front of others, and weight loss (mean score difference range 10-29). Mean score differences for global quality of life, cognitive function, appetite loss, EORTC QLQ-C30 summary score, and trouble with taste increased over time, and reached clinical and statistical significance at 1.5 and/or 2 years after surgery. For body image, there was a clinically relevant decrease in mean score difference over time.
CONCLUSION
Psychological distress was associated with several aspects of poor HRQoL up to 2 years after surgery for oesophageal cancer.
背景
食管癌手术后，患者面临更高的心理困扰和健康相关生活质量（HRQoL）下降风险。本项瑞典全国范围内基于人群的纵向研究旨在评估食管癌手术后 2 年内心理困扰与 HRQoL 之间的关系。
方法
本研究纳入了食管癌手术后生存 1 年以上的患者。使用医院焦虑和抑郁量表（Hospital Anxiety and Depression Scale）评估心理困扰。焦虑或抑郁亚量表得分至少为 8 分的患者被归类为有心理困扰。通过欧洲癌症研究和治疗组织（European Organisation for Research and Treatment of Cancer）生活质量问卷通用和疾病特异性问卷（EORTC QLQ-C30 和 QLQ-OG25）评估 HRQoL 作为结局。在手术后 1、1.5 和 2 年时进行暴露和结局测量。使用固定效应模型，调整所有时间不变的混杂因素和潜在的时间变化的混杂因素，来检验有和无心理困扰患者之间 HRQoL 的平均得分差异。
结果
共分析了 180 例患者。在情感功能、社会功能、呼吸困难、焦虑、进食困难、在他人面前进食和体重减轻方面，发现了具有临床意义且统计学显著且持续存在的平均得分差异（平均得分差异范围为 10-29）。总体健康状况、认知功能、食欲下降、EORTC QLQ-C30 总评分和味觉障碍的平均得分差异随时间增加，术后 1.5 年和/或 2 年时达到临床和统计学意义。身体形象方面，平均得分差异随时间呈持续下降趋势。
结论
食管癌手术后 2 年内，心理困扰与多个方面的 HRQoL 较差相关。
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