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[乳腺癌肿瘤治疗后的早期和晚期毒性以及社会医学相关疾病——康复需求的影响与评估]

[Early and Late Toxicities and Socio-Medical Relevant Disorders after Oncological Treatment for Breast Cancer-Implications and Assessment of Rehabilitation Requirement].

作者信息

Hass Holger G, Seywald Marianne, Stepien Jürgen, Muco Blerta, Tanriverdi Miro, Beckmann Matthias W, Kunzmann Volker, Wöckel Achim

机构信息

Paracelsus-Klinik, Scheidegg.

Institut für Rehabilitationsforschung und Survivorship (IREFOS), Scheidegg.

出版信息

Rehabilitation (Stuttg). 2021 Apr;60(2):77-85. doi: 10.1055/a-1361-3666. Epub 2021 Apr 15.

DOI:10.1055/a-1361-3666
PMID:33858016
Abstract

INTRODUCTION

Reasonable to the improved prognosis of breast cancer (BC) long-term toxicities and side effects of oncological therapy gain more importance for work ability and social life of BC patients. Aim of this study was the analysis of occurence and differences of treatment-related side effects in relation to type of rehabilitation (so-called AHB vs. later rehabilitation) after therapy for BC.

METHODS

Clinical and patient related data as early and late toxicities after oncological treatment of 8.000 patients with BC (55.7±10.4y) were analyzed and compared with current literature.

RESULTS

In 23.9% a mastectomy was performed, in 87.3% radiotherapy. In most cases an additional systemic treatment (57,6% CTX, 15,1% anti-Her2, 71% antihormonal treatment) was carried out. In 8.1% women suffered from recurrent or metastatic BC. As most common side effects of multimodal treatment weakness/fatigue (73,6%), insomnia (51,9%), CIPN (33%), lymph edema (13,9%) and drug-induced arthralgia (24,8%) were detected. In addition, 60.4% of women reported high levels of psychological distress. Shortly after therapy typical side effects were drug-induced toxicities (Leucopenia, p<0.0001; anemia, p<0.001; weakness/fatigue p<0.001; CIPN, p<0.0001), whereas in a later course chronic lymphedema (p<0.0001), chronic or recurrent disease (p<0.0001), status after mastectomy (p<0.0001) and psychological distress (p<0.0001) were significantly more often seen. Moreover, in this collective patients were significantly younger (53,7±9,8 vs. 56,3±10,7y).

CONCLUSIONS

In BC patients, significantly different impairments and toxicities were documented between patients with early rehabilitation and patients with later onset of rehabilitation. These data may help to establish more individual and focused rehabilitation concepts in specialized centers.

摘要

引言

鉴于乳腺癌(BC)预后的改善,肿瘤治疗的长期毒性和副作用对BC患者的工作能力和社会生活愈发重要。本研究的目的是分析BC治疗后与康复类型(所谓的早期康复与后期康复)相关的治疗相关副作用的发生率及差异。

方法

分析了8000例BC患者(55.7±10.4岁)肿瘤治疗后的临床及患者相关数据,包括早期和晚期毒性,并与现有文献进行比较。

结果

23.9%的患者接受了乳房切除术,87.3%的患者接受了放疗。大多数情况下还进行了额外的全身治疗(57.6%为化疗,15.1%为抗HER2治疗,71%为抗激素治疗)。8.1%的女性患有复发性或转移性BC。多模式治疗最常见的副作用为虚弱/疲劳(73.6%)、失眠(51.9%)、化疗引起的周围神经病变(CIPN,33%)、淋巴水肿(13.9%)和药物性关节痛(24.8%)。此外,60.4%的女性报告有高度心理困扰。治疗后不久,典型的副作用为药物性毒性(白细胞减少,p<0.0001;贫血,p<0.001;虚弱/疲劳,p<0.001;CIPN,p<0.0001),而在后期,慢性淋巴水肿(p<0.0001)、慢性或复发性疾病(p<0.0001)、乳房切除术后状态(p<0.0001)和心理困扰(p<0.0001)更为常见。此外,该队列中的患者明显更年轻(53.7±9.8岁对56.3±10.7岁)。

结论

在BC患者中,早期康复患者与后期康复患者的功能障碍和毒性存在显著差异。这些数据可能有助于在专业中心建立更具个性化和针对性的康复理念。

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