Noeres Dorothee, Sperlich Stefanie, Röbbel Lena, Safieddine Batoul, Deuker Jörg Uwe, Hillemanns Peter, Ismaéel Fakher, Moser Alexander, Noeding Karl-Heinz, Noesselt Thomas, Pape Joachim, Park-Simon Tjoung-Won, Peschel Susanne, Seifert Wolfram, Siggelkow Wulf, Thoma Martin, Uleer Christoph, Geyer Siegfried
Forschungs- und Lehreinheit Medizinische Soziologie, Med. Hochschule Hannover.
Vinzenzkrankenhaus, Hannover.
Rehabilitation (Stuttg). 2021 Apr;60(2):86-94. doi: 10.1055/a-1361-4028. Epub 2021 Apr 15.
This study explores the sociodemographic, medical and work-related factors leading to a participation in an in-house rehabilitation measure after primary treatment for breast cancer.
The prospective multi-center study is based on a written survey with employed breast cancer patients who were recruited at 11 breast cancer centers in Lower Saxony, Germany. Predictors of participation were examined by logistic regression, predictors of the time period before starting the rehabilitation by linear regression.
409 patients returned their questionnaires at all three time-points. Response rates were 80,1% 3 weeks after surgery (t0), 95,2% 6 months after surgery (t1) and 89,9% one year after surgery (t2). Altogether, 294 patients (72%) participated in the rehabilitation measure. Respondents, 90% of whom participated in rehabilitation before returning to work, began their rehabilitation on average 21 weeks after primary surgery. They showed an increased probability of participation if they had indicated the need to clarify their job situation (OR=2,74, p<0,01), or if their answers displayed a detrimental relation between effort and reward at work (OR=3,89, p<0,05). At the same time, higher age, a higher level of school education (OR=4,23) and reduced physical health (OR=0,94, p<0,01) increased the chance for breast cancer patients to take part in oncological rehabilitation. The starting point of rehabilitation was only predictable by medical treatments: adjuvant chemotherapy (β=0,492, p≤0,001), additional surgery (β=0,112, p<0,05), and radiation therapy within the second half year after primary surgery (β=0,20; p<0,001) led to a postponement.
This study shows that an increased need of breast cancer patients for medical and socio-psychological support leads to their participation in an in-house rehabilitation and thus underlines the necessity of these institutions. Women with an impaired psychological health should be given extra attention.
本研究探讨乳腺癌初次治疗后参与院内康复措施的社会人口学、医学及工作相关因素。
这项前瞻性多中心研究基于对德国下萨克森州11家乳腺癌中心招募的在职乳腺癌患者进行的书面调查。通过逻辑回归分析参与康复的预测因素，通过线性回归分析开始康复前时间段的预测因素。
409名患者在所有三个时间点都返回了问卷。术后3周（t0）的回复率为80.1%，术后6个月（t1）为95.2%，术后1年（t2）为89.9%。共有294名患者（占72%）参与了康复措施。受访者中，90%在重返工作岗位前参与了康复，他们在初次手术后平均21周开始康复。如果他们表示需要明确工作状况（比值比=2.74，p<0.01），或者其回答显示工作中努力与回报之间存在不利关系（比值比=3.89，p<0.05），则参与康复的可能性增加。同时，年龄较大、受教育程度较高（比值比=4.23）以及身体健康状况较差（比值比=0.94，p<0.01）会增加乳腺癌患者参与肿瘤康复的机会。康复的起始点仅可通过医学治疗来预测：辅助化疗（β=0.492，p≤0.001）、额外手术（β=0.112，p<0.05）以及初次手术后半年内的放射治疗（β=0.20；p<0.001）会导致康复推迟。
本研究表明，乳腺癌患者对医学及社会心理支持需求的增加导致他们参与院内康复，从而强调了这些机构的必要性。心理健康受损的女性应给予额外关注。
