Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Ann Surg Oncol. 2021 Nov;28(12):7196-7205. doi: 10.1245/s10434-021-10026-w. Epub 2021 Apr 19.
To assess whether higher dispositional optimism could predict better health-related quality of life (HRQL) after esophageal cancer surgery.
This Swedish nationwide longitudinal study included 192 patients who underwent esophagectomy for cancer. The exposure was dispositional optimism measured by the Life Orientation Test-Revised (LOT-R) at 1 year post-surgery. Patients were categorized into four subgroups (very low, moderately low, moderately high, and very high dispositional optimism) based on the quartile of the LOT-R sum score. The outcome was HRQL assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and Quality of Life Questionnaire-Esophago-Gastric module 25 (QLQ-OG25) at 1, 1.5, and 2 years post-surgery. Linear mixed-effects models, adjusted for potential confounders, were used to examine the mean score difference (MSD) with 95% confidence interval of HRQL among the four patient subgroups.
Patients with very high dispositional optimism reported clinically relevantly better global quality of life, emotional function, and social function (MSD range 10-16) and less severe symptoms in pain, dyspnea, diarrhea, eating difficulty, anxiety, dry mouth, trouble with taste, worry about weight loss, and self-doubt about body image (MSD range - 9 to - 22) than patients with lower dispositional optimism. Patients with moderately high dispositional optimism reported clinically and statistically significantly better global quality of life (MSD 10) and less severe diarrhea (MSD - 9) than patients with lower dispositional optimism. Adjusted MSDs were constant over the three time points in all aspects except for eating difficulty.
Measuring dispositional optimism could help identify patients at higher risk of poor HRQL recovery after esophageal cancer surgery.
评估倾向性乐观是否可以预测食管癌手术后患者健康相关生活质量（HRQL）的改善。
本项瑞典全国性纵向研究纳入了 192 名接受食管癌切除术的患者。在手术后 1 年，采用修订版生活取向测试（LOT-R）来评估倾向性乐观。根据 LOT-R 总分的四分位数，将患者分为四个亚组（非常低、中度低、中度高和非常高倾向性乐观）。使用欧洲癌症研究与治疗组织（EORTC）生活质量核心 30 问卷（QLQ-C30）和食管胃模块 25 问卷（QLQ-OG25）评估患者在手术后 1、1.5 和 2 年的 HRQL，作为结局指标。采用线性混合效应模型，调整潜在混杂因素后，分析四个患者亚组之间 HRQL 平均得分差异（MSD）及其 95%置信区间。
倾向性乐观程度高的患者报告的总体健康状况、情绪功能和社会功能明显更好（MSD 范围 10-16），疼痛、呼吸困难、腹泻、吞咽困难、焦虑、口干、味觉障碍、体重减轻担忧和自我身体意象怀疑等症状较轻（MSD 范围 -9 至-22），而倾向于乐观程度低的患者。与倾向于乐观程度低的患者相比，倾向于乐观程度中高的患者报告的总体健康状况更好（MSD 10），腹泻症状较轻（MSD -9）。除了吞咽困难之外，所有方面的调整 MSD 在三个时间点都保持不变。
测量倾向性乐观程度可以帮助识别食管癌手术后 HRQL 恢复不良风险较高的患者。
