Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Lung Cancer. 2022 Jan;163:42-50. doi: 10.1016/j.lungcan.2021.11.012. Epub 2021 Dec 2.
The number of lung cancer survivors is increasing along with advances in screening, diagnosis, and treatment. Following curative intent therapy, many lung cancer survivors experience significant health-related quality of life (HRQL) impairments. We sought to identify potentially modifiable factors that contribute to the HRQL of these patients.
In this cross-sectional observational study of disease-free, stage I-IIIA lung cancer survivors following curative intent therapy, we used a conceptual model to examine factors that included behavioral, objective functional and physiologic, self-rated function and symptom burden, specific comorbidities, and non-modifiable demographic and clinical lung cancer-related characteristics. We assessed HRQL using the valid and prognostic European Organization for Research and Treatment of Cancer Quality of Life (QoL) Core 30 global health/QoL subscale. We used univariable and multivariable linear regression modeling with backward elimination of potentially modifiable and non-modifiable factors, and interpreted clinically and statistically significant, consistent, and independent modifiable factors as meaningful.
Among 75 participants at a median of 12 months since treatment completion, the mean (standard deviation) C30 global health/QoL score was 62.7 (23.3) points (0-100 scale range). In multivariable analysis, with and without non-modifiable factors, we identified three clinically and statistically significant, consistent, and independent factors (unstandardized β range) associated with global health/QoL: 1) abnormal exercise-induced dyspnea (-9.23 to -10.0 points); 2) impaired self-rated role function (or inability to perform work or daily activities and pursuing leisure-time activities) (-12.6 to -16.4 points); and 3) abnormal insomnia (or trouble sleeping) (-12.6 to -16.4 points).
We identified meaningful modifiable factors associated with the HRQL of disease-free, stage I-IIIA lung cancer survivors following curative intent therapy. Interventions to improve the HRQL of these patients should aim to reduce exercise-induced dyspnea, improve role function - the ability to perform work and other daily including leisure-time activities, and control insomnia.
随着筛查、诊断和治疗的进步，肺癌幸存者的数量正在增加。在接受根治性治疗后，许多肺癌幸存者的健康相关生活质量（HRQL）受到严重影响。我们试图确定可能导致这些患者 HRQL 受损的可改变因素。
在这项针对接受根治性治疗后无疾病、I 期-IIIA 期肺癌幸存者的横断面观察性研究中，我们使用概念模型来检查包括行为、客观功能和生理、自我评估功能和症状负担、特定合并症以及不可改变的人口统计学和临床肺癌相关特征在内的因素。我们使用有效的欧洲癌症研究和治疗组织（EORTC）生存质量核心 30 全球健康/生存质量（QoL）量表评估 HRQL。我们使用单变量和多变量线性回归模型进行向后消除潜在的可改变和不可改变的因素，并将临床上和统计学上有意义的、一致的和独立的可改变因素解释为有意义的。
在 75 名参与者中，中位时间为治疗完成后 12 个月，C30 全球健康/QoL 评分的平均值（标准差）为 62.7（23.3）分（0-100 评分范围）。在多变量分析中，包括和不包括不可改变的因素，我们确定了三个与全球健康/QoL 相关的临床上和统计学上有意义的、一致的和独立的因素（未标准化β范围）：1）运动引起的呼吸困难异常（-9.23 至-10.0 分）；2）自我评估角色功能受损（或无法进行工作或日常活动以及从事休闲时间活动）（-12.6 至-16.4 分）；3）异常失眠（或睡眠困难）（-12.6 至-16.4 分）。
我们确定了与根治性治疗后无疾病、I 期-IIIA 期肺癌幸存者的 HRQL 相关的有意义的可改变因素。旨在改善这些患者 HRQL 的干预措施应旨在减少运动引起的呼吸困难，改善角色功能-执行工作和其他日常活动（包括休闲时间活动）的能力，并控制失眠。
