Al-Kaylani Hend M, Loeffler Bradley T, Mott Sarah L, Curry Melissa, Phadke Sneha, van der Plas Ellen
Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, United States.
Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, IA, United States.
Front Psychol. 2022 May 6;13:871194. doi: 10.3389/fpsyg.2022.871194. eCollection 2022.
Younger age at diagnosis is a risk factor for poor health-related quality of life (HRQOL) in long-term breast cancer survivors. However, few studies have specifically addressed HRQOL in young adults with breast cancer (i.e., diagnosed prior to age 40), nor have early changes in HRQOL been fully characterized.
Eligible female patients with breast cancer were identified through our local cancer center. To establish HRQOL, patients completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) around diagnosis and 12 months later. Sociodemographic factors, genetic susceptibility to cancer, tumor- and treatment-related factors, and comorbidities (e.g., depression/anxiety) were abstracted from medical records and the local oncology registry. Mixed-effects models were used to identify changes in FACT-B scores during the first year of treatment and to determine whether any demographic/treatment-related factors modulated changes in scores.
Health-related quality of life in young patients with breast cancer was within normal limits at baseline, with a FACT-B overall well-being score of 108.5 (95% confidence limits [CI] = 103.7, 113.3). Participants reported slight improvements over a 12-month period: FACT-B overall well-being scores increased 6.6 points (95% CI = 2.1, 11.1, < 0.01), functional well-being improved 3.0 points (95% CI = 2.0, 4.1, < 0.01), emotional well-being improved 1.9 points (95% CI = 0.9, 2.8, < 0.01), and physical well-being improved 1.5 points (95% CI = 0.2, 2.8, = 0.03), on average. Participants with anxiety/depression at baseline reported greater improvements in FACT-B overall well-being (change: 12.9, 95% CI = 6.4, 9.5) and functional well-being (change: 5.2, 95% CI = 3.5, 6.9) than participants who did not have anxiety/depression at baseline (change in FACT-B overall well-being: 4.9, 95% CI = 0.2, 9.7; change in functional well-being: 2.3, 95% CI = 1.1, 3.4). Marital status, reconstructive surgery, and baseline clinical staging were also significantly associated with changes in aspects of HRQOL, although their impact on change was relatively minimal.
Young women with breast cancer do not report HRQOL concerns during the first year of treatment. Improvements in HRQOL during the first year of treatment may be attributable to a sense of relief that the cancer is being treated, which, in the short run, may outweigh the negative late effects of treatment.
诊断时年龄较小是长期乳腺癌幸存者健康相关生活质量（HRQOL）较差的一个风险因素。然而，很少有研究专门探讨年轻乳腺癌患者（即40岁之前确诊）的HRQOL，HRQOL的早期变化也尚未得到充分描述。
通过我们当地的癌症中心识别符合条件的女性乳腺癌患者。为评估HRQOL，患者在诊断时及12个月后完成了癌症治疗功能评估-乳腺癌（FACT-B）。社会人口统计学因素、癌症遗传易感性、肿瘤及治疗相关因素以及合并症（如抑郁/焦虑）从病历和当地肿瘤登记处提取。混合效应模型用于确定治疗第一年期间FACT-B评分的变化，并确定是否有任何人口统计学/治疗相关因素调节了评分变化。
年轻乳腺癌患者的健康相关生活质量在基线时处于正常范围内，FACT-B总体幸福感评分为108.5（95%置信区间[CI]=103.7,113.3）。参与者报告在12个月期间有轻微改善：FACT-B总体幸福感评分增加6.6分（95%CI=2.1,11.1，P<0.01），功能幸福感提高3.0分（95%CI=2.0,4.1，P<0.01），情绪幸福感提高1.9分（95%CI=0.9,2.8，P<0.01），身体幸福感平均提高1.5分（95%CI=0.2,2.8，P=0.03）。基线时有焦虑/抑郁的参与者在FACT-B总体幸福感（变化：12.9，95%CI=6.4,9.5）和功能幸福感（变化：5.2，95%CI=3.5,6.9）方面的改善比基线时没有焦虑/抑郁的参与者更大（FACT-B总体幸福感变化：4.9，95%CI=0.2,9.7；功能幸福感变化：2.3，95%CI=1.1,3.4）。婚姻状况、重建手术和基线临床分期也与HRQOL各方面的变化显著相关，尽管它们对变化的影响相对较小。
年轻乳腺癌女性在治疗的第一年没有报告HRQOL问题。治疗第一年期间HRQOL的改善可能归因于癌症正在得到治疗的解脱感，短期内，这种解脱感可能超过治疗的负面后期影响。
