Veličković Katarina, Borrebaeck Carl A K, Bendahl Pär-Ola, Hegardt Cecilia, Johnsson Per, Richter Corinna, Rydén Lisa, Hallberg Ingalill Rahm
Department of Psychology, Lund University, Lund, Sweden.
Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden.
Front Oncol. 2022 Aug 16;12:891850. doi: 10.3389/fonc.2022.891850. eCollection 2022.
This study investigated the changes in health-related quality of life from diagnosis to 1 year after diagnosis in breast cancer (BC) patients and the influence of clinical, psychological, and sociodemographic variables. An additional aim was to explore the mediating and moderating effects of resilience on changes in health-related quality of life.
A longitudinal population-based study was conducted in southern Sweden. Newly diagnosed BC patients filled in measures of health-related quality of life, resilience, and sociodemographic variables at diagnosis ( = 980) and 1 year post-diagnosis ( = 780). Clinical variables were extracted from the Swedish national breast cancer quality registry. Mixed-model analyses were performed.
Most health-related quality of life outcomes declined from diagnosis to 1 year post-diagnosis. Role limitations due to emotional problems remained the same, whereas mental health improved. Lower health-related quality of life outcomes were associated with symptomatic detection and axillary dissection. Patients with a higher TNM stage and histologic grade and estrogen receptor (ER)-negative and human epidermal growth factor 2 (HER2)-positive status, who received chemotherapy, antibody therapy, or bisphosphonate therapy, had a steeper decline in outcomes. Changes in resilience were positively associated with all outcomes but did not mediate or moderate changes in any. Resilience at baseline moderated changes in bodily pain, vitality, and mental health, with higher baseline resilience being associated with a steeper decline, possibly due to floor or ceiling effects. Patients with lower socioeconomic status, educational level, and older age had a lower health-related quality of life.
Physical health-related quality of life among breast cancer patients declined 1 year post-diagnosis, whereas mental health-related quality of life improved. Low resilient patients may be especially vulnerable at diagnosis. Biopsychosocial assessment at diagnosis can help identify patients who may require additional support. A multidimensional treatment plan should be started early to help overcome the problems in everyday activities.
本研究调查了乳腺癌（BC）患者从诊断到诊断后1年健康相关生活质量的变化以及临床、心理和社会人口学变量的影响。另一个目的是探讨心理弹性对健康相关生活质量变化的中介和调节作用。
在瑞典南部进行了一项基于人群的纵向研究。新诊断的BC患者在诊断时（n = 980）和诊断后1年（n = 780）填写了健康相关生活质量、心理弹性和社会人口学变量的测量量表。临床变量从瑞典国家乳腺癌质量登记处提取。进行了混合模型分析。
从诊断到诊断后1年，大多数健康相关生活质量指标下降。因情绪问题导致的角色限制保持不变，而心理健康有所改善。较低的健康相关生活质量指标与症状性检测和腋窝淋巴结清扫有关。TNM分期较高、组织学分级较高、雌激素受体（ER）阴性和人表皮生长因子2（HER2）阳性且接受化疗、抗体治疗或双膦酸盐治疗的患者，其指标下降更为明显。心理弹性的变化与所有指标均呈正相关，但未介导或调节任何指标的变化。基线时的心理弹性调节了身体疼痛、活力和心理健康的变化，基线心理弹性较高与下降幅度较大有关，这可能是由于地板效应或天花板效应。社会经济地位较低、教育水平较低和年龄较大的患者健康相关生活质量较低。
乳腺癌患者诊断后1年与身体健康相关的生活质量下降，而与心理健康相关的生活质量有所改善。心理弹性低的患者在诊断时可能特别脆弱。诊断时的生物心理社会评估有助于识别可能需要额外支持的患者。应尽早启动多维治疗计划，以帮助克服日常活动中的问题。
