Gu Renjun, Chen Hao, Wang Xian, Jin Xiaoyuan, Jiang Fengyang, Zhao Wenhe, Yun Jingyi, Zhou Jie, Wang Hongmei
Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China.
Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang, China.
Qual Life Res. 2023 Apr;32(4):1069-1084. doi: 10.1007/s11136-022-03269-x. Epub 2022 Oct 19.
Adolescent and young adult (AYA) cancer survivors (first diagnosed with cancer at age 15-39) are distinct within the cancer community due to their unique challenges and diverse psycho-behavioral characteristics. This study aimed to analyze psycho-behavioral pathways and further explore the mediating role of cognitive appraisals on AYA cancer survivors' quality of life (QoL).
Three hundred and eighty-nine AYA cancer survivors were eligible for analyses and recruited to self-administer questionnaires on QoL (the Chinese version of EORTC Quality of Life Questionnaire-C30 v3.0), resilience, coping, and appraisal on site. This study performed structural equation modeling (SEM) to examine pathways on QoL based on the Rapkin & Schwartz QoL Appraisal Model.
The average age of participants (47.6% female) was 32.7 ± 4.1 years. The SEM results closely fit the measured data (RMSEA = 0.053, GFI = 0.955, CFI = 0.964, SRMR = 0.052). The final model showed direct negative effects of later clinical-stage, more comorbidities, and more Acceptance-Resignation coping on QoL; indirect positive effects of better resilience on QoL through less Acceptance-Resignation coping (β = 0.286, P = 0.002). Appraisal mediated the effects of treatment and resilience on QoL (β = -0.024, P = 0.038). Further, Calm, Peaceful, and Active appraisal patterns were associated with improved Cognitive Functioning (β = 0.119, P = 0.009).
Appraisal, coping, and resilience could significantly mediate the effects of cancer and its treatment on the QoL of AYA cancer survivors. Future interventions targeting cognitive appraisals and psycho-behaviors will be helpful. Figuring out what matters to such a unique population and how they appraise a cancer diagnosis through treatment trajectories could help nurses adjust support.
青少年及青年（AYA）癌症幸存者（首次确诊癌症时年龄为15 - 39岁）因其独特的挑战和多样的心理行为特征，在癌症群体中较为特殊。本研究旨在分析心理行为途径，并进一步探讨认知评估对AYA癌症幸存者生活质量（QoL）的中介作用。
389名AYA癌症幸存者符合分析条件，并被招募至现场自行填写关于生活质量（欧洲癌症研究与治疗组织生活质量问卷C30中文版v3.0）、心理韧性、应对方式及评估的问卷。本研究采用结构方程模型（SEM），基于拉普金和施瓦茨生活质量评估模型检验生活质量途径。
参与者的平均年龄为32.7 ± 4.1岁（女性占47.6%）。结构方程模型结果与实测数据拟合良好（RMSEA = 0.053，GFI = 0.955，CFI = 0.964，SRMR = 0.052）。最终模型显示，较晚的临床分期、更多的合并症以及更多的接受 - 顺从应对方式对生活质量有直接负面影响；更好的心理韧性通过较少的接受 - 顺从应对方式对生活质量有间接正面影响（β = 0.286，P = 0.002）。评估介导了治疗和心理韧性对生活质量的影响（β = -0.024，P = 0.038）。此外，平静、安宁和积极的评估模式与改善的认知功能相关（β = 0.119，P = 0.009）。
评估、应对方式和心理韧性可显著介导癌症及其治疗对AYA癌症幸存者生活质量的影响。未来针对认知评估和心理行为的干预将有所帮助。弄清楚对这样一个独特群体重要的事情以及他们如何通过治疗轨迹评估癌症诊断，有助于护士调整支持措施。
