Biostatistics, School of Public Health & Community Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Occupational & Environmental Medicine, School of Public Health & Community Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Cancer Med. 2023 Aug;12(16):17377-17388. doi: 10.1002/cam4.6356. Epub 2023 Jul 24.
Radiation-induced fecal urgency syndrome is highly prevalent in gynecological cancer survivors. It is associated with decreased quality of life (QoL) and with disability pension. The literature remains unclear about the mediating role of physical and psychological aspects of QoL in the association between urgency syndrome and disability pension. Identifying the pathways between urgency syndrome and disability pension may help to create effective and timely interventions for increasing QoL and reducing disability pension among gynecological cancer survivors.
We used patient-reported outcome measures from working-age gynecological cancer survivors (n = 247) and data on their disability pension from the official register. The mediating role of physical and psychological aspects of QoL was studied by utilizing mediation analysis based on the counterfactual framework, appropriate for binary outcome, binary mediator with an exposure-mediator interaction. The total effect (TE) was divided into direct and indirect effects using single mediation analysis. Adjusted relative risks and percentage mediated (95% confidence intervals) were calculated. All statistical tests were two-sided.
Urgency syndrome increased the risk of disability pension both directly and indirectly (via QoL). Satisfaction with sleep mediated half of the TE (RR = 2.2 (1.1-4.1)) of urgency syndrome on disability pension. Physical health also mediated a similar proportion of the TE (RR = 2.1 (1.2-3.9)). The proportions mediated were higher for physical aspects of QoL (35%-71%) than for psychological aspects (2%-47%).
The investigated aspects of the self-assessed QoL of gynecological cancer survivors may play a role in these women's continuing work-life. It appears that physical health, satisfaction with sleep, psychological well-being, and other investigated aspects of QoL mediate the urgency syndrome-disability pension association.
辐射诱导的粪便紧急综合征在妇科癌症幸存者中非常普遍。它与生活质量（QoL）下降和残疾抚恤金有关。文献对于 QoL 的身体和心理方面在紧迫性综合征与残疾抚恤金之间的关联中的中介作用仍不清楚。确定紧迫性综合征与残疾抚恤金之间的途径可能有助于为提高妇科癌症幸存者的 QoL 和减少残疾抚恤金创造有效和及时的干预措施。
我们使用了来自处于工作年龄的妇科癌症幸存者（n=247）的患者报告的结果测量和官方登记处关于他们残疾抚恤金的数据。利用基于反事实框架的中介分析研究了 QoL 的身体和心理方面的中介作用，该框架适用于二项结果、具有暴露-中介相互作用的二项中介。使用单一中介分析将总效应（TE）分为直接和间接效应。计算了调整后的相对风险和中介百分比（95%置信区间）。所有统计检验均为双侧。
急迫综合征直接和间接（通过 QoL）增加了残疾抚恤金的风险。对睡眠的满意度部分中介了急迫综合征对残疾抚恤金的 TE（RR=2.2（1.1-4.1））。身体健康也部分中介了类似比例的 TE（RR=2.1（1.2-3.9））。身体方面的 QoL 中介比例（35%-71%）高于心理方面（2%-47%）。
妇科癌症幸存者自我评估的 QoL 的各个方面可能在这些女性继续工作和生活中发挥作用。似乎身体健康、睡眠满意度、心理幸福感和其他调查的 QoL 方面在紧迫性综合征-残疾抚恤金关联中起中介作用。
