癌症康复：对乳腺癌幸存者工作能力和健康相关生活质量的影响。

Cancer Rehabilitation: Impact on Breast Cancer Survivors' Work Ability and Health-Related Quality of Life.

机构信息

ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA.

University of North Carolina at Chapel Hill, Chapel Hill, NC.

出版信息

J Natl Compr Canc Netw. 2024 Jun 13;22(5):315-321. doi: 10.6004/jnccn.2023.7329.

DOI:10.6004/jnccn.2023.7329

PMID:38871003

Abstract

BACKGROUND

Breast cancer survivors (BCSs) report persistent, diminished ability to work, and decreased health-related quality of life (HRQoL). Cancer rehabilitation interventions (physical therapy or occupational therapy [PT/OT]) aim to improve these outcomes, but little is known about their impact in the community.

METHODS

This retrospective, pre-post, uncontrolled study examined cases of younger BCSs (age <65 years) who attended cancer-specialized PT/OT over a 2-year period. Outcomes and covariates (age, race, US region, payer type, number of visits, length of care [weeks]) were extracted from electronic medical records. Patient-reported outcomes were overall-Work Ability Score (WASoverall), physical-WAS (WASphysical), and mental-WAS (WASmental) and PROMIS Global Physical Health (GPH), Global Mental Health (GMH), Physical Function (PF), and Ability to Participate in Social Roles and Activities (SRA). We used linear mixed effect models to examine pre- to post-rehabilitation change overall, and separately, while controlling for covariates.

RESULTS

PT/OT cases (NPT=758; NOT=140) had a mean [SD] age of 51.39 [8.49] years and attended approximately 12 visits (IQR, 8.0-19.0) over 10.71 weeks (IQR, 6.14-17.00). Overall, work ability outcomes (WASoverall: +1.79; WASphysical: +0.78; WASmental: +0.47; all P<.001) and HRQoL outcomes improved significantly (GPH: +5.38; GMH: +2.90; PF: +5.17; SRA: +5.83; all P<.001), and average change on each HRQoL outcome exceeded the minimal important change (2 points). Outcome scores were similar at each timepoint for both PT and OT cases (all P>.05) and both groups improved significantly (all P<.01).

CONCLUSIONS

In this large study of the impact of cancer-specialized, community-based PT and OT, younger BCSs reported significant improvement in ability to work and HRQoL. Although more research is needed, these findings suggest improved access to PT/OT could improve work ability and HRQoL for younger BCSs.

摘要

背景

乳腺癌幸存者（BCS）报告持续存在、工作能力下降，以及健康相关生活质量（HRQoL）下降。癌症康复干预措施（物理治疗或职业治疗[PT/OT]）旨在改善这些结果，但对其在社区中的影响知之甚少。

方法

这项回顾性、前后对照、非对照研究调查了在两年期间接受癌症专科 PT/OT 的年轻 BCS（年龄<65 岁）的病例。从电子病历中提取结局和协变量（年龄、种族、美国地区、付款类型、就诊次数、治疗时长[周]）。患者报告的结局包括总体工作能力评分（WASoverall）、身体-WAS（WASphysical）和心理-WAS（WASmental）以及 PROMIS 全球身体健康（GPH）、全球心理健康（GMH）、身体功能（PF）和参与社会角色和活动的能力（SRA）。我们使用线性混合效应模型来检查整体康复前后的变化，并在控制协变量的情况下分别进行检查。

结果

PT/OT 病例（NPT=758；NOT=140）的平均年龄为 51.39[8.49]岁，接受了约 12 次就诊（IQR，8.0-19.0），治疗时长为 10.71 周（IQR，6.14-17.00）。总体而言，工作能力结局（WASoverall：+1.79；WASphysical：+0.78；WASmental：+0.47；均 P<.001）和 HRQoL 结局显著改善（GPH：+5.38；GMH：+2.90；PF：+5.17；SRA：+5.83；均 P<.001），且每个 HRQoL 结局的平均变化都超过了最小重要差异（2 分）。在每个时间点，PT 和 OT 病例的结局得分均相似（均 P>.05），且两组的改善均显著（均 P<.01）。