Abdelrahman Salsabil Mohammed, Ibraheem Maher Hassan, Allam Hemat, Sewram Vikash
African Cancer Institute, Division of Health Systems and Pubic Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch, Cape Town, South Africa.
Department of Breast Surgery, Baheya Foundation, 4, Allouba St., El Haram St, 12511, Giza, Egypt.
BMC Womens Health. 2025 Feb 1;25(1):43. doi: 10.1186/s12905-025-03571-z.
Breast cancer treatment has many strategies, each with its own effects on survivors' quality of life (QoL). The current study evaluated factors influencing QoL in women who have undergone mastectomy and compared different treatments based on sociodemographic and clinical factors.
A retrospective cohort study was conducted utilizing the EORTC Quality of Life breast cancer specific tool and the FACT-B and FBSI questionnaires to measure functional and symptom scales impacting QoL. The questionnaire was administered to 318 Egyptian women post-mastectomy and at 6-month follow-up. Results were reported as median and interquartile range (IQR) or frequency and percentage. Fisher's exact and Kruskal-Wallis tests were used for statistical inferences. Generalized linear models were used to predict QoL measures (outcome) by sociodemographic and clinical variables (independent) with adjusting for potential confounders. Independent variables were selected by elastic net regression.
The Global QoL score for this cohort was 42.0 (IQR 25.0-67.0). The functional scale most affected was role (62%), with the cognition having the lowest effect. The most distressing symptoms on the symptom scale were fatigue (65%), insomnia (61%), and pain (60%). FACT-B had a median score of 79.0 (IQR 63.0-95.0). Generalized linear regression indicated that higher cognitive functioning (22.45; p < 0.050) and BCS (6.026, p < 0.010) was positively correlated with women > 60 years old. Urban women correlated with a lower SWB (-2.679, p < 0.05) and higher degree of insomnia. A BMI > 30 correlated negatively with many of the QoL domains. SM or MRM with reconstruction correlated positively with TQOL (8.109 < p < 0.050). Women who received chemotherapy had lower social functioning (-12.41, p < 0.050), BCS (-3.473, p < 0.010), greater association with diarrhoea (8.865, p < 0.010) and financial difficulties (15.23, p < 0.050). In contrast, women who received hormonal therapy had higher role functioning (17.64, p < 0.010), with less complaints of diarrhoea (-10.38, p < 0.010), nausea (-8.668, p < 0.010) and pain (-8.265, p < 0.050).
These results indicate that sociodemographic and clinical factors affect QoL in Egyptian women post-mastectomy. The worst functioning was the role and emotional scales, and the most distressing on the symptom scale were fatigue, insomnia, and pain making an imperative case for a more multidisciplinary team approach to treatment.
乳腺癌治疗有多种策略，每种策略对幸存者的生活质量（QoL）都有其自身的影响。本研究评估了影响接受乳房切除术女性生活质量的因素，并根据社会人口统计学和临床因素比较了不同的治疗方法。
进行了一项回顾性队列研究，使用欧洲癌症研究与治疗组织（EORTC）乳腺癌特异性生活质量工具以及FACT - B和FBSI问卷来测量影响生活质量的功能和症状量表。该问卷在318名埃及女性乳房切除术后及6个月随访时进行发放。结果以中位数和四分位间距（IQR）或频率和百分比形式报告。采用Fisher精确检验和Kruskal - Wallis检验进行统计推断。使用广义线性模型通过社会人口统计学和临床变量（自变量）预测生活质量指标（结果）并对潜在混杂因素进行调整。自变量通过弹性网回归进行选择。
该队列的全球生活质量得分为42.0（IQR 25.0 - 67.0）。受影响最大的功能量表是角色（62%），认知量表影响最小。症状量表上最令人苦恼的症状是疲劳（65%）、失眠（61%）和疼痛（60%）。FACT - B的中位数得分为79.0（IQR 63.0 - 95.0）。广义线性回归表明，较高的认知功能（22.45；p < 0.050）和保乳手术（BCS，6.026，p < 0.010）与60岁以上女性呈正相关。城市女性与较低的主观幸福感（SWB，-2.679，p < 0.05）和较高的失眠程度相关。体重指数（BMI）> 30与许多生活质量领域呈负相关。乳房单纯切除术（SM）或乳房根治术（MRM）加重建与总体生活质量（TQOL）呈正相关（8.109 < p < 0.050）。接受化疗的女性社会功能较低（-12.41，p < 0.050）、保乳手术得分较低（-3.473，p < 0.010），腹泻关联度更高（8.865，p < 0.010）且有经济困难（15.23，p < 0.050）。相比之下，接受激素治疗的女性角色功能较高（17.64，p < 0.010），腹泻（-10.38，p < 0.010）未得到更多投诉，恶心（-8.668，p < 0.010）和疼痛（-8.265，p < 0.050）也较少。
这些结果表明，社会人口统计学和临床因素会影响埃及乳房切除术后女性的生活质量。最差的功能是角色和情感量表，症状量表上最令人苦恼的是疲劳、失眠和疼痛，这迫切需要采用更具多学科团队的治疗方法。
