老年卵巢癌患者术后的复发恐惧调查与影响因素分析

Fear of cancer recurrence after surgery and its influencing factorsin elderly ovarian cancer patients

目的探讨老年卵巢癌患者术后的复发恐惧(fear of cancer recurrence,FCR)现状及影响因素,为老年卵巢癌患者临床管理和心理干预提供参考。方法收集2018—2019年于新疆医科大学附属肿瘤医院接受卵巢癌手术治疗的老年患者临床资料,筛选出符合纳入、排出标准的60例患者作为研究对象。手术后一个月时,采用恐惧疾病进展简化量表(fear of progression questionnaire-short form,FoP-Q-SF)调查患者的FCR情况,使用社会支持评定量表(social support rating scale,SSRS)和健康素养管理量表(health literacy management scale,HeLMS)对患者的社会支持水平和癌症健康素养进行评价,并收集患者的临床资料,可能的影响因素,使用Pearson回归和多因素logistic回归寻找老年卵巢癌患者FCR的影响因素。结果60名老年卵巢癌患者的FoP-Q-SF均分为(35.18±6.89)分,有33例(55.00%)出现较为严重的FCR。Pearson回归显示,老年卵巢癌患者FoP-Q-SF得分与SSRS(r=-0.574,P<0.001)和HeLMS得分(r=-0.681,P<0.001)呈现负相关性。多因素logistic回归结果显示,年龄70~79岁(OR=0.671,95%CI:0.526~0.856)、年龄80岁以上(OR=0.543,95%CI:0.449~0.657)、高社会支持(OR=0.726,95%CI:0.627~0.841)、中等社会支持(OR=0.807,95%CI:0.670~0.973)、疾病健康素养Q2(OR=0.621,95%CI:0.532~0.725)、疾病健康素养Q3(OR=0.385,95%CI:0.315~0.470)等因素是老年卵巢癌患者高FCR水平的阻碍因素;而FIGO肿瘤Ⅱ期(OR=2.083,95%CI:1.618~2.683)、Ⅲ期(OR=3.077,95%CI:1.988~4.764)和Ⅳ期(OR=3.310,95%CI:2.189~5.006)等是高FCR水平的风险因素。结论新疆地区老年卵巢癌病人FCR处于较高水平且普遍存在,癌症健康素养和社会支持水平与FCR关系密切,临床医护人员可以从提高病人癌症健康素养、社会支持方面出发,降低患者FCR水平。

Objective To explore the current status of fear of cancer recurrence(FCR)after surgery and its affecting factors in elderly ovarian cancer patients,and to provide references for clinical management and psychological intervention of elderly ovarian cancer patients.Methods We collected the clinical data regarding elderly patients who underwent surgical treatment for ovarian cancer in Cancer Hospital Affiliated to Xinjiang Medical University from 2018 to 2019,and 60 patients who met the inclusion and exclusion criteria were selected as the study subjects.One month after the surgery,the Fear of Progression Questionnaire-Short Form(FoP-Q-SF)was used to investigate the situation of FCR.Social Support Rate Scale(SSRS)was employed to evaluate the social support level among the patients,and Health Literacy Management Scale(HeLMS)was applied to assessing the patients’cancer health literacy status.The clinical data of the patients and the possible influencing factors were collected.Pearson regression and multifactor logistic regression analyses were used to identify the factors influencing FCR in the elderly ovarian cancer patients.Results The mean score of FoP-Q-SF in the 60 elderly ovarian cancer patients was(35.18±6.89),and 33(55.00%)cases were detected as severe FCR.Pearson regression showed that the score of FoP-Q-SF in the elderly ovarian cancer patients was negatively correlated with SSRS(r=-0.574,P<0.001)and HeLMS scores(r=-0.681,P<0.001).The results of multifactor logistic regression showed that 70-79 years old(OR=0.671,95%CI:0.526-0.856),over 80 years of age(OR=0.543,95%CI:0.449-0.657),high social support(OR=0.726,95%CI:0.627-0.841),moderate social support(OR=0.807,95%CI:0.670-0.973),disease health literacy Q2(OR=0.621,95%CI:0.532-0.725),and disease health literacy Q3(OR=0.385,95%CI:0.315-0.470)were hindering factors for high FCR levels in the elderly ovarian cancer patients,whereas FIGO tumor stage phase II(OR=2.083,95%CI:1.618-2.683),III(OR=3.077,95%CI:1.988-4.764),and IV(OR=3.310,95%CI:2.189-5.006)were risk factors for high FCR levels.Conclusion FCR in the elderly ovarian cancer patients in Xinjiang is at a high level and prevalent.Cancer health literacy and social support level are closely related to FCR;and hence,clinical health care workers can improve the patients’cancer health literacy and social support so as to reduce FCR level.