综合干预疗法对鼻咽癌患者生活质量的影响

Effects of combined interventional treatment on quality of life in patients with nasopharyngeal carcinoma

目的:观察肿瘤学、心理学和社会医学相结合的多学科综合干预措施对鼻咽癌患者生活质量的影响。方法:于2001-01/2002-07选择四川省肿瘤医院和四川大学华西医院经病理确诊为鼻咽癌的患者72例,随机分为干预组35例和对照组37例。采用专家指导下的系统抗癌指导和群体抗癌相结合的方法进行健康干预,包括躯体功能、心理状态、社会家庭角色恢复等多方面,干预期为2年。对照组则处于自发康复状态,干预前后采用EORTC-QLQ-C30改进的生存质量评定量表评价生活患者的生活质量。在调查时对调查员和患者施行“双盲”。该量表包括一般躯体健康功能,心理状态,社会家庭功能,一般症状副反应、自我生活质量评价以及特殊副反应6个测量维度43个条目。协方差分析比较两组的生活质量的差异。对照组在入组及2年后随访时分别进行两次问卷调查。结果:两组患者均完成治疗和问卷调查,全部进入结果分析。①干预组患者干预后生活质量各维度评分及总分均高于干预前(P<0.05或P<0.01)。对照组随访时各维度评分及总分均高于入组时(P<0.05或P<0.01)。②干预组患者心理状态、特殊副反应、自我评价及总分的差值均高于对照组,差异有显著性意义(P<0.05或P<0.01)。③在控制不均衡因素后,干预组心理状态、特殊副反应及总分的差值仍高于对照组,差异有显著性意义(P<0.05或P<0.01)。表明干预组在生活质量的这些维度有显著提高。结论:多学科联合的综合干预措施有助于鼻咽癌康复患者生活质量的提高。显著改善鼻咽癌患者心理状态、特殊副反应。对患者一般躯体功能、一般症状副反应的改善能起到一定的作用,但对社会家庭功能的远期效果还有待观察。

AIM： To observe the effects of combined interventions of oncology, psychology and social medicine on life quality of patients with nasopharyngeal carcinoma. METHODS： Seventy-two patients with nasopharyngeal carcinoma, who were identified in West China Hospital of Sichuan University and Sichuan Provincial Cancer Hospital from January 2001 to July 2002 were randomly divided into intervention group （n=35） and control group （n=37）. The health intervention was performed with mass anti-cancer method under systematic anti-cancer direction of specialists including multiple aspects such as body function, mental state, recovery of role in society and family etc. with the an interventional duration of 2 years. Patients in the control group were in a spontaneous convalescence. Double-blind investigation was conducted on patients by investigators. The scale was composed of 6 measuring dimension and 43 items including general healthy body function, mental state, function of society and family, syrup/ores and side effects, self-evaluated quality of life and special side effects. Differences in quality of life between two groups were compared with analysis of covariance. Patients in the control group were investigated with questionnaires twice respectively in grouping and the follow-up of 2 years later. RESULTS： Treatment and questionnaire were conducted in patients of two groups and all subjects entered the final analysis. ①Score of each dimension and total score of patients in the intervention group were higher than those before intervention, （P 〈 0.05 or P 〈 0.01）. Score of each dimension and total score in follow-up of the control group were higher than those in grouping （P 〈 0.05 or P 〈 0.01）.②Scores of mental state, special side effects, self-evaluation and differences of total score in patients of intervention group were higher than those in the control group and differences were remarkable （P 〈 0.05 or P 〈 0.01）. ③After the disproportion factors was controlled, scores of mental state, special side effects, self-evaluation and differences of total score in patients of intervention group were still higher than those in the control group, and differences were marked （P 〈 0.05 or P 〈 0.01）, which showed that quality of life in patients of intervention group were significantly increased in these dimensions. CONCLUSION： Combined intervention of multiple subjects facilitate the elevation of life quality of patients with nasopharyngeal carcinoma and can significantly improve mental status, special symptoms and side effects and somatic function of patients. But its remote effects on functions of society and family needs further observation.