自体外周血造血干细胞移植联合大剂量化疗的高危乳腺癌患者生活质量分析

Analysis of quality of life in high-risk breast cancer patients with autologous peripheral blood stem cell transplantation and high-dose chemotherapy

目的分析自体外周血造血干细胞移植(ASCT)联合大剂量化疗(HDCT)的高危乳腺癌患者在移植前后生活质量的变化情况,以期为医务工作者选择有针对性和有效性的干预措施改善患者的生活质量提供参考。方法选取2000～2003年本院经手术病理确诊并接受ASCT联合HDCT的61例女性高危乳腺癌患者,中位年龄46岁,作为病例组;用随机数字表法在320个普通健康人群中选取50例35～65岁健康女性作为对照组。采用欧洲癌症研究与治疗组织生活质量问卷第三版(EORTC QLQ-C30 version 3.0)作为问卷调查表。病例组选取5个时间点在患者返院复查时填写调查表,对照组经得同意后填写调查表,根据各个条目得分情况进行分析。采用重复测量法和两独立样本t检验进行统计分析。结果总体上患者在ASCT结束后3个月生活质量最差,此后逐渐恢复接近健康人水平,但很多方面仍与健康人相比存在明显差别。躯体功能在ASCT前后无显著性差别,但ASCT后5年的患者与对照组之间差异有统计学意义(P=0.000)。患者的情绪功能在ASCT后3个月时较ASCT前明显降低(P=0.000),虽然ASCT后3年较ASCT前显著升高(P=0.000),但ASCT后5年与健康对照组比较差异有统计学意义(P=0.011)。患者疲劳症状在ASCT后3个月比ASCT前显著增加(P=0.000),而随着时间推移有所缓解,ASCT后5年此症状才出现明显减轻,但较健康对照组差异有统计学意义(P=0.031)。病例组患者恶心呕吐症状在ASCT后3个月最明显,此后逐渐缓解,ASCT后3年明显改观,ASCT后5年与健康对照组相比差异无统计学意义(P=0.474)。病例组患者疼痛症状在ASCT前后一直存在,ASCT后5年与健康对照组比较差异有统计学意义(P=0.014)。病例组患者经济困难在ASCT前与ASCT后3个月间差异有显著的统计学意义(P=0.000),ASCT后5年有所缓解,但与健康对照组相比仍存在较为严重的经济问题(P=0.005)。结论 ASCT后患者普遍存在躯体功能受损、记忆力减退、社会家庭功能退缩、精神紧张、易疲劳、疼痛、经济困难等生活质量下降的情况,大部分可在移植后5年恢复到健康人水平,而躯体功能、疼痛症状、经济等方面仍存在严重问题。医护人员及患者家人应当给予精心护和理解照顾,帮助患者尽快改善生活质量、恢复正常生活。

Objective To analyze the quality of life in high-risk breast cancer patients with autologous peripheral blood stem cell transplantation （ASCT） plus high-dose chemotherapy （HDCT） in order to provide reference for doctors to select effective therapy and improve patients＂ life quality. Methods From 2000 to 2003, 61 high risk breast cancer patients pathologically diagnosed and treated with ASCT plus HDCT in our hospital were selected as the patients group, and 50 healthy people were randomly selected from healthy population as the control group. EORTC QLQ C30 version 3.0 （the quality of life questionnaire version 3.0 by European Organization for Research and Treatment of Cancer） was used for questionary. In the patients group 5 time points before and after ASCT were chosen and the patients were asked to fill in the questionary when they came to the hospital for re examination, and the healthy people of the control group filled in the questionary at their consent. The scores obtained by the two groups were analyzed and compared. Repeated measurement and students＂ t test were used for statistical analysis. Results Generally speaking, the patients＂ life quality was the poorest at 3 months after ASCT. With the time passing by, the patients were getting better and better, but they still had many problems in their life, their life quality was poorer than that of the healthy controls. The physical function in the patients group was not significantly different before and after ASCT, and even 5 years after ASCT the patients＇ life quality was still poorer than that of the healthy controls, with statistical difference between the two groups （P= 0. 000）. The emotional function of the patients group at 3 months after ASCT was the worst, much worse than before ASCT （P=0. 000）, then became better and better, though it was much better 3 years after ASCT than 3 months after ASCT （P=0. 000）, it was still worse 5 years after ASCT compared to the healthy controls （P= 0. 011）. Fatigue in the patients group after ASCT increased markedly and was statistically different 3 months after ASCT compared with before ASCT （P= 0. 000）, then abated with time, but 5 years after ASCT there was still statistical difference between the patients group and the healthy controls（P= 0. 031）. Nausea and vomiting of the patients were most obvious at 3 months after ASCT, ＂then relieved with time, and improved 3 years after ASCT, and 5 years after ASCT there was no statistical difference between the patients group and the healthy controls （P=0. 474）. Patients had pain all the time before and after ASCT, and there was a statistical difference between the patients group 5 years after ASCT and the healthy controls （P = 0. 014）. For economy status, in the patients group there was statistically significant difference between before ASCT and 3 months after ASCT （P= 0. 000）, the economic status became better 5 years after ASCT, but the patients still had more economic problems and difficulties, with statistical difference compared with the healthy controls （P=0. 005）. Conclusion ASCT breast cancer patients generally have problems like lesion in physical function, decrease of memoey, decrease of social and family functioning, mental tension, pain, fatigue, economic difficulties, and descent of life quality. Most patients can recover gradually to the level of healthy people 5 years after operation. But physical function, pain and economic difficulties can not be satistactorily improved. So doctors and family members should give great understanding and care to the patients, and help them to improve and recover their life as soon as possible.