食管癌患者术后随访应答等级及其影响因素分析

Response grades to telephone follow-up and its influencing factors for patients with esophageal carcinoma after esophagectomy

目的:探讨影响食管癌患者术后电话随访质量的影响因素。方法:电话随访2009-01-01-2009-06-01四川大学华西医院胸外科实施手术的食管癌患者及其亲属,排除失访患者后,其余病例根据其随访应答等级的不同分为1级、2级,利用Binary Logistic回归分析研究影响患者随访应答的因素。结果:本研究共纳入病例326例,失访患者26例,失访率8.0%。对影响应答等级的单因素分析发现,生存状态(χ2=35.464,P=0.000)、生存时间(P=0.000)、随访时是否患合并症或并发症(χ2=9.167,P=0.002)、TNM分期(χ2=10.236,P=0.006),与患者关系(χ2=8.938,P=0.011)在两组间的差异有统计学意义。而多因素序列Logistic回归分析综合发现,TNM分期(OR=6.347,P=0.011)、随访时是否患合并症或并发症(OR=1.649,P=0.30)为影响随访应答积极性的独立影响因子。结论:诊疗效果对患者的应答积极性可能有着直接影响,随访时能否解决患者的现时问题也是重要的影响因素,及时、长期而有健康指导价值的随访对于随访质量至关重要。

OBJECTIVE： To investigate possible factors influencing telephone follow-up response grades for patients with esophageal carcinoma following esophagectomy. METHODS： A telephone follow up survey was conducted on patients with documented esophageal carcinoma undergoing an esophagectomy from the first of January to June of 2009. After ex- cluding the cases lost to follow-up,the remaining patients were divided into two groups according to their or the relatives response grades to telephone follow-up as Grade 1,Grade 2. The possible factors influencing the response grades were in- vestigated by using both univariate and multivariate analyses. RESULTS： There were totally 326 patients were followed, while 26 of them were lost,with the lost to follow-up rate of 8.0%. The univariate analysis showed that at the time of fol- low-up, the survival status （X2 = 35. 464, P= 0. 000）, survival time （P= 0. 000 ）, complications/comorbidities （X2=9.167, P=0. 002）,TNM stages （X2=10. 236,P=0. 006） and the relationship with patient （X2 =8. 938,P=0. 011）were signifi- cantly different between two groups. Then the further ordinal logistic regression analysis demonstrated that only TNM stages （OR= 6. 347, P = 0.011 ） and complications/comorbidities （OR = 1. 649, P = 0.30） were the independent affecting factors to response grades. CONCLUSIONS： The primary therapeutic result and the interviewer＇s ability dealing with pa- tients current health concerns may be the most important influence factors to follow-up response enthusiasm. Therefore,a well planned and strictly executed follow-up schedule with proper health instruction could be crucial to the quality of fol low-up.