知情状况对老年晚期癌症患者生活质量的影响

Effects of awareness of diagnosis on quality of life in elderly patients with advanced cancer

目的探讨知情状况对老年晚期癌症患者生活质量和情绪的影响。方法选取2012年9月至2013年9月于北京老年医院住院诊治的老年晚期癌症患者为研究对象,根据知情状况将93例老年晚期癌症患者分为知情组（n=30）和不知情组（n=63）,采用欧洲癌症研究治疗组织生活质量测定表（EORTC QLQ-C30）进行生活质量的测量。以患者情绪功能为自变量,采用多因素Logistic回归分析方法分析老年晚期癌症患者情绪的影响因素。结果 93例患者中,仅有30例（32.3%）知情。知情组和不知情组患者的躯体功能、角色功能、认知功能、社会功能、总体健康,以及症状评分比较差异均无统计学意义（P〉0.05）。不知情组患者的情绪功能优于知情组（P=0.029）。以情绪功能为因变量,纳入相关因素进行多因素Logistic逐步回归分析结果表明,性别、知情状况、总体健康、疼痛和失眠是决定老年晚期癌症患者情绪功能的相关因素,其OR值（95%CI）分别为7.038（2.083-23.783）、0.214（0.061-0.752）、3.253（1.459-7.252）、0.142（0.040-0.504）、0.089（0.014-0.562）。结论老年晚期癌症患者知情比例低,知情状况对老年晚期癌症患者的总体生活质量无显著影响。老年晚期癌症患者中,女性、总体健康状况较差、伴有疼痛和失眠症状,以及知情者更易出现情绪功能异常,应给予积极有效的心理干预措施。

Objective To investigate the effect of patients＇ awareness of diagnosis on quality of life and emo- tion among elderly patients with advanced cancer. Methods Ninety-three elderly patients with advanced cancer hospitalized in Beijing Geriatric Hospital from September 2012 to September 2013 were enrolled in the study, which were divided into aware group （n=30, aware of the diagnosis results） and unaware group （n=63, unaware of the diagnosis resuits）. Data on patients＇ diseases, social characteristics, clinical factors, and scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire （EORTC QLQ-C30） were analyzed by logistic regres- sion models. Results Of all the 93 patients, only 32.3% （30 cases） of patients were aware of their diagnosis. There was no statistically significant difference in physical functioning, role functioning, cognitive functioning, social func- tioning, global health status, and symptom scales between the aware group and unaware group （P〉0.05）. The patients unaware of diagnosis had better emotional functioning than those aware of diagnosis （P=0.029）. Variables significant- ly associated with emotional functioning included sex, awareness of diagnosis, global health status, pain and insomnia, with OR （95%CI） of 7.038 （2.083-23.783）, 0.214 （0.061-0.752）, 3.253 （1.459-7.252）, 0.142 （0.040-0.504）, 0.089 （0.014-0.562）, respectively. Conclusion A majority of hospitalized elderly patients with advanced cancer did not know their diagnosis. Awareness of diagnosis tends to have no adverse effects on global quality of life of the patients. Patients with female gender, uncontrolled symptoms like pain and insomnia, poor global health status, awareness of di- agnosis are at increased risk of poor emotional functioning, and may benefit from psychological interventions.