治疗方式与心理弹性对Ⅰ-Ⅱ期宫颈癌患者生存质量的交互作用分析

Interaction between treatment modalities and psychological resilience on life quality in patients with stageⅠ-Ⅱcervical cancer

目的探讨治疗方式与心理弹性对Ⅰ-Ⅱ期宫颈癌患者生存质量影响是否存在交互作用,为合理选择治疗方案和加强个性化干预提供理论依据。方法选取2012—2018年在天津市肿瘤医院确诊的全部Ⅰ-Ⅱ期宫颈癌患者为研究对象。采用生存质量核心量表V3.0(EORTC QLQ-C30)、宫颈癌特异性模块量表(QLQ-CX24)和心理弹性量表,通过电话问询对患者治疗后生存质量和心理弹性进行测量和评价。应用SPSS 23.0统计软件进行χ~2检验、Kruskal-Wallis H检验和多重线性回归分析。结果共计134名Ⅰ-Ⅱ期宫颈癌患者实际参与研究,其中同步放化疗组30名,单纯手术组55名,手术加辅助治疗组49名。单纯手术组生存质量中位数为81.83分(P25~P75:79.61~85.37分),手术加辅助治疗组中位数为79.80分(P25~P75:77.09~82.14分),同步放化疗组中位数为73.43分(P25~P75:72.32~78.00分)。与手术加辅助治疗相比,单纯手术与总体生存质量正相关(β=8.37),而同步放化疗与角色功能(β=-8.11)和症状体验(β=4.25)领域生存质量受损高风险相关,均有统计学意义(P<0.05)。分层分析结果显示,心理弹性评分≤88分的患者,同步放化疗可能与躯体功能(β=-11.20)、角色功能(β=-16.48)、总体生存质量(β=-23.53)和身体形象(β=15.84)领域的生存质量受损高风险相关,并且疲乏(β=28.65)和更年期症状(β=19.83)更多;心理弹性评分>88分的患者中,单纯手术患者总体生存质量比手术加辅助治疗更高(β=10.38),均有统计学意义(P<0.05)。治疗方式与心理弹性对总体生存质量影响可能存在相乘交互作用(β=-11.40,P<0.05)。结论心理弹性影响治疗方式与生存质量的关联,应根据治疗方式和心理弹性水平给予宫颈癌患者个性化心理干预和健康宣教,提高患者生存质量。

Objective To explore the interaction between treatment modalities and psychological resilience on life quality in patients with stageⅠ-Ⅱcervical cancer,and provide the theory basis for reasonable choice of treatment scheme and individualization intervention.Methods All patients with stageⅠ-Ⅱcervical cancer diagnosed by Tianjin tumour hospital from 2012 to 2018served as the subjects.European Organization for Research and Treatment of Cancer quality of life questionnaire-core 30 and quality of life questionnaire cervical cancer module(EORTC QLQ-C30 and QLQ-CX24)and resilience scale(RS)were used.The psychological resilience and life quality in patients with stageⅠ-Ⅱcervical cancer were measured and assessed by telephone inquiry.Theχ~2test,Kruskal-Wallis H test and multiple linear regression model were used to analyze the data.The used software was SPSS 23.0.Results A total of 134 patients with stageⅠ-Ⅱcervical cancer participated in the study,including 30 cases in chemoradiotherapy(CC)group,55 cases in surgery alone(SA)group and 49 cases in surgery plus adjuvant chemoradiotherapy(SC)group.The life quality median in SA group was 81.83 scores(P-P:79.61-85.37 scores),the life quality median in SC group was 79.80 scores(P-P:77.09-82.14 scores),the life quality median in CC group was 73.43 scores(P-P:72.32-78.00scores).Compared with SC,SA was positively correlated with general life quality(β=8.37),while CC correlated with high risks of impaired life quality in role functioning(β=-8.11)and symptom experience(β=4.25),P<0.05.The stratified analysis found that in the patients with poor psychological resilience(≤88 scores),CC significantly correlated the high risks of impaired life quality in multiple domains(body functionβ=-11.20;role functionβ=-16.48;general life qualityβ=-23.53 and body imageβ=15.84),and more tired(β=28.65)or climacteric symptoms(β=19.83);in the patients with better psychological resilience(>88 scores),the general life quality in SA group was significantly higher than that in SC group(β=10.38),P<0.05.There was multiply interaction of treatment modalities and psychological resilience on general life quality(β=-11.40,P<0.05).Conclusion Psychological resilience influences the relationship between treatment modalities and life quality in patients.It should give the individualization psychological intervention and health education to patients with stageⅠ-Ⅱcervical cancer,according to treatment modalities and psychological resilience levels,so as to improve their life quality.