分化型甲状腺癌术后5年癌症复发恐惧的影响因素及与社会支持和生活质量的相关性研究

Influencing factors of fear of cancer recurrence after five years of surgery for differentiated thyroid cancer and its correlation with social support and quality of life

目的 分析分化型甲状腺癌(differentiated thyroid cancer,DTC)术后5年患者癌症复发恐惧(fear of cancer recurrence,FCR)的影响因素及与社会支持和生活质量的相关性。方法 选取四川大学华西医院116例DTC术后5年患者为研究对象,使用疾病进展恐惧简化量表(Fear of Progression Questionnaire-Short Form,FoPQ-SF)、社会支持评定量表(Social Support Revalued Scale,SSRS)和癌症患者生命质量测定量表(the European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30,EORTC QLQ-C30;以下简称QLQ-C30)对患者进行问卷调查。单因素分析采用R×C列联表χ^(2)检验或Fisher确切概率法,影响因素分析采用多因素logistic回归分析,并对多因素logistic回归分析中有统计学意义的变量进一步通过绘制受试者工作特征曲线(receiver operating characteristic,ROC)进行诊断价值研究。最后采用Pearson相关分析,分析DTC术后5年患者FCR与社会支持和生活质量的关系。结果 问卷调查结果显示,116例DTC术后5年患者的FoP-Q-SF评分为(35.92±2.52)分,其中FoP-Q-SF评分≥34分75例,<34分41例,FCR率为64.66%(75/116)。多因素logistic回归分析结果显示:性别、家庭年收入、SSRS评分和QLQ-C30总分是DTC术后5年患者FCR的主要影响因素(P<0.05)。ROC曲线诊断研究结果显示:SSRS评分≤47.5分诊断FCR的准确率为70.70%;QLQ-C30总分≤617.225分诊断FCR的准确率为69.02%;家庭年收入≤15万元诊断FCR的准确率为66.03%;女性诊断FCR的准确率为62.28%。Pearson相关性分析结果显示:DTC术后5年患者的FoP-Q-SF评分与SSRS评分和QLQ-C30总分均呈负相关关系(r=–0.629 6,P=0.000 1;r=–0.568 5,P=0.000 1)。结论 DTC术后5年患者有FCR的比例较高;性别、家庭年收入、SSRS评分和QLQ-C30总分是FCR的影响因素。可据此制定针对性的管理策略,以降低患者的FCR感、提高生活质量。

Objective To analyze the influencing factors of fear of cancer recurrence(FCR)and its correlation with social support and quality of life in patients with differentiated thyroid cancer(DTC)at 5 years after surgery.Methods A total of 116 patients with DTC from West China Hospital,Sichuan University at 5 years after surgery were selected as the research objects.The patients were investigated using the Fear of Progression Questionnaire-Short Form(FoP-Q-SF),Social Support Rating Scale(SSRS)and the European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30(EORTC QLQ-C30,hereinafter referred to as QLQ-C30).Theχ^(2) test or Fisher exact probability method were used for univariate analysis,and multivariate logistic regression analysis was used for influencing factor analysis.The diagnostic value of variables with significant influence on FCR in multivariate logistic regression was further studied by receiver operating characteristic(ROC)curve,and Pearson correlation analysis was finally adopted to analyze the relationship between FCR and social support and quality of life in patients with DTC at 5 years after operation.Results The questionnaire survey showed that the FoP-Q-SF score of 116 patients with DTC at 5 years after surgery was(35.92±2.52)scores,of which 75 patients had FoP-Q-SF score≥34 scores,41 patients had FoP-Q-SF score<34 scores,and the FCR rate was 64.66%(75/116).Multivariate logistic regression showed that gender,family annual income,SSRS score and total QLQ-C30 score were the main factors of FCR in patients with DTC at 5 years after surgery(P<0.05).Further ROC curve diagnosis showed that the accuracy rate of diagnosis of FCR with SSRS score≤47.5 scores was 70.70%,the total score of QLQ-C30≤617.225 scores was 69.02%.The accuracy rate of diagnosis of FCR was 66.03%when the annual income of family was less than 150000 yuan.The accuracy of women’s diagnosis of FCR was 62.28%.Pearson correlation analysis showed that FoP-Q-SF score was negatively correlated with SSRS score and total score of QLQ-C30 in DTC patients at 5 years after operation(r=–0.6296,P=0.0001;r=–0.5685,P=0.0001).Conclusions The proportion of patients who have FCR at 5 years after DTC operation is high,and gender,family annual income,SSRS score and total score of QLQ-C30 are the influencing factors.Therefore,we can develop targeted management strategies to reduce patients’FCR and improve their quality of life.