老年原发性肝癌患者经导管肝动脉化疗栓塞术后生活质量及其影响因素

Quality of life and its influencing factors in elderly patients with primary hepatic carcinoma after transcatheter arterial chemoembolization

目的调查经导管肝动脉化疗栓塞术(TACE)治疗的老年原发性肝癌(PHC)患者不良情绪、自护能力及生活质量,并分析其影响因素。方法选择2020年3月至2023年3月阜阳市第二人民医院收治的实施TACE治疗的348例老年PHC患者为研究对象,使用焦虑自评量表(SAS)、抑郁自评量表(SDS)、自护能力测评量表(ESCA)及欧洲癌症研究组织(EORTC)生活质量核心问卷量表(QOL-C30)调查患者术前及术后出院3个月回院复诊时负面情绪、自理能力及生活质量。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验或单因素方差分析进行组间比较。采用多元线性回归模型分析影响老年PHC患者术后生活质量的相关因素,并分析风险因素对焦虑抑郁情绪及自护能力的影响。采用Pearson相关性分析评估老年PHC患者术后生活质量与焦虑、抑郁、自护能力的相关性。结果老年PHC患者TACE术后SAS及SDS评分降低;ESCA及QOL-C30评分升高,差异均有统计学意义(P<0.05)。不同年龄、肝癌切除手术史、疾病知情患者术后焦虑、抑郁及自护能力比较,差异均有统计学意义(P<0.05)。多元线性回归分析显示,年龄(β=-0.320;P<0.001)、肝癌切除手术史(β=-0.245;P=0.001)及疾病知情情况(β=-0.290;P=0.001)均可显著影响老年PHC患者TACE术后生活质量,共同解释老年PHC患者TACE术后生活质量69.30%的变异度(F=35.128;P<0.001)。Pearson相关性分析显示,老年PHC患者术后QOL-C30与SAS、SDS评分呈负相关(r=-0.627,-0.609;P<0.05);与ECSA评分呈正相关(r=0.383;P<0.05)。结论经TACE治疗后,老年PHC患者生活质量有所上升,但整体水平依旧不佳,而年龄≥75岁、既往肝癌切除史及不知晓自身病情的老年PHC患者术后生活质量更差,且具有以上特征的患者焦虑、抑郁发生率更高,自护能力更差,建议临床关注具有以上特征的老年肝癌患者术后生活质量,并注重患者不良情绪的疏导及自护能力的培养。

Objective To investigate the nagative emotions,self-care ability and quality of life(QOL)in elderly patients with primary hepatic carcinoma(PHC)undergoing transcatheter arterial chemoembolization(TACE),and to analyze the influencing factors for QOL.Methods A total of 348 elderly PHC patients who received TACE treatment in our hospital from March 2020 to March 2023 were recruited in the study.Self-rating anxiety scale(SAS),self-rating depression scale(SDS),exercise of self-care agency scale(ESCA)and European Organization for Research of Cancer(EORTC)quality of life-core 30 questionnaire(QOL-C30)were used to i nvestigate the negative emotions,self-care ability and QOL in this patients before surgery and at three months after discharge.SPSS statistics 22.0 was used for data analysis.According to the data type,t test or one-way analysis of variance was performed for comparison between groups.Multivariate linear regression model was employed to analyze the related factors affecting the postoperative QOL in them,and the effect of the obtained risk factors on anxiety,depression and self-care ability was analyzed.Pearson correlation analysis was conducted to analyze the correlation of postoperative QOL with anxiety,depression and self-care ability in these elderly patients.Results After TACE,the SAS and SDS scores were significantly decreased,while those of ESCA and QOL-C30 were obviously increased in elderly PHC patients(P<0.05).There were statistically differences in postoperative anxiety,depression and self-care ability among the patients with different ages,history of hepatocellular carcinoma resection,and informed condition of disease(P<0.05).Multivariate linear regression analysis showed that age(β=-0.320;P<0.001),history of hepatocellular carcinoma resection(β=-0.245;P=0.001)and informed condition of disease(β=-0.290;P=0.001)significantly affected the QOL in these patients after TACE,and jointly explained 69.30%of the variation in their QOL after TACE(F=35.128,P<0.001).Pearson correlation analysis showed that the score of postoperative QOL-C30 was negatively correlated with the SAS and SDS scores(r=-0.627,-0.609;P<0.05),and positively with the ECSA score(r=0.383;P<0.05)in elderly PHC patients.Conclusion After TACE treatment,though the QOL level is increased in the elderly PHC patients,the overall level is still poor.For the elderly PHC patients who are≥75 years old,have a history of hepatocellular carcinoma resection and ignorance of disease condition,they have worse QOL,and are prone to anxiety and depression and worse self-care ability.It is suggested that attention should be paid to the postoperative QOL in elderly patients with above characteristics in clinical practice,and guidance of negative emotions and cultivation of self-care ability attention should also be focused on.