中晚期结直肠癌患者生活质量及健康相关影响因素分析

Analysis of quality of life and health-related factors in patients with advanced colorectal cancer

目的探讨中晚期结直肠癌患者健康相关生活质量(HRQOL)现状及其影响因素,为提升患者生活质量提供科学依据与干预策略。方法采用分层随机抽样方法抽取2020-03-20-2021-03-20在甘肃省肿瘤医院(90例)、兰州市第一人民医院(72例)以及新疆医科大学附属肿瘤医院(166例)就诊的328例中晚期结直肠癌患者作为研究对象,开展HRQOL问卷调查。以HRQOL总分为因变量,进行单因素方差分析和多元线性回归分析其影响因素。结果328例中晚期结直肠癌患者HRQOL总得分为(119.77±19.52)分,其中生理状况(50.71±8.33)分,社会家庭状况(20.77±7.29)分,情感状况(32.08±8.13)分,功能状况(16.21±6.50)分。男性[(122.45±19.09)分]、服务业/个体户/自由职业[(123.66±17.55)分]、手术+放化疗[(123.05±18.89)分]的患者生活质量评分较高,均P<0.05;男性[(51.75±7.67)分]、服务业/个体户/自由职业[(52.16±6.98)分]、未使用靶向药物[(51.37±7.50)分]、手术+放化疗[(52.11±7.54)分]的患者生理状况评分较高,均P<0.05。家庭收入>10万元[(22.38±8.44)分]、就诊2家医院[(21.27±7.78)分]的患者社会/家庭状况评分较高,均P<0.05。从事服务业/个体户/自由职业[(33.29±7.20)分]的患者情感状况评分较高,均P<0.05。41~60岁[(16.57±6.72)分]、家庭收入>10万元[(18.95±7.98)分]、就诊2家医院[(17.24±6.68)分]的患者功能状况评分较高,均P<0.05。职业(从事机关/事业单位的患者生活质量评分低于服务业/个体户/自由职业,β=-0.170,95%CI:-11.202~-2.026)、家庭收入(>10万元的患者生活质量高于无收入患者,β=0.224,95%CI:5.701~21.911)、治疗措施(采用手术+放化疗患者生活质量高于手术+放化疗+其他治疗的患者,β=0.132,95%CI:-10.247~-0.187)及就诊医院数量(就诊医院数≥3的患者生活质量低于就诊2家医院患者,β=-0.168,95%CI:0.508~12.584)是中晚期结直肠癌患者生活质量的主要影响因素。结论中晚期结直肠癌患者HRQOL的提高可以从社会、经济、家庭等多方面给予患者关怀入手,同时选择更好的治疗方式,有效改善患者预后。

Objective To understand the current situation of health-related quality of life(HRQOL)and its influencing factors in patients with advanced colorectal cancer,and to provide scientific basis and intervention strategies for improving patients'quality of life.Methods A stratified random sampling method was employed to extract 328patients with advanced colorectal cancer from Gansu Provincial Cancer Hospital(90cases),Lanzhou First People's Hospital(72cases),and Xinjiang Medical University Cancer Hospital(166cases)who were treated between March 20,2020,and March 20,2021.These patients were selected as the subjects for a HRQOL questionnaire survey.The total HRQOL score was used as the dependent variable,and the influencing factors were analyzed using one-way analysis of variance and multivariate linear regression analysis.Results The total score of HRQOL in 328patients with advanced colorectal cancer was 119.77±19.52,with the following breakdown:physical condition(50.71±8.33)points,social and family condition(20.77±7.29)points,emotional condition(32.08±8.13)points,and functional condition(16.21±6.50)points.Patients who were male[(122.45±19.09)points],service industry/self-employed/freelance[(123.66±17.55)points],and those who underwent surgery plus radiochemotherapy[(123.05±18.89)points]had higher quality of life scores,all P<0.05.Similarly,male patients[(51.75±7.67)points],service industry/self-employed/freelance occupations[(52.16±6.98)points],patients who did not use targeted drugs[(51.37±7.50)points],and those who underwent surgery plus radiochemotherapy[(52.11±7.54)points]had higher scores for physical condition,all P<0.05.Patients with a family income>100000yuan[(22.38±8.44)points]and those who visited two hospitals[(21.27±7.78)points]had higher scores for social/family condition,all P<0.05.Patients engaged in service industry/self-employed/freelance occupations[(33.29±7.20)points]had higher scores for emotional condition,with P<0.05.Patients aged 41to 60years[(16.57±6.72)points],those with a family income>100000yuan[(18.95±7.98)points],and those who visited two hospitals[(17.24±6.68)points]had higher scores for functional condition,all P<0.05.Occupation(patients engaged in government or public institutions had lower quality of life scores than those in service industry/self-employed/freelance occupations,β=-0.170,95%CI:-11.202--2.026),family income(patients with an income>100000yuan had higher quality of life than those with no income,β=0.224,95%CI:5.701-21.911),treatment measures(patients who underwent surgery plus radiochemotherapy had higher quality of life than those who also received other treatments,β=0.132,95%CI:-10.247--0.187),and the number of hospitals visited(patients who visited three or more hospitals had lower quality of life than those who visited two hospitals,β=-0.168,95%CI:0.508-12.584)were identified as the main factors affecting the quality of life of patients with advanced colorectal cancer.Conclusion The improvement of HRQOL in patients with advanced colorectal cancer can start with social,economic and family care,and choose better treatment methods to effectively improve the prognosis of patients.