乳腺癌患者睡眠质量及相关因素分析
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摘要
目的调查乳腺癌患者睡眠质量状况,并分析相关因素对睡眠质量的影响。方法选取2018年7月至11月就诊的女性乳腺癌患者100例作为病例组,同期行健康筛查的女性200例作为对照组,利用自行设计的一般资料调查表和匹兹堡睡眠质量指数量表(PSQI)收集研究对象人口学特征和睡眠质量,通过查阅病历系统获取患者的疾病相关信息。采用线性回归分析法分析乳腺癌患者睡眠质量的相关因素。结果病例组患者睡眠质量较对照组差(6.46±3.58 vs 4.99±3.06,t=3.512,P<0.001),根据划界分,病例组67.0%的患者睡眠质量判定为差,高于对照组的44.5%(χ~2=13.522,P<0.001)。乳房切除手术较未手术(B=2.81,Beta=0.38, 95%CI:0.77～4.85,P=0.007)及保乳手术(B=2.92,Beta=0.40,95%CI:1.40～4.45,P<0.001)的患者睡眠质量差。结论乳腺癌患者的睡眠质量较健康女性差,乳房切除手术是患者睡眠质量差的一个重要影响因素。提示临床应重视对乳腺癌术后患者睡眠质量的评估。
Objective To investigate the sleep quality of patients with breast cancer and analyze the influencing factors. Methods A total of 100 female breast cancer patients who received breast surgery during Jul. and Nov. 2018 were selected as the case group, and 200 healthy women who received health screening during the same period were selected as the control group. The demographic characteristics and sleep quality of the subjects were collected using a self-designed general data questionnaire and the Pittsburgh Sleep Quality Index(PSQI). Patients'; disease-related information was obtained from the medical records. The influencing factors of sleep quality were analyzed with linear regression analysis. Results The case group had lower sleep quality than control group(4.99±3.06 vs 6.46±3.58, t=3.512, P<0.001), and 67.0% of the patients and 44.5% of the healthy controls had poor sleep quality(χ~2=13.522, P<0.001). Patients who underwent mastectomy had poorer sleep quality than those who did not receive surgery(B=2.81, Beta=0.38, 95% CI: 0.77～4.85, P=0.007) and those who underwent breast-conserving surgery(B=2.92, Beta=0.40, 95% CI: 1.40～4.45, P<0.001). Conclusion Breast cancer patients have poorer sleep quality than healthy women. Mastectomy is an important influencing factor of sleep quality, indicating that attention should be paid to the evaluation of postoperative sleep quality.
Objective To investigate the sleep quality of patients with breast cancer and analyze the influencing factors. Methods A total of 100 female breast cancer patients who received breast surgery during Jul. and Nov. 2018 were selected as the case group, and 200 healthy women who received health screening during the same period were selected as the control group. The demographic characteristics and sleep quality of the subjects were collected using a self-designed general data questionnaire and the Pittsburgh Sleep Quality Index(PSQI). Patients'; disease-related information was obtained from the medical records. The influencing factors of sleep quality were analyzed with linear regression analysis. Results The case group had lower sleep quality than control group(4.99±3.06 vs 6.46±3.58, t=3.512, P<0.001), and 67.0% of the patients and 44.5% of the healthy controls had poor sleep quality(χ~2=13.522, P<0.001). Patients who underwent mastectomy had poorer sleep quality than those who did not receive surgery(B=2.81, Beta=0.38, 95% CI: 0.77～4.85, P=0.007) and those who underwent breast-conserving surgery(B=2.92, Beta=0.40, 95% CI: 1.40～4.45, P<0.001). Conclusion Breast cancer patients have poorer sleep quality than healthy women. Mastectomy is an important influencing factor of sleep quality, indicating that attention should be paid to the evaluation of postoperative sleep quality.
引文
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[9] 杨昕蕾, 杨艳杰, 杨秀贤, 等. 乳腺癌术后患者主观睡眠质量调查[J]. 黑龙江医学, 2012, 36 (10): 764-766.YANG Xinlei, YANG Yanjie, YANG Xiuxian, et al. Investigation on subjective sleep quality of postoperative patients with breast cancer[J]. Heilongjiang Medical Journal, 2012, 36(10): 764-766.
[10] 贾金平, 万冬桂. 乳腺癌患者睡眠质量调查分析[J]. 中国医药科学, 2015, 5(6): 129-131.JIA Jinping, WAN Donggui. Investigation and analysis on sleep quality of breast cancer patients[J]. China Medicine and Pharmacy, 2015, 5(6): 129-131.
[11] Janz NK, Mujahid M, Chung LK, et al. Symptom experience and quality of life of women following breast cancer treatment[J]. J Womens Health (Larchmt), 2007, 16(9): 1348-1361.
[12] Johns N, Dixon JM. Should patients with early breast cancer still be offered the choice of breast conserving surgery or mastectomy?[J]. Eur J Surg Oncol, 2016, 42(11): 1636-1641.
[13] Volders JH, AUID- O h o, Negenborn VL, et al. Cosmetic outcome and quality of life are inextricably linked in breast-conserving therapy[J]. J Surg Oncol, 2017, 115(8): 941-948.
[14] Tsai HY, Kuo RN, Chung KP. Quality of life of breast cancer survivors following breast-conserving therapy versus mastectomy: a multicenter study in Taiwan[J]. Jpn J Clin Oncol, 2017, 47(10): 909-918.
[15] Bower JE, Ganz PA, Irwin MR, et al. Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism?[J]. J Clin Oncol, 2011, 29(26): 3517-3522.
[16] Fontes F, Pereira S, Costa AR, et al. The impact of breast cancer treatments on sleep quality 1 year after cancer diagnosis[J]. Support Care Cancer, 2017, 25(11): 3529-3536.
[17] Hansen MV, Madsen MT, Wildschiodtz G, et al. Sleep disturbances and changes in urinary 6-sulphatoxymelatonin levels in patients with breast cancer undergoing lumpectomy[J]. Acta Anaesthesiol Scand, 2013, 57(9): 1146-1153.
[18] Eskitzis P, Zafrakas M, Papanicolaou A, et al. Quality-of-life changes over time in breast cancer patients undergoing breast-conserving surgery: a prospective study in Greece[J]. Arch Gynecol Obstet, 2016, 294(3): 639-645.
[19] Howes BH, Watson DI, Xu C, et al. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: a case-controlled cohort study[J]. J Plast Reconstr Aesthet Surg, 2016, 69(9): 1184-1191.
[20] Mustonen L, Aho T, Harno H, et al. What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer[J]. Pain, 2019, 160(1): 246-256.
[21] van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study[J]. Lancet Oncol, 2016, 17(8): 1158-1170.
[22] van Maaren MC, de Munck L, Jobsen J J, et al. Breast-conserving therapy versus mastectomy in T1-2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3071 patients[J]. Breast Cancer Res Treat, 2016, 160(3): 511-521.
[23] Chen K, Pan Z, Zhu L, et al. Comparison of breast-conserving surgery and mastectomy in early breast cancer using observational data revisited: a propensity score-matched analysis[J]. Sci China Life Sci, 2018, 61(12): 1528-1536.
[24] Kaminska M, Ciszewski T, Kukielka-Budny B, et al. Life quality of women with breast cancer after mastectomy or breast conserving therapy treated with adjuvant chemotherapy[J]. Ann Agric Environ Med, 2015, 22(4): 724-730.
[25] Soucise A, Vaughn C, Thompson CL, et al. Sleep quality, duration, and breast cancer aggressiveness[J]. Breast Cancer Res Treat, 2017, 164(1): 169-178.
[26] 邵志敏. 乳腺癌保乳手术的进展与评述[J]. 肿瘤防治研究, 2018, 45(5): 269-273.SHAO Zhimin. Progress and comment of breast conserving therapy[J]. Cancer Research on Prevention and Treatment, 2018, 45(5): 269-273.
[27] Habermann EB, Abbott A, Parsons HM, et al. Are mastectomy rates really increasing in the United States?[J]. J Clin Oncol, 2010, 28(21): 3437-3441.
[28] Kummerow KL, Du L, Penson DF, et al. Nationwide trends in mastectomy for early-stage breast cancer[J]. JAMA Surg, 2015, 150(1): 9-16.
[2] Fan L, Strasser-Weippl K, Li JJ, et al. Breast cancer in China[J]. Lancet Oncol, 2014, 15(7): e279-289.
[3] 王岩, 刘淼, 寇娟, 等. 乳腺癌患者睡眠质量、应对方式及生活质量的研究[J]. 解放军护理杂志, 2015, 32(22): 17-20.WANG Yan, LIU Miao, KOU Juan, et al. Study of Sleep Quality, Coping Style and Quality of Life in Breast Cancer Patients[J]. Nursing Journal of Chinese People?s Liberation Army, 2015, 32(22): 17-20.
[4] Fontes F, Goncalves M, Maia S, et al. Reliability and validity of the Pittsburgh Sleep Quality Index in breast cancer patients[J]. Support Care Cancer, 2017, 25(10): 3059-3066.
[5] Trudel-Fitzgerald C, Zhou ES, Poole EM, et al. Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses? Health Study[J]. Br J Cancer, 2017, 116(9): 1239-1246.
[6] 陈璐, 周佳玮, 杨艳杰, 等. 乳腺癌术后患者睡眠质量影响因素分析[J]. 中华行为医学与脑科学杂志, 2013, 22(7): 614-615.CHEN Lu, ZHOU Jiawei, YANG Yanjie, et al. The study of sleep quality and its associated factors in postoperative patients with breast cancer[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2013, 22(7): 614-615.
[7] Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research[J]. Psychiatry Res, 1989, 28(2): 193-213.
[8] 刘贤臣, 唐茂芹, 胡蕾, 等. 匹兹堡睡眠质量指数的信度和效度研究[J]. 中华精神科杂志, 1996, 29(2): 103-107.LIU Xianchen, TANG Maoqin, HU Lei, et al. Reliablility and validity of the Pittsburgh Sleep Quality Index[J]. Chinese Journal of Psychiatry, 1996, 29(2): 103-107.
[9] 杨昕蕾, 杨艳杰, 杨秀贤, 等. 乳腺癌术后患者主观睡眠质量调查[J]. 黑龙江医学, 2012, 36 (10): 764-766.YANG Xinlei, YANG Yanjie, YANG Xiuxian, et al. Investigation on subjective sleep quality of postoperative patients with breast cancer[J]. Heilongjiang Medical Journal, 2012, 36(10): 764-766.
[10] 贾金平, 万冬桂. 乳腺癌患者睡眠质量调查分析[J]. 中国医药科学, 2015, 5(6): 129-131.JIA Jinping, WAN Donggui. Investigation and analysis on sleep quality of breast cancer patients[J]. China Medicine and Pharmacy, 2015, 5(6): 129-131.
[11] Janz NK, Mujahid M, Chung LK, et al. Symptom experience and quality of life of women following breast cancer treatment[J]. J Womens Health (Larchmt), 2007, 16(9): 1348-1361.
[12] Johns N, Dixon JM. Should patients with early breast cancer still be offered the choice of breast conserving surgery or mastectomy?[J]. Eur J Surg Oncol, 2016, 42(11): 1636-1641.
[13] Volders JH, AUID- O h o, Negenborn VL, et al. Cosmetic outcome and quality of life are inextricably linked in breast-conserving therapy[J]. J Surg Oncol, 2017, 115(8): 941-948.
[14] Tsai HY, Kuo RN, Chung KP. Quality of life of breast cancer survivors following breast-conserving therapy versus mastectomy: a multicenter study in Taiwan[J]. Jpn J Clin Oncol, 2017, 47(10): 909-918.
[15] Bower JE, Ganz PA, Irwin MR, et al. Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism?[J]. J Clin Oncol, 2011, 29(26): 3517-3522.
[16] Fontes F, Pereira S, Costa AR, et al. The impact of breast cancer treatments on sleep quality 1 year after cancer diagnosis[J]. Support Care Cancer, 2017, 25(11): 3529-3536.
[17] Hansen MV, Madsen MT, Wildschiodtz G, et al. Sleep disturbances and changes in urinary 6-sulphatoxymelatonin levels in patients with breast cancer undergoing lumpectomy[J]. Acta Anaesthesiol Scand, 2013, 57(9): 1146-1153.
[18] Eskitzis P, Zafrakas M, Papanicolaou A, et al. Quality-of-life changes over time in breast cancer patients undergoing breast-conserving surgery: a prospective study in Greece[J]. Arch Gynecol Obstet, 2016, 294(3): 639-645.
[19] Howes BH, Watson DI, Xu C, et al. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: a case-controlled cohort study[J]. J Plast Reconstr Aesthet Surg, 2016, 69(9): 1184-1191.
[20] Mustonen L, Aho T, Harno H, et al. What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer[J]. Pain, 2019, 160(1): 246-256.
[21] van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study[J]. Lancet Oncol, 2016, 17(8): 1158-1170.
[22] van Maaren MC, de Munck L, Jobsen J J, et al. Breast-conserving therapy versus mastectomy in T1-2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3071 patients[J]. Breast Cancer Res Treat, 2016, 160(3): 511-521.
[23] Chen K, Pan Z, Zhu L, et al. Comparison of breast-conserving surgery and mastectomy in early breast cancer using observational data revisited: a propensity score-matched analysis[J]. Sci China Life Sci, 2018, 61(12): 1528-1536.
[24] Kaminska M, Ciszewski T, Kukielka-Budny B, et al. Life quality of women with breast cancer after mastectomy or breast conserving therapy treated with adjuvant chemotherapy[J]. Ann Agric Environ Med, 2015, 22(4): 724-730.
[25] Soucise A, Vaughn C, Thompson CL, et al. Sleep quality, duration, and breast cancer aggressiveness[J]. Breast Cancer Res Treat, 2017, 164(1): 169-178.
[26] 邵志敏. 乳腺癌保乳手术的进展与评述[J]. 肿瘤防治研究, 2018, 45(5): 269-273.SHAO Zhimin. Progress and comment of breast conserving therapy[J]. Cancer Research on Prevention and Treatment, 2018, 45(5): 269-273.
[27] Habermann EB, Abbott A, Parsons HM, et al. Are mastectomy rates really increasing in the United States?[J]. J Clin Oncol, 2010, 28(21): 3437-3441.
[28] Kummerow KL, Du L, Penson DF, et al. Nationwide trends in mastectomy for early-stage breast cancer[J]. JAMA Surg, 2015, 150(1): 9-16.