摘要
目的：描述不同治疗方法下宫颈癌患者的生存质量,比较和评价各种治疗方法的优劣,探讨影响其生存质量的因素,研究结果为改善其生存质量提供依据。
方法：采用美国结局、研究和教育中心(CORE)研制的宫颈癌量表(FACT-Cx),对福建省肿瘤医院妇科2004年1月至2008年10月期间诊断并治疗的原发宫颈癌出院存活病例102例进行调查。t检验、方差分析或非参数检验进行组间生存质量得分比较；校正年龄、临床分期及生存时间后,累积比数模型比较不同治疗方式下宫颈癌患者的生存质量；结构方程模型研究患者生存质量的影响因素。
结果：1.单因素分析显示年龄<45岁、每周娱乐时间>3小时、自费医疗者躯体状况好；每周娱乐时间>3小时、体质指数异常、非手术者社会／家庭状况好；文化程度高者,情感状况好；每周娱乐时间>3小时,娱乐方式≥2种功能状况好；每周娱乐时间>7小时,附加关注得分高；经济状况好、每周娱乐时间>3小时、每周娱乐时间>7小时者,总体生存质量好；
2. Spearman相关分析显示,面对应对与社会／家庭状况呈正相关,与躯体状况和情感状况呈负相关；屈服应对与躯体状况、情感状况、功能状况、附加关注、量表总分呈负相关；
3.手术患者的社会／家庭状况差；放疗患者的功能状况差；化疗患者的总体生存质量及功能状况差；相较于单纯放疗患者,单纯手术与手术综合治疗患者的社会／家庭状况差,放化疗较好；
4.健康促进、屈服应对因子直接影响患者躯体状况；社会经济地位、面对应对因子直接影响社会／家庭状况；屈服应对因子直接影响疾病治疗相关症状；躯体状况影响功能状况,功能状况影响社会家庭状况与情感状况。
结论：1.相较于单纯放疗的患者,接受单纯手术或手术综合治疗的患者社会／家庭状况较差,放化疗的患者的社会／家庭状况较好。
2.健康促进行为可改善患者躯体状况。
3.屈服应对者,躯体状况及疾病治疗相关症状差；面对应对者,社会／家庭状况好。
4.在整个治疗及康复过程,应重视对患者的健康教育和心理干预,帮助其了解自身疾病,采取积极有效的应对策略,并形成良好的生活方式。
Objective:To describe the quality of life with cervical cancer cases in different kinds of treatments, evaluate the pros and cons of the treatments, explore the influencing factors for improving the patients'quality of life.
Methods:In this study, cervical cancer scale(FACT-Cx),which is developed by Ending,Research and Education Center(CORE), United States, was used to investigate cervical cancer survivors(102 cases) diagnosed and treated in Fujian Provincial Tumor Hospital from January 2004 to October 2008. t test, analysis of variance or nonparametric test were used to compare scores of quality of life in different subgroups; cumulative odds model was used to compare patients'quality of life in different treatments after age, time and stage adjusted; structural equation model was used to study influencing factors.
Results:1. Univariate analysis showed that patients that age<45 years, weekly leisure time> 3 hours, paid for health care were in better physical wellbeing; patients that weekly leisure time> 3 hours, body mass index abnormal, non-surgery were in better social/family wellbeing; the higher the educational level, the better the emotional wellbeing; patients that weekly leisure time> 3 hours, entertainment≥2 kinds were in better function wellbeing; patients that weekly leisure time> 7 hours had good scores of additional attention; patients that good finance, weekly leisure time> 3 hours, weekly leisure time> 7 hours had better overall quality of life.
2. Spearman correlation analysis showed that, confrontation was positively correlated with social/family wellbeing, negatively correlated with physical wellbeing and emotional wellbeing; Acceptance-Resignation was negatively correlated with physical wellbeing, emotional wellbeing, functional wellbeing, additional attention and overall quality of life.
3. Surgical patients'social/family wellbeing were worse; patients in radiotherapy were in poor functional wellbeing; patients in chemotherapy were in poor overall quality of life and functional wellbeing; comparing to patients treated with radiotherapy alone, surgical patients, no matter surgery alone or combined treatment, social/family wellbeing were poor, but patients in chemoradiation is better.
4. The factors that had direct impact on the physical condition included health promoting behaviors and acceptance-resignation; the factors that had direct impact on social/family status included socioeconomic status and confrontion;the factors; acceptance-resignation had a direct impact on treatment-related symptoms. At the same time, physical condition impacted on functional condition, functional condition impacted on social/family status and emotional status.
Conclusion:1. Comparing with radiotherapy alone, patients receiving surgery alone or surgical combined treatment were in poor social/family wellbeing, patients in chemoradiation with better social/family wellbeing.
2. Health promoting behaviors could improve patients'physical condition.
3. Patients who were coping with acceptance-resignation had poor physical condition and treatment-related symptoms; patients who were coping with confrontion had good social/family status.
4. During the treatment and rehabilitation, more attention should be paid on patients'health education and psychological intervention to let them learn more about the disease what they had, cope with active and effective strategies and form good life styles.
引文
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