摘要
目的随着乳腺癌发病率及生存率的提高,其现患病例越来越多,开展有效的乳腺癌患者健康管理,提高患者的生命质量受到了社会的关注。本研究旨在探讨综合社会支持干预对社区女性新发乳腺癌患者生命质量的影响,为完善社区肿瘤患者的健康管理提供一定的经验基础。方法选取上海市浦东新区22家社区,以2011-01-01-2013-07-31确诊的乳腺癌患者为研究对象,对其中12家干预社区233例乳腺癌患者提供为期9个月的综合社会支持干预,10家对照社区的277例患者沿用常规随访模式。在基线和终期调查(间隔9个月)分别对所有的研究对象进行基本信息调查,应用领悟社会支持评定量表(perceived social support scale,PSSS)、乳腺癌患者生命质量测定量表(functional assessment of cancer therapy-breast cancer,FACT-B)分别进行社会支持感知度和生命质量评估,应用个体前后配对的方法,通过秩和检验、多因素分析了解综合社会支持对于患者生存状况的影响作用。结果干预组与对照组研究对象基线PSSS得分中位数均为66.0,FACT-B得分中位数均为97.0。与自身基线数据相比,干预组终期调查研究对象PSSS得分差值中位数为0.5,对照组为-5.0,差异有统计学意义,z=-4.536,P<0.001。干预组研究对象FACT-B量表中社会家庭维度得分差值中位数为1.0,而对照组为-1.0,差异有统计学意义,z=-2.794,P=0.005。多因素分析显示,在控制其他影响因素的作用下,综合社会支持干预可显著提高患者的生命质量,β=4.141,P=0.032;家庭月收入、诊断时疾病期别、化疗状况、与他人交流以及PSSS量表基线得分等因素也与生命质量得分差值呈显著相关,均P<0.05。结论在社区中开展综合社会支持干预的健康管理,对新确诊的女性乳腺癌患者社会支持感知情况、生命质量状况具有促进作用;选择低收入水平、低社会支持度、接受化疗及合并有多种其他疾病的乳腺癌患者作为干预对象,会收到更好的效果。
OBJECTIVE Currently the total number of breast cancer patients were increasing because the incidence was increasing and the survival time was comparatively longer. Effective health management to improve the patient＇s qual- ity of life（QOL） has becoming the concern in society. We aimed to evaluate the effectiveness of comprehensive social sup- port intervention on the improvement of QOL for the patients in the community,and provide practical experience for the improvement of health management for cancer patients in community. METHODS We included 22 communities~ breast cancer patients diagnosed from January 2011 to July 2013 ,and randomly divided them into two groups （treat group ＆ con- trol group） clustered. For the treatment group （12 communities including 233 patients）, we provided 9 months＇ social support intervention, including professional support, family support and peer support. While for the control group （10 communities including 277 patients）, routine follow-up was performed. The basic information, perceived social support status and QOL status of the patients were collected using questionnaire, Perceived Social Support Scale（PSSS） and the Functional As- sessment of Cancer Therapy-Breast Cancer（FACT-B） at the baseline and 9 months intervention later, respectively. Comparative methods, Willcoxon test, logistic regression were used to assess the impact of the comprehensive social support for the breast canc- er patients. RESULTS The median of PSSS score and FACT-B score in baseline were 66.0 and 97.0 in both groups,respective- ly. After the program,PSSS Score of treat group increased 0.5 points than 9 months ago,while it decreased 5.0 points in the con- trol group. The difference between the two groups was statistically significant（z= -4. 536, P〈0. 001）. Besides, the median of difference for FACT-B score between baseline and intervention was 1.0 and -1.0 for the treatment group and control group （z=-2. 794,P=0. 005）. Multi-factor analysis showed that the changes of total score of QOL were significantly related to the social support intervention（β= 4.141, P = 0.032）, and family income, disease stage at diagnosis, chemotherapy, communication with oth- ers status and the PSSS scale baseline scores were also related to the change of score of QOL（P^0.05）. CONCLUSIONS Com- prehensive social support intervention can improve the perceived social support status and QOL status of breast cancer patients in community and the implement of the intervention for the patients with low income, less social support, accepting chemotherapy or complicated with other diseases would be more effective.
作者
闫蓓
郝莉鹏
高玉堂
杨琛
林涛
王莉红
王莹莹
吴铮
孙乔
YAN Bei;HAO Li-peng;GAO Yu-tang;YANG Chen;LIN Tao;WNAG Li-hong;WANG Ying-ying;WU Zheng;SUN Qiao(Cancer and Injury Prevention Section, Center for Disease Control and Prevention, Pudong New Area, Shanghai 200136 ,P. R. China;Department of Epidemiology Research, Shanghai Cancer Institute, Shanghai 200032, P. R. China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2018年第1期1-7,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
上海市浦东新区卫生系统优秀青年医学人才培养(PWRq2012-24)
上海市浦东新区卫生系统重点学科建设(PWZxk2017-28)
关键词
社会支持
乳腺癌
生命质量
健康管理
social support
breast cancer
quality of life
health-management
