Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma
Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma
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DOI：
10.1089/thy.2016.0260
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发表时间：
2017-02-01
期刊：
影响因子：
6.6
通讯作者：
Swan, J. Shannon
中科院分区：
文献类型：
--
作者：
Lubitz, Carrie C.;De Gregorio, Lucia;Swan, J. Shannon
背景：甲状腺癌发病率呈上升趋势。在大多数患者的寿命没有改变的情况下，诊断和治疗对健康相关生活质量(HRQOL)的影响是一个基本变量。具有可用于疾病间比较的数据的HRQOL工具正越来越多地被用于卫生政策和结果评估。根据特定疾病的影响，不同的仪器之间存在差异。我们评估了四个有效的、基于偏好的调查中哪一个能检测到诊断为乳头状甲状腺癌(PTC)患者的健康变化和临床干预。方法：在第一年治疗的三个围术期时间点，对诊断为甲状腺乳头状癌(PTC)的患者进行了四种常用的HRQL问卷(简写形式-12v2(R)[SF6D]，EuroQol-5D[EQ5D]，以及健康实用指数标记2和3[HUI2，HUI3])。评估临床病理和疗程数据对HRQL的影响，包括手术并发症、持续/早期复发的再次手术和辅助性放射性碘治疗。结果：在117例患者中，27%的患者术前诊断为焦虑或抑郁，41%的患者有区域淋巴结转移，3例有远处转移，49%的患者接受了辅助放射性碘治疗。EQ5D的上限效应(满分比例)最大，SF6D最小。指数得分从0.77(SF6D)到0.90(EQ5D)。所有评分在术后两周下降，在六个月时恢复到治疗前水平。SF6D是唯一超过所有三个时间点之间的常规最小重要差异的仪器。质量调整寿命年：SF6D，0.79；EQ5D，0.90；HUI2，0.88；HUI3，0.86。结论：我们的结果反映了PTC患者的总体健康状况。对生活质量的影响主要与治疗的情感和社会影响有关。这些结果支持对类似基础结构的测量，尽管不同仪器在检测健康变化方面存在差异。在评估的仪器中，SF6D对治疗效果的反应最快，应该在未来对这一患者群体的经济分析中使用。
Background: Thyroid cancer incidence is increasing. The effect of diagnosis and treatment on health-related quality of life (HRQoL) is an essential variable in the absence of a change in life span for the majority of patients. HRQoL instruments, with data useful for between-disease comparisons, are being increasingly used for health policy and outcomes evaluation. Variation exits among the instruments based on the impact of a specific disease. We assessed which of four well-validated, preference-based surveys detect changes in health and clinical intervention in patients diagnosed with papillary thyroid cancer (PTC).Methods: Four commonly used HRQoL questionnaires (Short Form-12v2 (R) [SF6D], EuroQol-5D [EQ5D], and Health Utilities Index Mark 2 and 3 [HUI2, HUI3]) were administered to patients with the diagnosis of PTC at three perioperative time points during the first year of treatment. Clinicopathological and treatment course data were assessed for HRQoL impact including complications from surgery, re-operation for persistence/early recurrence, and adjuvant radioactive iodine treatment. We compared standard metrics, including ceiling effect, intraclass correlation coefficient, effect sizes, and quality-adjusted life-years between the four instruments.Results: Of 117 patients, 27% had a preoperative diagnosis of anxiety or depression, 41% had regional lymph node metastases, three had distant metastases and 49% underwent adjuvant radioactive iodine treatment. The ceiling effect (i.e., proportion with a perfect score) was greatest with EQ5D and least with SF6D. Index scores ranged from 0.77 (SF6D) to 0.90 (EQ5D). All scores declined at two weeks postoperatively and returned to pretreatment levels at six months. The SF6D was the only instrument to exceed the conventional minimally important difference between all three time points. Quality-adjusted life-years were as follows: SF6D, 0.79; EQ5D, 0.90; HUI2, 0.88; and HUI3, 0.86.Conclusions: Our results reflect the general good health of PTC patients. The effect on quality of life is primarily related to emotional and social impacts of treatment. The results support the measurement of a similar underlying construct, although variation in detecting changes in health exists between the instruments. Of the instruments assessed, the SF6D is the most responsive to treatment effects and should be utilized in future economic analyses in this patient population.