Factors Associated With Risk of Body Image-Related Distress in Patients With Head and Neck Cancer.
Factors Associated With Risk of Body Image-Related Distress in Patients With Head and Neck Cancer.
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DOI：
10.1001/jamaoto.2021.1378
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发表时间：
2021-12-01
期刊：
影响因子：
--
通讯作者：
Graboyes EM
中科院分区：
文献类型：
--
作者：
Macias D;Hand BN;Maurer S;Balliet W;Ellis MA;Pipkorn P;Huang AT;Nilsen ML;Ruggiero KJ;Williams AM;Marsh CH;Li H;Rhoten BA;Sterba KR;Graboyes EM
体像相关痛苦(BID)在头颈癌(HNC)幸存者中很常见，并与显著的发病率相关。HNC相关竞标的风险因素特征仍然不佳，因为先前的研究使用的结果衡量方法未能完全捕获HNC幸存者所经历的BID。为了评估人口学和肿瘤学特征与HNC相关BID的相关性，使用问卷来测量和评估影像干扰-头颈(IMAGE-HN)，这是HNC相关BID的一个经过验证的、多领域的、患者报告的结果衡量标准。这项横断面研究评估了4个学术医疗中心的301名接受手术治疗的成人HNC幸存者。主要的结果衡量标准是图像-HN得分，得分越高，反映HNC相关投标越严重。多变量线性回归分析评估患者特征与IMAGE-HN全局和4个子领域(他向外貌关注、个人对外貌的不满、功能障碍困扰和社交回避)的分数之间的关系。在301名参与者(212名男性，平均年龄65.3[11.7]岁)中，181名(60.1%)接受了游离皮瓣重建。大学毕业(β=−9.6；95%CI，−17.5至−1.7)或研究生毕业(β=−12.6；95%CI，−21.2至−3.8)与高中以下教育程度相比，与较低的形象-HN社交回避分数相关。与有偿工作相比，失业与形象-他向型(β=10.7；95%CI，2.0~19.3)、个人对外表的不满意(β=12.5；95%CI，1.2~2 3.7)和全球(β=8.0；95%CI，0.6~15.4)得分有关。与未重建组相比，游离皮瓣重建组的表象HN总分(β=11.5；95%CI，7.9~15.0)和各亚域评分(他向外观：β=13.1；95%CI，8.6~17.6；个人对外观的不满意：β=15.4；95%CI，10.0~2 0.7；困扰伴功能障碍：β=12.8；95%CI，8.1~17.4；社交回避和孤立：β=10.2；95%可信区间，5.8-14.6)。与单纯手术治疗相比，接受手术加放疗(β=7.8；95%CI，2.9~12.7)或放化疗(β=6.5；95%CI，1.8~11.3)的患者有更高的影像HN痛苦和功能损害评分。多变量回归模型可以较好地解释表象-HN全局(R2=0.18)和子域得分(R2=0.20代表外貌，0.14代表个人对外貌的不满，0.21代表苦恼的功能障碍，0.13代表社交回避和隔离)。在这项横断面研究中，与HNC相关竞标风险相关的因素包括游离皮瓣重建、较低的教育程度、失业和多种治疗方式。这些特征解释了图像HN得分的适度差异，表明其他特征可能是HNC相关投标的主要风险因素，应在未来的研究中探索。
Body image–related distress (BID) is common among head and neck cancer (HNC) survivors and associated with significant morbidity. Risk factors for HNC-related BID remain poorly characterized because prior research has used outcome measures that fail to fully capture BID as experienced by HNC survivors. To assess the association of demographic and oncologic characteristics with HNC-related BID using the Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN), a validated, multidomain, patient-reported outcome measure of HNC-related BID. This cross-sectional study assessed 301 adult survivors of surgically managed HNC at 4 academic medical centers. The primary outcome measure was IMAGE-HN scores, for which higher scores reflect more severe HNC-related BID. Multivariable linear regression analyses were performed to evaluate the association of patient characteristics with IMAGE-HN global and 4 subdomain (other-oriented appearance concerns, personal dissatisfaction with appearance, distress with functional impairments, and social avoidance) scores. Of the 301 participants (212 [70.4%] male; mean [SD] age, 65.3 [11.7] years), 181 (60.1%) underwent free flap reconstruction. Graduation from college (β = −9.6; 95% CI, −17.5 to −1.7) or graduate school (β = −12.6; 95% CI, −21.2 to −3.8) was associated with lower IMAGE-HN social avoidance scores compared with less than a high school education. Compared with paid work, unemployment was associated with higher IMAGE-HN other-oriented appearance (β = 10.7; 95% CI, 2.0–19.3), personal dissatisfaction with appearance (β = 12.5; 95% CI, 1.2–23.7), and global (β = 8.0; 95% CI, 0.6–15.4) scores. Compared with no reconstruction, free flap reconstruction was associated with higher IMAGE-HN global scores (β = 11.5; 95% CI, 7.9–15.0) and all subdomain scores (other-oriented appearance: β = 13.1; 95% CI, 8.6–17.6; personal dissatisfaction with appearance: β = 15.4; 95% CI, 10.0–20.7; distress with functional impairment: β = 12.8; 95% CI, 8.1–17.4; and social avoidance and isolation: β = 10.2; 95% CI, 5.8–14.6). Higher IMAGE-HN distress with functional impairment scores were found in those who received surgery and adjuvant radiation (β = 7.8; 95% CI, 2.9–12.7) or chemoradiotherapy (β = 6.5; 95% CI, 1.8–11.3) compared with surgery alone. The multivariable regression model accounted for a modest proportion of variance in IMAGE-HN global (R2 = 0.18) and subdomain scores (R2 = 0.20 for other-oriented appearance, 0.14 for personal dissatisfaction with appearance, 0.21 for distress with functional impairment, and 0.13 for social avoidance and isolation). In this cross-sectional study, factors associated with risk of HNC-related BID included free flap reconstruction, lower educational attainment, unemployment, and multiple treatment modalities. These characteristics explain a modest proportion of variance in IMAGE-HN scores, suggesting that other characteristics may be the major risk factors for HNC-related BID and should be explored in future studies.
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