Quality and Quantity of Life with Pancreatic Cancer
Quality and Quantity of Life with Pancreatic Cancer
复制标题
胰腺癌患者的生活质量和数量
作者：
J. Jacobson
在本期中，Müller-Nordhorn等人[5]使用欧洲癌症研究与治疗组织（EORTC）的问卷（评估功能和症状）和EuroQoL（EQ-5D）问卷（参考国家规范评估效用）报告了胰腺癌患者的健康相关生活质量。在这项分析中，使用了两套规范：德国规范，从一个样本大约匹配的年龄与德国患者参与研究，英语规范，这是最常用的文献。毫不奇怪，连续招募的45名确诊胰腺癌的患者，包括20名转移性疾病患者，报告功能受损，症状和问题更严重，生活质量比正常人群更差（女性的认知功能和疼痛量表除外）。这项研究的价值在于它的症状和功能区作为健康相关的生活质量的预测分析。在调整年龄和性别的线性回归模型中，生活质量受损的唯一统计学显著预测因素依次为疲劳和疼痛。几项研究表明，胰腺癌与抑郁和焦虑有关[6-8]。在EORTC功能量表中，患者在情感和社会功能方面得分特别低，可能是由于焦虑和抑郁。这些状态是否是疾病患者疲劳、疼痛和预后不良的原因或结果，或者与疾病过程有关，仍有待确定。在肿瘤学的早期，大约半个世纪前，大多数癌症患者被诊断为晚期疾病，生存前景很差。他们的情况证明有必要对剧毒制剂进行试验。在接下来的几十年里，临床试验方法不断发展，研究开始取得一些成功。今天，有效的治疗，不一定治愈，但显着延长生存，是广泛适用于许多常见的癌症。此外，对于几种常见癌症和癌症前体，已经开发了有效的筛查方法，对于某些癌症，早期发现确实可以进行根治性治疗。根据马斯洛的需求层次理论[1]，一旦我们的生存需求得到解决，我们就会把注意力转向生活质量。因此，随着长期癌症幸存者人数的增加，癌症临床医生和研究人员越来越认识到有责任最大限度地减少治疗和疾病对生活质量的不利影响。胰腺癌在很大程度上被排除在癌症研究的成功故事之外。胰腺癌患者的五年生存率约为5%，中位生存率不到1年。即使在诊断为局部疾病的患者中，5年生存率也不到20%。然而，胰腺癌患者开始受益于临床癌症研究人员对生活质量的日益关注。生活质量评估是胰腺癌临床试验的常规特征，尽管其目的可能仅仅是在生存期或疾病程度无差异的情况下发现治疗组之间的一些差异[2-4]。Published online：十二月21，2006
In this issue, Müller-Nordhorn et al. [5] report on health-related quality of life among pancreatic cancer patients using both the questionnaire of the European Organization for Research and Treatment of Cancer (EORTC), which assesses function and symptoms, and the EuroQoL (EQ-5D) questionnaire, which assesses utilities with reference to national norms. In this analysis, two sets of norms were used: German norms from a sample approximately matched for age with the German patients participating in the study, and English norms, which are most often used in the literature. It is no surprise that the 45 consecutively recruited patients with a confirmed diagnosis of pancreatic cancer, including 20 with metastatic disease, reported impaired functioning, worse symptoms and problems, and poorer quality of life than the norm populations (exceptions were cognitive functioning and pain scales in women). The value of the study lies in its analysis of symptoms and functional areas as predictors of healthrelated quality of life. In a linear regression model adjusted for age and sex, the only statistically significant predictors of impaired quality of life were fatigue and pain, in that order. Pancreatic cancer has been shown in several studies to be associated with depression and anxiety [6–8] . In the EORTC functional scales, patients scored especially poorly on emotional and social functioning, presumably due to anxiety and depression. Whether those states are the cause or result of fatigue, pain and poor prognosis among patients with the disease or are related to disease processes remains to be determined. In the early days of oncology, about half a century ago, most cancer patients were diagnosed with late-stage disease and had poor prospects for survival. Their circumstances justified trials of highly toxic agents. Over the next few decades, clinical trial methodology evolved, and research began to achieve some successes. Today, effective treatment, not necessarily cure but significant prolongation of survival, is widely available for many common cancers. In addition, effective screening methods have been developed for several common cancers and cancer precursors, and for some cancers, early detection does indeed make curative treatment possible. According to the theory of the hierarchy of needs by Maslow [1] , once our immediate requirements for survival are addressed, we turn our attention to quality of life. Thus, as the numbers of long-term cancer survivors grew, cancer clinicians and investigators increasingly acknowledged a responsibility to minimize the adverse effects of treatment and the disease on quality of life. Cancer of the pancreas has largely been left out of the cancer research success story. Five-year survival among patients with pancreatic cancer is about 5%, and median survival is less than 1 year. Even among patients diagnosed with localized disease, 5-year survival is less than 20%. However, patients with pancreatic cancer are beginning to benefit from the growing concern of clinical cancer investigators for quality of life. Assessment of quality of life is a routine feature of pancreatic cancer clinical trials, although its purpose may be merely to find some difference between treatment arms in the absence of a difference in survival or extent of disease [2–4] . Published online: December 21, 2006