Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study
Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study
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DOI：
10.1002/cncr.32663
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发表时间：
2019-12-20
期刊：
影响因子：
6.2
通讯作者：
Cohen, Harvey J.
中科院分区：
文献类型：
--
作者：
Mandelblatt, Jeanne S.;Zhai, Wanting;Cohen, Harvey J.
背景：关于纵向症状负担、其对健康的影响以及生活方式是否能减轻老年幸存者的负担，我们知之甚少。方法作者报告了2010年8月至2016年6月招募的年龄≥ 60岁的新诊断非转移性乳腺癌和非癌症对照的幸存者的36个月数据。症状负担测量为自我报告的症状/疾病的总和，如下所示：疼痛（是或否），疲劳（癌症治疗功能评估[FACT]-疲劳量表），认知（在FACT-Cognitive量表上），睡眠问题（是或否），抑郁（在流行病学研究中心抑郁量表上），焦虑（在状态-特质焦虑量表上），以及心脏问题和神经病（是或否）。幸福感采用FACT-General量表进行测量，分数从0到100。生活方式包括吸烟、饮酒、体重指数、体育活动和休闲活动。混合模型评估了治疗组（化疗加或不加激素治疗，仅激素治疗和对照组）与症状负担、生活方式和协变量之间的关系。单独的模型测试了症状负担和生活方式的波动对功能的影响。结果所有组均报告了高基线症状，并且随着时间的推移，水平仍然很高;幸存者和对照组之间的差异在认知和睡眠问题、焦虑和神经病变方面最为显著。与对照组相比，化疗暴露幸存者的调整后负担评分最高，其次是激素治疗暴露幸存者（P < .001）。负担评分与身体、情绪和功能健康相关（例如，负担评分较低的幸存者比负担评分较高的幸存者的身体健康评分高12.4分）。综合生活方式评分与症状负担或幸福感无关，但体力活动与每个结局显著相关（P < .005）。结论：与可比的非癌症人群相比，癌症及其治疗与老年乳腺癌幸存者更高水平的可操作症状和更大的幸福感损失相关，这表明需要进行监测和干预。
Background Little is known about longitudinal symptom burden, its consequences for well-being, and whether lifestyle moderates the burden in older survivors. Methods The authors report on 36-month data from survivors aged >= 60 years with newly diagnosed, nonmetastatic breast cancer and noncancer controls recruited from August 2010 through June 2016. Symptom burden was measured as the sum of self-reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]-Fatigue scale), cognitive (on the FACT-Cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiologic Studies Depression scale), anxiety (on the State-Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well-being was measured using the FACT-General scale, with scores from 0 to 100. Lifestyle included smoking, alcohol use, body mass index, physical activity, and leisure activities. Mixed models assessed relations between treatment group (chemotherapy with or without hormone therapy, hormone therapy only, and controls) and symptom burden, lifestyle, and covariates. Separate models tested the effects of fluctuations in symptom burden and lifestyle on function. Results All groups reported high baseline symptoms, and levels remained high over time; differences between survivors and controls were most notable for cognitive and sleep problems, anxiety, and neuropathy. The adjusted burden score was highest among chemotherapy-exposed survivors, followed by hormone therapy-exposed survivors versus controls (P < .001). The burden score was related to physical, emotional, and functional well-being (eg, survivors with lower vs higher burden scores had 12.4-point higher physical well-being scores). The composite lifestyle score was not related to symptom burden or well-being, but physical activity was significantly associated with each outcome (P < .005). Conclusions Cancer and its treatments are associated with a higher level of actionable symptoms and greater loss of well-being over time in older breast cancer survivors than in comparable noncancer populations, suggesting the need for surveillance and opportunities for intervention.