Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative
Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative
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DOI：
10.1007/s11764-015-0438-y
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发表时间：
2015-12-01
影响因子：
3.7
通讯作者：
Danhauer, Suzanne C.
中科院分区：
文献类型：
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作者：
Jones, Salene M. W.;LaCroix, Andrea Z.;Danhauer, Suzanne C.
目的 痛苦和生活质量 (QOL) 下降在癌症患者中很常见。尚无研究将乳腺癌诊断后的这些变量与癌前诊断水平进行比较。方法对 50 岁或以上乳腺癌女性 (n = 6949) 的数据进行分析，数据来自妇女健康倡议 (1993-2013)。使用 Rand-36 测量与健康相关的 QOL（身体功能、心理健康）。抑郁症状通过流行病学研究中心的六项抑郁量表进行测量。评估在癌症诊断之前和之后进行。分层线性模型将癌前 QOL 和抑郁症状与诊断后水平进行比较，并测试癌前体力活动、压力生活事件、睡眠障碍和疼痛是否预测诊断后结果。结果与癌前水平相比，抑郁症状增加（0-6 个月增加 20.0%，6-12 个月增加 12.9%），而身体功能（0-6 个月为 -3.882 分，诊断后第一年，心理健康状况下降（6-12 个月时为-3.545，0-6 个月时为-2.899，6-12 个月时为-1.672）（所有 p < .01）。 10 年后，抑郁症状恢复到癌前水平，但生活质量仍然显着较低。诊断后 10 多年，身体功能比癌前水平低 2.379 点 (p < 0.01)，而心理健康水平则低 1.922 点 (p < 0.01)。所有癌前预测因子均与所有结果相关。疼痛预示着诊断后身体功能会出现更大程度的下降。 结论 与癌前水平相比，乳腺癌诊断后抑郁症状增加，生活质量下降，尤其是在第一年。
Purpose Distress and reduced quality of life (QOL) are common among people with cancer. No study has compared these variables after breast cancer diagnosis to pre-cancer diagnosis levels.Methods Data on women with breast cancer 50 years of age or older (n = 6949) were analyzed from the Women's Health Initiative (1993-2013). Health-related QOL (physical function, mental health) was measured using Rand-36. Depressive symptoms were measured with the six-item Center for Epidemiologic Studies Depression scale. Assessments occurred before and after the cancer diagnosis. Hierarchical linear modeling compared pre-cancer QOL and depressive symptoms to levels post-diagnosis and tested whether pre-cancer physical activity, stressful life events, sleep disturbance, and pain predicted post-diagnosis outcomes.Results Compared with pre-cancer levels, depressive symptoms increased (20.0 % increase at 0-6 months, 12.9 % increase at 6-12 months), while physical function (-3.882 points at 0-6 months, -3.545 at 6-12 months) and mental health decreased (-2.899 points at 0-6 months, -1.672 at 6-12 months) in the first year after diagnosis (all p < .01). Depressive symptoms returned to pre-cancer levels after 10 years, but QOL remained significantly lower. At more than 10 years post-diagnosis, physical function was 2.379 points lower than pre-cancer levels (p < 0.01) while mental health was 1.922 points lower (p < 0.01). All pre-cancer predictors were associated with all outcomes. Pain predicted uniquely greater decreases in physical function post-diagnosis.Conclusions Depressive symptoms increased and QOL decreased following breast cancer diagnosis compared with pre-cancer levels, particularly in the first year.