Studying The Status And Influencing Factors On Quality Of Life In Patients After Resection Of Esophageal And Cardiac Carcinoma As Well As Correlation Analysis

Objective: this study was to investigate the outcomes in terms of quality of life (QoL) and influencing factors in patients with carcinoma of esophagus and cardia after surgery, to find out the relationship between the QoL and family social support, to provide the theoretical evidence for adopting better medical cares and nursing measurements, and to provide reference data for developing a self-assessed questionnaire which is suitable to Chinese culture background on QoL in patients with esophageal and cardianc carcinoma.Methods: in this cross section study, the questionnaires were completed by patients who came to our hospital for check-up after 1 month of esophagectomy and cardiectomy from February 2006 to December 2006. The instruments which applied to patients includes a General information questionnaire, an European Organization for Research and Treatment of Cancer (EORTC) QoL core questionnaire (QLQ-C30 version 3 ), an esophageal cancer–specific module, a family support questionnaire, and a social support questionnaire (SRSS). Statistic method: SPSS11.5 statistical package was used to analyze the data, Cronbach's alpha coefficient was used to indicate the reliability analysis of QLQ-C30 and QLQ OES 24 questionnaires. T-test and F-test were conducted to assess the sociodemographic information and cancer related information. On this basis, the stepwise regression analysis was conducted to determine the influencing factors on global QoL as well as each dimension. In the end, the correlation analysis was conducted to explore the relationship between the QoL and the family social support.Results: A total of 253 valid questionnaires were obtained, among them, 133 cases were esophageal carcinoma, and 120 cases were cardiac carcinoma; 191 were men, 62 were women. The patients ranged from 38 to 78 years old (average 59 years old). The results revealed the global QoL in 68.4±19.3,and the scores showed significant differences between the study patients and Norwegian normative value in almost every dimension. The cognitive function rated the highest score of 85.77±14.60 among the functional scale , fatigue rated the highest score of 29.80±17.72 in that of symptom scale, the financial difficulty rated the highest score of 29.51±25.86 among the single items, and dysphagia scored 35.67±12.12 in esophageal cancer–specific module.According to the results, many factors impacted the QoL in an interactive and integrated way. Significant differences were seen in the gender, origin, complications, educational level, and economical condition(P<0.05). That is to say, male patients had better QoL than that of female. The city dweller had a better QoL than that of patients from the rural area. Patients with complications had a lower QoL than the patients with no complications. We also found that a higher income meant a higher QoL.The main factors affecting the global QoL were cognitive function (CF), physical function (PF), complications, financial difficulty (FI), objective support, gastrointestinal symptoms (GI), insomnia (SL), and dyspnoea (DY) in turn. Of the several factors analyzed, CF, PF, and objective support affected the QoL positively. Negative impacts existed significantly between the postoperative complications, FI, GI, SL, DY and QoL.Factors that affected the PF significantly were Role function (RF), CF, DY, family support, fatigue and emotional problems. Among them, RF, CF, and family support had a positive relationship with the QoL, while the DY, fatigue, emotional problems had a negative relationship with QoL.The SF, PF, feeling of dry mouth, pain (PA), spouse health condition and coughing were the main factors that impact the RF. As we can see from the results, SF, PF and spouse health condition were correlated with RF positively, and feeling of dry mouth, PA, coughing were correlated with RF negatively.The main factors that impact on the emotional function (EF) were Nausea and vomiting (NV), RF, FI, Appetite loss (AP), changing of taste, gender, SF, GI. There was a positive correlation between RF, changing of taste, gender, SF and EF, whereas there was a negative correlation between NV, FI, PA, GI and EF.Similar analysis showed that CF was significantly affected by FA, eating related items, PF, PA, utilizing of social support, DY, EF, and education background. Positive correlation existed between the PF, utilizing of social support, EF, education background and CF. Negative correlation existed between FA, eating related items, PA, DY and CF.Factors that affected the SF significantly were RF, EF, social support, spouse health condition and family support. There was a positive correlation between RF, social support, family support and SF, and a negative correlation between EF, spouse health condition and SF.The Pearson correlation analysis (a value of p<0.05 was considered significant) showed stronger positive correlation between the global QoL and family social support, and positive correlation existed between the PF and social support, utilizing of social support, family support. The positive correlation also can be seen between RF and family support. There was positive correlation between EF and total social support, objective support, family support. The study also showed positive correlation between CF and total social support, utilizing of social support; positive correlation was presented between the SF and all the aspects of family social support.Conclusions: The studied patients'postoperative QoL decreased significantly compared with the Norwegian normative values. The affecting factors on QoL were complex, interactive and integrated. Especially, the gender, educational level, patients'origin, complications, FI, SL, DY, and GI were all seemed to be the most important factors on patients'QoL after esophaguectomy and cardiectomy, and the CF, PF, EF, SF were also confirmed to be the affecting factors too. According to the results, there was positive correlation between the QoL and family social support. We can conclude by saying that the more sufficient family social support was, the higher QoL patients had. Therefore, we must not only pay attention to the physical, psychological functions of patients, but also to the family social support in future, as well as make effort to connect the treatment, nursing and rehabilitation closely, and improve every aspects of QoL in patients with carcinoma after esophagectomy and cardiectomy.