A Study About Quality Of Life For Malignant Obstructive Jaundice Patients With Different Treatments

Objective1. To explore quality of life and influence factors for Malignant Obstructive Jaundicepatients.2. To analysis the trend of quality of life for Malignant Obstructive Jaundice patientswho were applied with different treatments.3. To analysis the current situation of the survival time for Malignant ObstructiveJaundice patients, and explore the risk factors of death for Malignant Obstructive Jaundicepatients.Methods1. Two hundred cases of malignant obstructive jaundice patients were selected toproceed prospective studies at Biliary surgical department of Eastern HepatobiliarySurgery Hospital from December2012to January2012by using non-random samplingmethods. Patients should fill in the QLQ-C30and QLQ-MOJ11scale while they wereadmitted, post-operative and before discharge, using the self-made scale to collect generalinformation and clinical data for malignant obstructive jaundice patients. Statisticalpackage18.0was applied to statistical analysis. T-test was used to analysis the score ofQLQ-C30scale to contrast with Reference value while patients were in the hospital.Analysis of variance (ANOVA) and non parametric test were used to exploredemographic characteristics, clinical data, biochemical indicator and so on to affect thequality of life of patients duration of hospital stay.2. The first day after treatment as the follow-up time, patients were followed up inpatients discharged from hospital one month, three months, six months and so on, we stopto follow up in February29,2012. We use the way of telephone, outpatient review andletter to follow up. According the different treatments, the patients were divided in theradical surgery group, the palliative surgery group, stent implantation group. T-test,one-way ANOVA and non parametric test were applied to analysis the assessmentoutcome of quality of life for the patients with different treatment methods. According tothe evaluation results to draw a line chart of the patients quality of life trends. 3. Chi square test, T-test and Non-parametric test were used to analysis whether thedemographic characteristics, biochemical indices and treatment methods had different ornot between the death patients and the survival patients. Analysis the quality of lifeconditions in the two groups of patients before treatment. Application Life Table toanalysis the two hundred patients of survival time, and predict the median survival of thepatients with different demographic, biochemical indices and different treatment methods.According the results, draw the survival curve. COX proportional hazards model wasused to predict the risk factors of death for malignant obstructive jaundice patients thatdid not lose follow.Results1. To compare the score of QLQ-C30and QLQ-MOJ11with Reference Values, wecan discover the score of Functional Scale and Global health are lower than ReferenceValues (except Emotional function), and the sore of Symptom scale and Independent scaleare higher than Reference Values. There has statistical significance between the score ofevery scale and Reference Values. We can consider that the quality of malignantobstructive jaundice patients was much poorer than that of750case patients who haveselected to research by the quality of life of European cancer treatment team.2. According to ANOVA, the risk factors of quality of life for malignant obstructivejaundice patients include age, occupation, educational history, monthly income, medicalinsurance, TBIL, DBIL, ALP, pre-albumin, CA19-9. The malignant obstructive jaundicepatients with age less than60years old, monthly income less than2000Yuan, TBILgreater than or equal to100μmol/L, DBIL greater than or equal to100μmol/L, pre-albuminless than170mg/L, CA19-9greater than or equal to200U/ml have poor quality of lifeduration of hospital stay.3. The results showed that the Function and Symptom scale of QLQ-C30have a poormanifest after operation. The scores of QLQ-C30and QLQ-MOJ11scale had slightlyfluctuation one month after discharge, and the scores would recover to the level ofadmission until the patients had discharged for three months. The score of QLQ-MOJ11Symptom scale reduced gradually along with time. The two Independent scale ofQLQ-MOJ11had a higher score after operation, and recovered to the admission level threemonths after discharge. The sore of the functional areas and overall health status subscalewas the "W" type, while score of the symptoms field decreased gradually over time. 4. According to Chi Square test, patients in death patients group with monthly incomeless than2000Yuan, TBIL greater than or equal to100μmol/L, DBIL greater than or equalto100μmol/L, pre-albumin less than170mg/L and CA19-9greater than or equal to200U/ml have higher proportion than those in survival patients group, and the differencehas statistical significance. The risk of death for the patients with monthly income less than2000Yuan is2.047times that of patients with monthly income greater than or equal to2000Yuan. The risk of death for patients with TBIL greater than or equal to100μmol/L is2.268times that of patients with TBIL less than100μmol/L. The risk of death for patientswith DBIL greater than or equal to100μmol/L is1.984times that of patients with DBILless than100μmol/L. The risk of death for patients with pre-albumin less than170mg/L is2.053times that of patients with pre-albumin greater than or equal to170mg/L. The risk ofdeath for patients with CA19-9greater than or equal to200U/ml is2.227times as high asthat of the patients with CA19-9less than200U/ml. We consider the monthlyincome<2000yuan, TBIL≥100μmol/L, DBIL≥100μmol/L, prealbumin<170mg/L,CA19-9≥200U/ml are risk factors of death for patients. The score of death patients waslower than that of the survival patients in Function scale and General health, and the scoreof death patients was higher than that of survival patients in Symptom scale. The scoredifference for Physical function, Cognitive function, Fatigue symptom, Pain symptom,Insomnia, appetite loss, Financial difficult and Jaundice symptom have statisticsignificance. Therefore we consider that the quality of death patients was poor beforetreatment.5. The median survival time for malignant obstructive jaundice patients is420days(approximately14months). The patients that accepted surgery therapy, age less than60years old, monthly income greater than or equal to2000Yuan, TBIL less than100μmol/L,DBIL less than100μmol/L, pre-albumin greater than or equal to170mg/L, CA19-9lessthan200U/ml, with a tube discharge have longer median survival time and higher survivalrate. According to the COX proportional hazards model, the risk of death for Gallbladdercarcinoma patients and metastatic cancer patients were2.865times and6.170times that ofhilar cholangiocarcinoma patients. The risk of death for patients with monthly less than2000Yuan is2.300times that of patients with monthly income is greater than or equal to2000Yuan. The risk of death for patients with Lymph node metastasis is3.235times thatof patients without lymph node metastasis. The risk of death for patients who accepted theimplementation of the stent treatment is3.067times and4.608times that of patients who accepted the implementation of palliative surgery and radical surgery treatment. The riskof death for patients with pre-albumin less than170mg/L is2.696times than that ofpatients with pre-albumin greater than or equal to170mg/L. The risk of death for patientswith CA19-9greater than or equal to200U/ml is1.966times than that of patients withCA19-9less than200U/ml. We consider a diagnosis of metastatic cancer, the monthlyincome of less than2000yuan, the implementation of the stent, with lymph nodemetastasis, prealbumin<170mg/L of CA19-9≥200U/ml are independent risk factors ofdeath for patients with malignant obstructive jaundice.Conclusions1. The whole QOL of malignant obstructive jaundice patients are poor duration ofhospital stay. The demographic characteristics such as age, occupation, educational history,medical insurance, and biochemical indicator include TBIL, DBIL, pre-albumin, CA19-9are the influence factors to the quality of life for the malignant obstructive jaundicepatients duration of hospital stay. Clinical nurses should combine demographiccharacteristics, clinical data with biochemical indicators to provide individual nursing carefor patients, so that we can achieve the aim that can improve the QOL of patients.2. The quality of life of malignant obstructive jaundice patients are poorpost-operative and one month discharge from hospital. Their quality of life of the overalltrend was the "W" type. Clinical health care workers should tell patients that healthrecovery is a long procedure, and they need adjunctive therapy, outpatient review on timeafter treatment. In order to help patients reduce the expectation value for healthy recoveryand release the mental stress of patients, accordingly can improve the quality of life forpatients post-discharge.3. We can consider that low monthly income, high bilirubin, low pre-albumin, highCA19-9, advanced cancer, lymph nodes metastatic are risk factors to death for malignantobstructive jaundice patients. Clinical health medical workers pay close attention to theindex change of patients. We should give patients health guidance about the disease. If thedisease were early discovered, early diagnosed, early treatment by surgery, the treatmenteffectiveness is the best. So we should appeal all people to take physical examinationregularly, so that we can rule out the potential risk factors and take the preventivemeasures. 4. The median-survival time for Malignant Obstructive Jaundice patients is420day(approximately fourteen months). But this research has short time to follow up, and thesurvival time of most of patients is not definite. Therefore we need further clinical studies.