| BackgroundsPrimary Hepatic Carcinoma (PHC) is one of the most common malignant tumor worldwide, and the incidence of mortality is the highest in the world. Deaths accounted for 45% of liver cancer deaths worldwide each year. TACE is the preferred clinical treatment of inoperable patients with advanced hepatocellular carcinoma. Under the guidance of digital subtraction angiography (DSA), we choose blood supply atery of tumor trans-hepatic artery to inject chemotherapy drugs in order to kill tumor cells. TACE can prolong the survival time of patients with advanced hepatocellular carcinoma. However, embolization syndrome, toxic effects of chemotherapy drugs and repeatedly TACE can affect patients’ quality of life (QOL). With the transformation of medical mode, enhancing patients’ QOL gets more and more attention and concern during the treatment of tumor, which becomes the main goal of treatment in advanced malignant tumor. In view of the difficulty to completely cure cancer, it is hard to evaluate the therapeutic effect with a cure rate, so QOL of cancer patients has become the mainstream of medical QOL research. Studies have shown that QOL of PHC patients accepted TACE was low, which is affected by social support and patients’choice of coping modes. The higher the degree of social support, and the more positive the coping modes, the higher is the QOL. However, previous studies are mostly cross-sectional study, while the patient’s QOL, social support and coping modes and how the correlation evolves during the disease progression and treatment throughout the course have been explored by no one. The effectiveness of TACE therapy can truly reflect the essence of the meaning and evaluation of the QOL research only after long-term continuity longitudinal QOL assessment. The effectiveness of the treatment with conventional only through long-term continuous measurement of the longitudinal quality of life can truly reflect the essence of its significance in the study of quality of life and evaluation. Therefore, this topic proposed adopting longitudinal study design to conventional liver cancer patients for 3 months of tracking to understand QOL, social support and changes of coping modes in the population, and to explore the correlation among QOL, social support and coping modeslt is participated that this study can help medical personnel understand the change trend QOL in liver cancer patients, and provide theoretical guidance and basis for improving QOL ofpatients.Objective(1) To describe the QOL level of the PHC patients undergoing TACE at different time points within 3 months.(2) To describe the social support level of the PHC patients undergoing TACE at different time points within 3 months.(3) To describe the coping mode level of the PHC patients undergoing TACE at different time points within 3 months.(4) To investigate the correlationamong QOL,social support, and coping mode of PHC patients undergoing TACE.Subjects and Methods1. SubjectsDue to privacy of illness, we adopt the method of convenience sampling to choose 200 cases (PHC patients accepted TACE and alive) meeting inclusion criteria and exclusion criteria in The Third Affliated Hospital of Sun Yat-sen University in Guangzhou from January 2013 to June 2014. Inclusion criteria:(1) PHC be diagnosed with imaging or pathology; (2) Age≥18 years of age; (3) Haven’t received TACE before; (4) Patients received primary school or higher education who can communicate with language and written; (5) Volunteered for the research. Exclusion criteria:(1) Secondary liver cancer from malignant tumor metastasis of other parts of the body; (2) Patients with other parts (such as lung, kidney, etc.) malignancies; (3) Patients having a history of mental illness; (4) Patients have serious major organ diseases such as heart, brain, kidney, etc; (5) Survival time <3 months. Once the investigation was ended due to death caused by any reason, we reselected patients meeting all the criteria above to fulfill the number.2. MethodsThis study adopts questionnaire. All patients were repeatedly surveyed the day before surgery,1 week,1 month and 3 months after surgery. We used General Situation Questionnaire designed by ourselves, Determination of Liver Cancer Patients Quality Of Life Scale (QOL-LC V2.0), Social Support Assessment Scale (SSAS), and Medical Coping Modes Quesionnaire (MCMQ) as measure tools. General situation questionnaire includes:gender, age, marriage, education, occupation, residence, monthly household income per capita, payment method, history of TACE and local treatment, etc. QOL-LC V2.0 includes four dimensions such as:Physical function, psychological function, symptoms/side effects, social function, a total of 23 items, including 23 patients self-assessment score (not counted in scale scores), and total score of this table is 220 points. The QOL score is the accumulative points of first 22 items, each dimension index of QOL is for each dimensions cores/each dimension total score. The higher the score, the higher are their QOL. SSAS includes objective support, subjective support and utilization of social support of the three dimensions, with a total of 10 items. The total score is the sum of ten items’score. The higher the score, the higher is the level of social support. MCMQ includes 3 dimensions of confrontation, avoidance and yield, with a total of 20 items, each item according to 4 degree score. In view of using frequency of the coping methods, from low to high respectively assign 1,2,3 and 4 points. The higher the score, the higher is the frequency of using coping methods.3. Data statistics and analysisStatistical analysis was performed using SPSS 13.0 software package, general information on the study was descripted with frequency, percentage, mean, standard deviation. We performed multivariate analysis of variance of repeated measurement data of QOL, score of social support, score of coping method and the score of various aspects of QOL at the time of 3 months after TACE of different Child-pugh grading patients who reveived TACE. For score of each factor of social support at 4 different time, score of each factor of QOL, and score of each factor of medical coping modes, we perfomed correlation analysis.Results1. Patients’Characteristics:200 PHC patients received TACE were recruited. The cohort consists of 132 (66.0%) men and 68 (34.0%) women. The age ranges from 33 to 81 years old, and the average age is 54.5±24.5 years old. The degree of education is described as following (cases):primary school or junior middle school (62), high school or technical secondary school (68), college or undergraduate (44), postgraduate (26). The status of marriage is described as following (cases):married (164), divorced (28) and widowed (8). The family monthly income (yuan/RMB) is as following:≤1000 (23),1001-2000 (28),2001-3000 (42),3001-4000 (51), and>4000 (56). The status of insurance is as following (cases):Self Pay (57), Public Expense (42), Urban Residents’ Basic Medical Insurance (24), Rural Cooperative Medical Service (32), Commercial Insurance (14), and Urban Employee Basic Medical Insurance (31). The Child-pugh grade of the patient is as following (cases):A (48), B (91) and C (61). The TACE history is as following (cases):yes (185) and no (15).2. Life quality of patients with liver cancer:All PHC patients were enrolled in the 4-stage questionnaire. The score of QOL in preoperative 1 week was 118.82±28.74, comprising of physical function score (22.44±3.37), mental function score (21.32±7.54), social function score (23.32±6.80) and side effect score (14.31±6.62). The relative scores in post-TACE 1 week were 122.37±21.24, 22.56±3.23,24.83±6.65,24.47±6.34 and 15.98±7.74, respectively. The scores after 1 month post-TACE were 123.47±23.58,23.57±4.24,23.98±8.50,25.47±5.95 and 15.05±8.42, respectively. The scores after 3 months post-TACE were 125.84±23.55, 24.86±4.32,24.21±4.47,25.77±6.63, and 13.87±3.67, respectively. Multivariable analyses showed significant alterations (F=4.585,P<0.05). According to our data, TACE-treated patients have a best life quality in 3 months after TACE treatment. Significant alterations were found in scores of different sections of questionnaire in patients at different Child-pugh stages.3. Social support of patients with liver cancer:All 200 PHC patients were enrolled in the 4-stage questionnaire. The score of social support in preoperative 1 week was 34.18±4.23, comprising of objective support score (8.72±3.32), subjective support score (19.11±4.65), and support usage score (6.85±2.21). The relative scores in post-TACE 1 week were 36.46±4.12,9.12±2.43,20.21±6.67 and 7.01±2.16, respectively. The scores after 1 month post-TACE were 36.19±6.00,8.86±2.62, 20.24±4.43 and 7.09±1.68 respectively. The scores after 3 months post-TACE were 35.68±2.67,8.89±3.24,21.48±3.87 and 6.98±2.12, respectively. Multivariable analyses showed significant alterations (F=3.853, P<0.05). The difference reached top peaks in 1 week and 1 month after TACE. Furthermore, we found that the life quality of PHC patients received TACE treatment was positively correlated to the social support, with a steady increase from pre-operation to post-operation and a top peak at 1 month after TACE. In particular, mental support was disclosed as the major factor that affects the life quality of patients in our cohort.4. Medical copy modes of patients with liver cancer:The scores of medical copy modes in preoperative lweek were as following:positive (18.11±1.18), avoidant (17.17±4.28) and yielding (11.81±3.86). The relative scores in post-TACE 1 week were 17.17±4.28,18.32±3.17 and 11.87±3.37, respectively. The scores after 1 month post-TACE were 19.20±2.20,17.34±2.37 and 10.80±4.46, respectively. The scores after 3 months post-TACE were 20.08±2.77,16.83±3.38 and 10.76±3.29, respectively. Significant alterations were found among the above scores (F=3.897, P<0.05). Furthermore, gradual decreases were noticed in the scores of factors of positive, avoidant and yielding. Correlation analyses revealed that the score of positive factor was positively associated with the scores of physical function, mental function and social function, and that the scores of avoidant and yielding factor were not connected with the score of life quality of patients with PHC who received TACE treatment.Conclusion1.The QOL of PHC patients treated with TACE gradually improved,and it was improved most significantly after 3 months of surgery, especially the psychological function.The lower the Child-pugh classification,the higher the QOL.2.The social support of PHC patients improved after TACE, after 1 weeks and 1 months improved obviously, mainly reflected in the subjective support.The utilization of support before and after surgery were not high.3.The most commonly used coping modes of PHC patients treated with TACE was to face, and the face of coping modes decreased 1 week after surgery. After 1 month,3 months the face of coping modes gradually increased.4.There is a clear positive correlation between social support and QOL. From the preoperative to 1 month, this correlation increased gradually, which was particularly evident postoperative 1 month, mainly in the field of psychological function.5.The face of coping modes and QOL scores of body function, social function, psychological function were positively correlated, and the correlation among the psychological function had a slight increase in postoperative.The avoidance coping modes were positively correlated with QOL scores,but not significantly correlated with each dimension. |
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