The Evaluation Of Health-Related Quality Of Life Among Women Breast Cancer Patients

BackgroundAccording to the data of Global Cancer in 2018,breast cancer is the most prevalent malignant cancer among new cancers worldwide,with incidence(24.2%)and mortality(15.0%),ranking first among women.In the incidence of malignant tumors in China,breast cancer ranked fifth,and in female malignant tumors,the incidence rate of breast cancer ranked first,while death ranked fifth.At present,the incidence and mortality of breast cancer in China's cancer-registered areas are generally increasing,and the incidence of breast cancer is gradually becoming younger.The burden of breast cancer in China is becoming more and more severe.Therefore,it is necessary to carry out Health-Related Quality of Life(HRQoL)study for breast cancer patients.The effective measurement of HRQoL is the key to and foundation(?)economic evaluation and health technology assessment,directly affecting its application in decision-making.Conducting the HRQoL study among breast cancer patients can objectively and quantitatively evaluate the long-term burden and survival status of the breast cancer survivors,thereby improving clinical diagnosis and treatment,assisting in clinical decision making,thus could contribute better to organize public health behaviors to address the challenges which cancer poses to the whole society.ObjectivesThis study aims to report the quality of life of breast cancer patients based on the perspective of the Patients'Report Outcomes.We use the generic questionnaires(such as EQ-5D-5L,SF-36)and the disease-specific questionnaires(QLQ-BR53 developed by the European Cancer Research and Treatment Organization)at same time,in order to comprehensively and systematically measure the HRQoL of women breast cancer patients.We aimed to explore the influencing factors of HRQoL,and to explore the evaluation results of the generic and disease-specific questionnaires in the quality of life assessment of women breast cancer patients and their respective adaptations.We hope this could provide basic data support and scientific clinical decision making basis for patient care services.And also to provide reference for clinical selection of optimal treatment options and the optimization of social health resource allocationMethodsThis is a cross-sectional descrnptive study.All the data come from literature review,on-site questionnaires research and face-to-face interviews.The respondents were women with breast cancer who were treated or hospitalized in the breast department of Qingdao Municipal Hospital from November 2014 to February 2015.A total of 621 patients were investigated,and 608 patients were finally included in the analysis.We collected basic information on patient socio-demiologic and clinical information through questionnaires.Patient's HRQoL was measured by using generic questionnaires(EQ-5D-5L and SF-36)and the disease-specific questionnaires(QLQ-BR53 developed by the European Cancer Research and Treatment Organization),assisting with face-to-face qualitative interview to explore the influencing factors of patients' quality of lifeThe main statistical analysis methods used include:descriptive analysis,nonparametric tests,Spearman correlation coefficient,multiple linear regression,exploratory factor analysis(EFA)and so on.Results1.Basic condition of the sample population:Among all the 621 participants,the effective questionnaire was 608,and the effective response rate was 97.9%.The average age of the sample population was 48.0 years old(SD=9.6).The proportion of urban residents and rural residents was basically the same.The education level of the sample population was generally low.About 33%were illiterate or only finished primary school education.About 65%of them were urban workers urban workers,and the average duration of disease is 38.2±40.9 months,about 55%of patients were in menopausal status,and 35.8%of patients were in TN-M stage ?,while 23.2%of patients have metastasized.Almost half participants(47.4%)only adopted chemotherapy.2.Health-Related Quality of Life of the sample population:patient's HRQoL score measured by EQ-5D-5L was EQ-VAS=80.6±9.1,the patient's physical health score measured by SF-36 was PCS=57.9±18.8,and the mental health score was MCS=62.90±18.42.The HRQoL measured by the EORTC QLQ-C30 and QLQ-BR23 scales were 75.7± 15.4 and 74.3 ± 14.8.respectively.The EQ-5D-5L measurement showed that about 60%of patients had"no and moderate difficulty"in the two dimensions of"pain/discomfort"and"anxiety/depression".The results of the SF-36 showed that patient's"physiological function"and "general health status" were the two most severely damaged dimensions.The EORTC QLQ-C30 and QLQ-BR23 measurements showed that the most severely impaired patients in all functional areas were social function and future expectations;and in all symptom areas,fatigue-insomnia,financial difficulties and hair loss troubles were most significantly serious.3.Factors affecting the HRQoL in the sample population:The results of non-parametric tests showed that the differences in socio-demographic characteristics and clinical characteristics of patients were indeed important causes of differences.Stepwise multiple linear regression analysis showed that age,residence,marital status,occupation,annual family income,education level,type of medical insurance,TNM clinical stage,whether metastasis and treatment were factors affecting patients'HRQoL.4.Comparison of the measurement results of different questionnaires:The results of correlation analysis showed that the correlation between EQ-5D and the other two measurement questionnaires was weak,and the correlation coefficient between SF-36 and QLQ-BR53 were pretty high.And the QLQ-C30,as the cancer disease-specific questionnaire,while the QLQ-BR23,breast cancer-specific questionnaire,had a strong correlation between the measurement results,however the correlation between the two scales was weak when it comes to the detailed domains.ConclusionsIn this study,a comprehensive systematic assessment of HRQoL in 621 women breast cancer patients was conducted using a combination of the generic and disease-specific quality of life questionnaires.We found that differences in patient socio-demographic and clinical characteristics information were responsible for the significant differences in patients quality of life.Multiple linear regression analysis help us confirmed that age,marital status,annual family income,and cancer metastasis were important factors and indicators of patients'quality of life.When the three tools were applied to the quality of life assessment of breast cancer patients,the correlation between the measurements was small,while the measurement results of different tools were quite different.In the future,when assessing the quality of life of breast cancer patients,the generic questionnaire should be considered in conjunction with the disease-specific ones to ensure the authenticity and accuracy of the measurement results,and attention should be paid to the highly relevant dimensions of the questionnaires,to avoid some results being repeatedly measured,thus increasing the burden of respondents.