老年多发性骨髓瘤患者维持治疗阶段生存质量与应对方式现状及其相关性

Correlation between quality of life and coping styles in elderly patients of multiple myeloma during maintenance treatment stage

【摘要】目的 调查老年多发性骨髓瘤(MM)患者维持治疗阶段生存质量与应对方式现状并分析其相关性。方法 选择南京医科大学第一附属医院2018年2月至2023年2月收治的150例老年MM患者为研究对象,分别在其诱导/巩固及维持治疗阶段,利用欧洲癌症研究与治疗组织生存质量问卷(EORTC QLQ-C30 V3.0)调查患者生存质量,医学应对方式问卷(MCMQ)调查患者应对方式。采用SPSS 19.0统计软件进行数据分析。采用Pearson相关性分析评估老年MM患者维持治疗阶段生存质量与医学应对方式的相关性。采用多元线性回归分析影响患者维持治疗阶段生存质量的相关因素。结果 患者维持治疗阶段的躯体功能、角色功能、情绪功能、认知功能、社会功能及总体生存质量得分均高于诱导/巩固治疗阶段,经济困难维度得分高于诱导/巩固治疗阶段,但其各功能维度及总体生存质量得分均低于常模,经济困难维度得分高于常模组,差异均有统计学意义(P<0.05)。患者诱导/巩固治疗阶段及维持治疗阶段的回避及屈服维度得分均高于常模水平,面对维度得分低于常模,差异均有统计学意义(P<0.05)。Pearson相关性分析提示,面对与老年MM维持治疗阶段患者总体生存质量得分呈正相关(r=0.315；P<0.001)；屈服与其总体生存质量之间呈负相关(r=-0.256；P<0.001)。多元线性回归分析提示,面对对老年MM维持治疗阶段患者的总体生存质量得分有正向预测作用(β=0.311,P=0.019)；而屈服(β=-0.293,P=0.023)、国际分期系统(ISS)分期(β=-0.298,P=0.032)、治疗自费比例(β=-0.216,P=0.038)及血红蛋白水平(β=-0.243,P=0.046)对其总体生存质量得分有负向预测作用,其共同解释总体生存质量得分42.9%的变异度。结论 老年MM维持治疗阶段患者生存质量较诱导/巩固治疗阶段提高,但依旧低于常模水平,老年MM维持治疗阶段患者倾向于选择消极应对方式,建议从改善老年MM患者维持治疗阶段的疾病应对方式入手,改善其生存质量。

基金项目:国家自然科学基金(81470329,81600096)

【Abstract】Objective To investigate the status quo of quality of life and coping styles in elderly patients with multiple myeloma (MM) during maintenance treatment stage and analyze their correlation. Methods A total of 150 elderly MM patients admitted to our hospital from February 2018 to February 2023 were enrolled in this study. During induction/consolidation stage and maintenance treatment stage, their quality of life was investigated by European Organization for Research and Treatment of Cancer quality of life questionnaire-core 30 V3.0 (EORTC QLQ-C30 V3.0), and their medical coping styles were surveyed with medical coping modes questionnaire (MCMQ). SPSS statistics 19.0 was used for data analysis, and Pearson correlation analysis was conducted to assess the correlation between quality of life and medical coping styles in elderly MM patients during maintenance treatment stage. Multivariate linear regression analysis was applied to identify the related factors affecting quality of life during the stage. Results The scores of physical function, role function, emotional function, cognitive function, social function and overall quality of life, and the score of financial difficulty dimension during maintenance treatment stage were higher than those during induction/consolidation treatment stage, but the scores of functional dimensions and overall quality of life of patients during maintenance treatment stage were lower, while the score of financial difficulty dimension was higher than the norm (P<0.05). The patients also had significantly higher scores of avoidance dimension and submission dimension, but lower score of facing dimension during induction/consolidation treatment stage and maintenance treatment stage when compared with the norm (P<0.05). Pearson correlation analysis indicated that the facing dimension (r=0.315; P<0.001) was positively correlated, while the submission dimension (r=-0.256; P<0.001) was negatively correlated with the overall quality of life in the elderly MM patients during maintenance treatment stage. Multivariate linear regression analysis revealed that facing dimension (β=0.311, P=0.019) had a positive predictive effect, while submission (β=-0.293, P=0.023), international staging system (ISS) stage (β=-0.298, P=0.032), self-paying treatment ratio (β=-0.216, P=0.038) and hemoglobin level (β=-0.243, P=0.046) had a negative predictive effect on the overall quality of life score in elderly MM patients during maintenance treatment stage, which together explained 42.9% of the variance of the overall quality of life score. Conclusion The quality of life in elderly MM patients during maintenance treatment stage is higher than that during induction/consolidation treatment stage, but still lower than the norm. Elderly MM patients during maintenance treatment stage tend to choose negative coping styles. It is suggested to improve the medical coping styles during maintenance treatment stage to promote the quality of life in elderly MM patients.

This work was supported by the National Natural Science Foundation of China (81470329, 81600096).