Study On Quality Of Life Among Community Breast Cancer Survivors And Community-based Intervention Strategy In Shanghai

BackgroundBreast cancer is the most prevalent cancer among women in the world today. There are approximately 1.3 million new diagnosed breast cancer patients every year and approximately 0.46 million women die of breast cancer,which has made breast cancer the leading mortality cause of cancer among women.Today,quality of life (QOL)is considered as an important outcome indicator of cancer rehabilitation.More and more researches have shown that the effect of clinical treatment would be increased if the QOL assessment is applied appropriately.QOL can also be the prognostic factor of cancer recovery.However,among existing QOL researches of breast cancer,most of them are new diagnosed cases on hospital base.Actually QOL of breast cancer may differ according to the stage,other physical situation and recurrence situation of the survivors.Researchers can choose proper study population according to different research objectives.Along with the technologic advancement of the diagnosis and treatment of breast cancer,there are more and more community breast cancer survivors.QOL of community breast cancer survivors should be a great concern of researchers.Besides,the quantitative methods are often applied in the QOL research of breast cancer,while the qualitative researches are limited.The questionnaire,the most frequent method of QOL research always gives us the results in number way.We would also like to know how the breast cancer survivors describe their experience from diagnosis,operation,adjuvant therapy to rehabilitation.Objective The study is to assess the QOL of community breast cancer survivors comprehensively and to discuss possible related factors of QOL through both quantitative and qualitative methods;to describe the survivors'need for community-based rehabilitation intervention from perspectives of both survivors and health care providers;to explore feasible community-based rehabilitation intervention model and to provide recommendations for the community-based breast cancer intervention. Methods1.The quantitative study of QOL among community breast cancer survivors:390 breast cancer survivors were asked to fulfill the questionnaires when the community doctors visit her at home.2.The qualitative study of QOL among community breast cancer survivors:In-depth interviews were conducted among 9 community breast cancer survivors.3.The intervention strategy of community-based rehabilitation for breast cancer: in-depth interviews were conducted among 9 community breast cancer survivors and 3 community health service providers.And literature anaylsis was also used.Results1.The current situation of QOL among community breast cancer survivors:the overall score of QOL based on FACT-B questionnaire is 102.21±16.62,accounting for 70.98%of the full score.The scores differ among different domains of QOL. Multiple regression analysis showed that economic situation,the severity of disease, social support situation and current treatment all have an independent,significant association with overall QOL and differential domains of QOL.Social support can improve the QOL of community breast cancer survivors;the related symptoms and side effects of treatment will bring negative influence to different domains of QOL; Self-adjustment is the internal motivation of breast cancer to improve their QOL.2.The need of breast cancer survivors for community-based intervention:the problem of current community cancer registration and visit system are:lack of user-friendly visit way;lack of efficient information platform;insufficient capacity of community health service providers for community-based breast cancer intervention; and shortage of funds for community-based breast cancer intervention.Community breast cancer survivors are expecting to return to the society;to get user-friendly rehabilitation and categorized health services;to obtain more economic support,to take part in more accessible,effective and various group activities;and to psychological care instruction. 3.The new model of community-based intervention should take comprehensive social support and classified rehabilitation instruction into consideration to increase knowledge of breast cancer survivors,to enhance their confidence and to improve the QOL.Conclusion and suggestionThe overall QOL of Shanghai community breast cancer survivors is quite good, but QOL of different domains have differences.As a comprehensive assessment indicator,QOL can reflect the survivorship of community breast cancer survivors. The new model of community-based intervention will address the inevitable requirement of modern medical development as well as benefit the most breast cancer survivors.The comprehensive social support and classified rehabilitation instruction are two main strategies.