Lebensqualität zur Bestimmung des Therapiebedarfs in der Brustkrebsnachsorge

abstract In the introduction the state of the art of breast cancer research diagnosis, therapy and follow up of breast cancer as well as an overview of the history and current state of quality of life research is summarized. The aspects of quality of life (QOL) in breast cancer patients concerning arm symptoms, impairment in housework/job/leisure time, negative affect, body image, sleep disorders, future perspectives and the global quality of life are explained and specific therapeutic options to improve the quality of life are pointed out. Objective: This study explores the proportion of patients needing therapeutic intervention and/or psychosocial support in the different QOL aspects during the first year after breastcancer diagnosis. It asks whether quality of life evaluations can be a diagnostic tool in early recommandation of therapeutic interventions in the follow-up of breast cancer patients. Study design: Cohort study with 3 evaluation visits (on discharge, first and forth follow-up visit). The study group was recruited over a 2 year period and consists of 204 patients initially diagnosed with breast cancer from the region around Marburg-Biedenkopf. Deficits calling for therapy in the different aspects of quality of life were reported using EORTC-QLQ-C30-BR23, a standardized QOL questionnaire and calculated using a cut-off value. Results: During hospitalization deficits in need for therapy (future perspective, sleep disorders, negative affect and arm symptoms) were very common (29-74%). The proportion of deficits in need for therapy generally declines until the first follow-up visit. Only in body image the proportion of patients needing therapy remained constant throughout the first year. There are no substantial improvements in all aspects of QOL. Between the 1st and 4th follow-up visit there are no significant changes in all aspects of QOL. Early recognition of deficits in need for therapy is possible using the QOL assessment. Already at discharge from the hospital deficits in body image, arm symptoms and sleep disorders carry an elevated relative risk of persisting throughout the first year after surgery. For all aspects of QOL investigated here deficits named at the first follow-up visit are predictive for persisting one year after surgery. Conclusion: During hospitalization patients are very stressed. Improving analgetic therapy on the wards (arm symptoms), treating sleep disorders and psychosocial support (negative affect) appear to be indispensable. The use of standardized QOL questionnaires as a diagnostic tool allows to objectify the need for therapy. Besides early individual and problem-orientated planning of rehabilitation is possible. This method of diagnosing the need for therapy together with the doctor-patient conversation can be part of an individual and problem-orientated design of oncologic after-care focussing on the well-being of the patient.