Guided care for postoperative comprehensive management of breast cancer patients

doi:10.3877/cma.j.issn.1674-0807.2021.05.004

Abstract

Abstract:

Objective

To explore the application of guided care in comprehensive management of breast cancer patients after surgery.

Methods

According to the inclusion and exclusion criteria, 160 female breast cancer patients who lived in two large communities of Nanjing and underwent surgery in the Department of Breast Diseases, First Affiliated Hospital of Nanjing Medical University from January 2019 to March 2020 were enrolled for a prospective study. The patients living in pilot area served as experimental group(n=80), and the patients living in non-pilot area served as control group(n=80). The patients in control group received whole-course case management and the patients in experimental group received guided care. The Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), Posttraumatic Growth Inventory (PTGI) and Social Support Rating Scale (SSRS) were used to evaluate the quality of life, post-traumatic growth and social support of all patients at 1 day before intervention, 3 and 6 months after intervention, respectively. The Morisky Medication Adherence Scale 8-item version was used to evaluate the medication compliance of patients taking endocrine drugs in both groups at 1, 3 and 6 months after intervention. The scores of each scale were analyzed with repeated measures analysis of variance.

Results

At 1 day before intervention, 3 and 6 months after intervention, the total scores of FACT-B in experimental group were 87.61±8.23, 98.59±8.13, and 103.01±8.30, which were significantly higher than 87.50±9.02, 91.50±8.59 and 96.35±7.62 in control group, respectively (time effect, F=88.637, P<0.001; grouping effect, F=35.159, P<0.001; interactive effect, F=9.051, P<0.001). At 1, 3 and 6 months after intervention, the scores of medication compliance were 6.97±0.76, 7.22±0.65 and 7.29±0.61 in experimental group, and 6.70±1.01, 6.91±0.83 and 7.01±0.72 in control group, suggesting a significant difference between groups and between different time points, but with no interaction (time effect, F=42.302, P<0.001; grouping effect, F=4.303, P=0.040; interactive effect, F=0.718, P=0.490). At 1 day before intervention, 3 and 6 months after intervention, the total scores of PTGI were 63.58±8.95, 72.95±10.30 and 75.95±8.58 in experimental group, and 63.25±7.98, 68.61±8.92 and 74.69±9.32 in control group, respectively, suggesting a significant difference between groups and between different time points, but with no interaction (time effect, F=75.279, P<0.001; grouping effect, F=5.123, P=0.025; interactive effect, F=2.296, P=0.102). At 1 day before intervention, 3 and 6 months after intervention, the total scores of SSRS were 33.44±4.59, 38.56±5.22 and 44.50±6.93 in experimental group, which were significantly higher than 34.00±5.47, 35.74±5.69 and 39.69±6.28 in control group, respectively (time effect, F=74.906, P<0.001; grouping effect, F=21.712, P<0.001; interactive effect, F=8.800, P<0.001).

Conclusion

The guided care can improve the quality of life, medication compliance, post-traumatic growth and social support of breast cancer patients in postoperative management, worthy of clinical application.

Key words: Breast neoplasms, Mastectomy, Case managers, Guided care

Shuangwei Mao, Haiping Xu, Haiyun Zhang, Cuifeng Jin, Ye Wen, Chunyan Li. Guided care for postoperative comprehensive management of breast cancer patients[J]. Chinese Journal of Breast Disease(Electronic Edition), 2021, 15(05): 288-294.

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Figures/Tables 5

References 19

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变量		对照组(n＝80)	试验组(n＝80)	检验值	P值
年龄(岁，±s)		48.3±10.4	47.8±10.2	t＝0.346	0.730
学历[例(%)]
	小学及以下	9(11.2)	7(8.7)	Z＝-0.489	0.625
	初中、高中	46(57.5)	46(57.5)
	本科及以上	25(31.3)	27(33.8)
婚姻状况[例(%)]
	未婚	1(1.2)	2(2.5)	χ²＝0.833	0.808^a
	已婚	73(91.3)	74(92.5)
	离异或丧偶	6(7.5)	4(5.0)
家庭月收入[例(%)]
	<5 000元	12(15.0)	11(13.7)	Z＝-0.098	0.922
	5 000~10 000元	40(50.0)	41(51.3)
	>10 000元	28(35.0)	28(35.0)
宗教信仰[例(%)]
	有	5(6.2)	4(5.0)		1.000^a
	无	75(93.8)	76(95.0)		1.000^a
临床分期[例(%)]
	Ⅰ~Ⅱ	59(73.8)	56(70.0)	χ²＝0.278	0.598
	Ⅲ	21(26.2)	24(30.0)	χ²＝0.278	0.598

变量		对照组(n＝80)	试验组(n＝80)	检验值	P值
年龄(岁，±s)		48.3±10.4	47.8±10.2	t＝0.346	0.730
学历[例(%)]
	小学及以下	9(11.2)	7(8.7)	Z＝-0.489	0.625
	初中、高中	46(57.5)	46(57.5)
	本科及以上	25(31.3)	27(33.8)
婚姻状况[例(%)]
	未婚	1(1.2)	2(2.5)	χ²＝0.833	0.808^a
	已婚	73(91.3)	74(92.5)
	离异或丧偶	6(7.5)	4(5.0)
家庭月收入[例(%)]
	<5 000元	12(15.0)	11(13.7)	Z＝-0.098	0.922
	5 000~10 000元	40(50.0)	41(51.3)
	>10 000元	28(35.0)	28(35.0)
宗教信仰[例(%)]
	有	5(6.2)	4(5.0)		1.000^a
	无	75(93.8)	76(95.0)		1.000^a
临床分期[例(%)]
	Ⅰ~Ⅱ	59(73.8)	56(70.0)	χ²＝0.278	0.598
	Ⅲ	21(26.2)	24(30.0)	χ²＝0.278	0.598

项目		例数	生理状况	社会家庭状况	情感状况	功能状况	附加状况	总分
对照组
	干预前1天	80	19.99±3.20	17.83±3.82	11.74±3.88	18.66±4.36	19.29±3.27	87.50±9.02
	干预后3个月	80	20.76±3.18	18.93±3.77	12.11±3.27	19.36±4.43	20.34±3.56	91.50±8.59^a
	干预后6个月	80	21.64±2.36	20.04±4.30	13.19±3.53	20.31±4.17	21.18±3.13	96.35±7.62^ab
试验组
	干预前1天	80	19.94±3.18	18.24±4.09	11.94±3.80	18.48±4.59	19.03±3.03	87.61±8.23
	干预后3个月	80	21.68±2.91	20.14±3.81	14.20±3.20	20.90±3.87	21.68±3.77	98.59±8.13^a
	干预后6个月	80	22.89±2.45	21.21±3.70	14.41±3.34	22.13±3.83	22.38±3.88	103.01±8.30^ab
时间效应
	F值		25.874	19.661	12.532	15.539	24.966	88.637
	P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
组间效应
	F值		7.032	5.631	14.284	7.915	5.471	35.159
	P值		0.009	0.019	<0.001	0.006	0.021	<0.001
交互效应
	F值		2.099	0.591	2.796	2.573	2.709	9.051
	P值		0.126	0.555	0.063	0.078	0.068	<0.001

项目		例数	生理状况	社会家庭状况	情感状况	功能状况	附加状况	总分
对照组
	干预前1天	80	19.99±3.20	17.83±3.82	11.74±3.88	18.66±4.36	19.29±3.27	87.50±9.02
	干预后3个月	80	20.76±3.18	18.93±3.77	12.11±3.27	19.36±4.43	20.34±3.56	91.50±8.59^a
	干预后6个月	80	21.64±2.36	20.04±4.30	13.19±3.53	20.31±4.17	21.18±3.13	96.35±7.62^ab
试验组
	干预前1天	80	19.94±3.18	18.24±4.09	11.94±3.80	18.48±4.59	19.03±3.03	87.61±8.23
	干预后3个月	80	21.68±2.91	20.14±3.81	14.20±3.20	20.90±3.87	21.68±3.77	98.59±8.13^a
	干预后6个月	80	22.89±2.45	21.21±3.70	14.41±3.34	22.13±3.83	22.38±3.88	103.01±8.30^ab
时间效应
	F值		25.874	19.661	12.532	15.539	24.966	88.637
	P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
组间效应
	F值		7.032	5.631	14.284	7.915	5.471	35.159
	P值		0.009	0.019	<0.001	0.006	0.021	<0.001
交互效应
	F值		2.099	0.591	2.796	2.573	2.709	9.051
	P值		0.126	0.555	0.063	0.078	0.068	<0.001

组别	例数	干预后1个月	干预后3个月	干预后6个月
对照组	61^a	6.70±1.01	6.91±0.83	7.01±0.72
试验组	59^a	6.97±0.76	7.22±0.65	7.29±0.61

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