全喉切除术幸存者的生活质量、心理幸福感与社会经济负担：来自中低收入国家环境的混合方法研究

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中文摘要

背景： 全喉切除术后的幸存状态伴随着深刻的功能、社会和经济变化。尽管沟通和就业方面的损害已被广泛认识，但其与心理幸福感和生活质量的关系仍不甚清楚，尤其是在低收入和中等收入环境（LMIC）中。
方法： 这项横断面混合方法研究纳入了87例接受过全喉切除术并在三级癌症中心随访的患者。生活质量采用EORTC QLQ-H&N35评估，心理困扰采用DASS-21评估，财务毒性采用COST-FACIT问卷评估，社会功能采用结构化社会功能问卷（SFQ-7）评估。对部分患者进行了深度访谈，以探讨幸存状态的生活体验。进行了描述性分析，定性数据采用主题分析。
结果： 我们的研究队列包括87例幸存者，中位年龄63岁，中位随访46个月。治疗后就业状况出现显著变化，失业率从治疗前的2.3%上升至评估时的46%。41.3%的患者存在财务毒性。大多数EORTC QLQ-H&N35领域的症状负担较低，负担较重主要与咳嗽和黏稠唾液有关。心理困扰不常见，大多数患者在抑郁、焦虑和压力方面处于正常范围。社会功能基本保留，仅5.6%报告功能受损。定性研究结果描述了患者对治疗后沟通和日常角色变化的适应，家庭支持成为重要的情境因素。这些发现可能反映部分幸存者的适应，尽管其潜在机制无法从这项横断面研究中确定。
结论： 全喉切除术幸存者尽管就业和财务状况发生重大变化，但生活质量相对保留，心理困扰较低。观察到的结构性幸存负担与感知幸福感之间的不一致可能反映个体适应和社会背景的差异，但这些应被视为可能的解释而非已确立的机制。

英文摘要

BACKGROUND: Survivorship after total laryngectomy is associated with profound functional, social, and economic changes. While impairments in communication and employment are well recognised, their relationship with psychological well-being and quality of life remains less clearly understood, particularly in low- and middle-income settings (LMIC).
METHODS: This cross-sectional mixed-methods study included 87 patients who had undergone total laryngectomy and were on follow-up at a tertiary cancer centre. Quality of life was assessed using the EORTC QLQ-H&N35, psychological distress using the DASS-21, financial toxicity using the COST-FACIT questionnaire, and social functioning using a structured social functioning questionnaire (SFQ-7). In-depth interviews were conducted in a subset of patients to explore the lived experiences of survivorship. Descriptive analyses were performed, and qualitative data were analysed using thematic analysis.
RESULTS: Our study cohort included 87 survivors with a median age of 63 years and a median follow-up of 46 months. A substantial shift in employment status was observed following treatment, with unemployment increasing from 2.3% pre-treatment to 46% at the time of assessment. Financial toxicity was present in 41.3% of patients. Symptom burden was low across most EORTC QLQ-H&N35 domains, with greater burden primarily related to coughing and sticky saliva. Psychological distress was uncommon, with the majority of patients within the normal range for depression, anxiety, and stress. Social functioning was largely preserved, with only 5.6% reporting impairment. Qualitative findings described adjustment to post-treatment changes in communication and daily roles, with family support emerging as an important contextual factor. These findings may reflect adaptation among some survivors, although the underlying mechanisms cannot be established from this cross-sectional study.
CONCLUSIONS: Survivors of total laryngectomy demonstrated relatively preserved quality of life and low psychological distress despite substantial changes in employment and financial status. The observed discordance between structural survivorship burden and perceived well-being may reflect differences in individual adaptation and social context, but these should be considered possible explanations rather than established mechanisms.