The general trend of humanization in medicine in recent decades, along with the biopsychosocial approach to health and illness, has put on the agenda the problem of patients’ quality of life, which resulted in numerous researches. The relevancy of this issue and the need of its investigation is substantiated in the present article on the ground of the analysis of modern literature and the work experience in the oncoorthopedic clinic; the results of the first stage of quality of life study and number of factors determining it in patients with bone and soft tissues tumors in lower extremities who underwent amputation are presented. Such a study should be comprehensive and should include an analysis of the objective functional capabilities and clinical indicators of patients, the subjective assessment of the main aspects of quality of life after amputation, as well as the psychological, social, demographic characteristics of patients. This implies the development of a theoretical model including the components of analysis in their integrated unity and interaction, as well as mathematical and empirical verification of the model. The development of quality of life psychosocial model can help to create scientifically based programs of individualized psychological assistance and social rehabilitation of cancer patients undergoing amputation of lower limb. The authors –doctors and clinical psychologists of the N.N. Blokhin Cancer Research Center and the St. Petersburg State University– put forward a research program in order to develop such a model, as well as present the first results of its implementation.
The article is devoted to study health-related quality of life and attitude to disease in 120 patients with bone tumor: osteosarcoma (41 persons), giant cell tumor (31 persons), chondrosarcoma (30 persons) and metastatic bone lesion (18 persons).Comparative analysis of quality of life basic parameters, attitude to disease and indices interconnections in four clinical groups of patients was made. Psychological methods were as follows: «SF-36 Health StatusSurvey», Quality of Life Questionnary-Core 30 of European Organization for Research and Treatment Cancer with module Bone Metastases 22, "The type of relation to disease". The results revealed differences in quality of life parameters, attitude to disease types and differences of correlations between the diagnostics indices in patients with different bone tumor types.
The article reflects the results of empirical research and theoretical understanding of the interaction of mechanisms of psychological adjustment to the disease and the main parameters of quality of life in chronic somatic disease. We examined139 patients suffering from different forms of oncological damage of bones of the musculoskeletal system, who treated in «N. N. Blokhin National Medical Research Centre of Oncology». Such psychodiagnostic methods as «BIG 5», «Ways of coping», «Purpose-in-Life Test», «Questionnaire of relation to disease «TOBOL», «SF-36 Health Status Survey», «Quality of Life Questionnaire» EORTC QLQ-C30 with additional module BM-22 for patients with bone tumor were used; Karnofsky scale and ECOG-WHO scale (from medical records) were used to assess the objective somatic status of patients. Cluster, factor and multifactorial dispersion analysis of data was performed, which showed the influence of the selected «profiles» (clusters) of personality («Neurotic person», «Mature, adapted person», «Person with a high level of self-consciousness and responsibility», «Socially maladjusted personality») on the generalized factors of quality of life («Life activity», «Optimal quality of life in the conditions of disease», as well as the factor «Gastrointestinal problems», reflecting the somatization of psychological problems in the situation of the disease). The results of the study show that the integrated study of the mechanisms of psychological adaptation and characteristics of the quality of life in the conditions of the disease opens up new ways of psychological care and social rehabilitation of cancer patients, as it allows to take into account in each case the influence of «the profile of personality» on individual domains of quality of life.
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