头颈部肿瘤患者身体意象潜在剖面分析及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.02.013

摘要/Abstract

摘要：

目的探究头颈部肿瘤患者身体意象的潜在剖面并分析不同剖面的影响因素。方法便利选取2023年10月—2024年5月在山东省某三级甲等医院接受治疗的351例头颈部肿瘤患者作为调查对象，采用一般资料调查表、身体意象量表、医学应对方式量表、领悟社会支持量表、患者报告结局的经济毒性综合评分量表对其进行问卷调查。采用潜在剖面分析和多元Logistic回归分析头颈部肿瘤患者身体意象的潜在剖面及其影响因素。结果本研究共回收有效问卷335份，有效问卷回收率为95.4%。头颈部肿瘤患者身体意象可分为躯体情感稳定型（41.5%）、躯体认知不满型（33.7%）和社交行为回避型（24.8%）3个类别。年龄、肿瘤发病部位、疾病分期、是否接受手术治疗、医学应对方式（面对应对、屈服应对）、社会支持及经济负担是头颈部肿瘤患者身体意象潜在剖面的影响因素（均P<0.05）。结论头颈部肿瘤患者身体意象具有明显的群体异质性，医护人员可根据头颈部肿瘤患者身体意象不同剖面的类别特征及影响因素，制订精准化的护理干预措施，以减少头颈部肿瘤患者身体意象失调的发生与发展，促进其更好地回归社会。

关键词: 头颈部肿瘤, 身体意象, 潜在剖面分析, 影响因素, 护理

Abstract:

Objective To explore the potential profile of body image and its influencing factors among head and neck cancer patients. Methods Convenience sampling was employed to investigate 335 head and neck cancer patients in a tertiary hospital in Shandong Province from October 2023 to May 2024. Data was collected using the patient’s general information questionnaire，Body Image Scale，Medical Coping Modes Questionnaire，Perceived Social Support Scale，Comprehensive Score for Financial Toxicity based on the Patient-Reported Outcome Measures. Latent profile analysis and multivariate Logistic regression analysis were used to explore distinct profiles and influencing factor of body image in head and neck patients. Results A total of 335 valid questionnaires were collected in this study, and 95.4% of the valid questionnaires were included. Body image of patients with head and neck cancer could be divided into 3 latent profiles：body emotional stability（41.5%），body cognitive dissatisfaction（33.7%） and social behavior avoidance（24.8%）. Age，location of cancer onset，stage of cancer，surgical treatment，medical coping style（facing coping，yielding coping），social support and economic toxicity were the factors influencing the latent profiles of body image in patients with head and neck cancer（P<0.05）. Conclusion There is heterogeneity in body image of patients with head and neck cancer. Medical staff should implement targeted management strategies based on the influencing factors of different profiles to reduce the body image disorders in patients with head and neck cancer，and to promote patients to better return to society.

Key words: Head and Neck Neoplasms, Body Image, Latent Profile Analysis, Influencing Factors, Nursing Care

徐萍, 闫荣, 张淼淼, 柳文慧, 姜凯. 头颈部肿瘤患者身体意象潜在剖面分析及影响因素研究[J]. 中华护理杂志, 2025, 60(2): 215-222.

XU Ping, YAN Rong, ZHANG Miaomiao, LIU Wenhui, JIANG Kai. Latent profile analysis and influencing factors of body image among patients with head and neck cancer[J]. Chinese Journal of Nursing, 2025, 60(2): 215-222.

图/表 4

表1 头颈部肿瘤患者的一般资料及身体意象潜在剖面的单因素分析

Table 1 General information and univariate analysis of potential profiles of body image among patients with head and neck cancer

表2 头颈部肿瘤患者身体意象潜在剖面模型的拟合指标（n=335）

Table 2 Model fitting results of potential profile analysis model for body image among patients with head and neck cancer（n=335）

图1 头颈部肿瘤患者身体意象3个潜在剖面的特征分布

Figure 1 The characteristic distribution of 3 potential profiles of body image among patients with head and neck cancer

表3 头颈部肿瘤患者身体意象潜在剖面的多因素分析（n=335）

Table 3 Multifactor analysis of potential profiles of body image among patients with head and neck cancer（n=335）

参考文献 30

[1]	Gormley M, Creaney G, Schache A, et al. Reviewing the epide-miology of head and neck cancer:definitions,trends and risk factors[J]. Br Dent J, 2022, 233(9):780-786.
[2]	Ellis MA, Sterba KR, Day TA, et al. Body image disturbance in surgically treated head and neck cancer patients:a patient-centered approach[J]. Otolaryngol Head Neck Surg, 2019, 161(2):278-287. DOI PMID
[3]	Gibson C, O’Connor M, White R, et al. ‘I didn’t even recognise myself’:survivors’ experiences of altered appearance and body image distress during and after treatment for head and neck cancer[J]. Cancers, 2021, 13(15):3893.
[4]	Rhoten BA. Body image disturbance in adults treated for cancer:a concept analysis[J]. J Adv Nurs, 2016, 72(5):1001-1011.
[5]	Henry M, Albert JG, Frenkiel S, et al. Body image concerns in patients with head and neck cancer:a longitudinal study[J]. Front Psychol, 2022, 13:816587.
[6]	中共中央国务院. 中共中央国务院印发《“健康中国2030”规划纲要》[EB/OL].(2016-10-25)[2024-06-24]. https://www.gov.cn/zhengce/2016-10/25/content_5124174.htm.
	The CPC Central Committee and The State Council. The State Council of the CPC Central Committee issued the outline of the “Healthy China 2030” plan[EB/OL].(2016-10-25)[2024-06-24]. https://www.gov.cn/zhengce/2016-10/25/content_5124174.htm.
[7]	曹德冉, 卢文红, 熊娜, 等. 头颈肿瘤术后出院患者身体意象现状及其影响因素研究[J]. 现代临床护理, 2022, 21(11):21-27.
	Cao DR, Lu WH, Xiong N, et al. Current status and influencing factors of body images in patients after head and neck tumour surgery[J]. Mod Clin Nurs, 2022, 21(11):21-27.
[8]	温忠麟, 谢晋艳, 王惠惠. 潜在类别模型的原理、步骤及程序[J]. 华东师范大学学报(教育科学版), 2023, 41(1):1-15. DOI
	Wen ZL, Xie JY, Wang HH. Principles,steps,and procedures of latent category models[J]. J East Chin Norm Univ(Educ Sci), 2023, 41(1):1-15.
[9]	中国临床肿瘤学会指南工作委员会. CSCO头颈部肿瘤诊疗指南(2024)[M]. 北京: 人民卫生出版社, 2024.
	Guidelines Working Committee of Chinese Society of Clinical Oncology. CSCO Head and Neck Cancer(2024)[M]. Beijing: Peoples’s Medical Publishing House, 2024.
[10]	格林尼FL, 佩基DL, 弗莱明ID, 等. AJCC癌症分期手册(第六版)[M]. 沈阳: 辽宁科学技术出版社, 2005.
	Greene FL, Page DL, Fleming ID, et al. AJCC Cancer Staging Manual(sixth edition)[M]. Shenyang: Liaoning Science and Technology Press Publishing House, 2005.
[11]	李峥, 刘宇. 护理学研究方法[M]. 2版. 北京: 人民卫生出版社, 2018.
	Li Z, Liu Y. Research methods in nursing[M]. 2nd ed. Beijing: Peoples’s Medical Publishing House, 2018.
[12]	Hopwood P, Fletcher I, Lee A, et al. A body image scale for use with cancer patients[J]. Eur J Cancer, 2001, 37(2):189-197. DOI PMID
[13]	崔宛玉, 林宽佳, 黄惠玑. 口腔癌手术病人於住院期间身体心像改变及其因应行为探讨[J]. 护理暨健康照护研究, 2013, 9(2):127-138.
	Cui WY, Lin KJ, Huang HJ. Exploration of changes in physical and mental images of patients undergoing oral cancer surgery during hospitalization and their corresponding behaviors[J]. Nurs Health Care Res, 2013, 9(2):127-138.
[14]	Chopra D, De La Garza RN, Lacourt TE. Clinical relevance of a Body Image Scale cut point of 10 as an indicator of psychological distress in cancer patients:results from a psychiatric oncology clinic[J]. Support Care Cancer, 2021, 29(1):231-237.
[15]	Feifel H, Strack S, Nagy VT. Coping strategies and associated features of medically ill patients[J]. Psychosom Med, 1987, 49(6):616-625. DOI PMID
[16]	沈晓红, 姜乾金. 医学应对方式问卷中文版701例测试报告[J]. 中国行为医学科学, 2000, 9(1):18-20.
	Shen XX, Jiang QJ. Report on application of Chinese version of MCMQ in 701 patients[J]. Chin J Behav Med Sci, 2000, 9(1):18-20.
[17]	Zimet GD, Dahlem NW, Zimet SG, et al. The multidimensional scale of perceived social support[J]. J Per Assess, 1988, 52(1):30-41.
[18]	姜乾金. 领悟社会支持量表[J]. 中国行为医学科学, 2001, 10(特刊):41-42.
	Jiang QJ. Perceived Social Support Scale[J]. Chin Beha Med Sci, 2001, 10(Special Issue):41-42.
[19]	de Souza JA, Yap BJ, Hlubocky FJ, et al. The development of a financial toxicity patient-reported outcome in cancer:the COST measure[J]. Cancer, 2014, 120(20):3245-3253.
[20]	于慧会, 毕雪, 刘运泳. 中文版癌症患者报告结局的经济毒性量表信度和效度研究[J]. 中华流行病学杂志, 2017, 38(8):1118-1120. PMID
	Yu HH, Bi X, Liu YY. Reliability and validity of the Chinese version on Comprehensive Scores for Financial Toxicity based on the patient-reported outcome measures[J]. Chin J Epidemiol, 2017, 38(8):1118-1120. DOI PMID
[21]	张旭, 孙迪, 李小寒, 等. 癌症患者复发恐惧的潜在剖面分析[J]. 中华护理杂志, 2023, 58(6):662-669. DOI URL
	Zhang X, Sun D, Li XH, et al. Fear of recurrence in cancer patients:a latent profile analysis[J]. Chin J Nurs, 2023, 58(6):662-669.
[22]	龚湖萍, 魏清风, 周振萍, 等. 头颈癌术后患者自我形象现状及其与社会支持应对方式的相关研究[J]. 重庆医学, 2018, 47(28):3639-3642.
	Gong HP, Wei QF, Zhou ZP, et al. Analysis of self-image status and its influence factors of postoperative patients with head and neck cancer[J]. Chongqing Med, 2018, 47(28):3639-3642.
[23]	Ivanova A, Rodríguez-Cano R, Kvalem IL, et al. Body image concerns in long-term head and neck cancer survivors:prevalence and role of clinical factors and patient-reported late effects[J]. J Cancer Surviv, 2023, 17(2):526-534.
[24]	Melissant HC, Jansen F, Eerenstein SE, et al. Body image dis-tress in head and neck cancer patients:what are we looking at?[J]. Support Care Cancer, 2021, 29(4):2161-2169.
[25]	杨雯雯, 周雪, 杜羿霏, 等. 预防性吞咽干预在喉部分切除术患者中的应用研究[J]. 中华护理杂志, 2023, 58(14):1683-1690. DOI URL
	Yang WW, Zhou X, Du YF, et al. Effectiveness of prophylactic swallowing interventions in patients with partial laryngectomy[J]. Chin J Nurs, 2023, 58(14):1683-1690. DOI URL
[26]	雷倍美, 李珍, 谢常宁, 等. 头颈部肿瘤患者吞咽功能促进策略的证据总结[J]. 中华护理杂志, 2023, 58(1):85-91. DOI URL
	Lei BM, Li Z, Xie CN, et al. Evidence summary for strategies to promote swallowing function in patients with head and neck tumors[J]. Chin J Nurs, 2023, 58(1):85-91. DOI URL
[27]	Chen SC, Huang CY, Huang BS, et al. Factors associated with healthcare professional’s rating of disfigurement and self-perceived body image in female patients with head and neck cancer[J]. Eur J Cancer Care, 2018, 27(2):e12710.
[28]	Chen CL, Cao JY, Wang LL, et al. Body image and its asso-ciated factors among Chinese head and neck cancer patients undergoing surgical treatment:a cross-sectional survey[J]. Sup-port Care Cancer, 2020, 28(3):1233-1239.
[29]	Hung TM, Lin CR, Chi YC, et al. Body image in head and neck cancer patients treated with radiotherapy:the impact of surgical procedures[J]. Health Qual Life Outcomes, 2017, 15(1):165.
[30]	Clarke SA, Newell R, Thompson A, et al. Appearance concerns and psychosocial adjustment following head and neck cancer:a cross-sectional study and nine-month follow-up[J]. Psychol Health Med, 2014, 19(5):505-518.