復發多中心型淋巴瘤犬隻之飼主化療經驗調查

Abstract

犬多中心性淋巴瘤通常對化療有良好的反應，適當治療往往能達到中位生存時間約12個月。然而，即使達到完全緩解，大多數患者最終仍會復發，且後續治療的效果與持續時間通常不如初次治療。在癌症復發的情況下，飼主可能更重視生活品質而非延長壽命。為了更好地理解這些優先事項，我們設計了一份問卷，針對接受多藥化療的復發犬隻飼主進行調查。 共有125隻犬在復發後接受治療，分發140份問卷，最終回收50份問卷。治療後，犬隻的生活品質顯著下降，其中52%的飼主報告生活品質下降，30%表示無變化，僅有18%認為有所改善（p = 0.012）。在與初次化療比較副作用時，42%的飼主認為副作用更為嚴重，42%認為相同，16%認為較輕（p = 0.034）。整體而言，58%的飼主認為治療結果不如預期，28%認為符合預期，14%認為超出預期（p < 0.001）。儘管面臨這些挑戰，52%的飼主並不後悔選擇治療，16%表示不確定，32%表示後悔。在復發後化療期間，當副作用較第一次治療更嚴重時，飼主更可能表達後悔（標準化殘差 = 2.8），而復發間隔時間或治療效果與後悔程度無顯著相關。在復發時，飼主主要關注的問題包括疾病快速進展（28%）、化療副作用（19%）和預後不良（14%），其他因素如高齡、治療成本和頻繁就診的影響比例均低於10%。 本研究強調，在復發後選擇繼續化療是一個複雜且充滿挑戰的決策過程。儘管治療結果通常不如初次治療，但仍有三分之二的飼主不後悔接受治療。後悔與副作用相較於初次化療的嚴重程度經驗有關，因此建議復發後化療應盡可能控制副作用的發生。

Canine multicentric lymphoma generally responds well to chemotherapy, with appropriate treatment often resulting in a median survival time of 12 months. However, even after achieving complete remission, most patients eventually experience relapse, and the effectiveness and duration of subsequent treatments are often less favorable compared to initial treatment. In cases of cancer relapse, owners may prioritize quality of life over extending survival time. To better understand these priorities, we designed a questionnaire for owners whose dogs received multi-drug chemotherapy following relapse. A total of 125 dogs received treatment after relapse, and 140 questionnaires were distributed, resulting in 50 responses. The quality of life for dogs treated after relapse significantly declined, with 52% of owners reporting a decline, 30% indicating no change, and only 18% perceiving improvement (p = 0.012). When comparing side effects to the initial round of chemotherapy, 42% of owners believed the side effects were more severe, 42% believed they were the same, and 16% believed they were milder (p = 0.034). Overall, 58% of owners felt the treatment outcomes were worse than expected, 28% thought they matched expectations, and 14% believed they exceeded expectations (p < 0.001). Despite these challenges, 52% of owners did not regret their decision to continue treatment, 16% were unsure, and 32% expressed regret. Owners were more likely to regret their decision if side effects during the post-relapse period were more severe than previous treatment (standardized residual = 2.8), while no significant differences were found regarding the relapse interval or treatment effectiveness. At the time of relapse, the primary concerns for owners included the rapid progression of the disease (28%), chemotherapy side effects (19%), and poor prognosis (14%), with other factors such as advanced age, treatment costs, and frequent visits accounting for less than 10%. This study highlights the complex and challenging nature of deciding to continue chemotherapy after relapse. While the outcomes are often less favorable than those of the initial treatment, two-thirds of the owners expressed no regret in pursuing treatment. Regret was associated with the perceived severity of side effects compared to the initial chemotherapy experience; therefore, minimizing side effects as much as possible is recommended.