不同年齡乳癌病患術後生活品質相關因素之探討

Abstract

乳癌發生率逐年增加，根據國健署103年癌症登記報告資料指出，乳癌佔十大癌症發生率(含原位癌)的首位，死亡率的第四位。目前台灣女性乳癌診斷的年齡大多介於45歲~59歲之間，小於45歲的年輕型乳癌病患亦有逐年攀升的趨勢，因此本研究希望透過生活品質問卷量表方式了解乳癌術後的輔助性療法對於不同年齡層的患者有何影響結果，以提供未來臨床照護上的參考。 本研究為橫斷性研究，收案時間自104年8月1日~106年2月28日，資料收集來源是北醫附醫、萬芳醫院及雙和醫院之乳房外科門診經病理切片診斷確診的乳癌病患，本研究中使用「EORTC QLQ-C30」、「EORTC QLQ-BR23」及「FACT-B」等問卷來評估受試者的生活品質，除此之外，也從「流行病學危險因子問卷」中收集基本人口學資料(病患年齡、乳癌初次診斷年齡、婚姻狀況、教育程度…等)、家庭經濟狀況、疾病史、生活習慣、月經史及懷孕史等。病理資料則由受過訓練的研究人員於醫院電腦系統上進行資料抄錄。受試者共有116名，其中年輕型乳癌病患(乳癌診斷年齡<45歲者)有50名，年長型乳癌患者(乳癌診斷年齡≧45歲者)有66名，所有資料分布情況以描述性統計呈現，並進一步以逐步回歸方式來分析不同乳癌診斷年齡患者在基本人口學、病理情況、輔助性療法的影響下其生活品質的差異性。 從本研究結果中可觀察到下面幾種變項對於年輕型與年長型患者的生活品質影響有差異性，像是家庭年收入對於整體生活品質的影響，年輕型患者生活品質下降，年長者反之；在有伴侶者對於性生活愉悅生活品質的影響，年輕型患者下降，年長者反之；賀爾蒙療法對於角色功能生活品質的影響，年長者生活品質下降；年輕型患者對乳房局部切除手術接受度高，年長型患者對乳房全部切除術接受度高。除此之外，下面幾種變項對兩組患者生活品質的影響一致，包含有職業者較家管者其生活品質下降；有慢性病史者生活品質下降，特別是年長型患者；淋巴結轉移會造成水腫情況增加，進而使工作或休閒娛樂活動受到影響；化療對於生活品質各面向的影響程度最明顯。整體而言，年長者、家管、癌症早期、社會支持度高者其生活品質佳。有接受化學治療者在許多面向都有負面影響，但在掉髮生活品質方面，僅在年輕型患者中觀察到生活品質有下降情況。 研究成果顯示，輔助性療法中以化學治療對於不同年齡層之乳癌患者在生活品質的影響最為明顯且為負向的。除化學治療之外，年輕型乳癌患者其他影響因子，如接受乳房全部切除、淋巴結有轉移、癌症期別晚期者其生活品質皆有下降情況，這在年長型患者中是沒有觀察到的。臨床照護上，除目前現有資源之外，應針對年輕型的乳癌病患提供心理諮商或是相仿年紀之病友會等以提供不同年齡層之乳癌病患更適切的照護。

The incidence rate of breast cancer was increasing year by year. According to the CANCER REGISTRY ANNUAL REPORT published in 2016, breast cancer accounts for the first place in top 10 cancer incidence (including carcinoma in situ) and the fourth place of mortality. In Taiwan, most of the age of breast cancer is between 45 and 59 years old. In addition, young patients with breast cancer (breast cancer diagnosed younger then 45 years old) is increasing gradually, different from the feature in Western countries. Therefore, this study aims to assess possible associative factors for quality of life after surgery among breast cancer survivors of different age groups. This was a cross-sectional study. Subjects are the breast cancer patients of breast surgery clinic in Taipei Medical University Hospital, Taipei Municipal Wanfang Hospital, and Taipei Medical University Shuang Ho Hospital. We used EORTC QLQ-C30, EORTC QLQ-BR23 and FACT-B to evaluate the patient’s QoL. Besides, we also collected demographic variables (age, the first breast cancer diagnosis age, marital status, and education), economical resource, medical history, lifestyle habits, menstrual history and pregnancy history with structured questionnaire. Clinical and pathological information were obtained by well-trained researchers from hospital system. The data were analyzed by descriptive statistics, univariate analyses, and stepwise regression. There were 116 subjects with collection period from August 1st, 2015 to February 28, 2017. All subjects were divided into two groups, young patients with breast cancer (the first breast cancer diagnosis age<45 years old, n=50) and elderly patients with breast cancer (the first breast cancer diagnosis age≧45 years old, n=66). The major findings of this study as follows：(1) For patients in both groups, there are several variables had different effects on the quality of life. First, young patients whose family annual income higher than 1.5 million had lower impact on global health status (QL2), whereas the elderly patients had a positive impact on QL2. Second, on the domain of sexual enjoyment (BRSEE), young breast cancer patients who have a partner had a negative impact on BRSEE, whereas the elderly patients had a positive impact on it. Third, elderly patients with breast cancer who received hormonal therapy had a negative impact on the domain of role functioning (RF2). Forth, there was a high acceptability of breast preserving surgery in young patients and a high acceptability of modified radical mastectomy in elderly patients. (2) For patients in both groups, the impacts of several variables on quality of life were consistent. First, patients who were in employment had a lower QoL than housekeepers. Second, patients who had chronic disease history had negative impact on quality of life, especially for elderdy patients. Third, patients with lymphatic metastasis whose arm edema increased, and thus make work or leisure and entertainment activities affected. Forth, the impacts of chemotherapy on the different domains of quality of life were most obvious. In general, elderly patients, housekeepers, the early stage of breast cancer and patients with high social support had positive impacts on QoL. Patients in both groups undergoing chemotherapy had negative impacts on most domains. On the domain of upset by hair loss (BRHL), young patients had a negative impact on it, however, we didn’t observe the same result in the elderly group. In conclusion, the effect of chemotherapy on quality of life of different breast cancer age groups is most pronounced and negative in all adjuvant therapy. Receiving mastectomy, having lymph node metastasis, later stage of cancer had negative impact on QoL in young breast cancer patients. In clinical care, in addition to the existing resources, we should provide psychological counseling or set up a patient support group of similar ages to provide more appropriate care to different age groups of breast cancer patients.