乳癌切除婦女接受重建與否的相關因素及其健康相關生活品質

Abstract

研究目的: 乳癌發生率逐年攀升，為增加幅度最高的女性癌症，高居婦女癌症的第一位。乳癌的早期診斷治療，大幅提升了乳癌患者的存活率。但乳癌切除治療將使乳癌婦女喪失乳房，造成婦女生理、心理極大的衝擊。國外許多文獻顯示在切除乳房後，若配合適當的乳房重建手術對於乳癌術後婦女身、心、社會各方面都具有正面的影響結果。但在台灣，病患接受乳房重建與否的相關因素、乳房重建對身體形象的影響、滿意度或健康相關生活品質的研究不多，是相當值得研究的議題。 研究方法：本研究係採橫斷式、立意取樣、非開放式的結構型問卷收集資料。以北部四所醫學中心的乳癌病友團體為研究對象，共收案165位乳癌婦女。探討乳癌切除的婦女接受乳房重建與否與「個人特質」、「社會支持度」、「乳房疾病特徵」、「乳房重建認知」、之相關性。以「身體形像量表」、「健康相關生活品質」為研究工具，並分析乳房重建者的滿意度 。使用SPSS 12 for Windows電腦統計套裝軟體進行描述性與推論性統計分析。 結果：研究結果發現：病患平均年齡51± 10.2歲(24~80)，其中52人(31.5%)接受乳房重建手術，重建手術的方法選擇用鹽水袋的有27人（51.92%），選擇自體組織的有25人（48.08%）。當時決定接受乳房重建最主要的考量因素為「穿衣服的方便」（44人, 17.3%）、其次是「心理上的需要」（38人, 14.9%）、「美觀」（35人, 13.7%）。當時如何決定接受重建以「自己決定」、「醫師建議」和「親人支持」為最主要因素，分別為38人（40%）、20人（21.1%）、18人（18.9%）。至於沒有接受重建手術的原因最主要為「害怕手術」（40人, 15.3 %），其次為「有沒有乳房無所謂」（34人, 13.0%）、「擔心手術併發症」和「費用太高」（28人, 10.7 %）。多變項羅吉士迴歸分析，在控制其他變項後，年齡、親人支持度和乳癌手術方式為影響是否接受乳房重建的顯著相關因素。乳癌切除後婦女的身體形象因素，雖然在雙變項以及初步迴歸中達到統計上的顯著意義，在最終模式中並無顯著意義；但有接受重建手術者，其術前術後身體形象分數顯著改善。至於是否接受乳房重建手術與健康相關生活品質之相關性，在生理功能（PF）、因身體健康所導致的角色限制（RP）、一般健康狀況（GH）、因情緒問題所導致的角色限制（RE）與生理面向健康生活品質，皆呈現了統計上的正相關顯著意義。對乳房重建的滿意度方面，整體的滿意度為可接受及滿意者達86.4%，92.2%的人會再一次選擇乳房重建，94.2%的人會推薦乳房重建手術給其他病友。 結論：(一) 本研究可促進臨床醫護人員對影響是否接受乳房重建之相關因素的了解，提供乳癌治療之完整性，並提升乳癌治療之品質。(二) 重建手術可以明顯改善乳癌切除婦女的身體形象。(三)接受乳房重建者比起未接受乳房重建者，在生理功能、因身體健康所導致的角色限制、一般健康狀況、因情緒問題所導致的角色限制與生理面向上，有較高的健康生活品質。(四)對乳房重建整體的滿意度相當高，而且樂意推薦其他病友，顯示乳房重建是值得推廣的手術。

Background and Purpose: Breast cancer is the leading cancer of women in Taiwan nowadays and also in the western countries. Most studies are focused on the cancer epidermiology, pathology, diagnosis, and treatment modalities. The purpose of this study was to investigate the influence factors of breast cancer women’s decisions for or against breast reconstruction,, health-related Quality of life (QOL SF-36), and satisfaction of breast reconstruction. Material and Method: We performed a cross-sectional, purposive sampling study in 4 breast-supporting groups in 4 teaching-based hospitals in Taipei. From Jan. 1997 to Dec. 2006, women had mastectomy and/or breast reconstruction at any of hospitals were considered eligible for the study. No age restrictions were imposed. However, women were excluded from the study if they had cancer metastasis. Postal Questionnaires were delivered and collected for analysis of patients' demographics, diseases profiles, social support, body image scale, and QOL SF-36. Data were analyzed using SPSS for Windows version 12. Result: Total 165 patients were valid for study including 52(31.5%) women who had postmastectomy breast reconstruction. Expert content validity and Cronbach's alpha reliability were reported in the context. The results showed that: (1) Age, family support, and mastectomy types were important factors for women’s decision for or against breast reconstruction. (2)The most frequently reason for not having breast reconstruction was fear of the reconstructive operation, followed by not essential for the breast, fear of the surgical complications, and expenses. The most frequently reason for having reconstruction was to be able to wear many different types of clothing, psychological demand, and cosmetic. (4) The participants who had undergone breast reconstruction had better global health-related quality of life. (5) The overall satisfaction of breast reconstruction was high and recommendable. Conclusion: This study provides important informations for clinical staffs to understand the determinants for women to have or not breast reconstrtuction. Family support is important factor for women to have breast reconstruction. Breast reconstruction can significantly improve patients’ body image scale and make a substantial contribution to health-realted Quality of life for breast cancer patients especially for the younger women.