接受賀爾蒙治療之乳癌婦女之尿失禁問題探討

Abstract

背景：荷爾蒙療法是乳癌術後的輔助性治療，目前已有諸多文獻提出接受此治療的乳癌患者因體內缺乏動情激素而發生更年期症狀(如：陰道乾澀、分泌物和性交痛等)之普遍性和嚴重性；尿失禁問題雖為更年期症狀的一部分，卻很少受到關注。目的：本研究目的為探討使用與未使用荷爾蒙療法之乳癌患者，尿失禁之盛行率、嚴重度及其對生活品質之影響並比較兩族群之差異。方法：本研究採用橫斷研究法，以具心理計量特性良好之尿失禁問卷，包含尿失禁症狀困擾量表(UDI-6)、尿失禁生活衝擊量表(IIQ-7)及金氏健康問卷(King's Health Questionnaire)調查使用荷爾蒙治療之乳癌婦女和年齡相配合之對照組，其尿失禁之盛行率、症狀嚴重度及對生活品質影響。描述性統計描述兩組婦女之特性，並以卡方檢定、t–test及Mann-Whitney U test比較兩族群之差異。結果: 共有137位受試者參與本研究，接受泰莫西芬之乳癌患者有70位，對照組有67位；接受泰莫西芬治療組之尿失禁盛行率顯著高於對照組(42.9% vs 20.9%，p < 0.05)，其中以應力性尿失禁(63%)最為普遍。在UDI-6量表中，接受泰莫西芬治療組病患的膀胱刺激之症狀嚴重程度 (irritative symptoms)(例如:頻尿、尿急)顯著高於對照組(p < 0.05)。在金氏健康問卷的次類組分析方面，接受泰莫西芬的病患其睡眠/活力 (Sleep/Energy) 和嚴重度測量 (Gravity) 都顯著高於對照組(p < 0.05)。討論與結論:本研究使用具有良好心理計量特性的尿失禁量表比較有無使用輔助性荷爾蒙治療婦女尿失禁盛行率及生活品質之研究。接受泰莫西芬之乳癌病患尿失禁盛行率高於無使用輔助性賀爾蒙治療的乳癌病患；尿失禁症狀嚴重程度屬輕度，亦會對患者的生活品質造成影響。輔助性荷爾蒙治療與尿失禁應有密切相關。此研究有助於接受輔助性賀爾蒙治療的乳癌婦女對尿失禁有所瞭解，未來評估治療乳癌患者應考量泌尿系統功能；臨床上，醫師可提供乳癌婦女治療建議或作出適當的轉介，以優化其生活品質並以確保乳癌病友對輔助性的荷爾蒙治療之順從性。

Background: Hormone therapy is a postoperative adjuvant treatment of breast cancer, side effects may occur due to estrogen deprivation. Various studies have documented the prevalence and severity of menopausal symptoms, such as: vaginal dryness, discharge and dyspareunia, in breast cancer patients with adjuvant endocrine therapy. However, urinary incontinence as a part of menopausal symptoms has received little attention. Purpose: This study aims to investigate the prevalence and severity of urinary incontinence symptoms and its impact on quality of life (QoL) in breast cancer patients with adjuvant endocrine therapy and non- users; and to compare the differences between the groups. Methods: A cross-sectional survey study was conducted using a structured validated questionnaires, including the Urinary Distress Inventory-6 (UDI-6), Incontinence Impact Questionaire-7 (IIQ-7) and King's Health Questionnaire (KHQ) to investigate the prevalence, severity of urinary incontinence (UI) and QoL in breast cancer patients with adjuvant endocrine therapy and age-matched non- users. Descriptive statistics was computed for subject demographics. Independent t- tests or Mann-Whitney U test were performed to compare the basic data of two groups. Frequencies were compared between groups by chi-square test. Results: A total of 140 breast cancer women were surveyed, 70 breast cancer patients taking tamoxifen and 67 controls. Tamoxifen-treated group had significantly more incontinent women than control group (42.9% vs 20.9%，p < 0.05); of these, stress UI was the most common symptom (63%). In addition, the domain of UDI-6 concerning irritative symptoms (e.g., frequency and urgency) was significantly poorer in tamoxifen- treated patients than in control group (p < 0.05). In the KHQ, the sleep/energy and gravity domains was significantly affected in tamoxifen-treated incontinent women than control group (p < 0.05). Discussion and Conclusion: This was a preliminary study using a validated questionnaire to assess the prevalence of incontinence and the impact on HRQOL in tamoxifen users. Tamoxifen was found to increase urinary incontinence compared with non-users of tamoxifen; and incontinence symptoms tend to be mild in severity. In addition, incontinence can have a negative impact on daily life. It is therefore possible that estrogen deficiency induced by tamoxifen plays an etiological role in the development of UI. Frequent monitoring of the presence and severity of incontinence symptoms and treatment of these bladder problems is required to optimize patient quality of life and to assure adherence to endocrine therapy.