探討乳癌存活者與其青少年子女生活品質之相關

Abstract

研究背景：目前研究較少同時探討乳癌存活者母親與其青少年子女生活品質的關，由於乳癌存活期加長，乳癌存活者的未成年子女與母親，在經歷治療期面對疾病過後，相互之間的影響以及生活適應的議題探討更顯得重要。 研究目的：探討乳癌存活者及其青少年子女焦慮、憂鬱、壓力事件因應以及生活品質的現況及影響其生活品質的主要預測因子。 研究方法：本研究採橫斷式研究設計(cross-sectional design)，採立意取樣(purposive sampling)於北部地區某醫學中心進行收案。研究對象為三十至六十五歲，經專科醫師診斷為乳癌，且目前已完成所有積極治療，包含手術治療、化學治療或是放射線治療的女性乳癌存活者，以及其共同居住之十三歲以上未滿十八歲的青少年子女，有被告知母親診斷為乳癌者，共有乳癌存活者及其青少年子女各79人參與本研究。研究使用量性測量工具包括由母親跟其青少年子女皆填寫的包含，BDI-II貝氏憂鬱量表第二版中文版、STAI焦慮狀態詢問表、SF-12生活品質量表；由母親單獨完成者為CCCS華人癌症體驗量表，由青少年子女單獨完成者為CIES孩童對壓力事件反應量表。 結 果：本研究發現乳癌存活者與其青少年子女生活品質相關達顯著。乳癌存活者與其青少年子女沒有呈現顯著嚴重的憂鬱和焦慮狀態。但青少年女性憂鬱程度較男性高。少數乳癌存活者呈現不良的靈性因應。近20%的青少年子女在CIES量表中得分大於17分，為創傷後壓力症候群的高危險族群。生活品質方面發現，乳癌存活者呈現良好的生理健康，但心理健康較差。乳癌存活者生理健康生活品質的主要預測因子為其年齡、自身焦慮、憂鬱與心理健康生活品質；乳癌存活者心理健康生活品質的主要預測因子為乳癌存活者的焦慮、憂鬱程度與生理健康生活品質以及CCCS癌症因應中的「不和諧而苦悶的因應」。在青少年子女生理健康的主要預測為自身焦慮程度以及母親乳癌手術後至參與本研究時間；心理健康的主要預測因子為自身焦慮程度。 結 論：焦慮和憂鬱同時是影響乳癌存活者生理和心理層面生活品質的主要因素。靈性的癌症因應方式影響乳癌存活者心理層面生活品質。青少年子女自身的焦慮是影響其生活品質的主要因素，而生理健康層面生活品質亦會隨母親完成手術後的時間越長而改善。

Background: Very few studies examine the relationships of quality of life between breast cancer survivors and their adolescent children. Given the increase of survivor time, the issue of daily life adjustments for both breast cancer survivors and their adolescent children during post-treatment survivorship needs to be explored. Purpose/Objectives: This study aimed to explore anxiety, depression, coping with the event of breast cancer as the predictors for quality of life in the breast cancer survivors and their adolescent children. Methods: The study adopts a cross-sectional design. The method of purposive sampling was used to recruit the subjects from outpatient department of surgery at breast centre at the general hospital. The criteria of breast cancer survivors are aged between 30 and 65 years old, complete the active cancer treatments including surgery, chemotherapy and/or radiation therapy. Their adolescent children aged between 13 and 18 years old, living with mother and knowing that mother had suffered from breast cancer were also invited to participate in this study. Total 79 breast cancer survivors and 79 adolescent children participated in this study. Breast cancer survivors and their adolescent children completed the questionnaires including Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), Short Form 12-item Health Survey (SF-12). The Chinese Cancer Coherence Scale (CCCS) was completed by breast cancer survivors while Children Impact of Events Scale (CIES) was completed by the adolescent children. Results: The quality of life between breast cancer survivors and their adolescent children are interrelated. Both the breast cancer survivors and their adolescent children did not appear to have serious anxiety and depression. As noted, the greater scores on BDI-II more likely occurred in adolescent daughters than sons. Few breast cancer survivors showed poor spiritual coping on Chinese Cancer Coherence Scale. Almost 20% of the adolescent children scored higher than 17 on Children Impact of Events Scale which indicated they were the high risk group for the post-traumatic stress disorder. Breast cancer survivors appeared to have a good physical quality of life, but they appeared to have relatively poor mental component of quality of life. The predictors of physical quality of life of breast cancer survivors were their age, anxiety, depression and mental component of quality of life. The predictors of mental quality of life of breast cancer survivors were anxiety, depression, physical component of quality of life, and the incoherent-embittered type of spiritual coping with cancer. The predictors of adolescents’ physical quality of life were their anxiety status and the time period between their mothers completing surgery and participating in this study. The predictors of adolescents’ mental quality of life were their anxiety status. Conclusions: The results illustrate that anxiety and depression both are the main factors associated with breast cancer survivors' physical and mental components of quality of life. Spiritual coping with cancer influences mental component of quality of life in breast cancer survivors. Adolescent children’s anxiety levels are the main factor associated with physical and mental quality of life, and their physical well-being is likely improved as the length of their mother completing cancer treatment is longer.