乳癌病人完成癌症治療後存活期之生活品質現況及其影響因素

Abstract

背 景：乳癌存活者人數和存活時間逐年增加，台灣目前較少探討完成癌症治療後存活期乳癌存活者之生活品質，以及影響生活品質的心理因素，因此對於治療後如何提供乳癌存活者後續的照護以提高生活品質的資訊較為缺乏。 目 的：探討乳癌病人完成癌症治療後存活期之乳房滿意度以及生活品質現況 (心理安適、身體安適和性安適) ，以及在控制疾病和治療因素後，影響生活品質之心理因素，包含：焦慮和憂鬱程度、親密關係的依附型態、正念特質。 方 法：本研究採橫段式設計，159位已完成癌症積極治療後滿一年以上的乳癌存活者，以結構式問卷進行資料收集，包括：「基本資料表」、「乳房問卷」、「貝氏憂鬱量表第二版中文版」、「焦慮狀態問卷」、「簡短版親密關係量表」和「止觀覺察注意量表中文版」。乳房問卷分為四個面向：乳房滿意度、心理安適、身體安適和性安適，每個面向總分為100，分數越高代表乳房滿意度和生活品質越好。 結 果：乳房滿意度和生活品質各層面得分為：乳房滿意度（54.04）和心理安適（身體心像和對社交場合）的信心（68.36)、身體安適（72.18）和性安適（42.26），皆未達80分。其中性安適和乳房滿意度未達60分。影響乳房滿意度的預測因子中，沒有接受放射線、焦慮程度較高和止觀覺察的正念程度較低者，其乳房滿意度得分較差。路徑分析結果說明正念會經由降低焦慮程度，而促進乳房滿意度（正念→焦慮程度→乳房的滿意度）；影響性安適的預測因子中，沒有接受放射線、憂鬱程度較高和止觀覺察的正念程度較低者，其性安適生活品質得分較差。路徑分析結果發現正念會經由降低憂鬱程度，而促進性安適（正念→憂鬱程度→性安適）；影響心理安適的預測因子中，焦慮程度較高者，其心理安適的生活品質得分較差。路徑分析結果說明正念會經由降低焦慮程度，而促進心理安適（正念→焦慮程度→心理安適）；影響身體安適的預測因子中，有服用憂鬱症藥物、無接受重建、憂鬱程度較高和止觀覺察的正念程度較低者，其身體安適生活品質得分較差。路徑分析結果說明正念會經由降低憂鬱程度，而促進身體安適（正念→憂鬱程度→身體安適）。 結 論：根據本研究結果，乳癌病人完成癌症治療後存活期之乳房滿意度和性安適較差。未來的照護介入措施可以藉由正念治療的介入改善焦慮和憂鬱以提升長期存活者對乳房滿意度和生活品質。

Background: In Taiwan, the number of breast cancer survivors is increasing rapidly. However, very few studies examine the quality of life (QOL) and its associated factors among breast cancer women who complete the active cancer treatments at least one year. Therefore, there is an insufficient information to inform professionals about how to provide the post-treatment care for breast cancer survivors. Purpose/Objectives: This study aimed to examine the satisfaction with breast and QOL (psychological, physical and sexual well-being) in breast cancer patients at the post-treatment survivorship stage and their associated factors including anxiety, depression, attachment styles in close relationship, and mindfulness trait after controlling disease and treatment factors. Methods: This study adopts the cross-sectional design. The questionnaires were administered to 159 breast cancer patients who had completed the active cancer treatments at least one year. The questionnaires are personal characteristics questionnaire, BREAST-Q, Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), Brief Taiwanese version of Experiences in Close Relationships-Revised (ECR-R), and Mindful Awareness Attention Scale (MAAS). Results: The results indicated the scores for satisfaction with breast were 54.04 and three domains of QOL: psychosocial well-being(68.36), physical well-being(72.18), and sexual well-being(42.26). As indicated, the lower scores were satisfaction with breast and sexual well-being. The worse satisfaction with breasts was associated with not receiving radiation therapy, higher levels of anxiety, and lower levels of mindfulness trait. Mediator analysis found that mindfulness increased satisfaction with breasts by reducing the level of anxiety (mindfulness→anxiety→satisfaction with breasts). The predictors of poor sexual well-being are not receiving radiation therapy, higher levels of depression and lower levels of mindfulness trait. Mediator analysis found that mindfulness can enhance sexual well-being by reducing the level of depression (mindfulness→depression→sexual well-being). The lower psychosocial well-being was associated with higher levels of anxiety. Mediator analysis found that mindfulness enhanced psychosocial well-being by reducing the levels of anxiety (mindfulness→anxiety→psychosocial well-being); The lower levels of physical well-being were associated with having antidepressants, no receiving radiation therapy, not receiving breast reconstruction, higher levels of depression and lower levels of mindfulness trait. Mediator analysis found that mindfulness increased physical well-being by reducing the levels of depression (mindfulness→depression→physical well-being). Conclusion: According to the results of this study, the lowest scores were satisfaction with breasts and sexual well-being in breast cancer patients at the post-treatment survivorship stage. The implication of study is to develop mindfulness therapy to reduce anxiety and depression in order to improve breast cancer survivors’ satisfaction with breast and quality of life.