乳癌存活者身體心像、憂鬱狀態與性生活調適之探討

Abstract

乳癌及其治療以許多不同方式影響婦女的身體心像感受、情緒安適與性健康。本研究以橫斷、描述性研究探討乳癌生存者身體心像、憂鬱狀態與性生活調適之相關。以北部兩所醫學中心乳房外科、整形外科與乳癌病友團體為研究場所，採立意取樣，共收案155位罹病滿六個月以上乳癌婦女。以「身體心像量表」、、「憂鬱量表」、「性生活調適量表」為研究工具，進行資料收集。重要結果如下： 研究結果發現，乳癌生存者身體心像感受屬於稍微〜相當(關注/受影響)程度；以診斷為零期、大專(含)以上學歷、罹病期間仍持續工作者，有較正向的身體心像感受。乳癌生存者之憂鬱狀態屬於正常範圍，25.2%個案得分大於16分，達臨床憂鬱診斷標準；教育程度為高中(含)以下、有宗教信仰者，有較高憂鬱感受。72.3%乳癌生存者感到性生活受到不同程度的負面影響，超過60%婦女有性慾降低情形，影響程度屬於輕〜中度影響；年齡愈大、已停經或無月經狀態、曾接受化療與荷爾蒙治療者性生活調適較差。婦女平均恢復性生活時間為4.90±5.4（月），以年齡小於40歲、大專（含）以上學歷、未接受化學治療、無憂鬱感受者較快恢復性生活。 接受不同手術乳癌生存者於年齡與月經週期狀態呈顯著差異，以乳房重建者最為年輕；三者於身體心像感受達臨界顯著（F=3.03, p=.05），以乳房保留手術者身體心像感受最正向；但在憂鬱狀態與性生活調適方面，三者則無差異。 乳癌生存者之身體心像感受與憂鬱狀態呈正相關；身體心像感受、憂鬱狀態與性生活調適亦呈正相關，即身體心像愈負向、愈憂鬱者，性生活調適愈差。乳癌生存者之性生活調適預測因子為罹病後情感變疏離、年齡、身體心像、月經狀態，可解釋44%性生活調適之變異量。本研究發現可促進臨床護理人員對乳癌生存者性生活調適之重視，了解影響性生活品質之相關因素，並提升乳癌生存者之性健康。

Breast cancer and cancer therapies impairs a woman's body image, emotional well-being, and sexual health in a multiple of ways. This descriptive, cross-sectional, correlative study was to explore the influence of body image and depression on breast cancer survivors’ (BCS) sexual well-being. By convenient sampling design, a total of 155 BCS (> 6 months after diagnosis) were recruited from two medical center and supportive groups in northern Taiwan. The participants were assessed with a self-report questionnaire that included body image scale, CES-depression (CES-D) scale, and sexual adjustment scale. The results indicated that BCS had mild to moderate body image concern. Breast cancer stage, subject’s education and vocational status were associated with body image. Especially for stage 0 with college graduate or more and non-homemaker had positive sense of body image. There were 25.2% women had CES-D score more than 16 and met clinical depression criteria. Depression status in BCS was related to a woman’s education and religiosity. Women with high school graduate or less and religion affiliation had higher depression. 72.3% of BCS feel that breast cancer and cancer treatments had negative effect on their sex life (mild to moderate). More than 60% women experienced low sexual desire. In order, menopausal women, ever having chemotherapy and those receiving hormone adjuvant therapy had worsen sexual adjustment. The average time to resume sexuality is 4.9 to 5.4 month. In younger (age below 40), college graduate, not having chemotherapy and non depressed BCS had short period to revert sexuality. The participants were divided into three groups by surgical method. There were significant difference in age and menstrual status among surgical groups. Women in the reconstruction group were younger than the others. A borderline difference in body image concern was seen among three surgical groups(F=3.03, p=.05). Women in the lumpectomy group had more positive body image than those in the reconstruction group or mastectomy-alone. However, the groups didn’t differ in depression and sexual adjustment. Body image had a positive correlation with depression(r=.59), and both variables were associated with sexual adjustment. BCS who had a poor body image, more depression, would have a more poor sexual well-being. The multiple regression model for the BCS’ sexual well-being explain 44% of the variance, and the significant predictors were emotionally separated during the course of the disease, age, body image, and menstrual status. The findings of this study would facilitate nurse professionals to note that BCS’s sexual adjustment, factors influent on sexual well-being and promote sexual health of BCS.