應用正念減壓課程於改善乳癌病人生理、心理及生活品質之成效

Abstract

研究背景：乳癌為全球女性最常見的癌症，發生率逐年增加，隨著醫療處置的進步，其存活率可達90%，雖存活率雖高，但在常規輔助治療結束後，病人邁入疾病緩解期及存活期，五年及十年復發率分別為13.1%與21%，常出現疲憊、體力下降、憂鬱、害怕疾病復發及睡眠困擾之情形，會影響其生理、心理、社會、靈性及健康生活品質。從系統性回顧及統合分析結果，指出正念減壓課程有助於改善乳癌患者之生、心、靈、社會、生活品質、正念及生物指標等問題。 研究目的：探討乳癌病人生理、心理、生活品質及正念的情形，以及評價乳癌病人接受正念減壓課程後，在生理、心理、生活品質及正念之成效。 研究設計：採單組多次重複性測量之前驅性實驗研究設計。 研究方法：本研究對象來源為「北部某家醫學中心」以及透過乳癌相關團體各式網站公告招募乳癌病人，共17人，介入處置為「八週正念減壓課程及一日練習」，內容涵蓋「身體掃描、靜坐及瑜珈」；測量工具為「一般疲憊量表(GFS)、中文版匹茲堡睡眠品質量表(C-PSQI)、中文版情境特質焦慮量表(C-STAI)、害怕疾病復發量表(FORS)、WHO-5幸福指標(WHO-5 well-being index)、乳癌患者生活品質測定量表(FACT-B)及止觀覺察注意量表(MAAS)」於前後測進行評量，第三、七週以GFS、STAI-S、CES-D及WHO-5 進行評量，第五週增加C-PSQI及MAAS進行評量；研究資料採Wilcoxon符號排序檢定之無母數統計及廣義估計方程式進行統計分析。 研究結果：16位乳癌病人接受八週正念減壓課程後之結果分析顯示：(1) 乳癌病人於治療期及緩解期之生活品質中度偏良好，但在「疲憊、焦慮、憂鬱及害怕疾病復發」均為中度困擾；幸福感偏低且睡眠品質不佳；止觀覺察注意程度中度偏低。(2) 接受正念減壓後，得分降低之變項為疲憊(P=.023)、情境焦慮(P=.006)、特質焦慮(P=.005)及憂鬱(P=.009)，生理及心理症狀獲得改善；得分增加之變項為幸福感(P=.003)及生活品質(P=.005)，有提升之傾向；(3) 接受正念減壓後，睡眠品質(P=.076)、害怕疾病復發 (P=.065)及止觀覺察注意(P=.258)得分改變情形，均未達統計上顯著差異之水準。 結論：正念減壓課程對乳癌病人在生理、心理、靈性、生活品質及正念有所助益，除了建立本土實證資料外，此成效可應用於未來醫護人員之培訓課程，教導醫護人員依病人個別需求引導其學習正念減壓，並提醒醫護人員於客觀評估個案亦能注重病人當下的主觀感受。

Background: Breast cancer is the most common cancer among women in the world. It’s incidence rate has been increasing yearly. With the progress of medical treatments, the survival rate could be 90%. Although the survival rate is high, after the routinely adjuvant therapy, patients who went into remission and survived had a relapsed rate of 13.1% and 21% within 5 and 10 years respectively. The usual symptoms are fatigue, decreased physical strength, depression, fear of cancer recurrence, and sleep disturbance. These symptoms affect patients’ physical, psychological, social and, spiritual status, and health related quality of life. Systematic reviews and meta-analysis results show that MBSR helps them improve their physical, psychological, social, and spiritual status, health related quality of life, mindfulness, and biomarkers. Aim: To explore breast cancer patients’ physical and psychological status, health related quality of life, and mindfulness, and to evaluate their effects on patients after receiving MBSR. Design: One-group multiple repeatability measurement pilot experiment was used. Methods: A total of 17 subjects were recruited from a medical center in northern Taiwan and from announcements on various websites that recruit breast cancer patients through breast cancer related groups. They underwent an “eight-week MBSR and one full day practice” intervention which included body scan, sitting meditation, and yoga. The measuring tools are GFS, C-PSQI, C-STAI, FORS, WHO-5 well-being index, FACT-B and MAAS. In the third and seventh week, we used GFS, STAI-S, CES-D and WHO-5 measurement tools, and in the fifth week C-PSQI and MAAS were added. Wilcoxon sign-rank test was used for non-parametric statistics and GEE used for statistical analysis. Results: After 16 breast cancer patients received the eight-week MBSR intervention, the results show that: (1) During the treatment and remission period, breast cancer patients’ quality of life is moderately good while fatigue, anxiety, depression and fear of recurrence are moderate disturbances; sense of well-being is low and sleep quality is bad; and mindful attention awareness is moderately low. (2) After receiving mindfulness-based stress reduction, the low scoring variables are fatigue (P=.023), state anxiety (P=.006), trait anxiety (P=.005) and depression (P=.009), which indicate an improvement in physical and psychological symptoms. The high scoring variables are sense of well-being (P=.003), and quality of life (P=.005), which indicate a tendency to be upgraded. (3) After receiving mindfulness-based stress reduction, there wasn’t a statistical significant difference in sleep quality (P=.076), fear of recurrence (P=.065) and mindful attention awareness (P=.258). Conclusions: MBSR benefits breast cancer patients’ physical, psychological and spiritual status, health related quality of life and mindfulness. Apart from establishing local evidence-based data, MBSR's effectiveness can also be applied to training courses for medical staff. Medical staff can teach MBSR to patients according to their individual needs. Moreover MBSR can remind medical staff to pay attention to patients’ present feelings when objectively assessing them.