婦癌病人睡眠障礙及相關因素探討

Abstract

睡眠障礙普遍發生於癌症病人，儘管安眠藥物治療後，病人仍主訴有睡眠問題未獲得改善，而過去研究婦科癌症相關睡眠障礙較少，因此，本研究目的為探討婦科癌症病人因疾病及治療過程中所造成生活衝擊之經驗並探討其相關因素，包括基本背景資料〔診斷疾病時間、疾病分期、治療形式（手術方式、化學治療、放射治療）與化學治療藥物有無使用〕、創傷後壓力症候群、恐懼疾病復發、治療不適症狀與睡眠障礙之相關性。 研究設計採橫斷式研究設計，以連續性取樣方式，於台北市某醫學中心婦科腫瘤門診收案，以結構式問卷進行資料收集。工具包括：「背景基本資料量表」、「歐洲癌症研究組織與治療之生活品質症狀量表及卵巢癌模組量表」、「事件衝擊中文翻譯量表」、「恐懼疾病復發量表」、及「睡眠困擾問卷量表」。 總共收案130人，其疾病診斷分為卵巢癌（24%）、子宮頸癌（38%）及子宮內膜癌（38%）；疾病分期以第一期最多（69.2%）其次為第二期（11.5%）；無復發者居多（88.4%）；診斷疾病時間以1-5年最多（43.8%）其次為5-10年（31.3%），研究結果發現（1）早期婦癌患者睡眠干擾偏低（2）距離疾病診斷時間越長，睡眠干擾越低；(3)心理相關因素方面，因疾病引發創傷後壓力及恐懼疾病復發程度低者，睡眠困擾呈低相關；(4)生理症狀方面，身體症狀困擾程度越少，其睡眠困擾越低；(5)創傷後壓力子量表中情緒警覺、恐懼疾病復發子量表中的病識感及距離疾病診斷時間可預測婦癌患者之睡眠情形，其解釋變異量為29.7％。 雖然整體恐懼疾病復發程度偏低，但我們發現有少數早期婦癌患者仍處於創傷後壓力及害怕癌症再回來的恐懼之中。同時也發現疾病引發創傷後壓力衝擊、恐懼疾病復發及身體症狀程度越低，睡眠干擾越少，可能為本研究以早期無復發且已結束治療門診追蹤的婦癌患者有關。因此在未來臨床實務上，若發現有潛在相關癌症心理壓力應主動提供情緒篩檢，另篩選後符合情緒困擾者則轉介心 理師或是個案管理師尋求協助。

Sleep disturbance is commonly seen in gynecological cancer survivors. Even after having sleep pills treatment, their sleep disturbance still could not be solved. As we know, just few of literatures investigate on the prevalence of psychological distress such as cancer related posttraumatic stress, fear of recurrence and its contribution to sleep disturbance among gynecologic population. Thus, the purposes of this study are to examine (1) sleep disturbance of cancer survivors and (2) identify related factors（time of disease diagnosis, stage of disease, types of treatment and whether usage of chemotherapy regimens）, cancer related posttraumatic stress, fear of recurrence，and symptoms are related. This study is a cross-sectional research design. Data were collected at the Outpatient Department of a medical center in North Taiwan by consecutive samplings method. Patients were assessed by trained nurses with structured interview using several scales, including (1) Background information form, (2) EORTC Core Quality of Life Questionnaire（QLQ-C30）-Physical Function Domain and 28-items Ovarian Cancer-Specific Questionnaire Module (OV-28),(3) Chinese Version of Impact of Events-Revised scale(CIES-R),(4) Fear of Recurrence Inventory(FCRI),(5) Sleep Disturbance Questionnaire-Physical Tension and Mental Anxiety Subscale(SDQ). An estimated of 130 patients were recruited. They are divided into Ovarian cancer (24%), cervical cancer(38%) and endometrial cancer(38%). About 70% of gynecologic cancer patients was Stage 1 in diagnosis, cancer with non-metastasis (88.4%) and with metastasis (11.6%).Time since diagnosis with range from 1-5year and 5-10year were in the majority which showed (43.8%) and (31.3) respectively. The results showed that (1) anxiety induce sleep disturbance among the early stage gynecologic cancer survivors was low in intensity; (2) the level of cancer-related posttraumatic stress and fear of recurrence was low; (3) the severity of symptoms after treatments was low; (4) patients with low cancer related stress and symptoms reported to have less sleep disturbance analyzed by Pearson correlation; (5) Overall, patients’ sleep disturbance was significantly predicted by hyper-arousal of posttraumatic stress, insight of fear recurrence and time since diagnosis and these factors accounted for 29.7% of the variance of sleep analyzed by regression. Even most of gynecologic cancer patients are in early stage with non-metastasis, we yet find out a minority of them still worried about the disease when to come back and sustained under mild posttraumatic stress after being diagnosis of cancer. Even the total score of sleep disturbance was low but we find out that a minority of them was disturbed by their mind kept turning over their sleep. And it might relevant to our sample as early stage with low level of psychological distress and less symptoms burden. Hence, our finding suggest the importance for clinical healthcare members of screening the possibility cause of sleep disturbance among cancer patients of not only emphasized on cancer symptoms but also on psychological stress as our research has shown.