早期乳癌存活者重返職場、工作轉變與生活品質間相關性之探討

Abstract

背景：乳癌為全球女性常見癌症之一，也為台灣發生率第一之癌症，早期乳癌存活者之存活率高，且被診斷時大多仍低於退休年齡，且乳癌有年輕化的趨勢，工作對於癌症存活者來說相當具有意義，可協助疾病復原、給予心理上滿足感與生活正常感，甚至能改善生活品質，然而我國目前對於乳癌存活者重返職場預後之生活品質研究鮮少，尚不清楚影響乳癌存活者重返職場之影響因素及其診斷後之工作轉變。 目的：了解影響台灣早期乳癌存活者重返職場之因素、工作轉變情形，並了解重返職場、工作轉變與生活品質間之關係。 方法：採橫斷面調查法方式(cross-sectional survey study)，以結構式問卷訪問早期女性乳癌存活者，問卷內容部分包含病患基本屬性、疾病相關因素、工作相關結果及生活品質，工作相關結果分為有無重返職場/工作狀態有無改變/職業類別有無轉變，生活品質量測工具使用EORTC QLQ-C30及QLQ-BR23中文版。 結果：本研究於2022年3月至6月於北中南共四間醫院進行紙本問卷之收案，總計收案0-II期早期乳癌之存活者(診斷年為2017後)共173人，診斷時於有給職工作者(全職+兼職)佔78%，於研究調查時仍有61.3%仍為有給職工作，近6%無工作、11%已退休，66人(38.2%)表示其診斷後曾停止工作過；診斷前與研究調查時均有工作者(n=97)，與其診斷前工時相比，工時不變佔56%、工時減少佔38%，部分工時增加佔6%。早期乳癌者年齡越大(OR=1.06, CI[1.01, 1.12])、有配偶(OR=0.27 , CI[0.11, 0.69])、家庭年收入越高(OR=0.19 , CI[0.06, 0.57])、需撫養子女(OR=3.29 , CI[1.35, 8.01])越可能重返職場，而在工作狀態轉變與職業類別轉變上均無顯著之項目；調整後，工作相關結果均與生活品質EORTC QLQ-C30、QLQ-BR23無顯著相關，可見台灣之早期乳癌存活者工作與否、工作改變與否，並未造成生活品質的差異。 結論：乳癌存活者於診斷後應考量其作為母親、工作者、自我照顧角色順序之變化，針對病患狀態給予重返職場之計畫與建議，提供適時的介入措施，且針對家庭年收入低及需撫養子女者，應給予相關的社會福利幫助，並確保其在工作上獲得平等對待。

Background: Breast cancer is one of the most common cancers in women around the world, and it is also the highest incidence rate of early breast cancer in Taiwan. Most were still below retirement age at the time of diagnosis and breast cancer patients tend to be younger. Work makes a lot of sense for cancer survivors, assisting in recovery from illness, providing psychological satisfaction and a sense of normalcy, and even improving the quality of life. However, there are few studies on the quality of life of breast cancer survivors returning to work in Taiwan, and the factors that affect them returning to work and their work transition after diagnosis are still unclear. Objective: To know the factors that affect early breast cancer survivors returning to the work, the situation of work transition, and to understand the relationship between return to work, work transition, and quality of life. Methods: A cross-sectional survey study was used to interview early-stage female breast cancer survivors with a structured questionnaire. The content of the questionnaire included basic patient attributes, disease-related factors, work-related results, and quality of life. In order to check whether there is a return to the workplace, whether there is a change in work status, or whether there is a change in occupational category, the Taiwanese version of EORTC QLQ-C30 and QLQ-BR23 is used as the quality of life measurement tool. Results: Questionnaires were received in four hospitals in North, Central, and South of Taiwan from March to June 2022. A total of 173 survivors of stage 0-II early breast cancer (diagnosis year after 2017) were received. 78% of employed workers (full-time + part-time) were employed, 61.3% were still employed at the time of the survey, nearly 6% were unemployed, 11% were retired, and 66 (38.2%) indicated that they had stopped working after their diagnosis. Compared with the working hours before the diagnosis and at the time of the investigation, the working hours remained unchanged by 56%, the working hours decreased by 38%, and the partial working hours increased by 6%. Early breast cancer survivors were older (OR=1.06, CI[1.01, 1.12]), had spouse (OR=0.27, CI[0.11, 0.69), and had higher annual family income (OR=0.19, CI[0.06, 0.57]) , have dependent children (OR=3.29, CI[1.35, 8.01]) are more likely to return to work, and there are no significant items in work transition and occupation category change; after adjustment, there was no significant correlation between EORTC QLQ-C30 and QLQ-BR23. It can be whether that whether the early breast cancer survivors in Taiwan worked or not, and whether their work transition changed or not, did not cause differences in the quality of life. Conclusions: Breast cancer survivors should be considered the changes in their roles as mother, employee, and self-care after diagnosis. It is important to provide the patient with plans and suggestions for returning to work based on their current status, and to implement timely interventions. Breast cancer survivors with children and/or lower annual household income need more social welfare assistance and ensure that they are treated equally at work.