乳癌病患手術後一個月之症狀困擾和情緒狀態之改變及其相關性
中文摘要
初診斷乳癌婦女在乳房手術後一個月的治療過程中，不僅需忍受身體之不適，亦常經歷極大的情緒 困擾。本研究目的為了解乳癌病患乳房手術後之症狀困擾與情緒狀態，並進一步探討連續四週的改 變及其相關性。研究方法為縱貫式探討，採方便取樣，以台北地區二所區域醫院之初診斷乳癌術後 之病患為收案對象，分別在術後第二天、第二週、第三週、第四週進行面對面訪談，研究工具包括 病人基本資料問卷、症狀困擾量表（ SDS ）、情緒狀態量表（ POMS-SF ）等，資料收集自 2001 年 7 月至 10 月，共計 39 位。資料分析以描述性分析、 t-test 、 One-way ANOVA 、皮爾森相關分 析（ Pearson’s correlation ）、重複測量變異數分析（ Repeated Measures ANOVA ）檢定。主要研究 結果分述如下：
一、症狀困擾程度屬於輕度且總分在第二週開始下降直到第四週，單題部份以食慾、展望在四週內 呈上升趨勢；疲憊感、噁心頻率、失眠呈下降後再上升趨勢；疼痛頻率、疼痛程度、咳嗽、胸部緊 縮感、手術側手臂受限制、軟弱無力及麻木感在四週內呈下降趨勢。分析年齡、疾病分期和手術方 式與症狀困擾有顯著相關與差異，以年輕者、診斷第二改良式手術者之症狀困擾較高。四週中最主 要之症狀困擾為：外貌、展望、手臂活動受限制、胸部緊縮感及疼痛頻率，其中以展望及外貌為四 週中持續出現最明顯之症狀困擾。
二、情緒狀態亦屬輕度程度，整體情緒得分隨時間逐漸升高，於第四週達最高峰，次量表中以「壓 力－焦慮」為四週內最主要且上升最明顯的情緒困擾。分析年齡、婚姻、罹病時間與情緒總分之關 係有顯著差異，以年輕、未婚及罹病時間較久者情緒困擾較高；手術方式與「疲倦－懶散」、「憂 鬱－沮喪」有顯著差異其中以改良式手術之情緒困擾較高育程度、宗教信仰、疾病分期與情緒並無 顯著差異。
三、第一週到第四週之症狀困擾總分和情緒總分及情緒次量表之「壓力－焦慮」、「憂鬱－沮喪」
、「憤怒－敵意」、「疲倦－懶散」有顯著正相關，亦即症狀困擾愈嚴重，情緒困擾愈明顯。
本研究結果可提供專業人員更多照護訊息，發展適合的護理措施，在病患最需要情緒支持與鼓勵時
，協助病患維持最佳的身心調適與生活品質。
Changes of and Relationships Between Symptom Distress and Emotional Status in Breast Cancer Patients Durings the First Month of Post Operation
英文摘要
Cytokines have a major role in cancer-related syndrome. In particular, proinflammatory cytoki nes interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) may be rele ased as part of host response to tumor or in response to tissue damage or depletion of immune cell subsets associated with cancer treatments. The aim of this study was to assess the level of symptom distress during radiotherapy of breast cancer patients and its relation among sympto m distress, serum cytokines, and radiation doses. Twelve patients who received adjuvant radio therapy without concomitant chemotherapy after Breast-conserving surgery were prospectivel y studied. Patients rated their cancer-related symptom with two standardized self-assessment i nstruments, the M.D.Anderson Symptom Inventory-Taiwan Form (MDASI-T) and Brief Fatig ue Inventory- Taiwan Form, BFI-Taiwan Form (BFI-T), before radiotherapy, during week 1-5 of treatment, and one week after radiotherapy completion. The serum of cytokines IL-1, IL-6, and TNF-α were determined in parallel to the symptom assessments. Symptom distress measur e with the MDASI-T did not increase significantly during treatment, but the subscores on pain intensity were elevated during treatment week 5 and week 6. Radiation doses did not correlate with symptom distress, fatigue, IL-1, IL-6, and TNF-α during therapy. We observed cytokines IL-1 was significantly related to pain and depress. The IL-6 was significantly related to nausea . The TNF-α was significantly related to fatigue and sleep distress. Consequently, this longitud inal prospective study was undertaken to investigate the pattern and duration of symptom distr ess experienced by individuals with breast cancer during the course of and after treatment with radiation therapy.
