乳癌病患實行乳房保留術或改良型乳房切除術之認知、滿意度與健
康相關生活品質之研究

研究背景與目的：乳癌為台灣婦女第二好發癌症，發生率逐年上升。而乳癌治療以外科手術之乳房保留術與改良型乳房切除術為主。然而，在台灣縱貫性追蹤調查其認知、滿意度與健康相關生活品質文獻甚缺。故本研究將針對兩種術式進行分析，呈現其認知、滿意度與健康相關生活品質結果。研究方法：本研究採前瞻性研究設計，收集國內二間醫學中心接受乳房保留術及改良型乳房切除術的早期女性乳癌病人為研究樣本，分別為23及20位。針對手術病人特性、手術相關因素等進行追蹤研究，以結構式問卷評估病人認知、滿意度與健康相關生活品質之改善趨勢及幅度，進而探討其影響因子。並利用GEE模式針對重複測量資料作完整性分析。研究結果：在人口學特性、手術相關因素上，BCS教育年數顯著高於MRM（p=0.00）；BCS平均手術時間顯著少於MRM(p=0.01)；BCS術後30天再入院數顯著低於MRM(p=0.04)。而病患認知與滿意度中，MRM組認知第6題分數顯著高於BCS(p=0.01)。滿意度則無顯著差異。在健康相關生活品質改善情形上，BCS整體健康生活品質、未來展望，及疼痛、食慾減退、全身性治療副作用和乳房症狀改善情形顯著高於MRM，其他則無顯著差異。若以個別改善情況來看，BCS乳房症狀術後三個月有顯著改善；但MRM身體功能、未來展望顯著變差，且疲倦、噁心及嘔吐、疼痛、食慾減退、全身性治療副作用、手臂等症狀則明顯變多。術後認知、滿意度與健康相關生活品質之相關性中，認知與多數滿意度題項呈正相關，但未達顯著水準。BCS認知與生活品質中的疼痛、失眠和乳房症狀呈顯著負相關；而MRM認知與便秘、財務困難和乳房症狀呈顯著負相關。而BCS和MRM的滿意度與生活品質的多數構面呈顯著正相關。「婚姻狀況」、「術後30天再入院」能預測BCS病患認知；「術後30天再入院」可預測其術後對乳房和整體外觀滿意度，「平均住院天數」、「術後30天再入院」可預測MRM病患對醫護人員服務態度滿意度。「癌症期別」對手術資訊獲得、整體滿意度具預測力，「術後30天再入院」可預測其對醫護人員衛教滿意度。而健康相關生活品質中，在BCS「年齡」、「婚姻狀況」、「化學治療」、「手術時間」、「平均住院天數」是預測健康相關生活品質多數構面的因子。MRM則為「年齡」、「婚姻狀況」、「荷爾蒙治療」、「手術時間」、「術後30天是否再入院」。結論：研究發現BCS教育年數較MRM高，且平均住院天數及術後30天再入院數也較低，不過MRM在術後肢體擺位認知較高，而滿意度及健康相關生活品質則差異不大。另外，術後認知、滿意度與健康相關生活品質呈正相關，而術後30天再入院為預測病患認知、滿意度最有力之變項，但預測健康相關生活品質的則為手術時間。整體而言，手術相關因素具極大影響力，故建議醫療提供者在病患照護過程中應留意手術品質，給予病患完整衛教並增設網際網路系統，使病患得以查詢，冀能提升病患認知、滿意度及健康相關生活品質。

關鍵字

乳房保留手術；改良型乳房切除術；認知；滿意度；健康相關生活品質

並列摘要

Background and Purpose: Breast cancer is the second most prevalent of woman in Taiwan. The incidence of the Breast Cancer is increasing for the Taiwanese women. Breast cancer treatment method is the breast-Conservation surgery or modified radical mastectomy. However, Few studies demonstrated patient,s perception, satisfaction and health-related quality of life literature regarding the patients undergoing breast cancer surgery in Taiwan. The purpose of this study was to investigate patient,s perception, satisfaction and health-related quality of life in patients undergoing breast-Conservation surgery or modified radical mastectomy. Method: This is a prospective study, 23 breast-Conservation surgeries and 20 modified radical mastectomy were collected in two medical centers. Follow the trail of research to operation patient's characteristic, relevant factors of operation, and assess patient's perception, satisfaction and improvement trend and range of the health-related quality of life with the structural formula questionnaire, and then discusses its influence factor. The study makes the complete analysis using the GEE pattern in view of the repeated measure material. Results： In the demography characteristic, the surgery correlation factor, the BCS education year is higher than MRM (p=0.00); The average operation time of BCS is less than MRM (p=0.01); Re-hospitalized of BCS is less than MRM (p=0.04). And in patient's perception and satisfaction, the mark of the perception question 6 of MRM is higher than BCS (p=0.01). Satisfaction has no difference. In the health-related quality of life improvement situation, patients who received BCS had “Global health status/quality of life” and “Future perspective” scores significantly higher than patients who received MRM, and “Pain”、“Appetite loss”、“Systemic therapy side effects ” and “Breast symptoms ”scores significantly lower than patients who received MRM . If by the individual improvement situation, BCS had “Breast symptoms ” postoperation three months scores significantly higher than preoperation. But MRM in “Physcial functional”、 “Future perspective” scores significantly lower than preoperational, and “Fatigue”、“Nausea and vomiting”、“Pain”、“Appetite loss”、“Systemic therapy side effects”、“Arm symptoms” significantly higher than preoperation. Correlation of the Postoperative perception, satisfaction and health-related quality of life, showed that the perception was positively correlated with the most satisfaction questions，but not significant. In the BCS analysis perception was negatively correlated with “Pain”、“Insomnia” and “Breast symptom” ; perception was negatively correlated with “Constipation”、 “Financial difficulties” in MRM. However, the satisfaction of BCS and MRM is correlated with majority of the quality of life. “Marital status”, “Re-hospitalized in 30 days” can predict patient's perception of the BCS；“Re-hospitalized in 30 days” can predict the satisfaction to the breast and overall aesthetic after operation. “Length of stay”, “Re-hospitalized in 30 days” can predict patient's satisfaction to medical personnel's attitude of the MRM. “Cancer stage” can predict patient's satisfaction to operation information and overall. “Re-hospitalized in 30 days” can predict the satisfaction of teaching to medical personnel. And in the health-related life quality, in BCS “age”, “marital status”, “chemotherapy”, “ surgery time”, “Length of stay” can predict most the health-related quality of life. MRM for “ age”, “ marital status” “ hormone treat ”, “operation time”, “Re-hospitalized in 30 days ”. Conclusion: In BCS, the education year is higher than MRM (p=0.00), and Length of stay and Re-hospitalized are lower than MRM. Patients who received MRM had perception scores than patients who received BCS, and satisfaction and health-related quality of life were no significantly different. In the correlation analysis postoperative perception was positively correlated with satisfaction and health-related quality of life. “Re-hospitalized in 30 days” can powerfully predict patient's perception and satisfaction, but the predict variable for the health -related quality of life is the surgery time. Overall, the relevant factors of operation have great influence power, so the medical providers should pay more attention on operation quality, provide adequate patients education and set up the internet network system, make patients inquire about, in order to improve patient's perception, satisfaction and health-related quality of life.