復健治療運動對於乳癌術後之生活品質之探討－以上臂症狀與患側乳房症狀為例

Effectiveness of Therapeutic Exercise to Improve Arm and Breast Symptoms in the Post-operative Breast Cancer Patients

宋瑞祥(Jui-Hsiang Sung) ； 黃昭竣(Chao-Chun Huang) ； 楊凱傑(Kai-Jie Yang) ； 陳冠誠(Kuan-Cheng Chen)

《台灣復健醫學雜誌》 47卷2期 (2019/12) Pp. 117-124

https://doi.org/10.6315/TJPMR.201912_47(2).0005

摘要

研究背景及目的：乳癌是全世界婦女最常見的癌症之一。目前在手術及放射治療後的乳癌患者常有淋巴水腫（Lymphedema）及肩部或上臂的功能受損。過去的研究已證實，運動介入可以改善乳癌患者治療後之疼痛、淋巴水腫與肩關節活動度的問題。本研究是蒐集台灣北部一間醫學中心之手術後乳癌患者資料，以EORTC QLQ - BR23中文版問卷評估乳癌術後指導治療性運動對於肩膀活動度、腫痛、淋巴水腫及患部乳房之腫脹、疼痛及皮膚破損之問題是否有改善。資料收集包含身體意象（body image）、性功能（Sexual function）、性生活滿意度（Sexual enjoyment）、對未來之期待（Future perspective）、全身副作用（Systemic side effect）、乳房症狀（Breast symptoms）、手臂症狀（Arm symptoms）、掉髮困擾（Upset by hair loss）等八大面向。研究方法：本研究以EORTC QLQ - BR23中文版問卷評估乳癌手術治療後指導治療性運動（Therapeutic exercise）對於肩膀活動度、腫痛、淋巴水腫及患部乳房之腫脹、疼痛及皮膚破損之問題是否有改善。並針對手臂症狀及乳房症狀進一步分析及討論。研究結果：2017年3月至2019年5月由放射腫瘤科及一般外科於手術後、放射治療前轉介至復健科的乳癌患者，進行個人化的治療性運動指導，包含運動治療及整合性退腫治療。總共291人納入統計資料，依據排除標準共排除258人，共33人進入統計分析。上臂症狀中的肩膀上臂疼痛經治療後之平均分數由2.03分變為1.72分；患部乳房症狀中，腫脹之分數從1.58分變為1.27分，皮膚問題（癢、乾燥、分層）則從1.64分增加至1.88分（p＜0.05）；而乳房之疼痛則沒有改善。相關性分析發現復健前之乳房疼痛與感覺過度敏感有中度相關（r=0.482, p=0.005）；復健後之乳房疼痛，則與乳房皮膚問題、感覺過度敏感、皮膚問題皆有中度相關。結論：治療性運動介入於放療後之乳癌患者，對於其上臂或肩膀之疼痛及乳房腫脹可能有幫助。

關鍵字

癌症復健（cancer rehabilitation） ； 乳癌（breast cancer） ； 生活品質評估（evaluation of quality of life） ； 淋巴水腫（lymphedema） ； 肩關節障礙（shoulder dysfunction）

並列摘要

Background: Breast cancer is one of the most common cancers in women worldwide. Current options for breast cancer therapy include surgical excision, radiotherapy, and chemotherapy. Many studies have indicated that multifactorial exercise and complete decongestive therapy have positive effects on post-operative/post-radiotherapy lymphedema and shoulder dysfunction (i.e., range of motion). Quality of life after cancer therapy has been a great concern. Many cancer-specific evaluation tools, such as EORTC QLQ - BR23 for breast cancer, have been established in recent years to evaluate quality of life. Objectives: To confirm the effectiveness of therapeutic exercise and complete decongestive therapy on arm and breast symptoms in breast cancer patients after operation and radiotherapy. Materials and methods: We collected data on breast cancer patients after operation and radiotherapy from March 2017 to May 2019, from a medical center in Northern Taiwan. Quality of life was evaluated by EORTC QLQ - BR23 questionnaire before and after individualized therapeutic exercise and complete decongestive therapy. We focused on arm symptoms and breast symptoms in the questionnaire. Statistical analysis was performed using the paired t-test and Spearman's rank-order correlation method using SPSS 20.0 version. Result: In total, data of 291 patients were surveyed, and data of 33 patients were enrolled in statistical analysis. We found that the average score of arm pain decreased from 2.03 to 1.72; swelling score of affected the breast decreased from 1.58 to 1.27. However, skin problem score in the area of the affected breast increased from 1.64 to 1.88. Pain in the affected breast revealed moderate correlation with hypersensitivity of the affected breast before rehabilitation, and moderate correlation with other breast symptoms after rehabilitation. Conclusion: Individualized therapeutic exercise and complete decongestive therapy may improve arm pain and swelling of the affected breast after operation and radiotherapy in patients with breast cancer.

並列關鍵字

cancer rehabilitation ； breast cancer ； evaluation of quality of life ； lymphedema ； shoulder dysfunction

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