- 學位論文
婦癌存活者對疾病復發擔憂之探討
Fear of Recurrence in Gynecological Cancer Survivors
摘要
根據統計，64.8~84%的卵巢癌、子宮頸癌及子宮內膜癌病人可存活超過五年，存活期中因癌症的衝擊，導致害怕復發是治療後常見的問題且嚴重影響病人存活期之生活品質，而病人亦會藉由反思的過程形成想法上的正向成長。因此，治療後害怕復發的相關研究逐日被受重視，但國內針對婦癌方面研究有限，故本研究目的為探討婦癌病人結束治療後 (1) 害怕復發之經驗；(2) 身體症狀；(3) 受到癌症創傷後心理正向成長程度；(4) 人口學特質、疾病及治療特質、症狀及創傷後成長與害怕癌症復發之相關性。本研究針對結束治療後未曾復發過之婦癌病人，採用橫斷式研究法 (cross-sectional design)，取樣於台灣北部某教學醫院婦科門診，共收案136位婦癌病人，透過結構式問卷進行資料收集，以描述性統計、單因子變異數分析及事後多重檢定、斯皮爾曼等級相關係數及逐步迴歸分析。 研究結果發現約一半的婦癌存活者擔心害怕癌症是否復發，但整體病人差異很大。最容易受到自己身體的不適所誘發，其次是看到與癌症相關的報章雜誌及醫療檢查，且影響到病人心情及對未來人生的規劃。面對這樣的擔憂，病人以正向思考的方式來因應最常見，有超過半數的病人相信，疾病已治癒不可能再復發，病人盡量每件事都正向的看待，在創傷後成長五個面向中，生病前後改變最明顯的是對生命的感激及珍惜與他人關係。另外，結束治療後最困擾他們的症狀是：疼痛、化療相關副作用及疲倦，同時整體症狀越嚴重其害怕復發程度越大。在整個治療結束的存活期中，年齡越大或治療後時間越久，對疾病復發的擔憂越少；教育程度越高則與害怕復發越大，工作、婚姻關係、疾病及期別，在害怕復發程度上無顯著差異。逐步迴歸分析後，創傷後成長越多、越疲倦、年齡越小及治療結束後間越短，可解釋33%之害怕復發變異量。 本研究可作為婦癌存活者害怕復發之照護參考，對於年紀較小、剛治療結束、教育程度較高、身體症狀多或正向改變多的病人，需多加留意對於疾病復發的害怕程度，協助病人在存活期減低害怕復發所造成的影響，並提供未來研究更了解病人狀況，以延伸害怕復發的研究範疇。
並列摘要
Gynecologic cancers, such as ovarian cancer, cervical cancer and endometrial cancer, have longer survival time as compared to other cancer survivors. For those cancer survivors, fear of cancer recurrence (FCR) is a common problem that keep annoying them, and that could give severe impact on their quality of life. Related researches about FCR after treatment have much more limited in the population of gynecologic cancer. Thus, the aims of this study are focus on off-treatment gynecologic cancer survivors to (1) explore fear of recurrence; (2) explore physical symptoms; (3) identify related factors (demographic, diagnosis, off-treatment duration, symptoms posttraumatic growth (PTG) to FCR. This is a cross-sectional research. 136 off-treatment gynecologic cancer survivors were collected at the Gynecologic Outpatient Department of a medical center in North Taiwan. Descriptive statistics analysis, Spearman’s rank correlation, ANOVA, and stepwise regressions were used in static. Around half patients fear of cancer recurrence since diagnosis for several years. Fatigue, cancer-related newspaper or report, and medical exams were the most influential item which triggered FCR, further more impacted their mood and the schedule in future. However, most patients used positively thinking as a coping. Age and off-treatment duration had negative correlated with FCR. Education, symptoms, and PTG had positive correlated. Otherwise, marriage, work, diagnosis, and staging did not have significant difference on FCR. The result of this research can provide into clinical gynecologic cancer survivors’ care plan, in order to reduce their FOR, and become reference to the study in the future.
參考文獻
延伸閱讀
- 吳淑芬、林佑樺、李來涼、簡婉儀（2014）。婦科癌症患者的疾病不確定感與憂鬱之相關性探討。護理暨健康照護研究，10(2)，83-93。https://doi.org/10.6225/JNHR.10.2.83
- 陳玟秀（1985）。婦科腫瘤學（17）癌症護理：癌症病人的壓力與調適。當代醫學，(145)，934-938。https://doi.org/10.29941/MT.198511.0012
- 李佳純、馮翠霞（2022）。淺談婦科癌症病人的心理困擾與支持－不僅僅只是疾病。護理雜誌，69(4)，20-26。https://doi.org/10.6224/JN.202208_69(4).04
- 王鵬惠、顏明賢、吳香達（2014）。Exenterative Surgery and Recurrent and/or Persistent Gynecological Cancers。中華民國婦癌醫學雜誌，(2014年2)，5-9。https://www.airitilibrary.com/Article/Detail?DocID=10195998-201410-201411180027-201411180027-5-9
- 郭素真、葉淑娥、陳淑芬、鄭涵文、謝佑珊（2011）。To Explore the Experience of the Supportive-Expressive Group on Gynecological Cancer Patients。榮總護理，28(2)，139-147。https://doi.org/10.6142/VGHN.28.2.139