以前瞻性探討乳癌手術病人憂鬱、焦慮與生活品質之研究

研究目的乳癌在台灣女性癌症發生率列居第一，在過去研究中已經證實憂鬱、焦慮與健康相關生活品質有關，因此本研究探討乳癌病患其憂鬱、焦慮和健康相關生活品質之間長期趨勢，並且探討彼此之間關係。研究方法本研究對象為三間醫學中心的乳癌手術病患，共有530位病患，該病患在術前、術後六個月、術後一年、術後兩年與術後五年完成健康生活質量(EORCT QLQ- BR23)、(EORCT QLQ- C30)、SF-36、貝克憂鬱量表第二版(BDI-II)與貝克焦慮量表(BAI)之問卷，生活品質問卷分數越高表示功能狀態越好，憂鬱與焦慮分數越高表示其有憂鬱與焦慮的狀態傾向。本研究採用廣義估計方程式(GEE)分析術前憂鬱、焦慮、生活品質對整體憂鬱、焦慮及生活品質之長期趨勢和彼此之間相關性。研究結果本研究發現乳癌手術病患術後五年之大部份健康生活品質構面、焦慮與憂鬱均有顯著的改善趨勢，僅有乳房症狀、手臂症狀與落髮失落呈現變差趨勢，經GEE校正時間影響與基準預測值後，研究結果發現：術前憂鬱與焦慮皆對健康生活品質功能量表具有顯著相關，如術前憂鬱與身體生理功能有顯著負相關-0.47(P<0.001)；術前生活品質皆對憂鬱與焦慮傾向具有顯著的相關，如術前整體生活品質與憂鬱及焦慮呈顯著相關-3.04(P<0.001)及-4.03(P<0.001)。結論與建議研究結果發現GEE在不同的時間，憂鬱和焦慮與病人的生活健康質量之情形。這項研究發現，憂鬱、焦慮和生活品質得分分別為最壞的症狀第六個月後，術後1年後有顯著改善症狀；但在術後5年，乳房症狀、手臂症狀、落髮失落、便秘與腹瀉呈現變差趨勢；術前焦慮與憂鬱能顯著預測整體健康相關生活品質以及術前健康生活品質能顯著預測焦慮與憂鬱，因此，在乳癌病患接受治療期間，要給予心理輔導和加強術後復原情形，定期追蹤乳癌手術病患，適時關心病患減少心理恐懼，提高健康生活品質。

關鍵字

乳癌；憂鬱症狀；焦慮症狀；健康相關生活品質；趨勢分析

並列摘要

Purpose Previous studies indicated depression, anxiety and health-related quality of life (HRQoL) associate with cancer patients’ longitudinal outcomes. Therefore, this study evaluated the changing trend of anxiety, depression, and HRQoL in breast cancer surgery patients and to explore their relationship between anxiety, depression, and HRQoL. Methods A total of 530 breast cancer surgery patients included in the study. All patients completed QLQ-BR23, QLQ-C30, Beck Depression Inventory II, and Beck Anxiety Inventory at preoperative, 6 month,1, 2 and 5 years after surgery. The highest quality of life scores had the best function symptoms, andd the BDI and BAI had the highest scores then there had the anxiety and depression symptoms. In this study, the generalized estimating equations (GEE) models was employed to evaluate long-term trends of depression, anxiety, and HRQoL, and to explore the relationship between anxiety, depression, and HRQoL during the study period. Results The results showed that HRQoL, anxiety, and depression significantly improved after 5-year breast cancer surgery, but breast symptoms, arm symptoms, upset by hair loss, constipation and diarrhoea were significantly getting worse. After adjusting for time effects, preoperative anxiety, depression, and preoperative HRQoL showed a significant association with overall HRQoL, for example preoperative depression were significantly related by physical functioning -0.47(P<0.001). Preoperative HRQoL were significantly associated with depression, anxiety, and overall HRQoL, for example, preoperative global health statusat were significantly associated with depression-3.04(P<0.001) and anxiety-4.03(P<0.001). Conclusions It showed that depression, anxiety, and HRQoL scores were worst symptoms after sixth months but then there were significantly improved symptoms after 1 years. But breast symptoms, arm symptoms and upset by hair loss become worse trend . Preoperative depression and depression significantly predictor Health-related quality of life, and preoperative HRQoL is significantlyassociated with depression and anxiety. It is suggested that not only to strengthening the relevant health authorities to achieve early of breast cancer screening and early treatment, but also care to reduce the psychological fear, improveoverall HRQoL.