癌症病人社會資本與身心健康關係之研究

癌症連續三十年蟬聯國人十大死因之首位，目前每日約有117人罹患癌症，每12分鐘即有1人因癌症而死亡。焦慮、憂鬱情緒困擾更是好發在癌症診斷及治療過程中，並且常被忽略。各個不同癌症期別的研究已發現20％-40％的癌症患者的體驗顯著經歷某種程度的身心困擾。但是，醫療保健專業人員往往低估並認為這種心理症狀的困擾機率低於10 ％，事實上癌症的診斷或後續的治療對病人及家屬而言都是極具壓力的。研究學者開始注意到一些社會因素如收入、貧窮、社會網絡等對健康的影響。研究證據顯示社會資本可以促進個人或族群的健康，並延長壽命。較高的社會資本造成相對較低的總死亡率和癌症死亡率。此外，較高的社會資本也與較好的自覺健康和心理健康有關聯。研究目的：本研究探討癌症病人社會資本與其身心健康關係之相關和影響研究方法：本研究為前瞻性橫斷式問卷調查，以結構式問卷為工具收集資料。以南部某教學醫院之癌症中心門診病人為研究對象。問卷內容包括（一）癌症病人人口學及疾病相關特質（二）憂鬱量表（三）非特異性心理壓力量表（四）以及癌症病人社會資本量表。所得資料以SPSS20.0進行描述性統計、皮爾森積差相關分析、逐步回歸分析。研究時間為98-99年，共發出問卷636份，回收508份回收率80％，回收有效問卷491份達77％。共收案491個病人。乳癌163位佔33％、大腸癌156位佔32％、口腔癌83位佔17％、肺癌43位佔9％、其它癌46位佔9％。研究結果：研究顯示女性、低教育程度者、無工作者、低收入者、接受放射治療或化學治療者易產生焦慮、憂鬱。其中，憂鬱程度以未婚、單身者較高。感覺自己健康狀況較佳的為有工作、腫瘤分期較低者。擁有較高社會資本者為較年輕者、乳癌患者、擁有子女數三位者、家庭收入高者、無接受放射治療者、以及有工作的癌症患者。統計至2013年9月3日，乳癌、大腸癌、口腔癌、肺癌一共445位，其中死亡人數155位，死亡率為35％，存活人數290位，存活率為65％。性別、癌症別、腫瘤分期、手術、放射治療與存活率達統計上的差異。本研究從癌症病人的角度探討存在於個人間的社會資本與其心理健康的關係，以個人非特異性壓力和憂鬱程度為關聯指標檢測社會資本四個構面（信任、活動參與、親人關係、朋友關係）。研究結果與非特異性心理壓力及憂鬱兩種心理眾太皆呈現顯著負相關，此結果驗證有較高的社會資本者，無論是在自覺健康、生活與健康滿意度都有較好的身心狀態。然而，社會資本較低者則自覺健康較差，較容易呈現較高的壓力與憂鬱傾向。此研究亦顯示信任、活動的參與、親人關係、朋友關係等構面對於身心健康是有影響的。此外，社會資本能作為癌症病人的緩衝，並減少社會壓力、提高存活率。本研究證實存活率與社會資本、自覺健康有相關。病人擁有的社會資本與其自覺健康越佳、其死亡風險會降低而存活率則會提升。結論與建議：社會資本高、自覺健康較好者的焦慮、憂鬱的程度較低、死亡風險降低；存活率越高。本研究可作為醫謢人員在臨床的癌症病人照護之參考並提升醫療品質。

關鍵字

癌症；非特異性心理壓力；憂鬱；自覺健康；存活率；社會資本

並列摘要

General Background Information: Cancer has been the first among the top ten leading cause of death for thirty years. At present, approximately 117 people become cancer patients per day and every 12 minutes a patient die of cancer. The relapse tendency of anxiety, depression, and emotional distress is usually higher during cancer diagnosis and treatment, which is often overlooked. A study of cancer in different stages has indicated that 20% -40% of cancer patients have suffered physical and mental discomfort to some degree. However, healthcare workers frequently underestimate those discomfort and consider the relapse tendency to be lower than 10%. In fact, the diagnosis of cancer and the follow-up treatment are very stressful for both patients and their family members. Researchers stated to notice that some social factors such as income, poverty, social networks, etc. have impact over health. Evidences show that social capital can contribute to the health of individuals and groups and extend life span. Higher social capital cause relatively low total death rate and low cancer mortality. Besides, higher social capital is also relevant to better self-rated of health and mental health. Research Purpose: The study aimed to investigate the correlation between the social capital of cancer patients and their physical and mental health. Method: The study was a prospective cross-sectional survey and a structured questionnaire was used to collect data. The subjects of this study are patients from the department of cancer center in a teaching hospital of southern Taiwan. The content of questionnaire included 1. Demography of cancer patients and disease-related characteristics 2. Depression scale 3. Non-specific psychological stress scale 4. Social capital scale for cancer patients. Collected data was analyzed by descriptive statistics of SPSS20.0, Pearson’s correlation coefficient, and stepwise regression. Study time was 2009-2010. Issued 636 questionnaires which retrieved 508 copies and created an 80% overall response rate. 491 copies are valid questionnaires, which created a 77% effective response rate and received totally 491 patients. Among those patients, 163 breast cancer patients accounted for 33%, 156 colorectal cancer patients accounted for 32%, 83 oral cancer patients accounted for 17%, 43 lung cancer patients accounted for 9%, and 46 patients of other cancers accounted for 9%. Research Result: The study showed that females, poorly educated patients, patients without work, patients with low income, and patients who took radio therapy or chemical therapy were more likely to feel anxiety and depression. Among these, unmarried and single patients have higher degree of depression. Patients who had better self-rated of health were people who had jobs and people who were in lower stages of cancer. Young patients, breast cancer patients, patients who had three children, patients with high income, patients who didn’t take radio therapy, and patients with jobs were those who had higher social capital. According to statistics till 2013/9/3, there were 155 deaths among 445 patients of breast cancer, colorectal cancer, oral cancer, and lung cancer, which created a death rate of 35%. There were 290 survivors, which created a 65% survival rate. Gender, cancers, tumor stages, surgeries, radio therapies caused statistical difference among survival rate. The study investigated the correlation between patients’ social capital and their mental health from the perspectives of cancer patients. Using personal non-specific stress and degree of depression as related indicators to detect four dimensions of social capital, including trust, activities engagement, family relations, and friend relations. Research results had significant negative correlation with non-specific stress and depression. The study verified that people with higher social capital had better physical and mental situation in both self-rated of health and satisfaction between life and health. Nevertheless, people with lower social capital had worse self-rated of health, which were more likely to be under higher stress and tended to be depress. The study indicated that trust, activities engagement, family relations, and friend relations had strong influence over physical and mental health. Other than this, social capital can serve as a buffer for cancer patients, which can decrease social stress and increase survival rate. The study confirmed that survival rate was correlated with social capital and self-rated of health. Patients with more social capital and higher self-rated of health had lower mortality risk and higher survival rate. Conclusion and Suggestion: Patients with more social capital and higher self-rated of health had lower degree of anxiety and depression and had lower mortality risk. This research can serve as a reference for healthcare workers during nursing cancer patients and can rise the quality of medical treatment.

並列關鍵字

cancer ； non-specific stress ； depression ； self-rated of health ； survival rate ； social capital

參考文獻

DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006). Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med, 21(3), 267-275. doi: 10.1111/j.1525-1497.2005.00291.x

Radloff, L. S. (1977). The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1(3), 385-401. doi: 10.1177/014662167700100306

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