以前瞻性評估乳癌病人術後生活品質之長期改變趨勢:系統性回顧、統合分析

研究目的乳癌在台灣女性癌症發生率列居第一，雖然乳癌患者在治療後有相當好的預後，但如何增進癌症患者治療後生活品質及改善病人心情已成為重要課題，因此本研究探討乳癌手術病患之生活品質、焦慮與憂鬱進行長期追蹤評估，並針對過去乳癌手術病人術後生活品質之相關文獻做統合分析。研究方法研究樣本以南部某三家醫學中心2007年6月至2013年12月之乳癌手術病患為研究樣本，共630位，於病患術前、術後6個月、術後1年、術後2年及術後5年進行生活品質、焦慮與憂鬱之評估，使用問卷為EORTC QLQ-BR23、 EORTC QLQ-C30、SF-36、貝克憂鬱量表第二版(BDI)、貝克焦慮量表(BAI)。本研究採用廣義估計方程式(GEE)分析乳癌手術患者生活品質、焦慮與憂鬱之長期趨勢，並針對過去乳癌手術病人術後生活品質之相關文獻做統合分析。研究結果本研究發現乳癌手術病患生活品質相較於術前，術後6個月大部份症狀構面與功能構面分數顯著變差，術後6個月憂鬱症狀顯著比術前差；相較於術後6個月，術後1年大部份症狀構面與功能構面有顯著改善趨勢，術後1年之焦慮與憂鬱顯著比術後6個月好。相較於術後2年，術後五年大部份症狀與功能構面無差異，而術後5年的焦慮症狀比術後2年好，此結果與統合分析之結果大致相同。結論與建議該研究了解GEE在不同時間點生活品質、焦慮與憂鬱之情形，並利用統合分析乳癌生活品質術前及術後之改變。研究發現生活品質、焦慮與憂鬱最壞的時候為術後6個月，術後1年則有顯著改善趨勢。因此，在乳癌患者接受治療期間，我們需要關注於術後情形，並給予輔導，提升生活品質及心情。

關鍵字

乳癌；健康相關生活品質；焦慮症狀；憂鬱症狀；趨勢分析；統合分析

並列摘要

Purpose Breast cancer incidence is ranking number one in Taiwan female. How to improve quality of life (QOL) on these patients after treatment has been became an important issue. Therefore, this study purposed to evaluate the changing trend of anxiety, depression and QOL in breast cancer surgery patients, and we also use meta-analysis to investigate short-term and long-term QOL after breast cancer surgery. Methods A total of 630 breast cancer surgery patients included in the study. All paients completd QLQ-BR23, QLQ-C30, SF-36, Beck Depression Inventory II, and Beck Anxiety Inventory at preoperative, 6th month, 1sy year, 2nd year and 5th year after surgery. The generalized estimating equations (GEE) models were also employed to evaluate long-term trends of HRQoL, depression, anxiety. The randomized fixed effect also was used to investigate short-term and long-term HRQoL after breast cancer surgery. Results The study found that the QOL of postoperative patients compared to preoperative, both of the symptom and functional dimensions after the 6th month deteriorated significantly; at the 6th month postoperatively, depressive symptoms significantly worse than before surger; compared to the 6th month postoperatively, most of symptom and functional dimensions and anxiety and depression have significant improvemet at the 1st year postoperatively; compared to the 2nd year postoperatively, most of the symptom and functional dimensions are indifference, but anxiety is better at the 5th year than the 2nd year postoperatively. These results with meta-analysis are roughly the same. Conclusions The study found the QOL, anxiety and depression at the 6th month postoperatively is the worst, but it showed a significant improvement after the 1st year postoperatively. It is suggested that during treatment period after breast cancer surgery, we need to focus on patients’ QOL before and after surgery, to reduce the psychological fear, and to improve overall QOL.