乳癌婦女的睡眠障礙與焦慮、憂鬱症狀及生活品質相關因素之探討

The relationships among sleep disorders, anxiety, depressive symptoms, and quality of life of females with breast cancer.

陳淑女(Shu-Nu Chen)

指導教授 ： 黃瓊玉

義守大學/醫學院/醫務管理學系/碩士(2017年)

摘要

研究背景與目的： 癌症自民國71年起高居國內十大死因之首，而乳癌位居台灣女性癌症發生率之第一名，亦為女性主要死因之一，隨著政策防癌篩檢之推廣，乳癌個案因早期發現，早期治療，五年整體存活率高達90%。罹患乳癌對婦女來說，是威脅生命的重大壓力事件，尤其在面對癌症確診，代表著健康狀況及生活品質即將面臨挑戰與影響，且面對手術的治療、輔助性治療的副作用和疾病可能復發的不確定性等，讓多數病人處在恐懼及憂鬱中。因此在治療期間面臨的症狀困擾與負面情緒反應、心理壓力，皆會導致生活品質的降低。本研究目的為瞭解乳癌婦女發生睡眠障礙、焦慮、憂鬱症狀之概況；探討乳癌婦女個人基本屬性及疾病特性，睡眠障礙、焦慮、憂鬱症狀及生活品質相關性。 研究方法： 本研究採橫斷性研究設計，以南部某區域教學醫院乳癌病人為抽樣對象，採便利取樣，收案數為145人，有效樣本數為140人，於病人在門診或住院化療中與回門診追蹤時收集資料，研究工具採結構式問卷，問卷包括病人基本屬性問卷、匹茲堡睡眠品質量表、醫院焦慮憂鬱量表及SF-36健康相關生活品質量表等收集資料，資料統計採用個人電腦SPSS 18.0中文版的統計軟體，以描述性統計分析研究對象的基本屬性、睡眠品質、焦慮、憂鬱及生活品質的平均值及標準差，並以推論性統計包括單因子變異分析（ANOVA）、皮爾森積差相關、複迴歸方式，探討各變項間的相關程度及生活品質的預測因子。 研究結果： 睡眠障礙與焦慮、憂鬱呈顯著正相關（r =.389, p＜.001；r =.187, p =.027）；睡眠障礙與生理、心理生活品質呈顯著負相關（r = -.268, p =.001；r = -.311, p＜.001）；亦即睡眠障礙嚴重時，焦慮與憂鬱程度愈嚴重，其生理、心理生活品質愈差。教育程度低及家庭月收入較少之乳癌婦女其憂鬱症狀之發生較高。睡眠障礙主要為焦慮、憂鬱症狀及生活品質之重要預測因子；其次教育程度是憂鬱與生理生活品質之預測因子；確診期間亦是生理生活品質之預測因子。 本研究發現乳癌婦女的睡眠障礙與焦慮、憂鬱及生活品質皆有相關，故建議在臨床上，護理人員若能及早發現病人的睡眠障礙問題，提早做預防與提供需要之醫療照護措施，改善乳癌病人的睡眠障礙問題，將可降地焦慮憂鬱之困擾並提升病人生活品質。

關鍵字

乳癌婦女 ； 睡眠障礙 ； 焦慮 ； 憂鬱症狀 ； 生活品質

並列摘要

Background and purpose：
Cancer has been among the top ten leading causes of death in the country since 1982, while breast cancer is the first in Taiwan for women, and one of the main causes of death. With the promotion of anti-cancer screening policy, the breast cancer cases are early discovered, early treatment, and five years of overall survival rate of up to 90%. The Breast cancer is a major stressful event for women, especially in the face of cancer diagnosis, which represents the impending challenge and impact of health and quality of life, and patients are in fear and depression in the face of surgical treatment, side effects of adjuvant therapy and uncertainty about the possibility of relapse. Therefore, in the treatment, the symptoms encountered, negative emotional reactions, and psychological pressure, all will lead to lower quality of life. The purpose of this study was to investigate the status of sleep disorder, anxiety and depression in women with breast cancer, and to explore the characteristics of individual and disease, sleep disorder, anxiety, depression and quality of life.
Methods：
The design of the research on the transverse and fault-taking of the patients with breast cancer in a regional teaching hospital in southern region, and convenient sampling the number was 145 patients, which collected data from patients in the clinic or hospitalized chemotherapy and back-clinic tracking. And studied tool was using structured questionnaires, including patient's basic attribute questionnaire, Pittsburg Sleep Quality Scale, Hospital Anxiety and Depression Scale and SF-36 Health-realted quality of Life Scale, and so on. Data statistics was using the personal computer SPSS 18.0 Chinese version of the statistical software, to describe the basic attributes of statistical analysis of the object, the average and standard deviation of sleep quality, anxiety, depression and quality of life, and the predictive factors of the correlation degree and quality of life of each variable were discussed by the one-wayanalysis of variance（ANOVA）, independent-sample T test,Pearson correlation and multiple regression.
Results:
Sleep disorders were significantly positively correlated with anxiety and depression (r = .389, p <.001；r = .187, p = .027)；sleep disorders were negatively correlated with physical and psychological life quality (r = -.268 , p = .001；r = -.311, p <.001)；That is, severe sleep disorders, the degree of anxiety and depression more serious, the physiological and psychological quality of life worse. The depressive symptoms of breast cancer women with low level of educational and less family monthly income were higher. Sleep disorders are important predictors of anxiety, depression and quality of life. Secondly, education is a predictor of depression and physiological quality of life. The diagnosis period is also a predictor of physiological quality of life. This study found that women with breast cancer sleep disorders and anxiety, depression and quality of life are related, it is suggested that in the face of clinical, nursing staff can early detection of patients with sleep disorders, early prevention and provision of necessary medical care measures to improve the sleep problems of patients with breast cancer will reduce anxiety and depression and improve the quality of life of patients.

並列關鍵字

females with breast cancer ； sleep disorders ； anxiety ； depressive symptoms ； quality of life

參考文獻

王蔚芸、王桂芸、湯玉英（2007）．焦慮之概念分析．長庚護理，18（1），59-67。

吳淑芬、井慶芸、董弘一、阮建維、趙東波（2015）．不同時期結直腸癌病人症狀困擾、憂鬱與生活品質關係之探討．護理雜誌，62（6），68-80。

李宇宙（2000）．身心疾病之睡眠障礙．臺灣醫學，4（6），673-680.Retrieved from http://dx.doi.org/10.6320/FJM.2000.4（6）.08

李昕宜、 許玉娟、陳佳慧（2014） ．癌症生存者之困擾症狀．臺灣醫學，18（3）,355-360。

周繡玲、姚鍾太、楊立華、朱基銘、趙婉青（2010）．肺癌病人化療期間疲憊、睡眠障礙及情緒困擾之探討．腫瘤護理雜誌，10（2），23-38。