항암화학요법으로 인한 유방암 환자의 인지기능 측정도구 사용 실태 분석
Analysis of a Trend of Instrument Usage to Assess Cognitive Function of Breast Cancer Patients Undergoing Chemotherapy
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초록
본 연구는 항암화학요법으로 인한 유방암 환자의 인지기능을 측정한 도구 사용 실태를 분석하여 제시함으로써 추후 유방암 환자의 인지기능 측정도구 개발의 기틀을 제공하고자 시도하였다. 연구결과 유방암 환자의 인지기능을 측정한 국내 연구는 한편도 없었으며, 국내 연구자에 의해 개발된 도구도 없는 실정이었다. 국외연구에 사용된 도구도 항암화학요법으로 인해 손상되는 유방암 환자의 인지영역을 모두 측정가능한 도구가 없었으며, 치매나 우울증 환자, 그리고 기질적 뇌 손상으로 인한 인지장애를 측정하기 위해 개발된 도구를 그대로 유방암 환자에게 적용하여 연구가 이루어진 것을 확인할 수 있었다. 또한 유방암 환자의 인지기능을 측정하기 위해 사용된 객관적인 신경심리 검사는 운동영역에서의 grooved pegboard 검사, 시공간적 기술 영역에서의 RCFT copy, WAIS-III block design를 제외한 모든 검사 방법은 민감도가 낮아 유방암 환자에게 그대로 적용시키기는 어려움을 알 수 있었다. 인지기능은 항암화학요법을 받고 있는 대상자에게서 주요하게 발생하는 개념이기는 하나 객관적이거나 주관적인 방법으로만 측정하기는 어려운 복합적인 현상으로 인지기능의 주관적인 속성을 객관적으로 확인할 수 있는 보다 타당하고 신뢰도 높은 한국형 인지기능 측정도구 개발이 요구된다. 그러나 도구개발 연구에 앞서 유방암 환자의 인지장애는 정서 상태와 피로 및 심리적인 스트레스와 밀접한 관련이 있으므로, 항암화학요법을 받고 있는 유방암 환자를 대상으로 항암화학요법으로 인해 변화되는 인지기능의 속성을 확인하기 위한 질적인 연구가 선행되어야 할 것이다.
Abstract
Purpose: This study analyzed recent trends of instrument usage assessing cognitive function of breast cancer patients undergoing chemotherapy. Methods: The researcher collected 64 studies outside the country that were published between January 1996 and August 2010. Results: There was no study on the instrument assessing all domains of cognitive function in breast cancer patients undergoing chemotherapy. Most instruments assessing cognitive function of breast cancer patients have been used for patients with dementia, depression, and/or organic brain damage. Also the objective neuropsychological tests such as the grooved pegboard for the psychomotor area, RCFT copy in visuospatial skill area and the WAIS-III block design have low sensitivity for measuring cognitive function in breast cancer patients, thus they are not good for applying to breast cancer patients. Conclusion: There is a need to develop an instrument which has good sensitivity and specificity for measuring the cognitive function of the breast cancer patients who experienced cognitive impairment after chemotherapy treatment. In addition, the developed instrument needs to be accessible and feasible in any nursing clinical setting for the purpose of accurate assessment and evaluation of the cognitive function among breast cancer patients.
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