유방절제술 환자의 상지감각변화와 삶의 질
Changes in Upper Extemity Sensation and the Quality of Life for Patients Following Mastectomy
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본 연구는 유방절제술 환자에게 나타나는 상지감각변화를 파악하고 환자들의 삶의 질에 영향을 미치는 증상을 파악하기 위한 서술적 조사연구이다. 연구 대상은 유방암 수술 후 항암화학 요법 또는 방사선 치료가 종료된 자 132명을 임의표출하여 2007년 7월부터 8월까지 자료를 수집하였다. 연구도구로 상지감각변화는 Lee15)와 Yoo17)의 도구를 사용했으며 삶의 질은 Medical Outcome Study 36-item Short Form Health Survey (SF-36)를 를 사용했다. 수집한 자료는 SPSS WIN 12.0 program을 이용하여 실수와 백분율, 평균과 표준편차, ANOVA, t-test, stepwise multiple regression으로 분석하였으며 결과를 요약하면 다음과 같다. 첫째, 인구사회학적 특성과 질병관련특성 및 상지감각변화와 삶의 질을 비교하였을 때 4기의 환자가 1, 2기 환자에 비해 상지감각변화가 심했고(F=3.90, p=.023, Duncan: 4기>1, 2기), 유방 전절제술한 환자가 부분절제술 환자보다 상지감각변화가 심했다(t=-2.77, p= .007). 삶의 질은 수입, 배우자 유무, 호르몬대체요법 여부, 전이유무에 따라 차이가 있었다. 둘째, 림프부종 없는 군과 림프부종 있는 군의 상지감각변화와 삶의 질을 비교하였을 때 상지감각변화는 림프부종 있는 군에서 더 심했고(t=4.53, p<.001), 총 삶의 질 점수는 두 군 간 유의한 차이가 없었으며(t=-0.54, p=.592), 8개 하부영역 중 통증 영역에서 림프부종 없는 군(71.2±23.2)이 림프부종 있는 군(57.5±25.3)에 비하여 통계적으로 유의하게 통증이 적었다(t=2.89, p=.004). 셋째, 삶의 질에 차이를 보인 특성인 수입, 배우자 유무, 호르몬대체요법 여부, 전이유무를 통제하고 상지감각변화 증상 10개를 예측변수로 삶의 질에 영향을 미치는 증상을 구했을 때 통증, 무거운 느낌이 삶의 질에 영향을 미쳤으며, 배우자가 없는 경우와 통증이 적을수록, 무거운 느낌이 적을수록 삶의 질이 높았고, 이들은 삶의 질을 22.4% 설명하였다. 유방절제술의 방법이 감시림프절절제술의 방법을 많이 함에 따라 림프부종, 상지감각이상들의 부작용을 줄어들고는 있지만 여전히 존재하므로 림프부종으로 인한 상지감각변화의 관리는 중요하며, 이를 감소시키기 위한 맞춤형 프로그램 개발과 주관적 증상을 측정할 수 있는 객관적 지표 개발과 활용이 필요하다.
Abstract
Purpose: The purpose of this study was to examine the sensation changes in upper extremity and the quality of life for post-operative mastectomy patients. Methods: This study used a descriptive study design. The participants were 132 women who had mastectomies after being diagnosed with breast cancer and were participating in breast cancer self-help groups. The sensation changes in the arm of the surgery site was measured by the arm symptoms which were subjective uncomfortable feelings of the affected arm, and the quality of life was measured by Medical Outcomes Study Short Form-36. Collected data were analyzed by ANOVA, t-test, χ2-test and multiple regression with SPSS WIN 12.0 program. Results: Patients with stage IV breast cancer had severe changes in sensation of the arm. Participants with lymphedema had statistically significant changes in sensation compared to participants without lymphedema, but the quality of life was not different between the two groups. Pain by the SF 36 was statistically different between the two groups, with- and without-lymphedema. The factors in upper extremity’s sensation changes which influence on quality of life were pain and heaviness. Conclusion: Nursing intervention for relieving pain and heaviness of the affected arm needs to be developed in order to improve QOL of the breast cancer survivors.
참고문헌 (30)
- "National Cancer Statistics 2008"[URL]
- Petrek JA, "Lymph-edema in a cohort of breast carcinoma survivors 20 years after diagnosis", Cancer, 92, pp.1368~1377 (2001)
- Kwan W, "Chronic arm morbidity after curative breast cancer treatment: Prevalence and impact on quality of life", J Clin Oncol, 20, pp.4242~4248 (2002)
- Kosir MA, "Surgical outcomes after breast cancer surgery: measuring acute lymphedema", J Surg Res, 95, pp.147~151 (2001)
- Petrek JA, "Limphedema: Current issues in research and management", CA Cancer J Clin, 50, pp.292~297 (2000)
- Sparaco A, "Arm Lymphedema following breast cancer treatment", Int J Clin Prac, 56, pp.107~110 (2002)
- Erickson VS, "Arm edema in breast cancer patients", J Natl Cancer Inst, 93, pp.96~111 (2001)
- 이숙정, "유방암 환자의 상지감각변화와 어깨관절기능 및 우울", 지역사회간호학회지, 19(3), pp.398~407 (2008), 지역사회간호학회
- Ahmed RL, "Lymphedema and quality of life in breast cancer survivors: the Iowa women’s health study", J Clin Oncol, 26, pp.5689~5696 (2008)
- 최경숙, "유방암환자 대상 국내 간호중재 연구 분석", Asian Oncology Nursing, 11(1), pp.74~82 (2011), 대한종양간호학회
- Lee KH, "Post-operative morbidity, menopause symptoms and quality of life in patients with breast cancer", 석사, pp.2006
- Ridner SH, "Quality of life and a symptom cluster associated breast cancer treatment related lymphedema", Support Care Cancer, 13, pp.904~911 (2005)
- Dawes DJ, "Impact of lymphedema on arm function and health-related quality of life in women following breast cancer surgery", J Rehabil Med, 40, pp.651~658 (2008)
- Nesvold IL, "The relationship between arm", shoulder problems and quality of life in breast cancer survivors: a cross-sectional and longitudinal study, 2011, pp.5, 62~72
- Lee MH, "Effects of rhythmic exercise in patients receiving mastectomy", 박사, pp.1995
- Yoo YS, "Effects of aquatic exercise program on the shoulder joint function, immune response and mood state", 박사, pp.1996
- Ware JE Jr, "The MOS 36-item short-form health survey (SF-36) I. Conceptual framework and item selection", Medical Care, 30, pp.473~483 (1992)
- Koh SB, "Reliability and validity on measurement instrument for health status assessment in occupational workers", J Prev Med and Public Health, 30, pp.251~266 (1997)
- Andersen L, "Treatment of breast cancer related lymphedema with or without manual lymphatice drainage-a randomized study", Acta Oncol, 39, pp.399~405 (2000)
- McCredie MR, "Prevalence of self-reported morbidity following treatment for breast cancer in the Australian Breast Cancer Family Study", Breast, 10, pp.515~522 (2001)
- Exercise intervention for upper-limb dysfunction due to breast cancer treatment (Review), "McNeely ML", The Cochrane Collaboration, ~ (2010)
- Engel J, "Axilla surgery severely affects quality of life: Results of 5-year prospective study in breast cancer patients", Breast Cancer Res Treat, 79, pp.47~57 (2003)
- Rietman JS, "Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review", Eur J Sur Oncol, 29, pp.229~238 (2003)
- Kim IS, "Breast cancer, damage body and sense of femininity crisis", J Korean Assoc of Women’s Studies, 22, pp.35~46 (2006)
- Mellon S, "A population-based study of the quality of cancer survivors and their family caregivers", Cancer Nurs, 29, pp.120~131 (2006)
- Northouse LL, "A family-based program of care for women with recurrent breast and their family members", Oncol Nurs Forum, 29, pp.1411~1419 (2002)
- Northhouse LL, "Couple adjustment to breast cancer and benign breast disease: a longitudinal analysis", Psychoonchology, 7, pp.37~48 (1998)
- Sagen A, "Changes in arm morbidities and health-related quality of life after breast cancer surgery-a five year follow-up study", Acta Oncol, 27, pp.1~31 (2009)
- 이은숙, "림프마사지 교육프로그램이 유방절제술환자의 상지 기능상태와 삶의 질에 미치는 효과", Journal of Korean Academy of Nursing, 35(8), pp.1390~1400 (2005), 한국간호과학회
- McLaughlin SA, "Prevalence of lymphedema in women with breast cancer 5years after sentinel lymph node biopsy or axillary dissection: objective measurements", J Clin Oncol, 26, pp.5213~5219 (2008)