방사선 치료를 받는 유방암 환자의 증상경험, 정서상태 및 사회적지지*

Abstract

It is reported that many cancer patients with pain, depression, and fatigue receive inadequate treatment for their symptoms. All patients with cancer should have optimal symptom control throughout the course of treatment. One of the important role of nurses is symptom management of patients in clinical practices. Nurses caring for breast cancer patients should be concerned about the distress of their patients who are undergoing treatment such as radiotherapy. In this study, the total score of symptom experience was 21.96, lower than that of 32.44 reported by Lee et al.(2004) for breast cancer patients with undergoing chemotherapy. This suggests that the symptom experiences of breast cancer patients receiving radiotherapy are less severe than those of breast cancer patients receiving chemotherapy. The result show that the highest score of sub-items of symptom experiences was fatigue(mean 4.18, SD=2.05), which was consistent with the previous study by Lee et al.(2004). Donovan et al.(2004) reported that chemotherapy was associated with more severe fatigue than radiotherapy. This study appears to confirm that fatigue is the most important distress of cancer patients undergoing either chemotherapy or radiotherapy. Breast cancer patients in the present study experienced a low-to-moderate level of mood disturbance. This finding was consistent with the study by Lee et al.(2004) that involved women receiving chemotherapy therapy for breast cancer. The score of social support is 3.70(SD=0.98). And the score of family support and health professional support were 3.94(SD= 1.03) and 3.47(SD=1.04), respectively. This result is similar with the study of Cimprich (1999) on women undergoing chemotherapy for breast cancer. Cimprich(1999) reported the pretreatment symptom distress in women newly diagnosed with breast cancer and that the mean score of family support from spouse, parents, siblings, children, or other extended family was 3.94(SD=1.03). This reported finding suggested that women recognized moderate to high level of social support. And also women percept more social support than professional support. According to Landmark, strandmach, & Wahl(2002), women with a new breast cancer diagnoses experienced both social support and lack of social support in their interactions with their close relatives, friends and colleagues, and institutional staff. Further, these researchers indicated a weak social network increased the patient's vulnerability whereas a strong social network increased the ability to cope with stress, distress, and cancer. Moreover, social support from health care professional was believed to promote feelings of wellbeing and coping in cancer patients(Landmark et al., 2002). Symptom experience and mood disturbance had a statistically significant positive correlation in this study. Similar result has been reported in a number of studies involving cancer patients receiving radiation. Manning- Walsh (2005) reported that symptom distress was related to psycho-spiritual well-being. Fulton (1997) also suggested a strong relation between anxiety and depression and sympto- matology. In sum, it appears that symptom experiences and mood disturbance are closely correlated in cancer patients undergoing treatments. Therefore, nurses caring for the breast cancer patients receiving radiotherapy should pay attention to their emotional status. The present study also indicated a statistically significant negative correlation between social support and mood disturbance (r=-.304, p=.003). This finding is consistent with a previous study involving breast cancer patients(Lee et al., 2004) and confirms the efficacy of social support to achieve the goal of patient's symptoms management. Potential interventions may be targeted at emotional reactions and social support in order to manage patients' symptoms effectively. But there was no significant correlation between symptom experience and social support. Bleaker, Pouwer, Ploeg, Leer, & Aderet(2000) reported that no significant association was found between previous life events, social support, biomedical variables and levels of distress in breast cancer patients. However, Chen and Ma(2004) suggested physical symptom distress, psychological distress, and social function distress were positively correlated in breast cancer patients. Further study is needed to find out the relationship between symptom experiences and social support in order to arrive a conclusive answer. Stepwise multiple regression analysis showed that the most powerful predictor of patient' symptom experiences was mood disturbance. Mood disturbance accounted for 16.5% of the variance of symptom experiences that included sub-items measuring physical experiences of breast cancer patients. This indicates mood disturbance was the most important factor influencing the symptom experiences of breast cancer patients undergoing radiotherapy. Symptom experiences of persons who are suffering from diseases would vary depending on the state and the type of disease, physical status, perception of disease, social support, emotional status, and so forth. To date, the majority of research on symptom management is inadequate in addressing how health care professionals can intervene to eliminate and reduce the symptoms of cancer patients. The current study suggests that nurses need to be concerned about patients' emotional status and social support in order to achieve the goal of symptom management in breast cancer patients undergoing radiotherapy.