방사선치료를 받는 유방암 환자의 피로, 수면장애, 삶의 질에 대한 연구

Abstract

본 연구는 방사선치료를 받는 유방암 환자를 대상으로 피로, 수면장애, 삶의 질을 파악하기 위한 서술적 조사 연구이다. 자료 수집 기간은 2013년 12월 10일부터 2014년 3월 27일까지였으며, 방사선치료를 받기 위해 경기도 소재 암 전문병원에 내원한 유방암 환자 201명을 연구 대상으로 설문지를 사용하여 자료 수집을 하였다. 피로는 Functional Assessment of Chronic Illness Therapy(FACIT)에서 개발한 측정도구인 한국어판 FACIT-fatigue scale을 이용하여 측정하였다. 수면장애는 피츠버그 수면센터에서 개발한 피츠버그 수면 질 지수(Pittsburgh Sleep Quality Index, PSQI)를 최희정, 김성재, 김범종과 김인자(2012)가 번역한 것을 사용하여 측정하였으며, 삶의 질은 FACIT에서 개발한 한국어판 Functional Assessment of Cancer Therapy-Breast Cancer version 4(FACT-B)를 이용하여 측정하였다. 자료 분석은 SPSS 21.0 program을 이용하여 각 변수의 실수, 백분율 및 평균과 표준편차로 분석하였다. 대상자의 일반적 특성, 질병관련 특성에 따른 피로, 수면장애, 삶의 질의 차이는 t-test, ANOVA로 분석하였고, 사후검정은 Scheffe test로 확인하였다. 피로, 수면장애, 삶의 질과의 관계는 Pearson´s correlation coefficient로 분석하였고, 대상자의 피로, 수면장애, 삶의 질에 영향을 미치는 요인을 확인하기 위해 다중회귀분석을 이용하였다. 본 연구의 결과는 다음과 같다. 1. 대상자의 피로는 평균 19.6 ± 10.89점(52점 만점)이었으며, 수면장애는 평균 7.55 ± 4.24점(21점 만점)으로 나타났다. 대상자의 삶의 질은 평균 92.16 ± 20.95점(148점 만점)으로 나타났다. 2. 대상자의 피로는 종교(t=-2.902, p=.004), 월수입(t=-2.130, p=.035), 운동(F=5.291, p=.006), 진단 기간(F=3.743, p=.025)에 따라 유의한 차이를 나타냈다. 대상자의 수면장애는 교육 정도(F=3.192, p=.043), 진단 기간(F=9.143, p<.001)에 따라 통계적으로 유의한 것으로 나타났다. 대상자의 삶의 질은 교육 정도(F=8.083, p<.001), 결혼 상태(F=3.828, p=.023), 운동(F=12.909, p<.001), 치료 방법(t=2.253, p=.025), 진단 기간(F=3.109, p=.047), 치료부위(F=3.310, p=.039)에 따라 유의한 차이를 나타냈다. 운동과 진단 기간은 피로, 수면장애, 삶의 질에 유의한 차이를 나타내었다. 3. 대상자의 피로, 수면장애와 삶의 질과의 상관관계는 피로와 수면장애(r=.403, p<.001)가 통계적으로 유의한 양의 상관관계를 나타내었고, 피로와 삶의 질(r=-.545, p<.001), 수면장애와 삶의 질(r=-.449, p<.001)은 통계적으로 유의한 음의 상관관계를 나타내었다. 4. 방사선치료를 받는 유방암 환자의 삶의 질에 영향을 미치는 요인을 확인하기 위해 다중회귀분석 결과 회귀 모형은 유의한 것으로 나타났으며(F=49.114, p<.001), 총 41.9%정도 설명력이 있는 것으로 나타났다. 피로(β=-.337, p<.001)와 수면장애(β=-.203, p<.001)가 삶의 질에 부정적인 영향을 미치는 것으로 나타났다. 이상의 연구 결과 피로와 수면장애가 높을수록 삶의 질은 저하되었다. 운동이 피로와 삶의 질에 유의한 차이가 있었고, 진단 기간은 피로와 수면장애, 삶의 질과 유의한 차이를 나타내었다. 따라서 방사선치료를 받는 유방암 환자의 삶의 질 향상을 위하여 피로와 수면장애를 감소시키고, 유방암 환자의 진단 기간과 운동에 대한 간호 중재가 필요하다.;This study is a descriptive survey investigating the fatigue, sleep disturbances, and quality of life (QOL) in breast cancer patients receiving radiotherapy. Data were collected from December 10, 2013, to March 27, 2014, through questionnaires distributed to 201 breast cancer patients of a specialized cancer hospital in Gyeonggi-do. Fatigue was measured using the Korean version of the Functional Assessment of Chronic Illness Therapy(FACIT) Fatigue Scale. Sleep disturbance was measured with the Pittsburgh Sleep Quality Index(PSQI), as developed by the University of Pittsburgh’s Sleep Medicine Institute and translated by Choi, Kim, Kim, and Kim (2012), and quality of life was measured using the Korean version of the Functional Assessment of Cancer Therapy – Breast Cancer Version 4 (FACT-B), as developed by FACIT. Data analysis consisted of analyzing the scores, percentages, means, and standard deviations of the given variables, using SPSS 21.0. The inter-subject differences in fatigue, sleep disturbances, and quality of life depending on the general and cancer-specific characteristics of the respondents were analyzed using t-tests and ANOVA, and post-hoc comparisons were made using Scheffe’s test. The correlations between fatigue, sleep disturbance, and quality of life were analyzed using Pearson’s correlation coefficients, and multiple regression analysis was used to determine the factors influencing respondents’ fatigue, sleep disturbances, and quality of life. The results of the current study were as follows: 1. The subjects showed the following general characteristics: the mean age was 47.36 ± 8.46, 50.2% (n = 101) were educated above the university level, 71.6% (n = 144) were religious, 82.6% (n = 166) were married, 79.6% (n = 160) were employed, 59.2% (n = 119) earned less than 2 million won (2000 USD) per month, 60.2% (n = 121) exercised at least twice a week, and 43.3% (n = 87) received emotional support from their spouses. In terms of disease-specific characteristics, 35.3% (n = 71) were in Stage II and 63.7% (n = 128) had undergone surgery, chemotherapy, and radiotherapy. More than half (57.7%; n = 116) were diagnosed between 6 and 12 months after their first clinical presentation, 76.6% (n = 154) received hypofraction therapy, and 70.1% (n = 141) received only local treatments on tumor sites 2. On average, the respondents rated fatigue as 19.6 ± 10.894, and sleep disturbance as 7.55 ± 4.24. The average QOL score was 92.16 ± 20.95, and the subscale score values were 19.57 ± 6.33 for physical well-being, 16.26 ± 5.33 for social well-being, 17.00 ± 4.87 for emotional well-being, 16.14 ± 6.22 for functional well-being, and 23.17 ± 6.90 for miscellaneous breast cancer-related factors. 3. The fatigue scores differed significantly, based on their religion (t = -2.902, p = .004), monthly income (t = -2.130, p = .035), exercise level (F = 5.291, p = .006), and time of diagnosis (F = 3.743, p = .025). The sleep disturbance scores showed statistically significant differences, depending on their education levels (F = 3.192, p = .43) and time of diagnosis (F = 9.143, p < .001). Their QOL values were also significantly different, based on education level (F = 3.192, p = .43), marriage status (F = 3.828, p = .023), exercise amount (F = 12.909, p < .001), treatment method (t = 2.253, p = .025), time of diagnosis (F = 3.109, p = .047), and irradiation site (F = 3.310, p = .039). In most cases, exercise and the timeframe of the diagnosis showed significant differences in their correlations with fatigue, sleep disturbance, and QOL. 4. As for the correlations between fatigue, sleep disturbances, and QOL, fatigue and sleep disturbances (r = .403, p < .001) showed positive statistically significant correlations, while fatigue and QOL (r = -.545, p < .001), and sleep disturbances and QOL (r = -.449, p < .001) showed statistically significant negative correlations. 5. The multiple regression analysis, which was used to determine the variables affecting breast cancer patients’ QOL after receiving radiotherapy, resulted in a significant regression model (F = 49.114, p < .001), which accounted for approximately 41.9% of the explanatory power. Fatigue (β = -.337, p < .001) and sleep disturbances (β = -.203, p < .001) were revealed to adversely affect quality of life. To summarize the above study results, QOL decreased in proportion to increases in fatigue and sleep disturbance. Exercise was associated with significant inter-subject differences in fatigue and QOL, and diagnosis time frame was a significantly influential factor for QOL. This suggests the importance of nursing interventions aimed at reducing fatigue and sleep disturbance, cutting the diagnosis timeframe, and promoting exercise in order to enhance breast cancer patients’ QOL of patients while receiving radiotherapy.