Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
권호 표지
DOI QR코드

DOI QR Code

Distress and Associated Factors in Patients with Breast Cancer Surgery : A Cross-Sectional Study

유방암 수술환자의 디스트레스 및 연관인자 : 단면연구

  • Lee, Sang-Shin (Department of Psychiatry, Kosin University College of Medicine) ;
  • Rim, Hyo-Deog (Department of Psychiatry, School of Medicine, Kyungpook National University) ;
  • Woo, Jungmin (Department of Psychiatry, School of Medicine, Kyungpook National University)
  • 이상신 (고신대학교 의과대학 정신의학교실) ;
  • 임효덕 (경북대학교 의과대학 정신의학교실) ;
  • 우정민 (경북대학교 의과대학 정신의학교실)
  • Received : 2018.06.22
  • Accepted : 2018.09.11
  • Published : 2018.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : This study aimed to investigate the level of distress using the distress thermometer (DT) and the factors associated with distress in postoperative breast cancer (BC) patients. Methods : DT and WHOQOL-BREF (World Health Organization Quality of Life Scale Abbreviated Version) along with sociodemographic variables were assessed in patients undergoing surgery for their first treatment of BC within one week postoperatively. The distress group consisted of participants with a DT score ${\geq}4$. The prevalence and associative factors of distress were examined by descriptive, univariable, and logistic regression analysis. Results : Three hundred seven women were recruited, and 264 subjects were finally analyzed. A total of 173 (65.5%) were classified into the distress group. The distress group showed significantly younger age (p=0.045), living without a spouse (p=0.032), and worse quality of life (QOL) as measured by overall QOL (p=0.009), general health (p=0.005), physical health domain (p<0.000), and psychological health domain (p=0.002). The logistic regression analysis showed that patients aged 40-49 years were more likely to experience distress than those aged ${\geq}60years$ (Odds ratios [OR]=2.992, 95% confidence interval [CI] 1.241-7.215). Moreover, the WHOQOL-BREF physical health domain was a predictive factor of distress (OR=0.777, 95% CI 0.692-0.873). Conclusions : A substantial proportion of patients are experiencing significant distress after BC surgery. It would be expected that distress management, especially in the middle-aged patients and in the domain of physical QOL (e.g., pain, insomnia, fatigue), from the early BC treatment stage might reduce chronic distress.

연구목적 유방암 환자가 치료 초기에 경험하는 디스트레스는 유방암 생존기까지 지속되는 만성 디스트레스의 위험요소로 알려져 있다. 본 연구는 유방암 첫 치료로써 수술을 받은 환자를 대상으로 디스트레스 온도계(distress thermometer, DT)를 이용하여 디스트레스의 정도와 이와 연관된 인자를 조사하는 것이다. 방 법 2013년 4월 1일부터 2017년 3월 31일 사이에 경북대학교병원에서 유방암 첫 치료로써 수술을 받고 일주일 이내에 있는 환자를 대상으로 하였다. DT로 디스트레스의 정도를 측정하였고 한국판 세계보건기구 삶의 질척도 단축형(Korean version of the World Health Oganization Quality of Life Scale Abbreviated Version, WHOQOL-BREF)으로 삶의 질을 측정하였다. 그 외 기본 인구학적 자료, 암 및 암 치료 관련 자료를 수집하였다. DT 점수 4점 이상인 대상자를 디스트레스 군으로 분류하였다. 디스트레군과 연관된 인자를 알기 위하여 디스트레스군과 비-디스트레스 군 사이의 변수 차이를 단변수 분석(univariable analysis) 하였다. 로지스틱 회귀분석을 시행하여 디스트레스 군을 예측할 수 있는 인자를 조사하였다. 결 과 대상자는 총 307명이었다. 이 중에서 DT에 응답하지 않은 39명, WHOQOL-BREF에서 6개 항목 이상 답을 하지 않아서 채점을 할 수 없었던 4명을 제외한 264명이 분석 대상자였다. 65.5%(n=173)가 디스트레스 군으로 분류되었다. 단변수 분석(univariable analysis)에서 디스트레스 군이 비-디스트레스 군과 비교하여 더 젊었으며(p=0.045), 배우자와 동거하지 않는 경우가 더 많았다(p=0.032). 삶의 질 영역에서 디스트레스 군이 전반적 삶의 질(p=0.009), 전반적 건강상태(p=0.005), 신체건강영역 p<0.001), 심리건강영역(p=0.002)에서 더 나쁜 삶의 질을 보였다. 로지스틱 회귀분석에서 60세 이상의 환자에 비하여 40-49세의 환자가 디스트레스에 이환 될 확률이 약 3배 높았고[OR=2.992, 95% confidence intervals (CI) 1.241-7.215], WHOQOL-BREF영역 중 신체건강영역이 디스트레스를 예측할 수 있는 인자로 나타났다(OR=0.777, 95% CI 0.692-0.873). 결 론 유방암 수술 치료 초기단계에서부터 상당한 수의 환자가 유의한 수준의 디스트레스를 경험하고 있다. 특히 생산성이 왕성한 삶의 주기에 있는 40대의 환자가 60대 이상의 환자에 비하여 수술 후 일주일 이내에 겪는 심리적 고통이 심할 가능성이 높다. 이러한 환자들에게서 수술 초기부터 신체적 삶의 질과 연관된 영역(예 : 통증, 불면, 피로 등)에 대해 평가하고 개입하는 것이 디스트레스 수준을 경감시킬 가능성이 있다.

Keywords

Table 1. Sociodemographic and clinical data of the sample (n=264)

JSSCBG_2018_v26n2_77_t0001.png 이미지

Table 2. Comparison of variables between distress and non-distress group

JSSCBG_2018_v26n2_77_t0002.png 이미지

Table 3. Logistic regression analysis of the determinants of distress

JSSCBG_2018_v26n2_77_t0003.png 이미지

Table 1. Sociodemographic and clinical data of the sample (n= 264) (continued)

JSSCBG_2018_v26n2_77_t0004.png 이미지

References

  1. NCCN org [homepage on the Internet]. Fort Washington: National Comprehensive Cancer Network. NCCN Guidelines for Distress Management version 2.2018-February 23,2018 [cited 2018 Jun 21]. Available from: https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#supportive.
  2. Hershman DL, Kushi LH, Hillyer GC, Coromilas E, Buono D, Lamerato L, Bovbjerg DH, Mandelblatt JS, Tsai WY, Zhong X, Jacobson JS, Wright JD, Neugut AI. Psychosocial factors related to non-persistence with adjuvant endocrine therapy among women with breast cancer: the Breast Cancer Quality of Care Study (BQUAL). Breast Cancer Res Treat 2016; 157:133-143. https://doi.org/10.1007/s10549-016-3788-x
  3. Brunault P, Champagne A-, Huguet G, Suzanne I, Senon JL, Body G, Rusch E, Magnin G, Voyer M, Reveillere C, Camus V. Major depressive disorder, personality disorders, and coping strategies are independent risk factors for lower quality of life in non-metastatic breast cancer patients. Psycho-Oncology 2016;25:513-520. https://doi.org/10.1002/pon.3947
  4. Andersen BL, Yang HC, Farrar WB, Golden-Kreutz DM, Emery CF, Thornton LM, Young DC, Carson WE 3rd. Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer 2008;113:3450-3458. https://doi.org/10.1002/cncr.23969
  5. Eskelinen M, Korhonen R, Selander T, Ollonen P. Beck Depression Inventory as a Predictor of Long-term Outcome Among Patients Admitted to the Breast Cancer Diagnosis Unit: A 25-year Cohort Study in Finland. Anticancer Res 2017; 37:819-824. https://doi.org/10.21873/anticanres.11383
  6. Yu ES, Shim EJ, Kim HK, Hahm BJ, Park JH, Kim JH. Development of guidelines for distress management in Korean cancer patients. Psychooncology 2012;21:541-549. https://doi.org/10.1002/pon.1931
  7. Cancer.go.kr [homepage on the Internet]. GyeongGi-Do: National Cancer Information Center. Recommendations for Distress Management in Cancer Patients [updated 2010 Jun 4;cited 2018 June 21]. Available from: https://www.cancer.go.kr/lay1/bbs/S1T674C680/B/26/view.do?article_seq=19644.
  8. Kang JI, Sung NY, Park SJ, Lee CG, Lee BO. The epidemiology of psychiatric disorders among women with breast cancer in South Korea: analysis of national registry data. Psychooncology 2014;23:35-39. https://doi.org/10.1002/pon.3369
  9. Begovic-Juhant A, Chmielewski A, Iwuagwu S, Chapman LA. Impact of body image on depression and quality of life among women with breast cancer. J Psychosoc Oncol 2012;30: 446-460. https://doi.org/10.1080/07347332.2012.684856
  10. Kim JY, Woo J, Lee SS, Kim HW, Khang D, Rim HD. Psychological factors predicting delayed diagnosis of breast cancer: the role of marital relationship functioning. Korean J Psychosom Med 2014;22:13-22.
  11. Lam WW, Bonanno GA, Mancini AD, Ho S, Chan M, Hung WK, Or A, Fielding R. Trajectories of psychological distress among Chinese women diagnosed with breast cancer. Psychooncology 2010;19:1044-1051.
  12. Liu JE, Wang HY, Wang ML, Su YL, Wang PL. Posttraumatic growth and psychological distress in Chinese early-stage breast cancer survivors: a longitudinal study. Psychooncology 2014;23:437-443. https://doi.org/10.1002/pon.3436
  13. Vahdaninia M, Omidvari S, Montazeri A. What do predict anxiety and depression in breast cancer patients? A follow-up study. Soc Psychiatry Psychiatr Epidemiol 2010;45:355-361. https://doi.org/10.1007/s00127-009-0068-7
  14. Saboonchi F, Petersson LM, Wennman-Larsen A, Alexanderson K, Brannstrom R, Vaez M. Changes in caseness of anxiety and depression in breast cancer patients during the first year following surgery: patterns of transiency and severity of the distress response. Eur J Oncol Nurs 2014;18:598-604.
  15. Lam WW, Shing YT, Bonanno GA, Mancini AD, Fielding R. Distress trajectories at the first year diagnosis of breast cancer in relation to 6 years survivorship. Psychooncology 2012; 21:90-99. https://doi.org/10.1002/pon.1876
  16. Syrowatka A, Motulsky A, Kurteva S, Hanley JA, Dixon WG, Meguerditchian AN, Tamblyn R. Predictors of distress in female breast cancer survivors: a systematic review. Breast Cancer Res Treat 2017;165:229-245. https://doi.org/10.1007/s10549-017-4290-9
  17. Brandao T, Schulz MS, Matos PM. Psychological adjustment after breast cancer: a systematic review of longitudinal studies. Psychooncology 2017;26:917-926. https://doi.org/10.1002/pon.4230
  18. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 2005;330: 702-705. https://doi.org/10.1136/bmj.38343.670868.D3
  19. Bardwell WA, Natarajan L, Dimsdale JE, Rock CL, Mortimer JE, Hollenbach K, Pierce JP. Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer. J Clin Oncol 2006; 24:2420-2427. https://doi.org/10.1200/JCO.2005.02.0081
  20. Tojal C, Costa R. Depressive symptoms and mental adjustment in women with breast cancer. Psycho-Oncology 2015;24: 1060-1065. https://doi.org/10.1002/pon.3765
  21. Hopwood P, Sumo G, Mills J, Haviland J, Bliss JM, START Trials Management Group. The course of anxiety and depression over 5 years of follow-up and risk factors in women with early breast cancer: results from the UK Standardisation of Radiotherapy Trials (START). Breast 2010;19:84-91. https://doi.org/10.1016/j.breast.2009.11.007
  22. Jorgensen L, Laursen BS, Garne JP, Sherman KA, Sogaard M. Prevalence and predictors of distress in women taking part in surgical continuity of care for breast cancer: A cohort study. Eur J Oncol Nurs 2016;22:30-36. https://doi.org/10.1016/j.ejon.2016.01.004
  23. Mitchell AJ. Screening and assessment for distress. Holland JC, Breitbart W, Butow P, Jacobsen PB, Loscalzo M, Mc-Corkle R, editors. Psycho-oncology, 3rd ed. New York: Oxford University Press;2015. p.384-395.
  24. Pockaj BA, Degnim AC, Boughey JC, Gray RJ, McLaughlin SA, Dueck AC, Perez EA, Halyard MY, Frost MH, Cheville AL, Sloan JA. Quality of life after breast cancer surgery: What have we learned and where should we go next? J Surg Oncol 2009;99:447-455. https://doi.org/10.1002/jso.21151
  25. Paraskevi T. Quality of life outcomes in patients with breast cancer. Oncol Rev 2012;6:e2. https://doi.org/10.4081/oncol.2012.e2
  26. Mitchell AJ. Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders. J Clin Oncol 2007;25: 4670-4681. https://doi.org/10.1200/JCO.2006.10.0438
  27. Ma X, Zhang J, Zhong W, Shu C, Wang F, Wen J, Zhou M, Sang Y, Jiang Y, Liu L. The diagnostic role of a short screening tool--the distress thermometer: a meta-analysis. Support Care Cancer 2014;22:1741-1755. https://doi.org/10.1007/s00520-014-2143-1
  28. Min SK, Kim KI, Park IH. Korean version of WHOQO. Seoul: Hana Medical Publishing;2002. p.7-70.
  29. Agarwal J, Powers K, Pappas L, Buchmann L, Anderson L, Gauchay L, Rich A. Correlates of elevated distress thermometer scores in breast cancer patients. Support Care Cancer 2013;21:2125-2136. https://doi.org/10.1007/s00520-013-1773-z
  30. Bidstrup PE, Johansen C, Mitchell AJ. Screening for cancer-related distress: Summary of evidence from tools to programmes. Acta Oncol 2011;50:194-204. https://doi.org/10.3109/0284186X.2010.533192
  31. Mertz BG, Bistrup PE, Johansen C, Dalton SO, Deltour I, Kehlet H, Kroman N. Psychological distress among women with newly diagnosed breast cancer. Eur J Oncol Nurs 2012; 16:439-443. https://doi.org/10.1016/j.ejon.2011.10.001
  32. Hegel MT, Collins ED, Kearing S, Gillock KL, Moore CP, Ahles TA. Sensitivity and specificity of the Distress Thermometer for depression in newly diagnosed breast cancer patients. Psychooncology 2008;17:556-560. https://doi.org/10.1002/pon.1289
  33. Ho SY, Rohan KJ, Parent J, Tager FA, McKinley PS. A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. J Pain Symptom Manage 2015;49:707-715. https://doi.org/10.1016/j.jpainsymman.2014.09.009
  34. Khang D, Rim HD, Woo J. The korean version of the body image scale-reliability and validity in a sample of breast cancer patients. Psychiatry Investig 2013;10:26-33. https://doi.org/10.4306/pi.2013.10.1.26
  35. Roma S, Tickoo R, Garrett Key, Willian S. Breitbart. Cancer-related pain Holland JC, Breitbart W, Butow P, Jacobsen PB, Loscalzo M, McCorkle R, editors. Psycho-oncology, 3rd ed. New York: Oxford University Press;2015. p.171-198.
  36. Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F, ESMO Guidelines Working Group. Management of cancer pain: ESMO Clinical Practice Guidelines. Ann Oncol 2012;23 Suppl 7:vii139-154. https://doi.org/10.1093/annonc/mds355
  37. Savard J, Savard MH. Insomnia and cancer: Prevalence, nature, and nonpharmacologic treatment. Sleep Med Clin 2013;8: 373-387. https://doi.org/10.1016/j.jsmc.2013.04.006
  38. Savard J, Ivers H, Savard MH, Morin CM. Cancer treatments and their side effects are associated with aggravation of insomnia: Results of a longitudinal study. Cancer 2015;121: 1703-1711. https://doi.org/10.1002/cncr.29244
  39. Caplette-Gingras A, Savard J, Savard MH, Ivers H. Is Insomnia Associated With Cognitive Impairments in Breast Cancer Patients? Behav Sleep Med 2013;11:239-257. https://doi.org/10.1080/15402002.2012.672940
  40. Savard J, Villa J, Ivers H, Simard S, Morin CM. Prevalence, natural course, and risk factors of insomnia comorbid with cancer over a 2-month period. J Clin Oncol 2009;27:5233-5239. https://doi.org/10.1200/JCO.2008.21.6333
  41. Garland SN, Johnson JA, Savard J, Gehrman P, Perlis M, Carlson L, Campbell T. Sleeping well with cancer: A systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat 2014;10:1113-1123.
  42. Wagner LI, Cella D. Fatigue and cancer: causes, prevalence and treatment approaches. Br J Cancer 2004;91:822-828. https://doi.org/10.1038/sj.bjc.6602012
  43. Tomlinson D, Robinson PD, Oberoi S, Cataudella D, Culos-Reed N, Davis H, Duong N, Gibson F, Gotte M, Hinds P, Nijhof SL, van der Torre P, Cabral S, Dupuis LL, Sung L. Pharmacologic interventions for fatigue in cancer and transplantation: a meta-analysis. Curr Oncol 2018;25:e152-e167. https://doi.org/10.3747/co.25.3883
  44. Qu D, Zhang Z, Yu X, Zhao J, Qiu F, Huang J. Psychotropic drugs for the management of cancer-related fatigue: a systematic review and meta-analysis. Eur J Cancer Care 2016;25: 970-979. https://doi.org/10.1111/ecc.12397