Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
권호 표지
DOI QR코드

DOI QR Code

Psychosomatic Integrative Care for Psychosocial Distress of Patients With Breast Cancer

유방암 환자의 정신사회적 디스트레스에 대한 정신신체의학적 통합치료

  • Yang, Chan-Mo (Department of Psychiatry, Wonkwang University School of Medicine, Wonkwang University) ;
  • Jang, Seung-Ho (Department of Psychiatry, Wonkwang University School of Medicine, Wonkwang University) ;
  • Lee, Hye-Jin (Department of Public Health, Wonkwang University Graduate School) ;
  • Lee, Sang-Yeol (Department of Psychiatry, Wonkwang University School of Medicine, Wonkwang University)
  • 양찬모 (원광대학교 의과대학 정신건강의학교실) ;
  • 장승호 (원광대학교 의과대학 정신건강의학교실) ;
  • 이혜진 (원광대학교 대학원 보건학과) ;
  • 이상열 (원광대학교 의과대학 정신건강의학교실)
  • Received : 2021.10.28
  • Accepted : 2021.12.13
  • Published : 2021.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Breast cancer is the most prevalent oncological disease among women. Various psychosocial distress is common at the diagnosis, treatment, and posttreatment phase of breast cancer. For the treatment of breast cancer, not only medical treatment but also psychosomatic integrative care will be needed. Patients with breast cancer may lead to increased vulnerability to stress, adjustment disorder, anxiety disorder, and depressive disorder, and these psychiatric diseases and conditions are associated with recurrence or exacerbation of breast cancer. Psychosocial treatment of anxiety and depression could increase the quality of life of patients and decrease the recurrence and progression of breast cancer. In this article, we reviewed 5 clinical breast cancer survivorship guidelines focused on psychosomatic integrative care including psychosocial treatment and alternative treatment for psychosocial distress. Because 5 treatment guidelines were using various definitions of evidence, we confirmed evidence of various psychosocial treatments for patients with breast cancer based on the definition of evidence by the US Preventive Service Task Force (USPSTF) guideline. We also reviewed the effect size of psychosocial treatment for anxiety, depression, mood, and quality of life in patients with breast cancer. This article discusses the barrier to the delivery of psychosomatic integrative care and suggests integrative care planning for breast cancer. Multi-disciplinary teams, patient's needs assessment, information technology support, patient and caregiver engagement, planned periodic monitoring of psychosocial distress by a psychosomatic specialist or consultation-liaison psychiatrist are recommended as key features of a psychosomatic integrated care plan.

유방암은 여성에서 가장 높은 유병율을 보이는 암으로, 진단과 치료과정 및 치료 후에도 다양한 정신사회적 디스트레스가 자주 나타난다. 유방암 환자의 치료에는 의학적 치료뿐만 아니라 정신신체의학적 통합치료가 필요하다. 유방암 환자는 스트레스, 불안장애, 우울장애, 적응 장애 등에 대한 취약성이 증가하고, 이러한 정신장애는 유방암의 악화 또는 재발과 연관이 있다. 유방암 환자의 불안과 우울에 대한 정신사회적 치료는 환자의 삶의 질을 증진시키고, 유방암의 재발과 악화를 감소시킨다. 본 연구에서는 5편의 유방암 치료 가이드라인에서 정신사회적 디스트레스에 대한 정신사회적 치료와 대체의학적 치료가 포함된 정신신체의학적 통합치료 부분에 초점을 맞추어 논의하였다. 5편의 가이드 라인에서 사용한 서로 다른 근거 기준은 US Preventive Service Task Force (USPSTF) 기준에 맞춰 연구자들이 평가하여 근거를 기술하였다. 또한 유방암 환자의 불안, 우울, 기분, 삶의 질에 대한 정신사회적 치료의 효과 크기를 요약하였고, 정신신체의학적 통합치료 서비스 제공에 대한 장벽과 이에 대한 대안을 제시하였다. 다학제 팀을 구성하고, 환자 요구도를 조사하며, 정신사회적 치료의 정보를 환자에게 제공하여 환자와 가족이 참여하는 것이 중요하다. 또한 준비된 계획에 따라 정기적으로 정신사회적 디스트레스를 평가하고, 정신신체의학 전문가 또는 자문조정 정신건강의학과 의사에 의한 정신신체의학적 통합치료가 환자에게 제공되는 것이 가장 중요하다.

Keywords

Acknowledgement

본 연구는 보건복지부의 재원으로 한국보건산업진흥원의 보건의료기술연구개발사업(과제고유번호: HI20C1951)의 지원으로 수행된 연구임.

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-2917. https://doi.org/10.1002/ijc.25516
  2. Bray F, Ferlay J, Soerjmomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 conturies. CA Cancer J Clin 2018;68:394-424. https://doi.org/10.3322/caac.21492
  3. Cancer registry statistics in Korea 2016 available at http://kosis.kr.
  4. Brown ML, Lipscomb J, Snyder C. The burden of illness of cancer: economic cost and quality of life. Annu Rev Public Health 2001;22:91-113. https://doi.org/10.1146/annurev.publhealth.22.1.91
  5. Balouch A, Hashemi SM, Rafiemanesh H, Amirshahi M, Afsargharehbagh R. Global prevalence of depression among breast cancer patients: a systematic review and meta-analysis. Breast Cancer Res Treat 2019;176:519-533. https://doi.org/10.1007/s10549-019-05271-3
  6. Hashemi SM, Rafiemanesh H, Aghamohammadi T, Badakhsh M, Amirshahi M, Sari M, Behnamfar N, Roudini K. Rrevalence of anxiety among breast cancer patients: a systematic reivew and meta-analysis. Breast Cancer 2019;27:166-178. https://doi.org/10.1007/s12282-019-01031-9
  7. Xin W, Jieru W, Reuben C, Atipatsa K, Aizhong L. Prevalence of posttraumatic stress disorder among breast cancer patients: a meta-analysis. Iran J Public Health 2016;45:1533-1544.
  8. Wang X, Wang N, Zhong L, Wang S, Zheng Y, Yang B, Zhang J, Lin Y, Wang Z. Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Mol Psychiatr 2020;25:3186-3197. https://doi.org/10.1038/s41380-020-00865-6
  9. Stanton AL. What happen now? Psychosocial care for cancer survivors after medical treatment completion. J Clin Oncol 2012;30:1215-1220. https://doi.org/10.1200/JCO.2011.39.7406
  10. Chae BJ, Lee J, Lee SK, Shin HJ, Jung SY, Lee JW, Kim Z, Lee MH, Lee J, Youn HJ. Unmed needs and related factors or Korean breast cancer survivors: a multicenter, cross-sctional study. BMC Cancer 2019;19:839 https://doi.org/10.1186/s12885-019-6064-8
  11. Giese-Davis J, Collie K, Rancourt KM, Neri E, Kraemer HC, Spiegel D. Decrease in depression symptoms is associated with longer survival in patietns with metastatic breast cancer: a secondary analysis. J Clin Oncol 2011;29:413-420. https://doi.org/10.1200/JCO.2010.28.4455
  12. Mirosevic S, Jo B, Kraemer HC, Ershadi M, Neri E, Spiegel D. "Not just another meta-analysis": sources of hetergogeneity in psychosocial treatment effect on cancer survival. Cancer Med 2019;8:363-373. https://doi.org/10.1002/cam4.1895
  13. Quality of Care and Health Outcomes, Australia. Psychosocial clinical practice guidelines information, support and counselling for women with breast cancer. https://www.canceraustralia.gov.au/.
  14. Harris SR, Schmitz HK, Campbell KL, McNeely ML. Clinical practice guidelines for breast cancer rehabilitation: synthesis of guideline recommendation and qualitive appraisals. Cancer 2012;118:2312-2324. https://doi.org/10.1002/cncr.27461
  15. Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D; Society for Integrative Oncology. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2014;2014:346-358. https://doi.org/10.1093/jncimonographs/lgu041
  16. Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA. American cancer society/American society of clinical oncology breast cancer surviviorship care guideline. CA Cancer J Clin 2016;66:43-73. https://doi.org/10.3322/caac.21319
  17. Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 2017;67:194-232. https://doi.org/10.3322/caac.21397
  18. US Preventive Service Task Force. Definitions of Grade system. https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/grade-definitions.
  19. Quality of care and health outcomes committee, National health and Medical research Counsil. Guidelines for the development and implementation of clinical practice guidelines. Canberra: Australian Goverment Publishing Service, 1995.
  20. Zainal NZ, Booth S, Huppoert FA. The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis. Psycho-Oncol 2013;22:1457-1465. https://doi.org/10.1002/pon.3171
  21. Guarino A, Polini C, Forte G, Favieri F, Boncompagni I, Casagrande M. The effectiveness of psychological treatments in women with breast cancer: a systematic review and metaanalysis. Clin Med 2020;9:1-26.
  22. Cohen J. Statistical power analysis for behavioral science. New York: Academic, 1988.
  23. Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P. The unmet supportive care needs of patients with cancer. Supportive Care Review Group. Cancer 2000;88:226-237. https://doi.org/10.1002/(sici)1097-0142(20000101)88:1@@<@@226::aid-cncr30@@>@@3.0.co;2-p
  24. Schmid-Buchi S, Halfens RJG, Dassen T, van den Borne B. Psychosocial problems and needs of posttreatment patients with breast cancer and their relatives. Eur J Oncol Nurs 2011;15:260-266. https://doi.org/10.1016/j.ejon.2009.11.001
  25. Sutherland G, Hill D, Morand M, Pruden M, McLachlan SA. Assessing the unmet supportive care needs of newly diagnosed patients with cancer. Eur J Cancer Care 2009;18:577-584. https://doi.org/10.1111/j.1365-2354.2008.00932.x
  26. Mehnert A. Discussing the need for psychosocial care in oncology. Psychother Psych Med 2014;64:251-252. https://doi.org/10.1055/s-0034-1370209
  27. Eakin EG, Strycker LA. Awareness and barriers to use of cancer support and information resources by HMO patients with breast, prostate, or colon cancer: patient and provider perspectives. Psychooncology 2001;10:103-113. https://doi.org/10.1002/pon.500
  28. Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review. Psychooncology 2014;23:601-612. https://doi.org/10.1002/pon.3474
  29. Atema V, van Leeuwen M, Kieffer JM, Oldenburg HSA, van Beurden M, Gerritsma MA, Kuenen MA, Plaisier PW, Lopes Cardozo AMF, van Riet YEA, Heuff G, Rijna H, van der Meij S, Noorda EM, Timmers GJ, Vrouenraets BC, Bollen M, van der Veen H, Bijker N, Hunter MS, Aaronson NK. Efficacy of Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors: results of a randomized controlled trial. J Clin Oncol 2019;37:809-822. https://doi.org/10.1200/jco.18.00655
  30. Beatty L, Koczwara B, Wade T. Evaluating the efficacy of a self-guided Web-based CBT intervention for reducing cancerdistress: a randomised controlled trial. Support Care Cancer 2016;24:1043-1051. https://doi.org/10.1007/s00520-015-2867-6
  31. Post KE, Flanagan J. Web based survivorship interventions for women with breast cancer: an integrative review. Eu J Oncol Nur 2016;25:90-99. https://doi.org/10.1016/j.ejon.2016.10.004