| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所 === 98 === Background & Purpose:
Breast cancer is the most common female cancer in the world, and its incidence tend is gradually increasing. In recent decade, the incidence of breast cancer remains the top of the ten most occurrence of female cancers in Taiwan. Most popular breast cancer treatment method is the Breast Conservation Surgery (BCS), Modified Radical Mastectomy (MRM) and Breast Reconstruction Surgery (TRAM). The importance of health-related quality of life (HRQoL) for the breast cancer patient is increasing, but few studies are available in Taiwan. The purpose of this study was to explore the impact factors of perceptions, satisfactions and HRQoL of patients under three types breast cancer surgery in two major medical centers of Taiwan.
Method:
This prospective study covered 270 breast cancer patients (147 MRM, 86 BCS and 37 TRAM treated patients) from two medical centers. The studies focus on patient demography, medical condition and care quality relevant factors of breast operation. It uses structural formula questionnaire to analyze patient’s perceptions, satisfactions and one year HRQoL. We also predict the influencing factors on breast cancer patient’s HRQoL by using the GEE method.
Result:
There was significant difference of age, educational years, menopausal status, child numbers, family heritage history, tumor stage, operation time, anesthesia time, radiotherapy, hormone therapy, admission days, complication, Body Image, Sexual Enjoyment, Future Perspective, Sleep Disturbance, Diarrhea, Financial Difficulty, Role Limitation due to Emotional problem on three types of breast cancer patients.
Due to adjuvant therapy after operation, three surgical types of breast cancer patients had high significant functional and symptoms scores at the 3rd month follow-up but reached a plateau at the 3rd to 6th month follow–up. MRM patients showed the poorest HRQoL through the study period.
Curative effects in all surgical types at each time point are different. BCS patients and TRAM patients had better HRQoL at early follow up stage, but MRM patients had poor ones. Moreover, BCS patients had poor function and better symptoms in this period. BCS patients had better HRQoL, MRM patients had poor ones, but TRAM patients’ HRQoL were found to deteriorate.
There was significant difference on patients’ satisfactions in three surgical types. There was negative correlation between perceptions and most functional dimensions, and positive correlation between perceptions and most symptom dimensions. On the other hand, there was positive correlation between satisfactions and most functional dimensions and negative correlation between satisfactions and most symptom dimensions.
Age, education, living with family, tumor grade, hair loss and upset, Physical Function can predict patient’s perceptions in BCS patients; menopausal status, Body Image, Physical Function, Bodily Pain can predict patient’s perceptions in MRM patients. Global health status, Role Function, Financial difficulty, Role Limitation due to Emotional problem can predict patient’s perceptions in TRAM patients; educational year, living with family, tumor grade, operation type, admission days after operation, Body Image, Physical Function, Bodily Pain can predict patients’ perceptions.
Menopausal status, tumor grade, hair loss and upset, Physical Function, Bodily Pain can significantly predict satisfactions in BCS patients; living with family, BMI, tumor grade, breast symptoms, Physical Function, Cognitive Function, Role Limitation due to Emotional problem work on satisfactions in MRM patients; Body Image, Physical Function on satisfactions in TRAM patients. Generally, age, living with family, Body Image, Breast Symptoms, Physical Function, Cognitive Function and Role Limitation due to Emotional problem can predict patients’ satisfactions.
In researching a HRQoL influence model against three surgical types, time, age, tumor grade, ASA score, chemotherapy, complication, pre- operation score are the major factors.
Additionally, time, age, educational year, BMI, Menopausal status, CCI, tumor grade, tumor stage, operation type, ASA score, chemotherapy, radiotherapy, hormone therapy, pre- operation score can significantly predict HRQoL after breast cancer surgery.
Conclusion:
It has been found the patients’ characteristics, medical condition, and quality of care differed significantly in three surgical types. Functional and symptom dimensions changed significantly on the first stage of three months, but, better functional dimensions and worsen symptom dimensions were shown in one year after the operation. MRM had poorest functional and symptom dimensions. There was significant difference on satisfactions among different surgical types. Time, age, tumor grade, tumor stage, operation type, ASA score, chemotherapy, and Pre-operation score can predict HRQoL. Medical provider should recognize and stress the importance of HRQoL for breast cancer patients so to promote satisfactions and improve quality of care environment in Taiwan.
Key word: Breast cancer, Breast Conservation Surgery, Modified Radical Mastectomy, Breast Reconstruction surgery, Perception, Satisfaction, Health-related quality of life
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