Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지

Psychology and Quality of Life in Cancer Patients on Radiation Therapy

방사선치료 중인 암 환자의 심리와 삶의 질

  • Yang Jong-Chul (Departments of Psychiatry, Chonnam National University Hospital) ;
  • Chung Woong-Ki (Departments of Radiation Oncology, Chonnam National University Hospital)
  • 양종철 (전남대학교병원 정신과) ;
  • 정웅기 (전남대학교병원 방사선종양학과)
  • Published : 2004.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The object of this study Is to investigate sociodemographic and clinical characteristics, psychology, self-esteem and quality of life in cancer patients on radiation therapy and to provide useful information for therapeutic approach to cancer patients on radiation therapy. Materials and Methods: The subjects were 36 patents who had been treated with radiation therapy and 20 normal people. Sociodemographic information and clinical characteristics of cancer patients on radiation therapy were investigated, and symptom checklist-90-revised, Rosenberg Self-esteem Scale for self esteem, World Health Organization Quality of Life Assessment Instrument for quality of life were administered to subjects. And Spearman's correlation analysis was used among these. Result : The tendency of somatization, depression, anxiety and hostility in cancer group were significantly higher than normal group. Self esteem and quality of life in cancer group were significantly lower than normal group. No significant difference was found in comparison of psychology, self esteem and qualify on life according to sociodemographic variables. Among clinical characteristics, in the presence of metastasis in cancer patients, the scores of anxiety, phobia and paranoid ideation were higher In patients with pain, the score of somatization was higher And in case of weight loss, the score of somatization was higher. The higher score of depression, anxiety and hostility were significantly associated with lower self-esteem. And higher score of somatization, depression, anxiety and hostility were significantly associated with lower quality of life. Conclusion: Understanding and management of psychological symptoms, such as somatization, depression, anxiety, and hostility, and pain control are necessary to improve quality of life in cancer patients on radiation therapy.

목적: 본 연구의 목적은 방사선치료 중인 암 환자의 심리적 특징과 삶의 질을 조사하고, 삶의 질에 영향을 미치는 변인들을 파악함으로써 암 환자의 심리에 대한 이해와 치료적 접근 및 삶의 질 향상을 위한 기초 자료를 제공함에 있다. 대상 및 방법: 전남대학교병원 방사선종양학과에서 방사선치료를 받고 있는 암 환자 36명과 정상대조군 20명을 대상으로 하였다. 환자들의 사회 인구학적 자료 및 임상적 특성을 조사하였고, 심리적 특징은 symptom checklist-90-revised, Rosenberg의 self-esteem scale을 통해 평가하였으며, 삶의 질은 World Health Organization Quality of Life Assessment Instrument를 통해 비교 분석한 후, 이들 간의 상관관계를 조사하였다. 결과: 암 환자는 정상대조군에 비해 신체화 경향, 우울, 불안, 적대감 등이 유의하게 높았고, 자아존중감과 삶의 질은 유의하게 낮았다. 사회 인구학적 변인에 따른 심리, 자아존중감, 삶의 질의 비교에서는 유의한 차이가 없었다. 임상적 특성과 연관성 조사에서는 전이가 있는 군에서는 불안, 공포, 경계심이 높고, 통증이 있는 경우에 신체화가 높게 나타났으며, 체중감량이 심할수록 신체화가 높았다. 우울, 불안, 적대감이 높을수록 자아존중감이 낮았으며, 신체화, 우울, 불안, 적대감이 높을수록 삶의 질이 낮은 것으로 나타났다. 결론: 방사선치료를 받고 있는 암 환자의 치료에 있어서는 신체화 경향, 우울, 불안, 적대감 등의 심리적 문제에 대한 이해와 치료적 접근이 병행되어야 하고, 특히 삶의 질을 개선하기 위해서 이러한 심리적인 문제의 해결과 통증 관리가 중요한 것으로 나타났다.{\%}$(1명)에서 관찰되었다.선기능저하증이 각각 7예($9\%$)씩 그리고 성선기능저하증 2예 ($3\%$) 등이 관찰되었다. 전예 중 15예 ($20\%$)에서는 정기적인 호르몬 추적검사를 실시하지 못하였다.이었다.인가는 단정할 수 없다. 이는 앞으로 관찰기간이 더 경과한 이후에 판단할 수 있겠고 또한 방사선치료전에 전지주막하의 종양범위를 명확히 확인할 것이 요구된다.고 (p < 0.05). LP1 군을 제외한 다른 모든 군 사이에는 유의한 차이가 없었다 (p > 0.05). 2. 파절양상을 관찰한 결과, LP1 군에서는 접착성 파절이 우세하게 나타났고, LP1 군을 제외한 다른 모든 군에서는 혼합형 파절이 주로 일어났다.64.96\%$, 5:5 첨가구가 $25.6{\times}10^3$cps와 $60.90\%$, 3:7 첨가구가 각각 $21.9{\times}10^3$cps와 $55.19\%$로 첨가량이 증가하면서 두 항목 모두 크게 감소하는 결과를 보였다. 색도를 분석한 결과 L값, a값, b값 모두 표고버섯 분말 함량이 증가하면서 감소하였고, 모든 처리구에서 기존 무첨가구와 극히 현저한 차이를 보이는 것으로 나타났다. 시료별 관능검사 결과에서 색 (color), 먹을때의 느낌 (chewiness)과 단맛(sweetness)의 경우 무첨가구와 모든 처리구가 유의적인 차이를 보였으며, 향미 (flavor)와 전반적인 기호도(overall acceptability)에서 당화액과 추출액의 혼합비가 7:3인 시료구만이 무첨가구와 유의적인 차이를 보이지 않았다

Keywords

References

  1. Lederberg MS, Holland JC. Psychooncology. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry, 6th ed. Baltimore: Williams & Wilkins 1995:1570-1592
  2. Katz MR, Irish JC, Devins GM, Rodin GM, Gullane PJ. Reliability and validity of an observer-rated disfigurement scale for head and neck cancer patients. Head & Neck 2000:2:132-141
  3. Craig AW. Body image dimensions and cancer: a heuristic cognitive behavioral model. Psycho-Oncology 2000;9:183-192 https://doi.org/10.1002/1099-1611(200005/06)9:3<183::AID-PON446>3.0.CO;2-L
  4. Yang MJ, Jeon YW, Han SI, Han CH, Eom HS. Depression and pain in patients with cancer. J Korean Neuropsychiatr Assoc 2000;39:1122-1131
  5. Antonella C, Paolo P. Assessment of depression among cancer patients the role of pain, cancer type and treatment. Psycho-Oncology 2001;10:156-165 https://doi.org/10.1002/pon.505
  6. Pellino TA, Ward SE. Perceived control mediates the relationship between pain severity and patient satisfaction. J Pain Symptom Manage 1998;15:110-116 https://doi.org/10.1016/S0885-3924(97)00255-8
  7. Holland JC, Rowland J, Lebovits A. Reactions to cancer treatment: Assessment of emotional response to adjunct radiotherapy. Psychiatr Clin N Am 1997;2:347-358
  8. Go GB, Kim GE. A Comparison of psychopathology between cancer patients on radiotherapy and noncancer patients. J Korean Neuropsychiatr Assoc 1990;29:662-663
  9. Jennifer LH, Steven DP. The cancer patient with borderline personality disorder: suggestions for symptom-focused management in the medical setting. Psycho- Oncology 2000;9:91-100 https://doi.org/10.1002/(SICI)1099-1611(200003/04)9:2<91::AID-PON437>3.0.CO;2-8
  10. Abse DW, Wilkins MM, Van Castle RL. Personality and behavioral characteristics of lung cancer patients. J Psychosom Res 1974;18:101-113 https://doi.org/10.1016/0022-3999(74)90073-7
  11. Go GB, Kim ST. Copying strategy of cancer patients. J Korean Neuropsychiatr Assoc 1988;27:140-150
  12. Go GB. Stress and Copying strategy of the families of cancer patients. J Korean Neuropsychiatr Assoc 1988;27:693-702
  13. Holland JC. Psychosocial issues in the care of the terminallyill. In: Flach F, eds. Directions in psychiatry, New York: Hatherleigh 1982
  14. Shauna LS, Ana ML, Gary ES, et al. Quality of life and breast cancer: Relationship to psychosocial variables. J Clin Psychol 2001;57:501-519 https://doi.org/10.1002/jclp.1026
  15. Leeuw JRJ, Alexander G, Wynand JGR, Geert HB, Gert-Jan H, Jacques AMW. Prediction of depressive symptomatology after treatment of head and neck cancer: The influence of pre-treatment physical and depressive symptoms, coping, and social support. Head & Neck 2000;22:799-807 https://doi.org/10.1002/1097-0347(200012)22:8<799::AID-HED9>3.0.CO;2-E
  16. Wright EP, Selby PJ, Gould A, Cull A. Detecting social problems in cancer patients. Psycho-Oncology 2001;10:242-250 https://doi.org/10.1002/pon.519
  17. Lesko LM, Massie MJ, Holland JC. Oncology. In: Stoudemire A, Fogel BS, eds. Principles of medical psychiatry, Orlando, FL: Grune & Stratton, 1987:494-520
  18. Schnoll RA, Harlow LL, Stolbach LL, Brandt U. A structural model of the relationships among stage of disease, adjustment in women with breast cancer. Psycho-Oncology 1998;7:69-77 https://doi.org/10.1002/(SICI)1099-1611(199803/04)7:2<69::AID-PON286>3.0.CO;2-8
  19. Schwartz CE, Kaplan RM, Anderson JP, Holbrook T, Genderson MW. Covariation of physical and mental symptoms across illness: results of a factor analytic study. Ann Behav Med 1999;21:122-127 https://doi.org/10.1007/BF02908292
  20. Greer S, Morris T. Psychological attributes of women who develop breast cancer: A controlled study. J Psychosom Res 1975;9:147-153
  21. Joffe RT, Rubinow DR, Denicoff KD, Maher M, Sindelar WF. Depression and carcinoma of the pancreas. Gen Hosp Psychiatry 1986;8:241-245 https://doi.org/10.1016/0163-8343(86)90004-6
  22. Carol MM. Challenges posed by non-random missing quality of life data in an advanced-stage colorectal cancer clinical trial. Psycho-Oncology 2000;9:340-354 https://doi.org/10.1002/1099-1611(200007/08)9:4<340::AID-PON466>3.0.CO;2-F
  23. Ovesen L, Hannibal J, Mortensen E. The interrelationship of weight loss, dietary intake, and quality of life in ambulatory patients with cancer of the lung, breast, and ovary. Nutr Cancer 1993;9:159-167
  24. Graeff A, Leeuw RJ, Ros WJG, Hordijk GJ, Blijham GH, Winnubst JAM. Long-term quality of life of patients with head and neck cancer. The Laryngoscope 2000;110: 98-106 https://doi.org/10.1097/00005537-200001000-00018
  25. Carina MB. Affected self-respect and self-value: the impact of breast cancer treatment on self-esteem and QoL. Psycho- Oncology 2002;1:356-364
  26. Mirjam AGS, Reike T, Wim JA, Van DH, Hanneke CJ, Haes M. Explaining quality of life with crisis theory. Psycho- Oncology 2002;11:419-426 https://doi.org/10.1002/pon.601
  27. Go GB. A comparison of stress perception between cancer and non-cancer patients. J Korean Neuropsychiatr Assoc 1990;29:669-675
  28. Kim HC, Mun CW, Park SS. A relation between clinical characteristics of cancer patients on radiotherapy and psychiatric disorders. Korean J Psychosom Med 1999;7:134-141
  29. Rosenberg M. Society and adolescent self-image. Princeton, NJ; Princeton University Press, 1965
  30. Ha HG. Anxiety and depression of the hospitalized cancer patients. J Korean Neuropsychiatr Assoc 1982;21:665-674
  31. Derogatis LR. SCL-90 Administration, scoring and procedures manual-I. Clinical Psychometric Research Unit, Baltimore; Johns Hopkins University, 1997
  32. Derogatis LR. SCL-90 (Revised) Mannual I. Clinical Psyhcometric Research Unit, Baltimore; University School of Medicine, 1997
  33. World Health Organization. Introduction and Background. In: WHO, eds. Field Trial WHOQOL-100, Geneva: MNH/PSF 1995
  34. Min SG, Lee CI, Kim KI, Suh SY, Kim DK. Development of Korean version of WHO quality of life scale abbreviated version (WHOQOL-BREF). J Korean Neuropsychiatr Assoc 2000;39:571-579
  35. Akechi T, Okamura H, Nishiwaki Y, Uchitomi Y. Predictive factors for suicidal ideation in patients with unresectable lung carcinoma. Cancer 2002;95:1085-1093 https://doi.org/10.1002/cncr.10769
  36. Jean ES. African Americans with cancer: the relationships among self-esteem, locus of control, and health perception. Research in Nursing & Health 2002;25:371-382 https://doi.org/10.1002/nur.10050
  37. Lee C. Psycho-oncology: a historical review. Korean J Psychosom Med 1994;2:3-9
  38. Jenkins C, Carmody TJ, Rush AJ. Depression in radiation oncology patients: A preliminary evaluation. J Affect Disord 1998;50:17-21 https://doi.org/10.1016/S0165-0327(98)00039-1
  39. Leopold KA, Ahles TA, Walch S, et al. Prevalence of mood disorders and utility of the PRIME-MD in patients undergoing radiation therapy. Int J Radiat Oncol Biol Phys 1998;42:1105-1112 https://doi.org/10.1016/S0360-3016(98)00346-0
  40. Hughson AV, Cooper AF, McArdle CS, Smith DC. Psychosocial effects of radiotherapy after mastectomy. Br Med J 1987;294:1515-1518 https://doi.org/10.1136/bmj.294.6586.1515
  41. Passik SD, Dugan W, McDonald MV, Rosenfelt B, Theobald DE, Edgerton S. Oncologists' recognition of depression in their patients with cancer. J Clin Oncol 1998;16:1594-1600 https://doi.org/10.1200/JCO.1998.16.4.1594
  42. Peck A. Emotional reactions to having cancer. Radium Ther Nucl Med 1972;114:591-599 https://doi.org/10.2214/ajr.114.3.591
  43. Jerse MA, Whitman HH, Gustafson JP. Cancer in adults. In: Roback HB, eds. Helping Patients and Their Families Cope with Medical Problems. San Francisco: Jossey-Bass 1984:251-285