Long-Term Quality of Life in Patients after Mastectomy
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根治的乳房切断術を受けた乳癌患者137例について，術後遠隔時のQOLをアンケート調査票を送付して行った．QOLの構成因子を患側上肢の機能障害，Activity of Daily Life（以下ADL），State of Daily Life（以下SDL），就労状況，身体的活動意欲，精神的活動意欲，手術満足度，癌再発不安度，ボディ・イメージの変容とした．患側上肢の自覚症状として，腫脹32％，筋力低下25％，疼痛14％，可動域制限14％，知覚異常7％が認められた．ADLを各項目別に検討すると，過半数の例に何らかの支障を認めた．これら機能障害の高度な例では，身体的・精神的活動意欲などの他のQOL因子も有意に不良であった．SDLが術前と不変と回答した例は108例中79％であった．手術不満例は16％であり，上肢の高度機能障害例に多かった．癌再発不安は，65歳以上の高齢者群に比し，65歳未満の若年者群に有意に高く，長期経過例であっても不安は解消されていなかった．乳房喪失というボディ・イメージの変容に対して，大多数の症例がブラジャー，衣服の工夫を行っていた． 以上により種々の程度の上肢の機能障害に対し，各人に適合した補整具の開発やアフタケアを含めた指導や，癌再発不安などに対する継続的な看護が重要であると考えられた．We conducted a questionnaire survey to evaluate the long-term quality of life (QOL) in 137 patients with breast cancer who underwent radical mastectomy. QOL factors consist functional impairment in the upper limb on the affected side, activity of daily life (ADL), state of daily life (SDL), the status of postoperative rehabilitation, mental activities, physical activities, satisfaction of the surgery, anxiety for recurrence of cancer, cosmetic factor (changes in the body image). In the upper limb on the affected side, swelling was observed in 32％, decreased muscle strength in 25％, pain in 14％, limitation in the range of motion in 14％, and sensory impairment in 7％. However, evaluation of the items of the ADL questionnaire revealed specific disturbance in daily life in more than 50％ of respondents. Patients who showed marked functional impairment in this limb had other QOL factors, such as the desire to do mental and physical activiies which were also significantly poor. Of these patients, 108 (79％) replied that state of daily living (SDL) did not change after the survey. Sixteen percent of the patients were not satisfied with the results of their surgery, and they often noted marked functional impairment in the upper limb. Anxiety about recurrence of cancer was more in the middle aged group (65 years or more) than in the aged group (less than 65 old). Anxiety persisted even in patients showing a long survival without regard to aging. Against changes in the body image, ie., loss of the breast, most patients used prosthetic devices in a brassiere and clothes. These results suggested the need to develop prosthetic consultation for each patient, and instruction in post operative care to help prevent functional impairment in the upper limb, continuous nursing intervention to the anxiety about recurrence of cancer might be needed. to various level of the functional impairment in the upper limb.
- 2000-03-24
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