Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Changes in Quality of Life and Related Factors of Surgical Patients with Thyroid Cancer

갑상선암 수술환자의 삶의 질 변화와 관련요인

  • Choi, Hyang-Suk (Public Health Administration, Chungbuk Health&Science University) ;
  • Kang, Young-Mi (Research Center for Endocrine and Metabolic Diseases, Chungnam National University Hospital) ;
  • Lee, Tae-Yong (Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine)
  • 최향숙 (충북보건과학대학교 보건행정과) ;
  • 강영미 (충남대학교병원 내분비대사질환특성화연구센터) ;
  • 이태용 (충남대학교 의학전문대학원 예방의학교실)
  • Received : 2018.08.10
  • Accepted : 2018.11.02
  • Published : 2018.11.30
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Abstract

This study was conducted 1) to investigate the effects of treatment and other factors on the quality of life of thyroid cancer surgical patients and 2) to provide fundamental data for development of an intervention and symptom management program to improve the quality of life of those patients. A total of 76 patients who were diagnosed with thyroid cancer and underwent thyroidectomy from July 2013 to December 2014 participated in this study. To investigate the factors affecting quality of life, a t-test and ANOVA analyses were conducted, after which multiple regression analysis was performed. The results were statistically significant between preoperative and one month after surgery of sex, cancer history, fatigue, and quality of life until 3 months after surgery of stage, cancer history, anxiety, and pain. Multiple regression analysis showed that the most influential factors affecting the quality of life were depression and fatigue at one month prior to and after surgery and anxiety at three months after surgery, while no factors were found to be influential at six months after surgery. Overall, the results of this study suggested that it is imperative to manage depression and fatigue one month prior to and after surgery to reduce the physical and psychological pain experienced by thyroid cancer patients. Moreover, three months after the surgery, anxiety should be closely monitored and controlled to improve the quality of life of the patients. This approach is expected to reduce the burden on the health care system and social costs, which will positively affect public health.

본 연구는 갑상선암 수술환자의 치료기간에 따른 삶의 질 변화에 대해 알아보고, 삶의 질 변화에 영향을 미치는 요인을 파악하여 갑상선암 환자의 삶의 질을 향상시키기 위한 개입 필요성과 증상관리 프로그램 개발을 위한 기초자료를 제공하고자 하였다. 대전광역시 소재 일개 상급종합병원 이비인후과에서 2013년 7월부터 2014년 12월까지 갑상선암 진단을 받고 갑상선절제수술을 받은 환자 76명을 대상으로 하였고, 삶의 질에 영향을 미치는 요인을 알아보기 위해 t-test와 ANOVA에서 통계적으로 유의하게 나온 변수를 산출하여 다중회귀분석(multiple regression)을 실시하였다. 연구결과에서 수술 전과 후 1개월까지의 삶의 질 변화에서는 성별, 암 병력, 피로가 통계적으로 유의하였고, 수술 후 3개월까지의 삶의 질 변화에서는 병기, 암 병력, 불안, 통증이 통계적으로 유의한 변화가 있었다(P<.05). 회귀분석 결과 조사시기별 삶의 질 변화에 영향을 미치는 요인은 수술 전과 후 1개월에서는 우울과 피로였으며, 수술 후 3개월에서는 불안이었고, 수술 후 6개월에서는 모두 유의하지 않은 것으로 조사되었다. 따라서 수술 전과 후 1개월 시기에 우울과 피로 증상을 관리하여 환자의 신체적, 정신적 고통을 줄일 수 있도록 노력해야 하며, 수술 후 3개월에서는 불안 증상을 관리하여 환자의 삶의 질을 향상시킬 수 있도록 해야 할 것이다. 이는 결과적으로 건강관리 시스템에 대한 부담을 줄이고, 공중보건에 긍정적인 영향을 미치는 사회적 비용을 감소시킬 수 있을 것으로 생각된다.

Keywords

SHGSCZ_2018_v19n11_370_f0001.png 이미지

Fig. 1. The pictures were compared with repeated measures analysis of variance for the quality of life of people with and without depression, anxiety, fatigue, and pain. t0: pre-operative, t1: 1 month after surgery, t2: 3 months after surgery, t3: 6 months after surgery.

Table 1. QoL changes during the overall study period

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Table 2. Repeated measures quality of life according to time

SHGSCZ_2018_v19n11_370_t0002.png 이미지

Table 3. Correlation Coefficient between depression,anxiety, fatigue, pain and quality of life

SHGSCZ_2018_v19n11_370_t0003.png 이미지

Table 4. The factors affecting quality of life by multivariate analysis from preoperative to 1 month after surgery

SHGSCZ_2018_v19n11_370_t0004.png 이미지

Table 5. The factors affecting quality of life by multivariate analysis from preoperative to 3 months after surgery

SHGSCZ_2018_v19n11_370_t0005.png 이미지

References

  1. T. Wang, M. Jiang, Y. Ren, Q. Liu, G. Zhao, C. Cao, H. Wang, "Health-Related Quality of Life of community thyroid cancer survivors in Hangzhou, China", Thyroid, Vol. 28, No. 8, pp. 1013-1023, 2018. DOI: https://doi.org/10.1089/thy.2017.0213
  2. H. Duan, E. Gamper, A. Becherer, M. Hoffmann, "Quality of life aspects in the management of thyroid cancer", Oral Oncol, Vol. 51, No. 6, pp. S1-S5, 2015. DOI: https://doi.org/10.1016/j.oraloncology.2015.03.008
  3. MK. Applewhite, BC. James, SP. Kaplan, P. Angelos, EL. Kaplan, RH. Grogan, B. Aschebrook-kilfoy, "Quality of Life in Thyroid Cancer is Similar to That of Other Cancers with Worse Survival", World J Surg, Vol. 40, No. 3, pp. 551-561, 2016. DOI: https://doi.org/10.1007/s00268-015-3300-5
  4. RH. Grogan, B. Aschebrook-Kilfoy, "Angelos. Interventions to improve thyroid cancer survivors' quality of life", Future Oncol, Vol. 12, No. 11, pp. 1309-1311, 2016. DOI: https://doi.org/10.2217/fon-2016-0052
  5. HJ. Abrahams, MF. Fielissen, IC. Schmits, CA. Verhagen, MM. Rovers, H. Knoop, "Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12327 breast cancer survivors", Ann Oncol, Vol. 27, No. 6, pp. 965-974, 2016. DOI: https://doi.org/10.1093/annonc/mdw099
  6. JE. Bower, "Treating cancer-related fatigue: the search for interventions that target those most in need". J Clin Oncol, Vol. 30, No. 36, pp. 4449-4450, 2012. DOI: https://doi.org/10.1200/JCO.2012.46.0436
  7. JA. Scott, KE. Lasch, AM. Barsevick, E. Piault-Louis, "Patients' experiences with cancer-related fatigue: a review and synthesis of qualitative research", Oncol Nurs Forum, Vol. 38, No. 3, pp. 191-203, 2011. DOI: https://doi.org/10.1188/11.ONF.E191-E203
  8. S. Tagay, S. Herpertz, M. Langkafel, Y. Erim, L. Freudenberg, N. Schopper, "Health-related quality of life, anxiety and depression in thyroid cancer patients under short-term hypothyroidism and TSH-suppressive levothyroxine treatment", Eur Journal of Endocrinol, Vol. 153, No. 6, pp. 755-763, 2005. DOI: https://doi.org/10.1530/eje.1.02047
  9. TJ. Craig, PA. VanNatta, "Current medication use and symptom of depression in a general population", Am Journal of Psychiatry, Vol. 135, pp. 1036-1039, 1978. DOI: https://doi.org/10.1176/ajp.135.9.1036
  10. A. Hinz, O. Krauss, JP. Hauss, M. Hockel, RD. Kortmann, JU. Stolzenburg, "Anxiety and depression in cancer patients compared with the general population", Eur Journal of Cancer Care(Engl), Vol. 19, No. 4, pp. 522-529, 2010. DOI: https://doi.org/10.1111/j.1365-2354.2009.01088
  11. J. I. Lee, S. H. Kim, A. H. Tan, H. K. Kim, H. W. Jang, K. Y. Hur, "Decreased health-related quality of life in disease-free survivors of differentiated thyroid cancer in Korea" Health Qual Life Outcomes, Vol. 8, pp. 101, 2010. DOI: https://doi.org/10.1186/1477-7525-8-101
  12. N. Dieudonne, A. Gomola, P. Bonnichon, YM. Ozier, "Prevention of postoperative pain after thyroid surgery: A double-blind randomized study of bilateral superficial cervical plexus blocks", Anesth Analg, Vol. 92, No. 6, pp. 1538-1542, 2001. DOI: https://doi.org/10.1097/00000539-200106000-00038
  13. LS. Radloff, "The CES-D Scale; A Self-report depression scale for research in the general population", Appl Psychol Meas, Vol. 1, pp. 385-401, 1977. DOI: https://doi.org/10.1177/014662167700100306
  14. D. Cella, D. Tulsky, G. Gray, B. Sarafian, E. Linn, A. Bonomi, "The functional assessment of cancer therapy scale: Development and validation of the general measure", Journal of Clin Oncol, Vol. 11, pp. 570-579, 1993. DOI: https://doi.org/10.1200/JCO.1993.11.3.570
  15. J. Y. Kim, D. K. Shin, "A study based on the standardization of the STAI for Korea", The New Medical Journal, Vol. 21, No. 11, pp. 69-75, 1978.
  16. D. Cella, D. Tulsky, G. Gray, B. Sarafian, E. Linn, A. Bonomi, "The functional assessment of cancer therapy scale: Development and validation of the general measure", Journal of Clin Oncol, Vol. 11, pp. 570-579, 1993. DOI: https://doi.org/10.1200/JCO.1993.11.3.570
  17. D. Taieb, F. Sebag, M. Cherenko, K. Baumstarck-Barrau, C. Fortanier, B. Farman-Ara, "Quality of life changes and clinical out-comes in thyroid cancer patients undergoing radioiodine remnant ablation(RRA) with recombinant human TSH (rhTSH): A randomized controlled study", Clin Endocrinol(Oxf), Vol. 71, No. 1, pp. 115-123, 2009. DOI: https://doi.org/10.1111/j.1365-2265.2008.03424.x
  18. J. H. Jin, Association between stress, anxiety, depression and quality of life in thyroid cancer patients with thyroidectomy, Unpublished Master's Thesis, Yonsei University, Seoul, 2015.
  19. PN. Schultz, C. Stava, R. Vassiloppoulou-Sellin, "Health profiles and quality of life of 518 survivors of thyroid cancer", Head Neck, Vol. 25, No. 5, pp. 349-356, 2003. DOI: https://doi.org/10.1002/hed.10217
  20. J. S. Jeong, I. S. Kim, E. S. Lee, "Factors Influencing the quality of life in thyroid cancer patients after thyroidectomy", Journal of the Korea Academia-Industrial cooperation Society, Vol. 16, No. 8, pp. 5442-5451, 2015. DOI: https://dx.doi.org/10.5762/KAIS.2015.16.8.5442
  21. J. Y. Yang, M. S. Yi, "Factors Influencing Quality of Life in Thyroid Cancer Patients with Thyroidectomy", Asian Oncology Nursing, Vol. 15, No. 2, pp. 59-66, 2015. DOI: http://dx.doi.org/10.5388/aon.2015.15.2.59
  22. J. Easley, B. Miedema, L. Robinson, "It's the "Good" Cancer, So Who Cares? Perceived Lack of Support Among Young Thyroid Cancer Survivors", Oncol Nurs Forum, Vol. 40, No. 6, pp. 596-600, 2013. DOI: https://doi.org/10.1188/13.ONF.596-600
  23. S. H. Yoo, K. S. Choi, "Changes in Quality of Life and Related Factors in Thyroid Cancer Patients with Radioactive Iodine Remnant Ablation", Journal of Korean Acad Nurs, Vol. 43, No. 6, pp. 801-811, 2013. DOI: http://dx.doi.org/10.4040/jkan.2013.43.6.801
  24. JD. Harrison, JM. Young, MA. Price, PN. Butow, MJ. Solomon, "What are the unmet supportive care needs of people with cancer? A systematic review", Support Care Cancer, Vol. 17, pp. 1117-1128, 2009. https://doi.org/10.1007/s00520-009-0615-5
  25. J. Angst, A. Gamma, W. Rossler, V. Ajdacic, DN. Klein, "Long-term depression versus episodic major depression: results from the prospective Zurich study of a community sample", Journal of Affect Disord, Vol. 115, pp. 112-121, 2009. DOI: https://doi.org/10.1016/j.jad.2008.09.023
  26. PB. Jacobsen, HS. Jim, "Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges", Journal of Clin Oncol, Vol. 58, pp. 214-230, 2008. DOI: https://doi.org/10.3322/CA.2008.0003
  27. EM. Richardson, JL. Scott, N. Schuz, K. Sanderson, B. Schuz, "Qualitatively Comparing the Support Needs of People with Cancer Based on Their History of Anxiety/Depression", Onco Targets Ther, Vol. 5, No. 1, pp. 41-51, 2017. DOI: https://doi.org/10.2337/dc07-S096
  28. J. E. Kim, Impact of fatigue on quality of life in patients with thyroid cancer after total thyroidectomy: the effectiveness of physical activity, Unpublished Master's Thesis, Yonsei University, Seoul, 2015.