Meme cerrahisi sonrası adjuvan tedavi almış meme kanserli kadınlarda psikoseksüel durum ve vücut imajı açısından yaşam kalitesi analizi
Küçük Resim Yok
Tarih
2002
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
ÖZET: Giriş ve Amaç: Meme kanserli kadınlarda, kanser tanısını almanın yanında tam ve tedavi amacıyla geçirdikleri cerrahiler nedeniyle vücutlarında oluşan şekil bozuklukları, eklenen adjuvan tedaviler ve bunlara bağlı gelişen yan etkiler, hissedilen endişe ve korku gibi bir çok stres faktörü bulunmaktadır. Tüm bunlar hastayı etkilemekte ve yaşam kalitesini, sosyal, fiziksel, fonksiyonel, psikolojik açıdan bozmaktadır. Bu çalışmanın amacı; meme kanseri nedeniyle meme cerrahisi sonrası adjuvan radyoterapi ve/veya kemoterapi ve/veya hormonoterapi uygulanmış kadınlarda; mastektomi ile meme koruyucu cerrahinin (MKC), yaşam kalitesinin önemli iki parametresi olan vücut imajı ve psikoseksüel durum açısından karşılaştırmasıdır. Gereç ve Yöntem: Tedavileri, Dokuz Eylül Meme Tümörleri Grubu meme karsinomu tedavi protokolüne uygun olarak planlanan 112 hasta değerlendirilmiştir. Hastaların tümü, meme cerrahisi sonrası adjuvan radyoterapi ve/veya kemoterapi ve/veya hormonoterapi almıştır. Tanıdan itibaren en az 24 aylık takibi olan, yerel-bölgesel ve uzak yinelemesi olmayan ve soru formunu yanıtlamayı kabul eden hastalar çalışmaya dahil edilmiştir. Kullanılan soru formu; hasta ve tedavi özelliklerini, vücut imajım ve seksüel değişiklikleri irdeleyen 42 sorudan oluşmaktadır. İstatistiksel analizler "SPSS for Windows version 10.0" bilgisayar programı yardımıyla Ki Kare testi, Student's t testi, Cox Regresyon testi kullanılarak yapılmıştır. Bulgular: Toplam 112 hastanın, yaş gruplarına göre dağılımları; 16 hasta 20-39 yaş (%14), 77 hasta 40-59 yaş (%69), 19 hasta 60 yaş (%17) üzeri şeklindedir. Cerrahi öncesi, %57 hasta premenopozal, %5 hasta perimenopozal, %38 hasta postmenapozal evrededir. Analiz sırasında, %20 hasta premenopozal, %80 hasta postmenopozal evrededir. Elli bir hastaya mastektomi (%46), 61 hastaya MKC uygulanmıştır (%54).Tüm hastalara cerrahi sonrası radyoterapi ve/veya kemoterapi ve/veya hormonoterapi uygulanmıştır. Psikoseksüel disfonksiyon değerlendirmesinde, sorulan yanıtlayan cinsel aktif hastaların %41'i benzer psikoseksüel sorunların cerrahi öncesinde de var olduğunu, %59'u ise cerrahi öncesi herhangi bir sorunları olmadığını belirtmişlerdir. Cerrahi öncesinde psikoseksüel sorunları olan %24 hasta cerrahiden sonra sorunlarının daha çok artığım belirtmişlerdir. Sonradan gelişen psikoseksüel disfonksiyonlar hastaların %55'inde cerrahi, % 24'ünde kemoterapi ve % l'inde radyoterapi sonrası gelişmiştir. Cinsel yaşamını cerrahi öncesi "iyi" olarak ifade eden %53 hastanın %39'u, cerrahi sonrası dönemi "orta" veya "yetersiz" olarak tanımlamaktadır. Tek ve çok değişkenli analizde, mastektomi uygulanması (p=0.043) ve menopozal durum (p=0.024) cinsel istekte azalma üzerine istatistiksel anlamlı olarak etkili bulunmuştur. Vücut imajım değerlendiren sorularda mastektomi uygulanan kadınlar, MKC uygulanan kadınlara kıyasla, kendilerini istatistiksel anlamlı olarak daha az çekici bulduklarını belirtmişlerdir (p=0.03). Sonuç: Meme kanserli kadınların yaşam kalitesi, operasyon tipinin, cinsel istekte azalma ve vücudunu çekici bulma üzerine olan negatif etkisi nedeniyle etkilenmektedir. Elde edilen sonuçlar, hasta sayısının kısıtlılığı ve örneklemin ülkenin sınırlı bir bölgesinden sağlanmış olması nedeniyle toplum geneline uyarlanamaz. Bununla birlikte; uygun olan hasta grubuna, meme koruyucu tedavi yaklaşımı önerilerek hastaların vücut imajı ve psikoseksüel durum açısından yaşam kalitesi daha çok korunabilir. Ayrıca, multidisipliner tedavi gruplarına, konu ile ilgili belirli birikimi olan psikolog ve psikiyatristlerin de dahil edilmesiyle de, hasta psikolojisinin daha tedavi başında profesyonelce desteklenmesi ile daha iyi yaşam kalitesi sağlanabilir. Anahtar kelimeler: Meme kanseri, yaşam kalitesi, vücut imajı, psikoseksüalite
SUMMARY: Introduction and aim: There are several factors why a patient with a diagnosis of breast cancer can become distressed. These include the diagnosis itself, a change in body image due to surgery, adjuvant therapy and their complications as well as anxiety and fear. All these factors can effect the patients social, physical, functional and psychological quality of life. The aim of this study was to compare the body image and psycho-sexual aspects of quality of life in patients with a diagnosis of breast cancer treated with either mastectomy followed by adjuvant radiotherapy with or without chemotherapy/ hormonotherapy to a group of patients who underwent breast conserving surgery and radiotherapy with or without chemotherapy/ hormonotherapy. Patients and methods: The study group consisted of 112 patients who underwent all treatment at Dokuz Eylül University under the care of the breast tumour group. Following surgery all patients underwent adjuvant radiotherapy with or without chemo / hormontherapy. The minimum follow-up period was 24 months and none had local or distant metastases. Basic patient treatment related factors were collected. The patients completed a questionnaire consisting of 42 questions related to their body image and sexual functioning. Analysis was performed using "SPSS for Windows version 10.0". For comparison between groups we used the chi squared test, Student's t test and Cox regression. Results: Of the 1 12 patients 16 (14%), were aged between 20-39 years, 77 (69%) 40- 59 years and 19 (17%) over 60 years. Prior to surgery 57% of patients were pre menopausal, 5% peri -menopausal and 385 post-menopausal. At the time of the present study, 20% pre-menopausal and 80% post-menopausal. Fifty-one patients (46%) had undergone mastectomy and 61 (54%) breast conserving surgery. All patients receivedadjuvant radiotherapy with or without chemo/hormonotherapy after surgery. Forty-one percent of sexually active patients who completed all questions had psycho-sexual dysfunction prior to surgery. In 24% of these patients the problems increased following surgery. In the 59% of patients who had no psycho-sexual dysfunction prior to surgery problems developed in 55% following surgery, 24% following chemotherpy and 1% following radiotherapy. Prior to surgery 53% of patients evaluated their sexual activity as good. Of these 53%, 39% evaluated their sexual activity as only medium or unsatisfactory following surgery. In univariate analysis the loss of sexual desire was significantly higher compared to the breast conserving group (p=0.043). In addition there was also a significant difference in the loss of sexual desire when comparing pre and post menopausal patients (p=0.024). In multivariate analysis menopausal status and type of surgery remained significant factors affecting loss of sexual desire (p<0.05). Women who had undergone mastectomy felt less attractive compared to those who had undergone breast conserving surgery (p=0.03). Conclusion: The type of surgery has a significant impact on the loss of sexual desire and alterations in a womens body image. However, due to the small sample size and limited geographical area from which the sample population was drawn it is difficult to generalise these conclusions to all patients. Body image and psychosexual aspects of quality of life problems can ce avoided by the offering breast conserving treatment whenever possible. However, this study does highlight the need for psychological and psychiatric support for this group of patients which should be intergrated into the multidisciplinary team aproach to treatment of breast cancer. Key words: Breast cancer, quality of life, body image, psychosexuallity 10 BotfUMCIASW* W»
SUMMARY: Introduction and aim: There are several factors why a patient with a diagnosis of breast cancer can become distressed. These include the diagnosis itself, a change in body image due to surgery, adjuvant therapy and their complications as well as anxiety and fear. All these factors can effect the patients social, physical, functional and psychological quality of life. The aim of this study was to compare the body image and psycho-sexual aspects of quality of life in patients with a diagnosis of breast cancer treated with either mastectomy followed by adjuvant radiotherapy with or without chemotherapy/ hormonotherapy to a group of patients who underwent breast conserving surgery and radiotherapy with or without chemotherapy/ hormonotherapy. Patients and methods: The study group consisted of 112 patients who underwent all treatment at Dokuz Eylül University under the care of the breast tumour group. Following surgery all patients underwent adjuvant radiotherapy with or without chemo / hormontherapy. The minimum follow-up period was 24 months and none had local or distant metastases. Basic patient treatment related factors were collected. The patients completed a questionnaire consisting of 42 questions related to their body image and sexual functioning. Analysis was performed using "SPSS for Windows version 10.0". For comparison between groups we used the chi squared test, Student's t test and Cox regression. Results: Of the 1 12 patients 16 (14%), were aged between 20-39 years, 77 (69%) 40- 59 years and 19 (17%) over 60 years. Prior to surgery 57% of patients were pre menopausal, 5% peri -menopausal and 385 post-menopausal. At the time of the present study, 20% pre-menopausal and 80% post-menopausal. Fifty-one patients (46%) had undergone mastectomy and 61 (54%) breast conserving surgery. All patients receivedadjuvant radiotherapy with or without chemo/hormonotherapy after surgery. Forty-one percent of sexually active patients who completed all questions had psycho-sexual dysfunction prior to surgery. In 24% of these patients the problems increased following surgery. In the 59% of patients who had no psycho-sexual dysfunction prior to surgery problems developed in 55% following surgery, 24% following chemotherpy and 1% following radiotherapy. Prior to surgery 53% of patients evaluated their sexual activity as good. Of these 53%, 39% evaluated their sexual activity as only medium or unsatisfactory following surgery. In univariate analysis the loss of sexual desire was significantly higher compared to the breast conserving group (p=0.043). In addition there was also a significant difference in the loss of sexual desire when comparing pre and post menopausal patients (p=0.024). In multivariate analysis menopausal status and type of surgery remained significant factors affecting loss of sexual desire (p<0.05). Women who had undergone mastectomy felt less attractive compared to those who had undergone breast conserving surgery (p=0.03). Conclusion: The type of surgery has a significant impact on the loss of sexual desire and alterations in a womens body image. However, due to the small sample size and limited geographical area from which the sample population was drawn it is difficult to generalise these conclusions to all patients. Body image and psychosexual aspects of quality of life problems can ce avoided by the offering breast conserving treatment whenever possible. However, this study does highlight the need for psychological and psychiatric support for this group of patients which should be intergrated into the multidisciplinary team aproach to treatment of breast cancer. Key words: Breast cancer, quality of life, body image, psychosexuallity 10 BotfUMCIASW* W»
Açıklama
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Anahtar Kelimeler
Onkoloji, Oncology, Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
