接受乳癌相關手術婦女之患肩功能變化及相關因素探討

Exploring the Changes and Correlates of Shoulder Function in Females Receiving Breast Cancer-related Surgery

背景：乳癌術後婦女之患肩功能恢復不理想，過往探討乳癌術後婦女接受治療期間患肩功能變化及相關因素之研究較為缺乏，可協助乳癌婦女改善術後患肩功能之具體建議非常有限。目的：檢視接受乳癌相關手術婦女術後三個月內患肩功能、癌症相關症狀及手臂運動促進感受的變化，並探討與其術後患肩功能相關之因素。方法：本研究採縱貫性研究設計，研究對象為初次診斷為I-III 期乳癌且首次接受乳癌手術之婦女。本研究完成71位乳癌婦女手術前一天、術後第一個月、第二個月及第三個月的資料收集，四次資料收集皆包含結構式問卷填寫及患肩關節外展活動角度測量（患肩功能）。資料分析包含描述性統計、重複測量變異數分析(repeatedmeasures ANOVA)、t檢定(t-test)、皮爾森相關分析(Pearson correlation)及廣義估計方程式(Generalized EstimatingEquation, GEE)模式。結果：研究對象於術後三個月之患肩關節外展活動角度（患肩功能）隨時間改善，但術後第三個月之表現仍比術前差，研究對象於術後第三個月之癌症整體相關症狀平均得分顯著高於其他時間點，手臂運動促進利益感受得分於術後第三個月顯著高於術後第二個月。術後三個月內之乳癌婦女中，未接受化學治療、疲倦程度愈低、手臂運動促進利益感受愈佳、能規則執行手臂運動者，其患肩功能愈佳。結論：健康照護者需細心且持續監測及處理乳癌術後婦女接受治療期間的患肩功能、癌症相關症狀、手臂運動感受及手臂運動執行狀況，針對可調整之因素提供相關措施，以協助改善乳癌婦女術後之患肩功能。

Background:Recovery of affected shoulder function in females receiving breast cancer-related surgery isinadequate. Information related to the changes and correlates of affected shoulder function for females receiving breastcancer-related surgery is lacking. Feasible recommendations to improve affected shoulder function for femalesreceiving breast cancer-related surgery are limited. Aims:The purpose of the study was to examine the changes inshoulder function at the affected side, cancer-related symptoms and perceptions of arm exercise, and to explore possiblecorrelates of affected shoulder function during the first three months after surgery in a sample of females receivingbreast cancer-related surgery. Methods:This study was a longitudinal study consisting of 71 females all newlydiagnosed with breast cancer (I-III) and receiving their initial breast cancer-related surgeries. Related information wascollected by a structured questionnaire at four time points: at one day before surgery, and at the ends of the 1st, 2nd, and3rd months after surgery. At the four data collection points, participants’ shoulder abduction angles (shoulder function)at the affected side were measured. Data analyses included descriptive statistics, repeated measures ANOVA, t-test,Pearson correlation, and Generalized Estimating Equation (GEE) model. Results:During the first three months aftersurgery, participants’ shoulder abduction levels (shoulder function) improved over time. However, participants’ shoulderfunction at the 3rd month after surgery could not achieve to pre-surgery levels. Overall cancer-related symptoms peakedat the 3rd month after surgery. The perceived benefits of arm exercise at the 3rd month after surgery was significantlymore positive than that at the 2nd month after surgery. Participants who did not receive chemotherapy, who experiencedless fatigue, who perceived more benefits of arm exercise, and who performed arm exercise regularly were more likelyto have positive changes in the affected shoulder function during the first 3 months after surgery. Conclusions: Forfemales receiving breast cancer-related surgery and undergoing active treatment, healthcare providers need to cautiouslymonitor and manage participants’ shoulder function at the affected side, cancer-related symptoms, perceptions of armexercise, and conditions of performing arm exercise. Related interventions focusing on modifiable correlates could beprovided to improve the recovery of the affected shoulder function.