Cancer patients' mental health and family functioning-a longitudinal study on psychosocial factors among breast cancer survivors and their family members-

背景：我们已经报道，在早期乳腺癌患者中，家庭功能，特别是相互沟通不良，与癌症的负面心理适应显著相关。然而，很少有研究探讨遭受复发风险不确定性的乳腺癌幸存者在无病期间心理适应的变化，以及家庭功能与这些变化的相关性。研究目的：探讨乳腺癌幸存者在无病期间，在家庭功能等多种心理社会因素的影响下，心理适应的变化。方法：在广岛大学医院乳房收治所的72名乳腺癌患者中，研究对象为乳腺癌患者。研究的书面知情同意是从每个患者和她的丈夫那里获得的。研究对象在至少3个月(时间1)和3年后(时间2)完成癌症心理适应量表(MAC)、家庭功能评定量表(FAD)、Zung抑郁自评量表(SDS)和Zung焦虑自评量表(SAS)。结果：患者在时间1和时间2的家庭亲密度较高，抗争精神应对能力较弱，时间1较低的宿命主义应对方式与时间二较少的无助感/绝望感应对方式显著相关。结论：一种能够支持患者的希望思维，减少宿命性适应，促进家庭沟通和家庭凝聚力的家庭干预方法可能有助于维持精神应对，减少无助/绝望的应对。

BACKGROUND : We have reported that family functioning, especially poor mutual communication, significantly correlated with negative psychological adjustment to cancer among early-stage breast cancer patients. However, only few studies exists that investigate how mental adjustment changes during disease-free period of breast cancer survivors suffering from uncertainty of recurrence risk and how family functioning correlates with those changes.PURPOSE : To investigate how mental adjustment changes under the influence of diverse psychosocial factors such as family functioning during disease-free period of breast cancer survivors.METHODS : The subjects were 72 ambulatory breast cancer survivors after mastectomy at the Mammary Gland Dispensary of Hiroshima University Hospital. Documented informed consent for the study was obtained from each patient and her husband. The subjects completed the Mental Adjustment to Cancer scale(MAC), Family Assessment Device(FAD), the Zung Self-rating Depression Scale(SDS), and the Zung Self-rating Anxiety Scale(SAS) after interval of at least three months (Time 1) and three years later (Time 2). Husbands also completed FAD, SDS, and SAS at Time 1 and Time 2. At Time 2, 55 survivors and their husbands were eligible.RESULTS : Higher level of patient-perceived family cohesion at Time 1 significantly correlated with less reduction of Fighting Spirit coping at Time 2. Higher level of patient-perceived family communication and less Fatalism coping at Time 1 significantly correlated with less Helplessness/Hopelessness coping at Time 2.CONCLUSION : A family intervention approach which could support patients' hopeful thinking and diminish fatalistic adjustment, and could facilitate family communication and family cohesion might contribute for maintaining Fighting Spirit coping and reducing Helplessness/Hopelessness coping among breast cancer survivors,