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1 Korean Journal of Adult Nursing (Korean J Adult Nurs) Vol. 28 No. 2, , April 2016 ISSN (Print) / ISSN X (Online) 두경부암환자의우울과불안증상유무에따른증상의심각성 김현주 1 조옥희 2 유양숙 3 가톨릭대학교서울성모병원간호부 1, 공주대학교간호대학 2, 가톨릭대학교간호대학 3 Symptom Severity according to the Presence of Depressive and Anxiety Symptoms among Patients with Head and Neck Cancer Kim, Hyun-Joo 1 Cho, Ok-Hee 2 Yoo, Yang-Sook 2 1 Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 2 College of Nursing and Health, Kongju National University, Gongju 3 College of Nursing, The Catholic University of Korea, Seoul, Korea Purpose: The purpose of this study was to compare symptom severity and the impact of presence of depressive and/or anxiety symptoms among patients with head and neck cancer (HNC). Methods: One hundred and fifteen patients diagnosed with HNC completed two questionnaires: Hospital Anxiety and Depression Scale (HADS) and the M. D. Anderson Symptom Inventory-Head and Neck Cancer (MDASI-HN). Results: Of the total sample, 55.6% reported depressive symptoms and 33% reported anxiety symptoms. Patients who reported either depressive or anxiety symptoms also had significantly more severe symptoms. The most severe symptom was dry mouth. Participants who were depressed reported that interference in the enjoyment of life due to symptoms was the most distressing whereas participants with anxiety reported symptom interference in work was of most concern. Of patients reporting moderate to severe symptoms, more than 60% reported depressive symptoms. Of patients reporting moderate to severe feelings of being distress and feeling sad, more than 70% reported anxiety symptoms. Conclusion: Patients with HNC reporting moderate to severe symptoms also report depressive and/or anxiety symptoms. The results suggest the need to develop an integrated nursing intervention of both physical and emotional symptoms for patients with HNC. Key Words: Head and neck neoplasms, Symptom, Depression, Anxiety 서론 1. 연구의필요성 전세계적으로두경부암은남성에서 10 번째로흔한암이며, 입술이나구강암은말레이시아와인도등의남부아시아에서, 비인두암은동남아시아에서발생률이가장높은것으로나타나 [1] 나라마다차이를보이고있다. 1999년부터 2012년까지조사한결과에따르면우리나라두경부암의유병률은남자의경우 11,501명으로 10위를차지하였으며, 두경부암의발생률은증가 주요어 : 두경부암, 증상, 우울, 불안 Corresponding author: Yoo, Yang-Sook College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Secho-gu, Seoul , Korea. Tel: , Fax: , ysyoo@catholic.ac.kr Received: Jan 26, 2016 / Revised: Apr 6, 2016 / Accepted: Apr 18, 2016 This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. c Korean Korean Society Journal of of Adult Adult Nursing Nursing

2 두경부암환자의우울과불안증상유무에따른증상의심각성 하고있는추세이다 [2]. 두경부암은 90% 이상이편평상피세포암으로알코올과흡연의남용이위험요인으로알려져있는데 [3] 2013년우리나라성인남자의흡연율은 42.1%, 고위험음주량은 22.5% 로높으며, 성인여성의흡연율과고위험음주율도 2007년이후증가하여 [4] 앞으로도두경부암의발생률은증가할것으로예상되므로두경부암에대한이해와관심이필요하다. 암환자들은암진단에따른충격뿐만아니라암자체로인한증상및치료에따른부작용으로많은고통을경험한다. 특히두경부암은구강이나비인두, 구인두, 하인두, 후두, 부비동혹은타액선등씹고삼키고숨을쉬고말하는생리적기능이나맛보고냄새를맡는감각적기능을하는것은물론외모와같이미용적으로도중요한해부학적위치에발생하므로 [3] 환자들이질병이나치료과정에서경험하는신체적, 정신적고통이큰실정이다 [5]. 두경부암의치료는암이발생한부위를고려하여결정하지만초기병기인 1, 2기에는수술이나방사선치료중단독요법을시행하고, 진행된병기인 3, 4기에는일반적으로항암화학요법과방사선치료를병행하게된다 [3]. 두경부암환자들은치료를시작하기전에도질병과관련하여중등도이상의피로, 수면장애, 디스트레스, 통증등의증상을경험하지만 [6], 항암방사선병행치료를받는경우에는항암화학요법의부작용은물론방사선치료부위의피부손상과구내염, 구강건조, 미각의변화, 연하장애도경험한다 [7]. 이러한증상때문에환자들은음식물을섭취하는것은물론다른사람들과함께식사를나누면서상호작용하는데어려움을겪을수있다 [8]. 또한두경부암으로수술을받는환자는암이발생한부위에따라혀의일부나얼굴의구조를이루는뼈또는후두를절제하거나안구를적출하기도하는데, 이러한수술로인하여다른암수술과는달리감출수없는얼굴의기형이초래되거나목소리를상실하거나발음장애혹은연하장애와같은문제가발생하면사회적으로고립되기도한다 [9]. 두경부암환자가경험하는신체증상이잘조절되지않으면치료과정이지연되거나중단되기도하며, 병원재원기간이나의료비부담이증가하는등치료성과에부정적인영향을미치기도한다 [6]. 또한신체증상들은환자가불안하고우울한느낌을가지게하는데 [10], 암환자의우울과증상의심각성은질병의궤도를예측할때고려하는사항이되고있다 [11]. 선행연구에따르면두경부암환자의우울과불안은다른암환자보다높으며 [12], 특히우울은피로나수면장애와같은신체증상과기능상태, 인지능력및삶의질과관련이있는요인이었다 [5,13]. 그러므로환자가경험하는증상의심각성과그에 따른정서상태를파악하여중재하는것이필요하다. 암환자를대상으로하여우울유무에따라신체증상으로인한부담감을비교한선행연구 [11] 가있었으나두경부암환자의특수한증상을모두반영하지못하였으며, 진행된암환자를대상으로한연구 [10] 에서는신체증상과우울이나불안과의관련성이없었다. 또한지금까지국내간호학분야에서두경부암환자를대상으로우울이나불안정도에따라증상의심각성을파악한연구는미흡한실정이다. 이에본연구에서는두경부암환자의우울과불안유무에따라증상의심각도에차이가있는지를비교하고, 특히중등도이상의심한증상을경험하는환자중우울이나불안의발생률을조사하여앞으로두경부암환자의증상과정서상태를함께관리하는중재를개발하는데기초자료를마련하고자하였다. 연구방법 1. 연구설계 본연구는두경부암환자를대상으로우울이나불안유무에따른증상의심각성을파악하고특히중등도이상의증상을경험하는환자중우울이나불안의발생률을알아보기위한횡단적조사연구이다. 2. 연구대상대상자는서울시에소재한 C대학교 S병원에서두경부암으로진단을받고암병동에입원하거나암센터외래에서치료를받고있으며, 인지기능의손상이없어말이나글로의사소통할수있고, 본연구에참여하기로동의한 18세이상의환자였다. 정신과적병력이있거나현재정신과적약물을복용하고있는자는제외하였다. 두집단의평균차이를파악하는데필요한대상자의수는양측검정유의수준.05, 효과크기 0.6, 검정력 0.8로하여 G*Power 프로그램으로계산하였을때, 최소 90명이필요하였다. 탈락율을고려하여 119명을대상으로자료를수집하였으나응답내용이불충분한 4명을제외하여최종대상자는 115명이었다. 3. 연구도구 1) 증상두경부암환자가질병이나치료로경험하는다양한증상 Vol. 28 No. 2,

3 김현주 조옥희 유양숙 의심각성과그증상으로일상생활에서영향을받는정도는 M.D. Anderson Symptom Inventory-Head and Neck Cancer (MDASI-HN) 로측정하였다. 이도구는총 28문항으로, 공통핵심증상 (13 문항 ), 두경부암특수증상 (9 문항 ), 증상으로인한일상생활의방해 (6 문항 ) 로구성되어있다. 공통핵심증상과두경부암특수증상은증상이전혀없음은 0점부터매우심함은 10점으로응답하도록하였고, 증상으로인하여일상생활에방해를받는정도가전혀없음은 0점부터매우심함은 10점으로응답하도록하여점수가높을수록증상의정도와그로인하여영향을받는정도가심각한것을의미한다. 본연구에서는선행연구의결과에의거하여각각의증상이나증상으로인한영향의정도가 10 점만점에 5점이상인경우를중등도이상으로분류하였다 [6,14]. 이도구는두경부암환자가경험하는증상의정도와증상으로인하여일상생활에서지장을받는정도의심각성을측정하는데신뢰할수있다고승인된도구로 [14] 도구의신뢰도 Cronbach s 값은본연구에서.94였다. 2) 우울과불안우울과불안은한국어로표준화한병원불안-우울척도 (Hospital Anxiety-Depression Scale, HADS)[15] 를이용하여측정하였다. HADS는총 14문항의 4점척도로홀수문항 7 개는불안증상을, 짝수문항 7개는우울증상을측정하는것이다. 각문항에대하여없음 0점부터심함 3점까지응답하도록되어있으며, 점수의범위는 0~21점으로점수가높을수록우울이나불안증상의정도가높은것을의미한다. 본연구에서는선행연구결과를토대로하여우울이나불안증상의합이각각 8점이상인경우를우울군또는불안군으로분류하였다 [16,17]. 이도구는임상실무현장에서두경부암환자의우울과불안을 1차적으로선별하는데의미있는도구로 [16], 본연구에서도구의신뢰도 Cronbach s 값은우울증상이.91, 불안증상이.83이었다. 4. 자료수집 2012년 3월부터 2013년 6월까지종양전문간호사가병동에입원한두경부암환자는병동의면담실에서, 외래를방문한환자는암센터면담실에서 1:1로면담하여연구의목적을설명하여참여동의를받았으며, 설문지의내용과작성방법을설명한후환자가작성하도록하였다. 설문지작성에소요된시간은약 15분이었다. 5. 윤리적고려및자료분석본연구의내용과방법에대하여 C대학교 S병원에서 IRB 승인 (KC12QISI0065) 을받았으며, 수집된자료는 SAS 9.2 통계프로그램을이용하여분석하였다. 대상자의특성과우울및불안증상의정도는서술통계로제시하였으며, 우울이나불안증상유무에따른증상의심각성과일상생활에미치는방해정도는 t-test로비교하였다. 연구결과 1. 대상자의특성대상자 115명중 86.1% 가남자였으며, 평균연령은 56.6세였다. 84.4% 는배우자가있었으며, 66.1% 가종교가있었고, 고졸이상이 77.4% 였다. 암의발생부위는비인두를포함한인, 후두부위가 40.8% 로가장많았으며, 병기는 3기가 26.9 %, 4기가 57.4% 였다. 유병기간은 6개월이하가 43.5% 였고, 25개월이상이 29.5% 였으며, 방사선치료경험이있는경우가 79.1%, 항암화학요법경험이있는경우가 83.5% 였다. Karnofsky performance status scale로측정한환자의일상생활수행정도는평균 89.3% 였다 (Table 1). 3) 일상생활수행능력환자의일상생활수행능력은 Karnofsky performance status (KPS) 로측정하였다. KPS는암환자의신체적기능및도움이필요한정도를측정하는신뢰도와타당도가높은대표적인도구로불편한증상이없는정상 100% 에서죽음 0까지 10 단계로구성되어있다. 80~100% 는정상생활이가능한단계이고, 50~70% 는정상생활이불가능하고도움이필요한단계이며, 10~40% 는자기관리가불가능하고병원치료가필요하며질병이빠르게진행하는단계로분류할수있다 [18]. 2. 우울증상유무에따른증상의심각성비교우울군에해당하는환자는전체의 55.6%(64명 ) 였으며, 우울군환자는비우울군환자보다구토와구내염, 변비를제외한모든증상의정도가더심했다. 우울군환자가경험하는증상중정도가가장심한것은구강건조 (10점만점에 5.52점 ) 였고, 다음은피로 (5.00점), 연하곤란 (4.98점), 미각의변화 (4.95점), 식욕부진 (4.46점), 치아와잇몸의문제 (4.27점) 의순이었다. 또한우울군환자는비우울군환자보다증상때문에일상생활에 150 Korean Journal of Adult Nursing

4 두경부암환자의우울과불안증상유무에따른증상의심각성 Table 1. Demographic and Disease-related Characteristics of the Participants (N=115) Characteristics Categories n(%) or M±SD Age (year) 56.6±11.1 Gender Spouse Religion Education Occupation Monthly income (10,000 won) Cancer site Cancer stage Period since diagnosis (month) Treatment type Male Female Yes No Yes No Middle school High school College Disabled due to illness Employed Unemployed ~ Nasopharynx, larynx, pharynx Tonsil Oral cavity, tongue, salivary gland Nasal cavity, paranasal sinuses Other I II III IV 6 7~12 13~24 25~90 Operation (Yes) Radiation therapy (Yes) Chemotherapy (Yes) Symptomatic management (Yes) 99 (86.1) 16 (13.9) 97 (84.4) 18 (15.6) 76 (66.1) 39 (33.9) 26 (22.6) 50 (43.5) 39 (33.9) 36 (31.3) 44 (38.3) 35 (30.4) 25 (21.7) 60 (52.2) 30 (26.1) 47 (40.8) 26 (22.6) 24 (20.9) 14 (12.2) 4 (3.5) 11 (9.6) 7 (6.1) 31 (26.9) 66 (57.4) 50 (43.5) 20 (17.4) 11 (9.6) 34 (29.5) 62 (53.9) 91 (79.1) 96 (83.5) 8 (7.0) Karnofsky performance status (%) 89.3±10.9 Multiple response. 방해를받는정도가높았다. 우울군환자가증상으로인하여일상생활에방해를받는정도가가장심한것은삶을즐기는것 (6.23점) 이었으며, 다음은대인관계 (5.91점), 일 (5.89점), 일상활동 (5.69점) 순이었다 (Table 2). 3. 불안증상유무에따른증상의심각성비교불안군에해당하는환자는전체의 33.0%(38명 ) 였으며, 불안군환자는비불안군환자보다졸림이나구내염, 미각의변화, 연하곤란을제외한모든증상의정도가더심했다. 불안군환자가경험하는증상중가장심한것은구강건조 (10점만점에 5.83점 ) 였고, 다음은피로 (5.62점), 디스트레스 (5.50점), 슬픔 (5.38점), 수면장애 (5.05점) 와식욕부진 (5.05점) 의순이었다. 또한불안군환자는비불안군환자보다증상때문에일상생활에방해를받는정도가높았다. 불안군환자가신체증상때문에방해를받는정도가가장높은것은일 (6.93점) 이었으며, 다음은삶을즐기는것 (6.67점), 대인관계 (6.64점), 일상활동 (6.34 점 ) 순이었다 (Table 2). 4. 중등도이상의증상을경험하는환자중우울과불안증상의발생률호흡곤란의정도가 5점이상인환자는모두우울군에해당하였으며, 슬픔이나피부문제 ( 통증, 작열감, 발진등 ) 가 5점이상인환자의 80% 가우울군에속했고, 그외의증상도 5점이상인환자는 60% 이상이모두우울군이었다. 디스트레스나슬픔이 5점이상인환자의 70% 이상이불안군에해당하였으며, 통증이나피로, 오심, 수면장애, 식욕부진, 감각이상, 기침, 피부문제, 변비및인후통증상이각각 5점이상인환자중불안군에해당하는경우는각각 50% 이상이었다 (Figure 1). 논의 본연구의결과우울군에해당하는환자는 115명중 64명 (55.6%) 이었고, 불안군은 38명 (33.0%) 이었다. 이는본연구와동일한도구로측정한선행연구에서두경부암환자의 18~31 % 가우울군, 13~21% 가불안군이라고한결과보다높았다 [5, 16]. 선행연구에서두경부암이진행된병기일때우울정도가높았는데 [5] 본연구대상자의 84.3% 가 3,4기로진행된병기의환자이므로우울군에해당하는환자가상대적으로많았던것으로추정된다. 본연구에서우울군이나불안군에해당하는환자는우울이나불안증상이정상범위였던환자보다대부분의증상을경험하는정도와그로인한영향의심각성이더높았다. 이는암환자를대상으로한연구 [11], 두경부암환자를대상으로한연구 Vol. 28 No. 2,

5 김현주 조옥희 유양숙 Table 2. Symptom Severity according to the Presence of Depressive and Anxiety Symptoms (N=115) Symptom Core items Pain Fatigue Nausea Disturbed sleep Feeling of being distressed Shortness of breath Difficulty remembering Lack of appetite Feeling drowsy Having a dry mouth Feeling sad Vomiting Numbness or tingling Depressive symptoms Anxiety symptoms Yes (n=64) No (n=51) p Yes (n=38) No (n=77) M±SD M±SD M±SD M±SD 3.33± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±2.08 p Head and neck cancer specific items Problem with oral mucus Difficulty swallowing or chewing Choking or coughing Difficulty with voice or speech Skin pain/burning/rash Constipation Problem with tasting food Mouth/Throat sores Problem with teeth or gum 2.97± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± Interference items General activity Mood Work Relations with others Walking ability Enjoyment of life 5.69± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±3.05 [13], 방사선치료를받은비인두암환자를대상으로한연구 [19] 와방사선치료를받은구강암환자를대상으로한연구 [20] 에서증상의심각성과우울이관련이있다고한것과유사하였다. 그러나구내염은우울이나불안증상유무에따라차이가없었다. 구내염은치료와관련된급성증상으로 [7] 방사선치료를받은구강암이나구인두암환자가경험하는가장심각한증상이며 [21], 항암방사선치료를받는두경부암환자가경험하는일반적인부작용으로치료후 6개월안에거의회복이되는것으로알려져있다 [22,23]. 본연구의결과는구강암, 혀, 타액선암이전체의 20.9% 로낮고대상자의 56.5% 가진단후 6개월이상이었으므로구내염의심각성이 10점만점에 2.97점으로상대적으로낮았기때문으로추정된다. 그러나구내염을완화시키는약물이나중재등다른관련요인의영향이있었는지를분 석하고, 치료후경과기간에따라추적조사하는것이필요할것으로생각된다. 본연구에서연하곤란과미각의변화는우울군에서높았으나불안증상유무에따른차이는없었다. 연하곤란은치료후 1 년이지나도회복되지않는만성증상이며 [22,23], 미각문제도구강건조나연하곤란과마찬가지로치료후 5년까지도불편한문제로지속될수있어서 [9] 불안보다는우울을초래하는증상으로추정된다. 본연구의결과우울군과불안군모두심각성이가장높은증상은구강건조였는데, 이는선행연구 [13,19] 와유사하였다. 구강건조는방사선치료가끝난후에도장기간지속되는만성증상인데 [9,22] 본연구대상자의 79.1% 가방사선치료를받은경험이있었기때문으로추정된다. 구강건조는연하곤란과미각의변화와관련이있는데 [7], 이러한구강관련문제들은치료 152 Korean Journal of Adult Nursing

6 두경부암환자의우울과불안증상유무에따른증상의심각성 Figure 1. Occurrence of depressive and anxiety symptoms in moderate to severe symptoms. 후 5년까지장기간지속되면서체중감소와식습관의변화, 음식을맛보는즐거움의상실을초래하고 [8] 삶의질을저하시키는주요요인이므로 [9,22] 구강건조의불편감을완화시키는적극적인중재가필요하다. 최근방사선치료법이발달하면서이하선을보존하는세기조절방사선치료 (Intensity Modulated Radiation Therapy, IMRT) 로구강건조와관련된삶의질이향상되었다는연구결과가많았다 [24]. 그러나세기조절방사선치료법은고가의첨단장비를사용해야하므로치료가능한병원이제한적이고, 비용부담이크므로아직까지는일반적인치료법으로보기어려운실정이다. 그러므로임상실무현장에서구강건조로인한불편감을완화시키는근거중심의중재를개발하는것이필요하다고생각한다. 본연구에서우울군이나불안군환자가경험하는신체증상중구강건조다음으로심각한것은피로였다. 이는우울또는불안이있는환자가피로가심하다는선행연구와유사하였다 [11,13,19]. 피로는항암방사선병행치료를받는두경부암환자가경험하는심각한증상중의하나로 [7], 항암화학요법이나항암방사선병행치료후심각한피로를호소하는암환자가많았다 [25]. 본연구에서대상자의대부분이방사선치료 (79.1 %) 나항암화학요법 (83.5%) 을받은경험이있었던것도피로와관련이있을것으로추정된다. 암과관련된피로를완화시키기위한중재의효과에대하여메타분석한연구에서는운동프로그램이피로감소에효과적이라고제시하였으나 [26] 두경부암환자를대상으로피로를감소시키는중재를개발하여적용, 평 가한연구는거의없었다. 추후두경부암환자의피로를감소시키기위한중재프로그램을개발하고적용하여우울이나불안에영향을미치는지조사해보는것이필요하다고생각한다. 두경부암치료 1년후삶의질에대하여체계적으로고찰한연구 [24] 에서구강건조와피로는치료전수준으로회복되지않고악화되어삶의질에영향을미치는주요한요인이었으므로질병과정에서구강건조와피로에대하여지속적으로모니터링하고효과적인중재방안을모색하는것이필요한것으로판단된다. 본연구에서두경부암환자가경험하는증상이중등도이상 (10점만점에서 5점이상 ) 일때우울과불안의발생률을조사한결과호흡곤란이있는환자는 100% 가, 피부문제가있는환자는 80% 이상이, 그외중등도이상의증상이있는환자의 60% 이상이우울군에해당하였다. 호흡곤란은진행성암환자에게주로나타나는주관적인증상으로우울이나불안과같은정서상태와밀접한관계가있었다 [27]. 본연구에서중등도이상의호흡곤란을경험하는환자는모두우울군에해당하여호흡곤란을완화시키는것이중요하고도필요함을알수있었다. 피부문제는방사선치료를받은유방암이나전립선암, 회음부암, 두경부암환자가경험하는일반적인부작용으로알려져있는데, 초기에는발적이나가려움, 화끈거림, 건조함등의증상을보이지만시간이지나면서색소침착, 위축, 궤사, 모세혈관확장, 섬유성변화등의심각한증상을초래하기도한다 [28]. 두경부암환자가경험하는피부문제또한방사선치료와관련 Vol. 28 No. 2,

7 김현주 조옥희 유양숙 된부작용으로두경부암특수증상클러스트에포함되었다 [7]. 본연구에서피부문제가중등도이상인환자들은 80% 이상이우울군에해당하였으므로피부과의협진을통하여증상을빨리완화시키는것이중요하며환자의우울수준을함께평가하여적극적으로관리하는것이필요하다고생각한다. 본연구에서중등도이상의디스트레스나슬픔을경험하는환자의 70% 이상이불안군에해당하였다. 이는임상적으로높은수준의디스트레스는불안과같은정서상태와관련이있다고한선행연구와유사하였다 [29]. 이러한디스트레스는전반적인삶의질을저하시키고특히정서적영역의삶의질에부정적인영향을미치기때문에 [30] 환자가감정을표현하도록지지하고경청하며, 필요한정보를제공하고, 필요에따라정신의학과의뢰와상담및약물개입을고려하는것이필요하다. 본연구의결과에서두경부암환자의구강건조와피로는심각성이높았고우울증상이나불안증상유무에따라차이가있었으므로지속적인모니터링과집중적인관리가필요함을알수있었다. 또한호흡곤란과피부문제를포함한중등도이상의증상은우울이나불안의예측인자가될수있음을알수있었다. 그러므로두경부암환자의증상을적극적으로관리하고, 우울과불안증상을사정하여증상관리계획에포함시키는것이필요하다. 즉환자의상태를정기적으로관찰, 평가하여적절한시기에적극적으로증상을관리하고, 필요한정보및정서적지지를제공하며, 필요시정신건강의학과에의뢰하는등통합적인접근이필요하다. 그러나본연구의제한점은두경부암환자의증상이나우울및불안증상의유무를횡단적으로조사하였으므로그인과관계를정확하게파악하기어렵다는것과일개병원의환자만을대상으로하였다는것이다. 앞으로두경부암으로진단받은시점부터질병과정을통하여환자가경험하는증상과정서상태를종단적으로조사하는연구를제언한다. 결론및제언 본연구의의의는국내간호학분야에서연구가미흡했던두경부암환자를대상으로우울과불안증상유무에따라경험하는증상의정도를비교하고, 중등도이상의증상을경험하는환자의우울이나불안의발생률을조사한것이다. 본연구의결과우울군이나불안군환자는우울이나불안증상이없는환자보다경험하는증상의정도가심했으며, 이로인하여삶을즐기거나일을하거나대인관계, 일상활동이나기분, 걷기에서방해를받는정도가더심했다. 또한우울군이나불안 군에해당하는두경부암환자가경험하는증상중정도가가장심한것은구강건조와피로였으며, 중등도이상의증상을경험하는환자의 60% 이상이우울군에, 40% 이상이불안군에속하였다. 이를통하여두경부암환자의증상과정서상태를함께평가하고적극적으로중재하는것이필요함을알수있었다. 그러므로두경부암환자의치료와간호를제공하는다학제간의협력관계를통하여두경부암환자의신체적, 정서적증상을완화하고삶의질을향상시키기위한통합적인관리가필요하다. REFERENCES 1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. A Cancer of Journal for Clinicians. 2011;61(2): Jung KW, Won YJ, Kong HJ, Oh CM, Cho HS, Lee DH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in Cancer Research and Treatment. 2015;47(2): National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers version [Internet]. Washington: National Comprehensive Cancer Network; 2013 [cited 2013 September 4]. Available from: ines.asp 4. Statistics Korea. Korean Statistical Information Service [Internet]. Seoul: Statistics Korea.2013 [cited 2015 May 27]. Available from: _11702_N001&vw_cd=&list_id=&scrId=&seqNo=&lang_mo de=ko&obj_var_id=&itm_id=&conn_path=e1 5. Haisfield-Wolfe ME, McGuire DB, Soeken K, Geiger-Brown J, De Forge BR. Prevalence and correlates of depression among patients with head and neck cancer: a systematic review of implications for research. Oncology Nursing Forum. 2009;36(3): E Gunn GB, Mendoza TR, Fuller CD, Gning I, Frank SJ, Beadle BM, et al. High symptom burden prior to radiation therapy for head and neck cancer: a patient-reported outcomes study. Head & Neck. 2013;35(10): Xiao C, Hanlon A, Zhang Q, Ang K, Rosenthal DI, Nguyen-Tan PF, et al. Symptom clusters in patients with head and neck cancer receiving concurrent chemoradiotherapy. Oral Oncology. 2013;49(4): McQuestion M, Fitch M, Howell D. The changed meaning of food: physical, social and emotional loss for patients having received radiation treatment for head and neck cancer. Euro- 154 Korean Journal of Adult Nursing

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Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical