Transcription

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5 ⅰ ⅲ ⅲ ⅳ I II III IV i -

6 1) 16 2) ) 22 2) V FACT-BMT 33 VI ii -

7 <Table 1> Demographics Characteristics of the Patients 7 1 <Table 2> Medical Characteristics of the Patients 91 <Table 3> Comparison of Quality of Life after HSCT 12 <Table 4> Quality of Life according to Demographics Characteristics of the Patients 23 <Table 5> Quality of Life according to Medical Characteristics of the Patients 5 2 <Table 6> Education Need after HSCT 27 < 1> IRB 44 < 2> FACT-BMT(version 4) 46 < 3> FACT-BMT(version 4) Scoring Guidelines 48 < 4> 50 - iii -

8 ,. S 3, Functional Assessment of Cancer Therapy-BMT Scale(FACT-BMT) version 4 FACT-BMT 37 FACT-BMT 50 SPSS 15.0 Win Program t-test, one-way ANOVA, Scheffé test. 1) 3 1 ~3. (FACT-BMT 37 F=3.54, p=.031, FACT-BMT 50 F=3.23, p=.042) 2), (FACT-BMT 37 t=3.07, p=.003, FACT-BMT 50 t=3.04, p=.003) (FACT-BMT 37 F=8.93, p<.001, FACT-BMT 50 F=8.68, p<.001), (FACT-BMT 37 F=3.55, p=.031, FACT-BMT 50 F=3.64, p=.028), (FACT-BMT 37 F=5.50, p=.001, FACT-BMT 50 F=4.89, p=.003), (FACT-BMT 37 F=5.59, p=.001, FACT-BMT 50 F=4.93, p=.003). 3), (FACT-BMT 37 F=15.41, p<.001, FACT-BMT 50 F=14.58, p<.001), - iv -

9 (FACT-BMT 37 F=21.95, p<.001, FACT-BMT 50 F=20.76, p<.001). 4) 89.4%,,.. 5) FACT-BMT(version 4) FACT-BMT 37 FACT-BMT ,,,,,,,.,. - v -

10 I. 1., (, 1999)., 1983, ,561. 5,617 (59%), 3,944 (41%)..,,, (Lee & Kim, 2008).,,,,,,,,.,,, (Andrykowski, et al., 2005; Buchsel, Leum, & Randolph, 1996; Velikova et al., 2007; Wong, et al., 2010).,, (, 1998; Molassiotis & Moris, 1998)., 1, 3-1 -

11 . 1 (Heinonen, et al., 2001; Marks, Gale, Venhara, & Bird, 1999; Syrjala, Chapko, Vitaliano, Cummings, & Sullivan, 1993), 3 (Hensel, Egerer, Schneeweiss, Goldschmidt & Ho, 2002; Sutherland et al., 1997; Syrjala, et al., 2004; Wong, et al., 2010), 1 4 (Bush, Donaldson, Haberman, Dacanay, & Sullivan, 2000).., (, 2003) 1, 3, 5 (2006)., (, 2004;, 2002;,, &, 2008;, 2009;, 2006).,,,, (King, Haberman & Berry, 1997; Lee E. H., et al., 2002). (Wulff, Pederson, & Rosenberg, 1986), (, 2007). (, 2002;, 2006;, 2007;, 2001; Andrykowski, et al., 2005; Andrykowski, Henslee, & Barnett, 1989; Hensel, et al., 2002; Molassiotis, Boughton, Burgoyne, & Akker, 1995; Pidala, Anasetti, & Jim, 2009; Syrjala, et al, 1993),., - 2 -

12 ). 2). 3). 4) FACT-BMT

13 3.. 1) - : ( ) (, 1994). - : 20 1.,,. 2) - :, (Padilla, Ferrell, Grant, & Rhiner, 1990). - : Functional Assessment of Cancer Therapy -BMT Scale(FACT-BMT; McQuellon et al,, 1997) FACT-BMT. FACT-BMT Scoring Guidelines 37 (FACT-BMT 37 ), 50 (FACT-BMT 50 )

14 II. 1. (Ferrell, Wisdom, & Wenzl, 1989) (Johanna, & Ferdinand, 1985). Ragsdale, Kotarba Marrow (1992). (Gastron-Johansson & Foxall, 1996; Molassiotis, et al.,1996; Belec, 1992). (1988),, (2001)... Ferrell (1989),,, Padilla (1990),. Molassiotis Morris(1999),,, Andrykowski Bruehl (1995),,. Bush, Habermand, Donaldson - 5 -

15 Sullivan (1995),,., Ferrell, Grant, Schmidt, Rhiner, Whitehead (1992a, 1992b) 119,,,.,, ;, ;, ;,. (1998) 32,,,,, ;,, ;, ;,,. Molassiotis Morris(1998) 28,,,,,,,. (2001) 101,,,,,.,,, ; - 6 -

16 ,, ;,, ;.,,

17 2.,,. (Hacker, 2003).,,., (, 2007). European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30: EORTC QLQ C-30) the City of Hope quantitative - BMT instrument: COH QOL-BMT), Functional Assessment of Cancer Therapy-Bone Marrow Transplant Module(FACT-BMT). EORTC QLQ-C (,,, ) (,, ),. Aaronson (1993) COH QOL-BMT Ferrell (1992a, 1992b)

18 Grant (1992). 30, Whedon, Stearns, & Mills(1995), 62.,, Cronbach s alpha.95,.91,.92,.83,.75. FACT-BMT McQuellon (1997). Bone Marrow Transplant Subscale(BMTS) ,, 100. FACT-BMT Scoring Guidelines ~.89., /,,,. Kopp (2000) 56 EROTIC QLQ-C30 FACT-BMT. FACT-BMT EROTIC QLQ-C30. EROTIC QLQ-C30, FACT-BMT,. FACT-BMT (Yoo, H. J., et al, 2006). FACT-BMT FACIT(Functional Assessment of Chronic Illness Therapy). 70 FACT-BMT(version4) 7, / 7, 6, 7, , 3, 6, 1-9 -

19 . Cronbach s alpha.83. (.64) Cronbach s alpha.70. (2001) Cronbach s alpha.90,.82,.67,.87,.77.. (2001), (, 2004;, 2007) FACT-BMT. (2001) FACT-BMT,,,,, 51 5, FACT-BMT,,,, 50 5., FACT-BMT., FACT-BMT. FACT-BMT.. FACT-BMT 50. FACT-BMT Scoring Guidelines 37 (FACT-BMT 37 ), 50 (FACT-BMT 50 )

20 3.,. (Molassiotis & Morris, 1998).,. (, 2007; Andrykowski, 1995; Molassiotis & Morris, 1999), (, 2002;, 2007;, 2009;, 2006), (, 2009; Ferrell, 1992a), (Andrykowski, 1995; Baker, 1994; Bieri, 2008; Heinonen, 2001; Schmidt, 1993), (, 2002;, 2008;, 2001;, 2006; Andrykowski, 1995; Bieri, 2008; Hjermstad & Kaasa, 1995; Molassiotis, 1995, 1999).,,, (Hjermstad & Kaasa, 1995). (, 2004;, 2002;, 2008;, 2007;, 2009; Andrykowski, 1995; Molassiotis, 1995, 1999; Wong, 2010), (, 2002;, 2007; Andrykowski, 1990; Heinonen, 2001; Wong, 2010), (, 2007). (, 2007;, 2009; Andrykowski, 1995; Watson, 2004; Wong, 2010; Zittoun, Achard Ruszniewski, 1999), (, 2009), (Pallua, 2010), (, 2001; Baker, 1994; Chiodi, 2000; Diez-Campelo, 2004; Ferrell & Whedon, 1994; Pallua, 2010; Piadala, 2009; Wong, 2010), (, 2002), (, 2002;, 2008;, 2007;, 2006), (, 2002;, 2006; Andrykowski, 1995;

21 Molassiotis, 1999), (, 2006). (, 2004;, 2007;, 2001; Andrykowski, 1989; Belec, 1992; Bush, 2000; Hensel, 2002; Sutherland, 1997; Syrjala, 1993)., 1 (Heinonen, 2001; Mark, 1999; McQuellen, 1998; Syrjala, 1993). Syrjala (1993) McQuellen (1998) 1. Mark (1999) %. Heinonen (2001) 109 1, 1 51% 1 81%. 3 (Bush, 2000; Hensel, 2002; Sutherland, 1997; Syrjala, 2004; Wong, 2010). Sutherland (1997) ,. Bush (2000) Hensel (2002) Syrjala (2004)

22 . Wong(2010) % 3. (2003) (2006). 18, 42 National Conference on Cancer Nursing (1988), , 3, 5,

23 III S.. 1) 2) 20 3) 3 4) 1 3 1, 1 3, 3. Cohen(1988).05, 3, 80%

24 IRB,. 180, ,,,. FACT-BMT(version 4). FACIT Team FACT-BMT. FACT-BMT 7, / 7, 6, 7, FACIT Team FACT-BMT Scoring Guidelines , FACT-BMT (, 2004;, 2007) 50. FACT-BMT 37 FACT-BMT 50 (PWB : Physical Well-Being) 7, / 7 (SWB : Social Well-Being), (EWB : Emotional Well-Being) 6 (FWB : Funtional Well-Being) 7. FACT-BMT 37 (AC : Additional Concerns) (BMTS : Bone Marro Transplnat Subscale) 37, FACT-BMT

25 FACT-BMT Scoring Guidelines 37 (FACT-BMT 37 ) (, 2004;, 2007) 50 (FACT-BMT 50 ). (2004) (2007) Cronbach s alpha Cronbach s alpha SPSS 15.0 Win Program. 1),. 2) 3 ~ 1, 1 ~ 3, 3 (one-way ANOVA). 3) t-test (one-way ANOVA), scheffé test

26 IV. 1. 1) <Table 1>. 58.8%, 41.7 (±11.86). 53.8%, 66.9%, 61.9%, 5.61 (10 ). 58.1%, 4 (2.5%) 60 (37.5%) %

27 <Table 1> Demographics Characteristics of the Patients (N=160) Variable Category n(%) Mean±SD Gender Male 94(58.8) Female 66(41.2) Age(year) 41.7±11.86 Education level Below Middle school 17(10.6) High school 57(35.6) Above College 86(53.8) Marital status Single 45(28.1) Married 107(66.9) Other 8( 5.0) Religion Yes 99(61.9) No 61(38.1) Perceived religious status 5.61±3.36 Economic status High Level 25(15.6) Middle Level 93(58.1) Low Level 42(26.3) Job before Employed 99(61.9) transplantation Unemployed 4( 2.5) Housewife 31(19.4) Student 26(16.3) Job after Employed 55(34.4) transplantation Unemployed 60(37.5) Housewife 37(23.1) Student 8( 5.0) Business return(year) <1 23(41.8) 1~2 16(29.1) 2~3 7(12.7) 4 9(16.4)

28 2) <Table 2> (±27.17), (±39.79), (±12.29). 46.3%, 24.4%. 50.6%, 36.3%, 2.59 (±1.85), 1.84 (±2.40). 47, 39 CMV. 39.4%

29 <Table 2> Medical Characteristics of the Patients (N=160) Variable Category n(%) Mean±SD Post-Transplantation duration(month) 30.58±27.17 Diagnosed duration(month) 43.55±39.79 Age at Transplantation (year) 39.18±12.29 Post-Transplantation <1 54(33.8) Duration(year) 1~3 53(33.1) > 3 53(33.1) Diagnosis Acute Myeloid Leukemia 74(46.3) Acute Lymphoid Leukemia 39(24.4) Myeolo-Dyplastic Syndrome 19(11.9) Severe Aplastic Anemia 12( 7.5) Multiple Myeloma 6( 3.8) Chronic Myeloid Leukemia 4( 2.5) Lymphoma 2( 1.3) Other 4( 2.5) Type of Transplantation Unrelated 58(36.3) Allogeneic sibling 81(50.6) Autologous 16(10.0) Familial Mismatched 5( 3.1) Source of Peripheral 90(56.3) Transplantation Bone Marrow 68(42.5) Periphral +Bone Marrow 2( 1.3) HLA match Full-match 141(88.1) Major-mismatch 11( 6.9) Minor-mismatch 3( 1.9) Haploid 5( 3.1) Pre-Transplantation Chemotherapy times 2.59±1.85 Total Body Irradiation Yes 111(69.4) No 49(30.6) GVHD experience Present 24(15.0) Past 63(39.4) Past + Present 33(20.6) No experience 40(25.0) Present cgvhd Limited 7( 4.4) Extensive 50(31.3) None 103(64.4) Readmission times 1.84±2.40 Readmission reasons GVHD 47 CMV 39 Fever 25 Pneumonia 9 Other

30 2. <Table 3>. BMTS(Bone marrow transplant subscale), FACT-BMT 37, AC(Additional Concerns) FACT-BMT 50., BMTS ~3 (p<.001), FACT-BMT ~3 (p=.031), AC ~3 (p=.001), FACT-BMT ~3 (p=.042)., /,,

31 <Table 3> Comparison of Quality of Life after HSCT (N=160) Variable <1 yr (a) 1~3yr (b) > 3yr (c) Mean±SD total F (p) Scheffé Physical Well-Being 3.06± ± ± ±0.71 Social/Family Well-Being 2.55± ± ± ±0.77 Emotional Well-Being 3.02± ± ± ±0.69 Functional Well-Being 2.23± ± ± ±0.92 FACT-BMT ± ± ± ±0.58 Bone Maroow Transplant Subscale 2.34± ± ± ±0.70 FACT-BMT ± ± ± ±0.56 Additional Concerns 2.61± ± ± ± (.056) 0.84 (.433) 2.46 (.089) 2.21 (.089) 3.54 (.031*) 9.30 (<.001**) 3.23 (.042*) 7.66 (.001**) c>b c>a,b c>b c>a,b *p<0.05, **p<0.01. HSCT, hematopoietic stem cell transplantation; FACT-BMT, Functional Assessment of Cancer Therapy-Bone Marrow Transplant Module

32 3. 1) <Table 4>. FACT-BMT 37,,,,., (p=.003),,, (p<.001), (p=.031), (p=.001), (p=.001). FACT-BMT 50,,,,., (p=.003),,, (p<.001), (p=.028), (p=.003), (p=.003)

33 <Table 4> Quality of Life according to Demographics Characteristics of the Patients FACT-BMT 37 FACT-BMT 50 Variable Category n(%) F or t F or t Mean±SD Mean±SD (p) (p) Gender Male 94(58.8) 2.78± ± Education Female 66(41.3) 2.50±0.60 (.003*) 2.54±0.57 (.003*) Below Middle school 17(10.6) 2.48± ± High school 57(35.6) 2.70±0.53 (.386) 2.74±0.50 (.383) Above College 86(53.8) 2.67± ±0.58 Marital Single(a) 45(28.1) 2.79± ± status Married(b) 107(66.9) 2.66±0.56 (<.001**) 2.71±0.54 (<.001**) Other(c) 8( 5.0) 1.89±0.57 a,b>c 1.96±0.54 a,b>c Religion Yes 99(61.9) 2.65± ± No 61(38.1) 2.67±0.53 (.878) 2.71±0.51 (.884) Economic High level(a) 25(15.6) 2.88± ± status Middle level(b) 93(58.1) 2.67±0.55 (.031*) 2.72±0.53 (.028*) Job before T Job after T Business return (year) Low leve(c) 42(26.3) 2.50±0.62 a>c 2.54±0.59 a>c Employed(a) 99(61.9) 2.74± ± Unemployed(b) 4( 2.5) 2.05±0.70 (.001**) 2.14±0.69 (.003**) Housewife(c) 31(19.4) 2.37±0.58 a,d>c 2.44±0.57 a>c Student(d) 26(16.3) 2.80± ±0.58 (N=160) Employed(a) 55(34.4) 2.88± ± Unemployed(b) 60(37.5) 2.53±0.62 (.001**) 2.58±0.60 (.003**) Housewife(c) 37(23.1) 2.49±0.58 a>b,c 2.54±0.56 a>b,c Student(d) 8( 5.0) 2.90± ±0.35 <1 23(41.8) 2.90± ± ~2 16(29.1) 3.07±0.34 (.292) 3.08±0.33 (.273) 2~3 7(12.7) 3.08± ± (16.4) 2.76± ±0.52 *p<0.05, **p<0.01. FACT-BMT, Functional Assessment of Cancer Therapy-Bone Marrow Transplant Module; T, Transplantation

34 2) <Table 5>. FACT-BMT 37,,., 3 1~3 (p=.031),, (p<.001), (p<.001). FACT-BMT 50,,., 3 1~3 (p=.042),, (p<.001), (p<.001)

35 <Table 5> Quality of Life according to Medical Characteristics of the Patients (N=160) FACT-BMT 37 FACT-BMT 50 Variable Category n(%) F or t F or t Mean±SD Mean±SD (p) (p) Acute Myeolid Leukemia 74(46.3) 2.69± ±0.52 Acute Lymphoid Leukemia 39(24.4) 2.68± ±0.65 Myelo Dysplastic 19(11.9) 2.61± ±0.57 Syndrome Diagnosis Severe Aplastic 12(7.5) 2.65±0.59 Anemia (.961) 2.68±0.56 (.967) Multiple Myeloma 6(3.8) 2.73± ±0.39 Chronic Myeloid Leukemia 4(2.5) 2.35± ±0.73 Lymphoma 2(1.3) 2.68± ±1.30 Other 4(2.5) 2.46± ±0.49 Unrelated 58(36.3) 2.65± ±0.59 Type of Allogeneic sibling 81(50.6) 2.62± ± Transplanta Autologous 16(10.0) 2.85±0.48 (.489) 2.87±0.46 (.532) tion Familial 5(3.1) 2.81± ±0.37 mismatched Peripheral 90(56.3) 2.68± ±0.57 Source of BoneMarrow 68(42.5) 2.62± ± Transplanta Periphral (.302) (.279) tion 2(1.3) 3.24± ±0.37 +Bonemarrow Full-match 141(88.1) 2.65± ±0.57 HLA Major-mismatch 11(6.9) 2.67± ± match Minor-mismatch 3(1.9) 3.04±0.59 (.636) 3.08±0.57 (.591) Haploid 5(3.1) 2.81± ±0.37 Total Body Yes 111(69.4) 2.63± ± Irradiation No 49(30.6) 2.72±0.56 (.372) 2.76±0.54 (.338) Present(a) 24(15.0) 2.41± ±0.56 GVHD Past(b) 63(39.4) 2.89± ± (<.001**) (<.001**) Experience Past +Present(c) 33(20.6) 2.22±0.55 b,d>a,c 2.28±0.54 b,d>a,c No experience(d) 40(25.0) 2.81± ±0.40 limited(a) 7(4.4) 2.41±0.28 Present ± extensive(b) 50(31.3) 2.28±0.59 (<.001**) 2.34±0.58 (<.001**) cgvhd None(c) 103(64.4) 2.86±0.49 c>b 2.89±0.47 c>b Readmission Yes 114(71.3) 2.62± ± No 46(28.7) 2.76±0.53 (.173) 2.80±0.51 (.171) *p<0.05, **p<0.01. FACT-BMT, Functional Assessment of Cancer Therapy-Bone Marrow Transplant module; HLA, human leukocyte antigen; cgvhd, chronic graft-versus host disease

36 4. <Table 6>., 89.4%. 1 (50.0%), (24.1%), (14.8%), 1 ~3 (39.6%), (30.2%), (18.9%), 3 (39.6%), (24.5%), (22.6%). (46.3%) (38.1%)

37 <Table 6> Education Need after HSCT (N=160) Variable Category <1 yr (n=54) 1~3yr (n=53) > 3yr (n=53) Total (n=160) n(%) Education Very useful 25(46.3) 29(54.7) 22(41.5) 76(47.5) satisfaction Useful 22(40.7) 21(39.6) 24(45.3) 67(41.9) Moderate 7(13.0) 3(5.7) 7(13.2) 17(10.6) Desirable Physical 27(50.0) 21(39.6) 21(39.6) 69(43.1) education Psycho 8(14.8) 16(30.2) 12(22.6) 36(22.5) content Diet 13(24.1) 10(18.9) 13(24.5) 36(22.5) Business or School return 6(11.1) 4(7.5) 5(9.4) 15(11.5) Sexual 0(0.0) 2(3.8) 1(1.9) 3(1.9) Other 0(0.0) 0(0.0) 1(1.9) 1(0.6) Desirable Expert education counseling 26(48.1) 24(45.3) 24(45.3) 74(46.3) method Sending leaflet 23(42.6) 18(34.0) 20(37.7) 61(38.1) Surviva's meeting 3(5.6) 4(7.5) 3(5.7) 10(6.3) Open lecture 2(3.7) 5(9.4) 3(5.7) 10(6.3) Other 0(0.0) 2(3.8) 3(5.7) 5(3.1)

38 V.,.,. 1., 3 1 1~3. (2006).. Sutherland (1997), 3,,. Bush (2000) Hensel (2002) 3 6. Syrjala (2004) 3 5. HLA, 88.1% HLA,,. Deeg (2001) HLA

39 1~3.. 1/3, 3 3 3,,,

40 2... Molassiotis (1999). (, 2002;, 2006;, 2001; Sutherland, 1997).,,,,,, 8 (2007),, /,,,. (, 2004),. (, 2004;, 2002; 2006;, 2009; Andrykowski, 1995; Molassiotis, 1995, 1999). (1998). (, 2002; 2006;, 2001;, 2006; Andrykowski, 1995; Molassiotis, 1995, 1999).. Marks (1999) 20 1, 75%

41 % %,.,,,. (, 2004;, 2002;, 2006;, 2001; 2007; Belec, 1992; Bush, et al., 2000; Hensel, et al., 2002; Syrjala, 1993; Sutherland, et al.,1997)., Chiodi (2000) (2001). Baker (1994),. Pallua (2010) Wolcott (1986) (2006) Belec(1992).. (, 2002; Byar, 2005) Andrykowski (1995) (2006)

42 3.., 89.4%. 43.1%, 22.5%. 1, 1 ~3, 3 1, %, 38.1%.,,.,,,.,,

43 4. FACT-BMT FACT-BMT(version4). FACT-BMT Scoring Guidelines 37 (FACT-BMT 37 ) (, 2004;, 2007) 50 (FACT-BMT 50 ). 3 BMTS(Bone marrow transplant subscale), FACT-BMT 37, AC(Additional Concerns) FACT-BMT 50., /,,. FACT-BMT(version4), FACT-BMT Scoring Guideline (FACT-BMT 37 ) (FACT-BMT 50 )., FACT-BMT 37,. FACT-BMT 50,

44 VI. 1.,. S Fuctional Assessment of Cancer Therapy-BMT Scale(FACT-BMT) version 4.. 1) 3 1 ~3., /,,. 2),,,,,. 3),,,. 4),,,. 5),, HLA match,,. 6) 89.4%,,

45 . 7) FACT-BMT(version 4) FACT-BMT 37 FACT-BMT 50. 3,, /,, ). 2). 3)

46 (2004).,,.. (1994).. (1999). :.. (2002)... (2006)... (1988)... (2003)...,, (2007).., 9(1), (2009)... (1998).., 28(3), (2001)... (2007).., 37(3), (2006)... (1988)

47 Aaronson, N. K, Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. Journal of the Nationlal Cancer Institute, 85(5), Andrykowski, M. A., Bishop, M. M., Hahn, E. A., Cella, D. F., Beaumont, J. L., Brady, M. J., et al. (2005). Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. Journal of Clinical Oncology, 23(3), Andrykowski, M. A., Bruehl S., Brady M. J. & Henslee-Downey, P. J. (1995). Physical and psychosocial status of adults one-year after bone marrow transplantation: a prospective study. Bone Marrow Transplantation, 14, Andrykowski, M. A., Henslee, P. J. & Barnett, R. L. (1989). Longitudinal assessment of psychosocial functioning of adult survivors of allogeneic bone marrow transplantation. Bone Marrow Transplantation, 4, Baker, F., Winqard, J. R., Curbow, B., Zabora, J., Jodrey D., Foqarty, L., et al. (1994). Quality of life of bone marrow transplant long-term survivors. Bone Marrow Transplantation, 13, Belec, R. H. (1992). Quality of life: Perceptions of long-term survivors of bone marrow transplantation. Oncology Nursing Forum, 19, Bieri, S., Roosnek, E., Helg, C., Verholen, F., Robert, D., Chapuis, B., et al. (2008). Quality of life and social integration after allogeneic hematopoietic SCT, Bone Marrow Transplant, 42(12), Buchsel, R. C., Leum, E. W. & Randolph, S. R. (1996). Delayed complications of bone marrow transplantation : An update. Oncology Nursing Forum, 23(8),

48 Bush, N. E., Donaldson, G. W., Haberman, M. H., Dacanay, R. & Sullivan, K. M. (2000). Conditional and unconditional estimation of multidimensional quality of life after hematopoietic stem cell transplantation: a longitudinal follow-up of 415 patients. Blood Marrow Transplant. 6, Bush, N. E., Haberman, M., Donaldson, G. & Sullivan, K. M. (1995). Quality of life of 125 adults surviving 6 18 years after bone marrow transplantation. Social Science and Medicine, 40, Byar, K. L., Eilers, J. E. & Nuss, S. L. (2005). Quality of life 5 or more years post-autologous hematopoietic stem cell transplant. Cancer Nursing, 28, Chiodi, S., Spinell, S., Ravera G, Petti, A. R., van Lint, M. T., Lamparell, T., et al. (2000). Quality of life in 244 recipients of allogeneic bone marrow transplantation. British Journal of Hematology, 110, Cohen, J. (1988). Statistical power analysis for the behavioral sciences: L. Erlbaum Associates. Deeg, H. J., Amylon, M. D., Harris, R. E., Collins, R., Beatty, P. G., Feig, S., et al. (2001). Marrow transplants from unrelated donors for patients with aplastic anemia: minimum effective dose of total body irradiation. Biology of Blood and Marrow Transplantation, 7(4), Diez-Campelo, M., Perez-Simon, J. A., Gonzalez-Porras, J. R., Garcia-Cecilia, J. M., Salinero, M., Caballero, M. D., et al. (2004). Quality of life assessment in patients undergoing reduced intensity conditioning allogeneic as compared to autologous transplantation : result of a prospective study. Bone Marrow Transplantation, 34, Ferrell, B., Grant, M., Schmidt, G. M., Rhiner, M., Whitehead, C., Fonbuena, P., et al. (1992a). The meaning of quality of life for bone marrow transplant survivors : Part 1. The impact of bone marrow transplant on quality of

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51 overall quality of life in 50 long-term survivors of autologous and allogeneic bone marrow transplantation. Journal of Advanced Nursing, 22, Molassiotis, A. & Morris, P. J. (1998). The meaning of quality of life and the effects of unrelated donor bone marrow transplants for chronic myeloid leukemia in adult long-term survivors. Cancer Nursing, 21(3), Molassiotis, A. & Morris, P. J. (1999). Quality of life in patients with chronic myeloid leukemia after unrelated donor bone marrow transplantation. Cancer Nursing, 22(5), Molassiotis. A., van den Akker, O. B., Milliqan, D. W., Goldman J. M., Bouqhton, B. J., Holmes J. A., et al. (1996). Quality of life in long-term survivors of marrow transplantation: comparison with a matched group receiving maintenance chemotherapy. Bone Marrow Transplantation, 17, Padilla, G. V., Ferrell, B. R., Grant, M. M., & Rhiner, M. (1990). Defining the content domain of quality of life for cancer patients with pain. Cancer Nursing, 13(2), Pallua S, Giesinger J, Oberguggenberger A, Kemmler G, Nachbaur D, Clausen J, et al. (2010). Impact of GVHD on quality of life in long-term survivors of haematopoietic transplantation, Bone Marrow Transplant, 45(10), Pidala, J., Anasetti, C., Jim, H. (2009). Quality of life after allogeneic hematopoietic cell transplantation, Blood, 114(1), Ragsdale, D., Kotarba, J. A., & Morrow, J. R. (1992). Quality of life of hospitalized persons with autoimmune deficiency syndrome, Image. Journal of Nursing scholarship, 2, Schmidt, G. M., Niland, J. C., Forman S. J., Fonbuena P. P., Dagis A. C., Grant M. M., et al. (1993). Extended follow-up in 212 long-term allogeneic bone marrow transplant survivors. Transplantation, 55(3), Sutherland, H. J., Fyles, G. M., Adams, G., Hao, Y., Lipton, J. H., Minden, M. D., et al. (1997). Quality of life following bone marrow transplantation : A comparison of

52 patient reports with population norms. Bone Marrow transplant, 19, Syrjala, K. L., Chapko, M. K., Vitaliano, P. P., Cummings, C., & Sullivan, K. M. (1993). Recovery after allogeneic marrow transplantation: prospective study of predictors of long-term physical and psychosocial functioning. Bone Marrow Transplant., 11, Syrjala, K. L, Langer, S. L, Abrams, J. R., Storer, B, Sanders, J. E., Flowers, M. E., et al. (2004). Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma, The Jornal of the American Medication Association, 291(19), Velikova, G., Weis, J.. Hjermstad M. J., Kopp, M., Morris, P., Watson, M., et al. (2007). The EORTC QLQ-HDC29: a supplementary module assessing the quality of life during and after high-dose chemotherapy and stem cell transplantation., European Journal of Cancer, 43(1), Watson, M., Buck, G., Wheatley, K., Homewood, J. R., Goldstone, A. H., Rees, J. K., et al. (2004). Adverse impact of bone marrow transplantation on quality of life in acute myeloid leukemia patients : analysis of the UK Medical Research Council AML 10 trial. European Journal of Cancer, 40, Whedon, M., Stearns, D., & Mills, L. E. (1995). Quality of life of long-term adult survivors of autologous bone marrow transplantation. Oncology Nursing Forum, 22(10), Wolcott, D. L., Wellisch, D. K., Fawzy, F. I. & Landsverk, J. (1986). Adaptation of adult bone marrow transplant recipient long-term survivors. Transplantation, 41(4), Wong, F. L., Francisco, L., Togawa, K., Bosworth, A., Gonzales, M., Hanby, C., et al. (2010). Long-term recovery after hematopoietic cell transplantation: predictors of quality-of-life concerns. Blood, 115(12), Wulff, H. R., Pedersen, S. & Rosenberg, R. (1986). Philosophy in medicine: An introduction. Oxford: Blackwell Scientific Publication

53 Yoo, H. J., Lee, K. H., Lee, J. H., Sonya, E., Choi, S. J., Kim, H., et al. (2006). Korean translation and validity of FACT-BMT version 4 and the quality of life in allogeneic bone marrow transplantation patients. Quality of Life Research, 15, Zittoun, R., Achard, S. & Ruszniewski, M. (1999). Assessment of quality of life during intensive chemotherapy or bone marrow transplantation. Psyco-Oncology, 8,

54 < 1> IRB

55 - 46 -

56 < 2> FACT-BMT(version 4)

57 - 48 -

58 < 3> FACT-BMT(version 4) Scoring Guidelines

59 - 50 -

60 < 4>? BMT ( ).,.,.,... : 2011 : ( ) : : raphaela@catholic.ac.kr

61 Ⅰ.. 7. 지난 7 일동안에 전혀 그렇지 않다 그렇지 않다 보통 이다 꽤 그렇다 매우 그렇다 1 슬프다. 2 내가병에대처해나가는방법에만족한다. 3 병과의싸움에서희망을잃고있다. 4 불안하고초조하다. 5 죽음에대해걱정이된다 내상태가더나빠질까봐걱정이다. 나는일을할수있다. ( 집안일포함 ) 나의하는일 ( 집안일포함 ) 에서성취감을느낀다. 9 삶을즐길수있다. 10 내병을받아들였다. 11 잠을잘잔다. 12 평소에재미로하는일들을즐겁 게한다. 13 지금의삶의질에만족하고있다. 14 기운이없다. 15 속이메슥거린다. 16 몸상태때문에가족의요구를들 어주는데어려움이있다. 17 통증이있다. 18 치료의부작용때문에괴롭다. ~

62 지난 7일동안에 19 몸이아픈느낌이다. 전혀 그렇지 않다 그렇지 않다 보통 이다 꽤 그렇다 매우 그렇다 20 자리 ( 침대 ) 에누워있어야만한다. 21 친구들과가깝게느껴진다. 22 정서적으로가족의따뜻한보살핌 을받는다. 23 친구들로부터도움을받는다. 24 내가족들은내병을받아들였다. 내병에대한가족과의대화에만 25 족한다. 배우자와가깝게느낀다. ( 배우자 26 가없는경우는나에게가장많은도움을주는사람 ) * 현재당신의성생활정도와상관없이 ( 성생활을하고있든, 하고있지않든간에 ), 아래질문에답해주십시오. 만약답하고싶지않 27 으면다음질문으로넘어가주십시오. 성생활에만족한다. 28 근무를계속할수있을지가걱정된다. ( 집안일포함 ) 29 다른사람과멀어지는느낌이다. 30 이식받은것이제대로기능하지않을까봐걱정이된다. 31 내가생각했던것보다치료효과가더나쁘다. ~

63 지난 7일동안에 32 식욕이좋다. 전혀 그렇지 않다 그렇지 않다 보통 이다 꽤 그렇다 매우 그렇다 33 내몸의모습이마음에든다. 34 나혼자서도잘다닐수있다. 35 쉽게피로하다. 36 섹스에대해흥미가있다. 37 아이를가질수있을지걱정이된다. 38 담당간호사를신뢰한다. 39 골수이식받은것을후회한다. 40 여러가지일을기억할수있다. 41 나는어떤일 ( 예를들면독서와같은일 ) 에집중할수있다. 42 나는자주감기에걸린다. ( 감염된다.) 43 눈이침침하다. 44 식성 ( 미각 ) 이변하여괴롭다. 45 몸이떨리는증상이있다. 46 숨이찰때가있다. 47 가려움증때문에괴롭다. 48 변보기가어렵다. 49 내병으로인해나의가까운가족이곤란을겪는다. 50 치료비가부담이된다. ~

64 Ⅱ : 2. : 3. : 4. : 5. : 1)? ( O.).. (,,, ) 2)? (0 ~ 10.) ? : 1) ( ) 2) ( ) ~

65 8. (.)? 6 6 ~ 1 1 ~ 2 2 ~ 3 3 ~ ) ( )? )? (.) / (. ) 3)? (.) (. )

66 Group1.( 3 ~1 ) Group2.( 1 ~3 ) Group3.( 3 ) NO. Ⅲ ( ) 2. : 3. : 4. : 5. : 1) Type / 2) Source 1 PB 2 BM 3 Cord 4 3) HLA match 1 Full-match 2 Major mismatch 3 Minor mismatch 4 Haploid 6. : 7.? ) ) 1 Limited 2 Extensive 3 None

67 9. 1). 2). : 1 2 : ) ) CMV ) ) )

68 <ABSTRACT> Quality of Life for Hematopoietic Stem Cell Transplantation Recipients Throughout Recovery Trajectory Her, Sook Department of Oncology Nursing Care Graduate School of Nursing Yonsei University This study aimed to describe and compare quality of life (QOL) throughout the recovery trajectory after hematopoietic stem cell transplantation (HSCT) for patients with hematologic disorders. This study utilized a cross-sectional descriptive comparative research design with 160 patients who had received HSCT at a single center in Seoul, Korea. The research applied a Functional Assessment of Cancer Therapy-BMT Scale (FACT-BMT),Version 4. It consisted of 50 items (FACT-BMT 50) including 37 core items (FACT-BMT 37) intended to measure QOL. Data were analyzed with descriptive statistics, T-test, and one-way ANOVA using SPSS The results were as follows: 1) The 3 years or more group had a better quality of life compared to the

69 year and 1-3 years after HSCT groups. 2) Gender, marital status, economic status, job before transplantation and job after transplantation were correlated with quality of life. 3) Experience of GVHD and present status of GVHD were correlated with quality of life. 4) The participants were satisfied with their present education status. However, they wanted more physical symptom management as well as diet and psychological symptom counseling. They noted that they preferred expert counseling and sending leaflets as educational methods. 5) FACT-BMT 37 questionnaires and FACT-BMT 50 questionnaires were similar for assessing HSCT recipients quality of life. In conclusion, the study found that the major factors influencing QOL after HSCT were gender, marital and economic status, experience of GVHD and whether the patients had a job before and after HSCT. Another factor was whether the patients suffered from GVHD at the time of study. According to the results, most HSCT recipients were interested in their physical symptom management. They also wanted to be individually and professionally educated by experts and/or receive educational material continuously. To improve QOL of HSCT recipients, development of nursing intervention and multidimensional support programs is needed