대한금연학회지 JKSRNT 2019;10(1):23-30 https://doi.org/10.25055/jksrnt.2019.10.1.23 Journal of the Korean Society for Research on Nicotine and Tobacco Original Article 성인암생존자의흡연양상과현재흡연관련요인 변정애 1,2 ㆍ양연수 1 ㆍ김희진 1, * 윤지은 1,3 ㆍ지선하 1 1 연세대학교보건대학원역학건강증진학과, 국민건강증진연구소, 2 인천남동구보건소, 3 한국보건의료연구원의료기술평가연구단 접수일 :2019 년 4 월 23 일수정일 :2019 년 6 월 13 일승인일 :2019 년 6 월 17 일 * 교신저자 : 김희진연세대학교보건대학원역학건강증진학과, 국민건강증진연구소서울시서대문구연세로 50-1 03722 Tel: 02-2228-1531 Fax: 02-365-5118 E-mail: heejink@yuhs.ac Adult Cancer Survivors Patterns of Smoking and Current Smoking-related Factors: Analysis on 2007-2011 Korea Medical Institute (KMI) Data Jung Ae Byun 1,2, Yeunsoo Yang 1, Heejin Kimm 1, *, Ji Eun Yun 1,3, Sun Ha Jee 1 1 Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, 2 Namdong Public Health Center, Incheon, 3 Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea Background: Cancer survivors have high risk of secondary cancer and diseases other than cancer. However, there are persistent smokers among them. This study aims to explore the tobacco use patterns and associated factors with current smoking among cancer survivors. Methods: The results of surveys and blood tests collected from the Korea Medical Institute (KMI) from 2007 through 2011 were used as data. The subjects of this study were 91,040 adults (59,132 men) aged 20-64, and they were divided into cancer survivor group (1,375 men, 671 women) and non-cancer counterparts according to their past history of cancer. Results: The current smoking rate of cancer survivors was lower than that of non-cancer survivors, but 33.53% of men and 2.53% of women among cancer survivors were still current smokers. In the cancer survivors, in men, the younger they were, the higher the risk of current smoking became (The odds ratio of smoking in those aged 20-39 to 51-64 was 2.47 while that of smoking in 40-50, 1.43); and that the odds ratio of smoking in persons in drinkers to non-drinkers, 2.80 (95% CI: 2.02-3.88). In women cancer survivors, the odds ratio of current smoking was 21.15 (95% CI: 2.72-164.35) in alcohol drinkers to non-drinkers. Conclusion: Young age in men and alcohol use in both men and women were important factors correlated with tobacco smoking among cancer survivors. Further research and policy is needed to support cancer survivors smoking cessation and health promotion. Key Words: Cancer survivors; Health behavior; Tobacco smoking; Alcohol drinking; Cross sectional studies Copyright c 2019 by Journal of the Korean Society for Research on Nicotine and Tobacco. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 배 경 국가암등록통계 (2016) 에의하면, 우리나라에서 2016 년 새로발생한암환자수는 229,180명으로 2015년 216,542명보다 12,638명 (5.8%) 증가하였다. 국가암등록사업결과에서, 2011-15 년발생한암환자의 5년상대생존율은 70.7% 로 23
JKSRNT Vol. 10, No. 1, Jun. 2019 1993-95년 41.2% 대비 29.5%p 증가하였고, 2001-05년 54.0% 대비 16.7%p 로지속적인향상이관찰되었다. 암발생증가와동시에사망보다암생존자 (Cancer survivor) 가증가하고있는것이다. 따라서이들의사망률에영향을미치는것으로알려진건강증진을위한건강행태개선및삶의질향상에대한관심이높아지고있다.(1) Mullan (1985) 은기존의 완치 라는표현대신, 현재치료중인사람을포함한 암생존자 라는표현을처음으로사용하였다. Aziz (2002) 는암생존자는 암진단후치료를받고있는사람부터치료후생존하고있는모든사람 들을말하며, 치료후부작용을겪고있는사람들도포함하여야한다고하였다.(1) Aziz 와 Rowland (2003) 는암생존자는치료과정중겪는신체적문제뿐만아니라경제적, 사회적, 정서적문제, 건강시스템의문제를겪기때문에이를고려해야한다고하였고,(2) 현재이든과거이든, 어떤종류의암이든, 앞으로진단받은후현재생존해있는모든사람으로여기에더이상치료가불가능하여점차악화되고있는말기암환자를포함한개념 으로서, 가족, 친구, 돌봄제공자를포함시키기도하였다.(3) 암생존자의흡연영향에대해보고된바에따르면, 흡연하는암생존자는흡연하지않는암생존자보다치료부작용이흔하고치료효과는낮았다. 생존율이낮고, 암재발율은높았으며, 2차원발암이많다.(4,5) 암생존자의흡연에대해, 특정암진단을받은사람들의흡연양상, 암진단전후흡연양상변화, 흡연관련요인이보고되었다. Demark- Wahnefried 등 (2000) 은유방암, 전립선암을진단받은사람들중 8% 는여전히현재흡연을하고있다고하였다.(6) 현재흡연자의 25% 는 30일이내금연을할의향이있고, 현재흡연자의 30% 는 6개월이내금연을할의향이있었으나, 50% 는금연을고려하지않았다. Mayne 등 (2009) 의연구에서는암생존자중흡연자의흡연기간이길고, 흡연량이많은사람이암사망률이높았다.(7) Bassett 등 (2012) 은방광암생존자중나이가많고, 백인이며, 결혼하지않고, 교육수준이낮은경우에현재흡연위험이높다고하였다.(8) 국내에서암생존자에대한연구는암생존자의사망률, 2 차원발암의위험요인, 자살가능성, 삶의질에대해조사되었으며, 건강행태및현재흡연관련요인에대해서도연구되었다. 그중에서도유방암생존자의삶의질에관한연구가상대적으로많았다. 암생존자는일반인에비해흡연과음주 를적게할가능성이높다는보고가있었고, 암생존자는흡연과음주를적게하나, 암생존자중 10% 에서는바람직하지않은건강행동을보였으며, 특히대장암환자들의현재흡연율이높았다 (26.6%) 는보고가있었다.(9,10) 양형국등 (2013) 은암생존자중여성, 미혼, 건강보험에가입이되어있지않은사람, 취직을안한사람, 음주를하는사람, 암의전이가되어있는사람, 폐암이아닌다른암에이환되어있는사람이현재흡연위험이높다고보고하였다. 그러나암생존자의흡연양상을보고한국내연구들은흡연을암생존자의여러건강문제중하나로다룬경우가많았고, 흡연의양, 기간, 연령, 금연기간에대한보고는찾기어려웠다. 이에이연구에서는한국인을대상으로암생존자의흡연양상과현재흡연과의관련요인을살펴보고자한다. 방법이연구는 2007-2011년도에한국의학연구소 (Korea Medical Institute, KMI) 의서울 3곳 ( 광화문, 여의도, 강남 ) 과지방 4곳 ( 수원, 대구, 부산, 광주 ) 건강검진센터검진센터를방문한내원자로서본연구에동의한 108,321명중 20세이상 65세미만의성인 91,040 명을대상으로하였다. 1. 신체계측몸무게와키는맨발과가벼운옷차림으로측정하였다. 체질량지수 (Body mass index, BMI) 는몸무게를키의제곱으로나눈값 (kg/m 2 ) 으로하였다. 수축기혈압과이완기혈압은자동혈압계를이용하여최소한 5분이상안정을취하고난뒤측정되었다. 2. 혈액검사혈액검사는대상자들이 12시간이상금식한상태에서채혈하여총콜레스테롤, 중성지방, HDL- 콜레스테롤, LDL- 콜레스테롤, 공복혈당, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) (Hitachi-7600 analyzer, Hitachi Ltd., Tokyo, Japan) 를측정하였다. 모든혈액검사는한국의학연구소중앙검사실에서측정되었다. 검사자료의내, 외부정도관리는대한임상검사정도관리협회의절차에준거하여유지되었다. 24
변정애외 : 성인암생존자의흡연양상과현재흡연관련요인 3. 설문조사설문지는 7개검진센터공통설문으로흡연력 ( 흡연여부, 일일흡연량, 흡연기간, 흡연시작연령, 금연연도, 금연기간, 과거흡연량, 과거흡연기간 ), 음주력 ( 음주여부, 주당음주횟수, 1회당음주량 ), 운동여부, 과거력 ( 암, 심장병, 뇌졸중, 당뇨병, 이상지질혈증등 ), 가족력등을포함하였다. 설문의과거력상에암과거력이있다고응답한경우를암생존자군으로정의하였다. 4. 분석방법분석은대상자를암과거력유무로나누어진행하였다. 암과거력유무에따른두집단의일반적특성, 흡연양상및건강행위양상을비교하기위해남녀에서백분율과, 평균의차를확인하고카이제곱검정, T검정을하였다. 전체대상자에서남녀의비흡연, 과거흡연에비해현재흡연의관련요인을확인하기위해암과거력, 연령, 체질량지수, 암가족력, 만성질환과거력, 음주, 신체활동을보정하여로지스틱회귀분석을시행하였다. 암생존자군에서현재흡연을종속변 Table 1. General characteristics of cancer survivor group and non-cancer group. Men (N=59,132) Women (N=31,908) Cancer survival Non-cancer Cancer survival Non-cancer group (N=1,375) group (N=57,757) P-value group (N=671) group (N=31,237) Mean±SD Mean±SD Mean±SD Mean±SD Age (years) 43.99±7.44 39.22±8.07 <0.0001 41.64±8.65 36.13±9.05 <0.0001 Body mass index (kg/m 2 ) 24.25±2.93 24.34±2.93 0.2458 22.20±3.16 21.53±2.94 <0.0001 Systolic blood pressure (mmhg) 120.60±12.14 120.40±12.47 0.4967 111.30±12.99 109.40±13.00 0.0002 Diastolic blood pressure (mmhg) 75.74±9.51 75.79±8.99 0.8434 69.86±9.11 68.83±8.85 0.0029 Fasting glucose (mg/dl) 94.31±14.97 91.30±19.51 <0.0001 89.05±13.44 85.48±12.88 <0.0001 Total cholesterol (mg/dl) 192.40±34.60 193.10±33.00 0.4999 189.70±34.18 180.60±31.15 <0.0001 HDL cholesterol (mg/dl) 49.81±10.78 48.60±8.15 <0.0001 59.94±12.84 57.67±9.85 <0.0001 LDL cholesterol (mg/dl) 111.90±31.34 115.20±32.23 0.0002 108.80±30.83 104.60±29.69 0.0004 Triglyceride (mg/dl) 160.40±112.10 160.90±102.00 0.8623 104.30±59.88 92.76±51.50 <0.0001 Aspartate aminotransferase (IU/L) 26.00±11.38 25.45±15.00 0.0801 21.15±7.07 19.29±10.12 <0.0001 Alanine aminotransferase (IU/L) 29.50±18.95 30.85±25.60 0.0097 19.28±13.05 15.96±12.53 <0.0001 N (%) N (%) N (%) N (%) Family history of cancer No 507 (36.87) 50,258 (87.02) <0.0001 352 (52.46) 27,463 (87.92) <0.0001 Yes 868 (63.13) 7,449 (12.98) 319 (47.54) 3,774 (12.08) Chronic disease history No 670 (48.73) 32,076 (55.54) <0.0001 497 (74.07) 26,120 (83.62) <0.0001 Yes 705 (51.27) 25,681 (44.46) 17 (25.93) 5,117 (16.38) Smoking status Non smoker 365 (26.55) 18,292 (31.67) <0.0001 629 (93.74) 28,888 (92.48) 0.0673 Former smoker 549 (39.93) 12,667 (21.93) 25 (3.73) 1,008 (3.23) Current smoker 461 (33.53) 26,798 (46.40) 17 (2.53) 1,341 (4.29) Alcohol consumption No 327 (23.94) 6,749 (11.69) <0.0001 410 (61.47) 13,592 (43.59) <0.0001 Yes 10,139 (76.06) 50,961 (88.31) 257 (38.53) 17,586 (56.41) Physical activity Yes 1,192 (88.36) 39,147 (68.08) <0.0001 490 (73.80) 13,533 (43.57) <0.0001 No 157 (11.64) 18,353 (31.92) 174 (26.20) 17,527 (56.43) Abbreviation: SD, standard deviation. Chronic disease history: Any history of hypertension, cerebrovascular accident, diabetes mellitus, dyslipidemia, or cardiovascular disease. P-value 25
JKSRNT Vol. 10, No. 1, Jun. 2019 수로하여비흡연, 과거흡연에비해현재흡연관련요인에대해연령, 체질량지수, 암가족력, 만성질환과거력, 음주, 신체활동을보정하여로지스틱회귀분석을시행하였다. 분석도구로는 SAS 9.2 version 을사용하고, 통계적인유의성검정은 P<0.05 인경우를기준으로설정하였다. 결과대상자 91,040명중남성이 59,132명 (64.95%), 여성이 31,908 명 (35.05%) 으로남성이많았다. 남성암생존자는연령, 공복혈당, HDL- 콜레스테롤의평균이비 ( 非 ) 암생존자보다유의하게높았으며, LDL- 콜레스테롤, ALT 의평균은유의하게낮았다. 체질량지수, 수축기혈압, 이완기혈압, 총콜레스테롤, 중성지방, AST 의평균은남성암생존자와비 ( 非 ) 암생존자간의유의한차이가없었다. 또한암생존자가비 ( 非 ) 암생존자보다암가족력, 만성질환과거력, 신체활동을하지않는분율이높았으나, 현재흡연율, 음주율은낮았다. 여성의경우암생존자는연령, 체질량지수, 수축기혈압, 이완기혈압, 공복혈당, 총콜레스테롤, 중성지방, HDL- 콜레스테롤, LDL- 콜레스테롤, AST, ALT 의평균이비 ( 非 ) 암생존자에비해통계적으로유의하게높았다. 또한여성암생존자는비 ( 非 ) 암생존자보다암가족력, 만성질환과거력, 신체활동의분율이높았으나, 현재흡연과음주율은낮았다 ( 표 1). 표 2는남녀암과거력유무에따른흡연, 음주, 신체활동양상을보여주고있다. 남성과거흡연자중암생존자는비 ( 非 ) 암생존자보다과거흡연율과흡연기간, 흡연량이유의하게많았다. 현재흡연자를비교하면, 남성암생존자는현재흡연율이비 ( 非 ) 암생존자에비해낮으며, 흡연기간이통계적으로유의하게길었다. 여성암생존자는비 ( 非 ) 암생존자에비해현재흡연율이낮고흡연시작연령도유의하게낮았다. 남녀암생존자는비 ( 非 ) 암생존자보다음주율이낮았으나, 주간음주빈도의평균은높았고, 1회음주량의평균은낮았다 (P<0.0001). 남녀암생존자는비 ( 非 ) 암생존자보다신체활동분율이높았고, 신체활동빈도와신체활동시간평 Table 2. Comparison of health behaviors between cancer survivor group and non-cancer group. Cancer survivor group (N=1,375) Men (N=59,132) Non-cancer group (N=57,757) P-value Cancer survivor group (N=671) Women (N=31,908) Non-cancer group (N=31,237) Smoking status Nonsmoker, N (%) 365 (26.55) 18,292 (31.67) <0.0001 629 (93.74) 28,888 (92.48) 0.0673 Former smoker, N (%) 549 (39.93) 12,667 (21.93) 25 (3.73) 1,008 (3.23) Duration of smoking, Mean±SD* 16.36±8.20 14.66±8.55 <0.0001 6.37±4.43 6.61±5.61 0.8375 Amount of smoking in a day, Mean±SD 15.51±7.84 14.57±7.38 0.0053 7.48±4.56 6.86±4.74 0.5578 Age of smoking, Mean±SD 20.73±2.85 20.59±3.34 0.7310-22.31±5.26 - Current smoker, N (%) 461 (33.53) 26,798 (46.40) 17 (2.53) 1,341 (4.29) Duration of smoking, Mean±SD (years) 19.89±7.56 16.98±7.48 <0.0001 9.65±4.95 9.37±5.83 0.8434 Amount of smoking, Mean±SD (cigarettes/day) 15.89±7.18 15.54±7.26 0.3131 7.35±4.44 8.10±5.33 0.5651 Age of smoking, Mean±SD (year) 21.15±3.34 20.73±3.58 0.2401 20.00±0.00 23.04±6.02 <0.0001 Alcohol consumption No, N (%) 327 (23.94) 6,749 (11.69) <0.0001 410 (61.47) 13,592 (43.59) <0.0001 Yes, N (%) 1,039 (76.06) 50,961 (88.31) 257 (38.53) 17,586 (56.41) Frequency of drinking in a week, Mean±SD 1.87±1.25 1.29±1.15 <0.0001 1.31±1.20 0.78±0.79 <0.0001 Amount of drinking, Mean±SD (number of 6.88±4.22 7.71±4.21 <0.0001 3.06±2.16 3.76±3.12 <0.0001 drinks/session) Physical activity No, N (%) 157 (11.64) 18,353 (31.92) <0.0001 174 (26.20) 17,527 (56.43) <0.0001 Yes, N (%) 1,192 (88.36) 39,147 (68.08) 490 (73.80) 13,533 (43.57) Frequency of physical activity in a week, Mean±SD 2.41±1.61 2.22±1.31 <0.0001 2.82±1.74 2.37±1.45 <0.0001 Minutes of physical activity in one time, Mean±SD 15.26±11.60 0.00±0.10 <0.0001 14.20±12.69 0.00±0.30 <0.0001 P-value 26
변정애외 : 성인암생존자의흡연양상과현재흡연관련요인 균또한높았으나 14-15 분으로짧았다 (P<0.0001) ( 표 2). 전체대상로지스틱회귀분석에서, 남성은암생존자가비 ( 非 ) 암생존자에비해현재흡연을할위험이 0.69 배 (95% CI: 0.62-0.78) 로낮았다. 51-64 세연령군에비해젊은연령에서현재흡연의위험이높았다 (P<0.0001). 만성질환과거력을갖고있는사람이흡연할오즈비는만성질환과거력이없는경우에비해 1.29 배높았고, 음주를하는경우, 신체활동을하지않는경우현재흡연할위험이높았다 (P< 0.0001). 여성은암생존자가비 ( 非 ) 암생존자에비해현재흡연할위험이 0.79 로낮았으나유의하지않았다. 음주를하는경우 (OR=3.42, 95% CI: 2.95-3.95), 신체활동을하지않는경우 (OR=1.14, 95% CI: 1.02-1.28) 현재흡연할위험이높았다 ( 표 3). 암생존자의비흡연, 과거흡연에비해현재흡연의관련요인을보면, 남성은 51-64 세연령군에비해그이하의연령대에서현재흡연의위험이높았다 (P<0.0001). 만성질환과거력자가흡연할오즈비는만성질환과거력이없는경우에비해 1.37 배높았고, 음주자, 신체활동을하지않는경우현재흡연위험이높았다 (P<0.0001). 음주를하는여성은현재흡연의위험도가유의하게높았다 (OR=21.15, 95% CI: 2.72-164.35) ( 표 4). 고찰암생존자의현재흡연률은비 ( 非 ) 암생존자에비해낮았으나남성암생존자의 33.53%, 여성암생존자의 2.53% 가여전히현재흡연자였다. 암생존자중남성은 50세이하젊은연령, 만성질환과거력, 음주를하는경우, 신체활동을하지않는경우현재흡연위험이높았다. 여성은음주를하는경우, 신체활동을하지않는경우현재흡연위험이높았다. 이러한결과는암생존자중현재흡연위험군에대해적극적인금연치료가필요함을시사한다. 기존연구에서암진단을받은환자들은현재흡연율이낮았다.(11) 이연구에서도암생존자의현재흡연율은비 ( 非 ) 암생존자의현재흡연율보다낮았으며, 현재금연을한상태인과거흡연자는현재흡연자보다많았다. 이연구가단면연구이고, 암진단시점을알수없기때문에암진단후금연하였는지정확히알수는없지만 Hawkes 등 (2007) 에서대장암진단후건강생활태도에긍정적인영향을가져와금연을한다고보고한바에비추어볼때, 암진단과금연의관 Table 3. Associated factors with current smokers compared with nonsmokers or former smokers. Men (N=59,793) Women (N=32,280) OR (95% CI) P-value OR (95% CI) P-value Non cancer group 1.00 1.00 Cancer survivor group 0.69 (0.62-0.78) <0.0001 0.79 (0.48-1.32) 0.3665 Age (years) 20-39 1.96 (1.86-1.76) <0.0001 1.65 (1.25-2.19) 0.0005 40-50 1.42 (1.34-1.50) <0.0001 0.98 (0.72-1.33) 0.8925 51-64 1.00 1.00 BMI (kg/m 2 ) <18.5 1.00 1.00 18.5-22.9 0.59 (0.51-0.67) <0.0001 1.02 (0.86-1.19) 0.8611 23.0-24.9 0.54 (0.47-0.62) <0.0001 0.93 (0.74-1.16) 0.4997 25.0 0.59 (0.51-0.68) <0.0001 1.06 (0.84-1.35) 0.6130 Family history of cancer No 1.00 1.00 Yes 1.01 (0.96-1.06) 0.6909 1.00 (0.83-1.20) 0.9962 Chronic disease history No 1.00 1.00 Yes 1.29 (1.24-1.33) <0.0001 0.96 (0.80-1.15) 0.6494 Alcohol consumption No 1.00 1.00 Yes 2.12 (2.01-2.24) <0.0001 3.42 (2.95-3.95) <0.0001 Physical activity Yes 1.00 1.00 No 1.14 (1.10-1.18) <0.0001 1.14 (1.02-1.28) 0.0227 Abbreviations: OR, odds ratio; CI, confidence interval. 27
JKSRNT Vol. 10, No. 1, Jun. 2019 Table 4. Associated factors with current smokers compared with nonsmokers or former smokers in cancer survivor group. Men (N=1,375) Women (N=671) OR (95% CI) P value OR (95% CI) P value Age (years) 20-39 2.47 (1.76-3.47) <0.0001 - - 40-50 1.43 (1.04-1.97) 0.0275 - - 51-64 1.00 - - BMI (kg/m 2 ) <18.5 1.00 - - 18.5-22.9 1.49 (0.47-4.75) 0.5001 - - 23.0-24.9 1.29 (0.40-4.13) 0.6738 - - 25.0 1.46 (0.46-4.68) 0.5228 - - Family history of cancer No 1.00 1.00 Yes 1.42 (1.11-1.84) 0.0064 1.73 (0.61-4.94) 0.3074 Chronic disease history No 1.00 1.00 Yes 1.37 (1.07-1.76) 0.0138 0.72 (0.15-3.57) 0.6870 Alcohol consumption No 1.00 1.00 Yes 2.80 (2.02-3.88) <0.0001 21.15 (2.72-164.35) 0.0035 Physical activity Yes 1.00 1.00 No 2.00 (1.41-2.87) 0.0001 1.00 (0.33-3.07) 0.9983 Abbreviations: OR, odds ratio; CI, confidence interval. 련성을추정해볼수있다.(12) 그러나암생존자의현재흡연율이비록낮다고하나암치료, 완치, 재발, 삶의질향상등여러측면에서암생존자의금연율을더욱향상시켜야할필요가있다. 흡연하는암생존자는흡연하지않는암생존자보다 2차원발암의위험과심혈관질환의위험이높다.(13,14) 그러므로암생존자의상당수가여전히현재흡연중이라는결과는심각하게받아들여져야한다. 기존연구에따르면암생존자의 60% 가건강증진프로그램에관심이있으며현재흡연자외에흡연자의가족들도금연프로그램에대해관심이있었다. 금연교육프로그램참가, 치료전에느끼는스트레스에의해금연가능성이높아지나, 흡연량이많을수록금연가능성은낮다.(6,15) 이연구에서암생존자현재흡연자의흡연량은비암생존자와차이가없었는데, 이는현재흡연량을조사한것이며, 암발생이전의흡연량은알수없었기때문일수있다. 흡연, 음주, 운동부족등의건강위험행위의실천여부는독립적인것이아니라같은양상으로군집을이룬다고알려져있다. 이것은각행태들이인구집단에서무작위로발견되는것이아니라다른행태들과높은상관성을가지고결과적으로함께나타난다는뜻이다. 따라서인구집단별건강행태의군집을파악한다면각집단에맞는건강증진프로그램을 개발하는데유용한정보가될수있다.(16) 이연구에서흡연외에같이조사된암생존자의음주율은비 ( 非 ) 암생존자에비해낮았으나, 남성암생존자의 76.06%, 여성암생존자의 38.53% 가여전히음주를하고있는것으로나타났다. Lown 등 (2008) 은암생존자의불안, 우울등이음주와관련이있다고하였으며, Mayne 등 (2009) 은암진단전에음주횟수가많았던사람이사망률이높고, 암진단후에도지속되는음주와사망률과는관련성이높다고보고하였다. 따라서암생존자의금주에대한대응역시필요하다.(7,17) 암생존자중신체활동분율은남성암생존자 88.36%, 여성암생존자는 73.80% 이었다. 이는오명근등 (2013) 의연구에서암생존자의신체활동분율 26% 와는달리신체활동분율은높았으나, 미국암협회와 Healthy People 2010에서제시한신체활동의기준이 20 분이상의격렬한운동을주당 3회이상시행 인점을볼때운동시간 14-15 분은부족하다.(9) 암환자에게신체활동은심폐활량을늘이고 2차원발암, 만성질환예방에도움이된다. 따라서운동시간과강도를증가시킬수있는방법에대한연구가필요하다.(18,19) 로지스틱회귀분석에서현재흡연을종속변수로비흡연또는과거흡연군을합쳐서대비하여분석하였으나, 이는해석상의어려움을불러일으킬수있다. 이를명확히하기위 28
변정애외 : 성인암생존자의흡연양상과현재흡연관련요인 해, 암생존자의현재흡연관련요인을비흡연자와비교, 과거흡연자와비교한분석을각각추가로시행하였고, 이두건의추가분석에서도기존과결과는동일하였다. 즉남성암생존자는연령이낮은군에서, 암가족력과만성질환을가지고있는경우, 음주자, 신체활동을하지않는경우현재흡연과의관련성이높았다. 여성암생존자의경우, 현재흡연은음주와유의한관련성을보였다. 이연구의제한점은다음과같다. 본연구에서분석한자료는암생존자연구를위한자료가아닌건강검진자료였으므로, 암의종류, 암의병기, 중증도, 암진단후치료관련자료및진단후기간등암발생과관련된여러변수에대해충분한자료를확보하지못하였다. 교육수준, 결혼여부, 경제수준등의일반적특성, 암발생이전의흡연량, 금연의향여부도조사하지못하였다. 표본수는암종류별건강행위, 여성의흡연관련특성등을분석하기에충분치못하였으며, 검진센터를방문한사람들의자료를이용하였으므로, 선택편견을배제할수없다. 또한단면연구로서금연과암진단과의관련성에대해원인-결과관계를가정할수없다. 이러한요인들은암진단과흡연양상의선후관계와세부적인관련요인을파악, 해석하기어렵게하므로, 추후중요변수를포함한대규모, 장기간의전향적연구를통해암종별세부분석을비롯하여이연구에서설명되지못한사항들을지속적으로알아보아야할필요가있다. 이연구의의의는암생존자를대상으로, 암진단후에도금연을하지못하는현재흡연관련요인을분석하되흡연양상과관련요인을심화분석하였다는점이다. 향후지속적인연구와개입방법개발을통해암생존자의건강증진을위한기초자료생산과금연치료지원대책이필요하다. 감사의글본연구는보건복지부암정복추진연구개발사업지원으로이루어진것임 (HA16C0012). 한국의학연구소 (Korea Medical Institute, KMI) 의도움에감사드립니다. 요약연구배경 : 암생존자는이차암및질환위험이높다. 그러나 이들중에도흡연을지속하는경우가남아있다. 이연구에서는암생존자의흡연양상과이들의현재흡연과의관련요인을살펴보고자한다. 방법 : 2007-2011년도에한국의학연구소 (Korea Medical Institute, KMI) 에내원한연구동의자 20-64 세성인 91,040 명 ( 남자 59,132 명 ) 을대상으로, 암과거력유무에따라암생존자군 ( 남 1,375명, 여 671명 ) 과비 ( 非 ) 암생존자군으로나누어설문, 신체계측, 혈액검사자료를분석하였다. 결과 : 암생존자의현재흡연률은비 ( 非 ) 암생존자에비해낮았으나남성암생존자의 33.53%, 여성암생존자의 2.53% 가여전히현재흡연자였다. 암생존자중남성은 50세이하젊은연령, 만성질환과거력, 음주를하는경우, 신체활동을하지않는경우현재흡연위험이높았다. 여성은음주를하는경우, 신체활동을하지않는경우현재흡연위험이높았다. 암생존자에서, 남성이현재흡연할오즈비는 51-64 세에비해 20-39세 2.47, 51-64세 1.43으로높았으며, 음주시비음주군에비해현재흡연할오즈비도남성 2.80(95% CI:2.02-3.88), 여성 21.15(95% CI:2.72-164.35) 로높았다. 결론 : 남성의젊은연령과남녀음주는암생존자의현재흡연지속과관련된중요한요인이다. 향후지속적인연구와개입방법개발을통해암생존자의금연과건강증진을위한지원이필요하다. 중심단어 : 암생존자 ; 건강행동 ; 담배흡연 ; 알코올 ; 단면연구 References 1. Aziz NM. Cancer survivorship research: challenge and opportunity. J Nutr. 2002; 132(11): 3494S-3503S. 2. Aziz NM, Rowland JH. Trends and advances in cancer survivorship research:challenge and opportunity. Semin Radiat Oncol. 2003; 13(3): 248-66. 3. EM Ahn. Suicide rates of Korean cancer survivors and its related factors. Dept. of Epidemiology [ master s thesis] Seoul; The Graduate School of Public Health Seoul National Univ; 2009. 4. Brown BW, Brauner C, Minnotte MC. Noncancer deaths in white adult cancer patients. J Natl Cancer Inst. 1993; 85(12): 979-87. 5. Kikidis D, Vlastarakos PV, Manolopoulos L, Yiotakis I. Continuation of smoking after treatment of laryngeal cancer: an independent prognostic factor? ORL J Otorhinolaryngol Relat Spec. 2012; 74(5): 250-4. 29
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