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여성건강간호학회지제 19 권제 4 호, 2013 년 12 월 Korean J Women Health Nurs Vol. 19. 4, 201-210, December, 2013 pissn 2287-1640 eissn 2093-7695 http://dx.doi.org/10.4069/kjwhn.2013.19.4.201 부인암환자의말초신경병증과삶의질 정주현 1 노주희 2 김기숙 1 이영은 1 유선영 1 이현주 1 심유미 1 이영선 1 서울아산병원 1, 울산대학교간호학과 2 Characteristics and Quality of Life in Gynecologic Cancer Patients with Chemotherapy-induced Peripheral Neuropathy Jeong, Ju-Hyeon 1 Nho, Ju-Hee 2 Kim, Gi-Suk 1 Lee, Young-Eun 1 Yu, Sun-Young 1 Lee, Hyun-Ju 1 Sim, Yu-Mi 1 Lee, Young-Sun 1 1 Asan Medical Center, Seoul 2 Department of Nursing, University of Ulsan, Ulsan, Korea Purpose: The purpose of this study was to identify chemotherapy induced peripheral neuropathy, quality of life of patients with gynecologic cancer. Methods: This was a cross-sectional survey design. We collected 130 patients with gynecologic cancer. They complete a self reported questionnaire including items related neuropathy and quality of life (FACT-GOG/Ntx subscale, FACT-G scale). Results: The neuropathy score was 14.3±7.9. The quality of life score was 64.8±16.4. The neuropathy induced significant difference according to diabetic status, difficulties in performing household chores and willing to discontinuity of chemotherapy. And duration of cancer diagnosis, neuropathy, number of total chemo agent associated with quality of life. There was a negative correlation between number of total chemo agent and quality of life. Neuropathy independently affected quality of life. Conclusion: Chemotherapy induced peripheral neuropathy of patients with gynecologic cancer adversely affected women s quality of life and activities of daily living. To improve patient s quality of life, it is important that accurate assess and appropriately manage neuropathy in patients with gynecologic cancer. Key Words: Gynecologic neoplasm, Chemotherapy induced peripheral neuropathy, Quality of life 서론 1. 연구의필요성부인암은자궁경부암, 난소암, 자궁내막암이대표적으로전체여성암발생률의 10% 를차지한다 (Statistics Korea, 2010). 부인암환자들은질병의특성과병기에따라수술, 방사선, 항암화학요법등의치료를받는다. 이중항암화학요법은부인암환자의생존율향상에큰기여를하였으나이 로인한부작용들은일상적인활동과사회적활동을저해시켜 (Kiser, Greer, Wilmoth, Dmochowski, & Naumann, 2010) 삶의질측면에서잠재적이고부정적인영향을미친다. 부인암의치료에주로사용되는항암제는파클리탁셀, 카보플라틴, 시스플라틴등으로강한항암작용을가지고있으나저용량이더라도반복적으로투여할경우신경학적독성이문제가되어 (Calhoun et al., 2003) 90% 이상에서말초신경병증이발생된다 (Viens et al., 2006). 특히난소암의경우수술후보조항암화학요법으로파클리탁셀과플래티넘계열 ( 카보 주요어 : 부인암, 말초신경병증, 삶의질 Corresponding author: Nho, Ju-Hee Department of Nursing, University of Ulsan, Daehakro 93, Nam-gu, Ulsan 680-749, Korea. Tel: +82-52-259-2712, Fax: +82-52-259-1236, E-mail: jhnho@ulsan.ac.kr 투고일 : 2013년 8월 27일 / 수정일 : 2013년 11월 1일 / 게재확정일 : 2013년 12월 2일 This is an open access article distributed under the terms of the Creative Commons Attribution n-commercial License (http://creativecommons.org/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 2013 Korean Society of Women Health Nursing http://www.women-health-nursing.or.kr

정주현 노주희 김기숙등 플라틴, 시스플라틴 ) 의약제를투여하는것은표준치료법 (Berek, 2007) 으로항암제용량, 환자요인등에따라말초신경병증의빈도는 10~100% 까지다양하게나타난다 (Bakitas, 2007; Pan & Kao, 2007). 항암화학요법중말초신경병증이심한경우에는항암제용량의감소, 치료기간연장, 또는항암제치료의중단까지이르게되며 (Mantyh, 2006) 이와같은결과는항암화학요법의효율성을감소시켜생존율에영향을미치게된다 (Wolf, Barton, Kottschade, Grothey, & Loprinzi, 2008). 말초신경병증은말초신경섬유의손상, 염증, 퇴화작용으로인하여운동, 감각, 자율신경이손상되어나타나는증상을말한다 (Yabro, Frogge, & Goodman, 2004). 운동, 감각신경관련증상은손가락, 발가락의저림 (tingling), 둔한느낌 (numbness), 타는듯한느낌 (burning), 찌르는느낌 (stabbing), 따끔거림 (pricking) 등이며자율신경관련증상은변비, 기립성저혈압, 요실금등이다 (Smith, Beck, & Cohen, 2008). 이러한증상은급성으로나타나항암화학요법종료후회복되기도하지만통증으로느껴질정도로악화될수있고 (Sweeney, 2002) 일부는비가역적으로몇년동안지속되기도한다 (Wickham, 2007). 여성암환자가 70% 포함된연구에서말초신경병증은암환자의고통스러운증상중하나로신체기능의감소와감정스트레스뿐아니라사회적역할장애까지부정적인영향을미친다고하였다 (Bakitas, 2007). 남녀모든암환자가말초신경병증으로인해옷입기와글쓰기, 집안일하기, 물건집기등의어려움을호소하였고특히여성암환자는속옷입기, 악세서리착용같은일상생활에제한을받게되어삶의질이더욱낮다고하였다 (Bakitas, 2007; Tofthagen, 2010). 국내연구에서도항암화학요법으로인한말초신경병증을경험하는성인남녀암환자의삶의질은감각영역의삶의질이가장낮고 (Kwak, Kim, Lee, Kwon, & Hwang, 2010), 전반적인삶의질은말초신경병증을경험하지않은환자보다낮은것으로나타났다 (Kim, Choi, Kim, & Hong, 2011). 여성암환자는남성암환자보다건강관련삶의질이낮게측정되어 (Kim et al., 2011) 가정이나사회에서다양한역할을수행해야하는여성암환자들에게말초신경병증은기능적손상과일상생활의장애로삶의질을더욱저하시킨다. 그러나말초신경병증은항암화학요법으로인한다른부작용에비해잠재적이고점진적으로진행되기때문에의료진들은골수기능억제, 오심, 구토, 점막염등의증상보다는덜중요하게생각하는경향이있다 (Kwak et al., 2010; Wickham, 2007). 또한말초신경병증은예방과치료에대한근거가미약하여일부환자들은증상과관련한표준화되지않은자가조절방법을적용하는경우도많이있다. 이에, 간호사는부인암환자의말초신경병증에대한정확한사정과특성파악으로치료의효율성을높이고암환자의삶의질을향상시킬수있도록노력해야할것이다. 최근말초신경병증을겪는암환자의삶의질에대한연구가진행되고있으나 (Calhoun et al., 2003; Kim et al., 2011; Kwak et al., 2010) 부인암환자의경우말초신경병증발생가능성이높은항암화학요법을받고있음에도불구하고이들이경험하는말초신경병증의특성과삶의질에대한연구는미미한실정이다. 따라서본연구를통해항암화학요법을받는부인암환자의말초신경병증정도와삶의질을파악하고삶의질에영향을미치는말초신경병증관련특성을파악함으로써, 말초신경병증을경험하는부인암환자의삶의질향상을위한간호중재개발을위한기초자료를제공하고자한다. 2. 연구목적본연구의목적은부인암환자의항암화학요법으로인한말초신경병증관련특성과삶의질을파악하는것으로구체적인목적은다음과같다. 대상자의말초신경병증관련특성과정도를파악한다. 대상자의삶의질을파악한다. 삶의질에영향을미치는말초신경병증관련요인을파악한다. 연구방법 1. 연구설계본연구는부인암환자의항암화학요법으로인한말초신경병증관련특성과정도, 삶의질을파악하기위한서술적조사연구이다. 2. 연구대상연구표본의수는 2007년부인암발생건수 6,778건중에서부인암평균 5년상대생존율 75.4%(2003~2007 년 ) 을계산하였을때생존자수는 5,110명으로추정되어최종모집단의수를약 5,200명으로기준하여산출하였다 (Statistics Korea, 202 Korean Journal of Women Health Nursing

부인암환자의말초신경병증과삶의질 2010). 이에대하여오차.03, 유의수준.05, 양측성검정으로설정하였을때목표표본수가 119명이었으며 (Bartlett, Kotrlik, & Higgins, 2001) 탈락률 10% 를고려하여 130명을대상으로하였다. 구체적인대상선정기준은다음과같다. 만 20세이상성인환자로최근 3년이내말초신경병증을유발하는항암제를투여받고말초신경병증을경험하고있으며, 항암화학요법이전에말초신경병증을경험하지않았던환자를대상으로의사소통에장애가없으며연구의목적을이해하고연구에참여하기로동의한환자를대상으로하였다. 본연구대상자중지및탈락기준은환자가연구를종료하기를원하는경우나설문조사지작성이매우불충분한경우로하였고탈락자는없었다. 3. 연구도구 1) 말초신경병증본연구에서말초신경병증정도는 Functional Assessment of Cancer Therapy/ Gynecologic Oncology Group Neurotoxicity (FACT/GOG-Ntx) subscale 한국어판으로측정한 11 문항의점수를말한다. 감각영역 4문항, 운동영역 3 문항, 기능장애영역 2문항, 청각영역 2문항을포함한총 11문항의 4점척도로구성되어있으며모든문항은 0~4점으로측정된다. 점수의합이높을수록말초신경병증정도가심한것을의미한다. Calhoun 등 (2003) 의연구에서도구의신뢰도는 Cronbach's =.82였다. 본연구에서 Cronbach's =.87 이었다. 본도구사용에대해도구개발기관인 Functional Assessment of Chronic Illness Therapy (FACIT) 의사용승인을받았다..78이었다. 본도구사용에대해 FACIT에서사용승인을받았다. 3) 대상자의특성일반적특성은연령, 결혼상태, 직업유무, 교육정도, 출산력, 당뇨여부를조사하였고말초신경병증관련특성은진단명, 암진단기간, 병기, 수술유무, 투여된항암제개수, 말초신경병증경험기간, 말초신경병증유발항암제투여개수, 집안일의어려움, 말초신경병증으로인한치료중단의사, 말초신경병증악화요인, 중재방법을조사하였고구조화된설문지와의무기록을사용하였다. 4. 자료수집및윤리적고려자료는 2013년 4월 1일부터 2013년 7월 15일까지서울시내 A종합병원산부인과병동에부인암진단후항암화학요법을받기위해입원한환자중연구대상에부합하는환자를대상으로구조화된설문지와면담, 전자차트를통해수집하였다. 연구자가직접대상자에게연구의목적과취지를설명하고연구에대한자발적참여, 익명성보장, 연구방법, 연구를거부할권리등에대한동의후에진행하였다. 대상자의일반적특성과말초신경병증관련특성및정도, 삶의질측정문항은환자가구조화된설문지를작성하도록하였고부족한내용은의무기록을바탕으로연구자가작성하였다. 총 134부중중복되었거나응답이불충분한 4부는제외하고 130부만분석하였다. 본연구는 A 병원임상연구심의위원회승인을받았고 (. 2013-0178) 해당병원간호부의연구진행승인을받은후에진행하였다. 2) 삶의질삶의질은 Cella (1997) 가개발한암환자의일반적인삶의질측정도구인 Functional Assessment of Cancer Therapy- General (FACT-G) 한국어판도구로측정하였다. FACT-G 는 4영역의총 27 문항으로서신체적안녕은신체상태및치료의부작용 (7문항), 사회적안녕은대인관계및주변의지지정도 (7문항), 정서적안녕은투병생활에서의정서적어려움 (6 문항 ), 기능적안녕은직업이나집안일또는여가생활 (7문항) 로구성되었다. 모든문항은 0~4점으로도구의점수화지침에따라 0~108점이며, 점수의합이높을수록일반적인삶의질이높음을의미한다. Cella (1997) 가개발당시도구의신뢰도는 Cronbach's =.89였다. 본연구에서 Cronbach's = 5. 자료분석본연구에서수집된자료는 SPSS/WIN 20.0 프로그램을이용하여통계처리하고구체적인방법은다음과같다. 대상자의일반적특성과말초신경병증관련특성은실수와백분율로산출하였다. 말초신경병증정도와삶의질은서술통계를이용하여평균, 표준편차를산출하였다. 대상자의특성에따른말초신경병증정도와삶의질과의관계는 t-test와 ANOVA를이용하였고, 사후분석은 Scheffe 를사용하였다. 말초신경병증관련특성에따른말초신경병증정도와삶 Vol. 19. 4, 2013 203

정주현 노주희 김기숙등 의질과의관계는 Pearson 상관관계를이용하였다. 삶의질영향요인은다중회귀분석을이용하여분석하였다. 연구결과 1. 대상자의특성에따른말초신경병증정도와삶의질본연구대상자의연령은평균 52.5세로 51~60세가 77명 (59.2%) 으로가장많았다. 105명 (80.8%) 이기혼이었으며직업은 107명 (82.3%) 이없었다. 교육수준은고졸이 57명 (43.8%) 으로가장많았고출산경험이있는대상자가 118명 (90.8%), 당뇨가없는경우가 122명 (93.9%) 으로나타났다. 일반적특성에따른말초신경병증정도는유의한차이가없었다. 삶의질은교육정도에따라차이가있었다 (F=5.36, p=.006)(table. 1). 2. 말초신경병증관련특성에따른말초신경병증정도와삶의질연구대상자는난소암환자가 80명 (61.5%) 으로가장많았고암진단기간은평균 30.4개월로 12개월미만이 55명 (42.3 %) 으로가장많았으며임상병기는 3기환자가 66명 (50.8%) 으로가장많았다. 수술을받은환자가 114명 (87.7%) 으로대부분이었고, 투여받은항암제는평균 3.3개로나타났고 2개를사용한경우가 59명 (45.4%) 으로가장많았다. 말초신경증을경험한기간은평균 16.5개월로 5개월이하가 65명 (50.0 %) 으로가장많았고 24개월이상지속되는경우가 32명 (24.6 %) 으로나타났고, 60개월이상나타난다고하는경우도 10명 (7.7%) 으로나타났다. 말초신경병증을유발하는항암제를평균 2.7개투여받았고이중 2개이하로투여받은경우가 65명 (50.0%) 으로나타났다. 집안일을수행하는데어려움이있다고응답한경우가 98명 (75.4%) 으로나타났으며, 말초신경병증으로인해항암치료를중단하고싶다고응답한경우가 34명 (26.2%) 으로나타났다. 말초신경병증이악화되는경우는잠자기전이라고응답한환자가 63명 (48.5%) 으로가장많았고, 차가운것이라고응답한대상자가 44명 (33.8%) 으로나타났다. 현재말초신경병증을조절하기위해치료를받은경우는없다고응답한경우와약물요법을시행한경우가각각 47명 (36.2%) 으로대부분을나타났다. 암진단후현재까지한번이라도비약물요법을사용한경우가있다고응답한대상자는 60명 (43.2%) 으로나타났고사용한중류에대한복수응답을하도록한경우마사지 (100.0%), 온열요법 (80.0%), 운동 (51.7 Table 1. Neuropathy and Quality of Life by General Characteristics (N=130) Characteristics Categories n(%) Age (year) 40 41~50 51~60 61 13(10.0) 25(19.2) 77(59.2) 15(11.5) FACT/GOG-Ntx subscale FACT/G M±SD t or F p M±SD t or F p 52.5±7.8 12.2±6.8 13.7±9.1 14.5±7.8 16.2±6.9 0.66.579 67.5±15.9 61.7±15.9 65.8±16.4 62.4±17.7 0.60.613 Marital status Married Single Other 105 (80.8) 8(6.2) 17 (13.1) 14.4±7.7 11.3±5.9 15.5±9.4 0.81.447 65.0±16.0 72.8±12.9 59.6±18.7 1.82.166 Job 23(17.7) 107 (82.3) 14.6±7.9 14.3±7.9 0.16.872 64.6±15.2 64.8±16.7-0.06.955 Education Middle school a High school b College 30(23.1) 57(43.8) 43(33.1) 14.1±7.8 15.1±8.6 13.5±7.0 0.52.597 70.5±12.0 59.8±18.0 67.3±15.1 5.36.006 (a>b) Childbirth 118 (90.8) 12 (9.2) 14.6±8.0 11.3±5.7 1.87.080 64.3±16.7 69.6±12.5-1.35.195 DM 8(6.2) 122 (93.8) 20.3±7.0 13.9±7.8 2.45.039 58.4±16.7 65.2±16.3-1.12.295 FACT/GOG-Ntx subscale=functional assessment of cancer therapy/gynecologic oncology group neurotoxicity subscale; FACT-G=functional assessment of cancer therapy-general. Scheffe test. 204 Korean Journal of Women Health Nursing

부인암환자의말초신경병증과삶의질 %), 뜸 (10%), 지압 (10%), 수지침 (5%) 의순서로나타났다. 말초신경병증정도는말초신경병증을경험한기간, 집안일수행에대한여려움여부, 말초신경병증으로인한치료중단의사에따라유의한차이가있었다 (t=3.23, p=.015; t= 5.31 p<.001; t=3.67, p<.001). 삶의질은집안일수행에대한어려움여부에따라유의한차이가있었다 (t=-4.01, p<.001)(table 2). 말초신경병증정도와삶의질은부적상관관계를보였다 (r=-.55, p<.001). 암진단기간, 말초신경병증을경험한기간과항암제총투여개수와말초신경병증정도는유의한양적상관관계를보였다 (r=.23 p=.009; r=.30, p<.001; r=.22, p=.013). 항암제총투여개수와삶의질과는유의한부적상관관계를보였다 (r=-.17, p=.047)(table 3). 3. 말초신경병증정도와삶의질말초신경병증정도는 44점만점에 14.3점으로나타났고삶의질은 108점만점에 64.8점으로나타났다. 삶의질의하위영역인신체상태는 28점만점에 16.9점, 사회 / 가족상태는 28점만점에 17.5점, 정서상태는 24점만점에 15.9점, 기능상태는 28점만점에 14.5점으로나타났다 (Table 4). 4. 삶의질영향요인본연구에서부인암환자의삶의질영향요인을알아보기위해대상자특성및상관관계분석상에서유의수준 5% 이내의변수인교육정도, 집안일의어려움, 투여된항암제개수, 말초신경병증정도를포함한상태에서더미변수처리, 단계선택방법을이용하여다중회귀분석을한결과는 Table 5와같다. 회귀분석의가정을검정하기위하여 Durbin-Watson 을이용하여오차의자기상관을검정한결과 2.006으로검정통계량 (1.74) 보다크기때문에자기상관이없었다. 다중공선성검정을위한공차한계 (Tolerance) 와 VIF 값측정시, 공차한계가 0.1 이하이거나 VIF 값이 10보다크지않아다중공선성의문제가없는것으로나타났다. 영향력분석을위해 Cook's D 통계량을이용하여분석한결과 130개중 1.0 이상인것은없었다. 잔차분석결과모형의선형성 (linearity), 오차항의정규성 (normality), 등분산성 (homoscedasticity) 이확인되었다. 회귀모형을분석한결과회귀모형은부인암환자의삶의질을설명함에있어서유용한모형으로나타났고 (F=55.09, p<.001), 이모형이삶의질을 29.5% 설명하였다. 부인암환 자의삶의질에영향을미치는주요요인은말초신경병증정도 (β=-.549, p <.001) 로나타났으며, 말초신경병증이 1점증가할때, 삶의질점수는평균 1.141점감소함을보여주고있다 (Table 5). 논의본연구에서말초신경병증사정을위해 FACT/GOG-Ntx subscale 도구를사용하였다. 치료시기에따라부인암환자의말초신경병증정도와삶의질을측정하는데타당도와신뢰도가확인된도구로 (Calhoun et al., 2003) 본연구에서측정한부인암환자의말초신경병증정도는심한것으로나타났다. 이는같은도구를사용하여측정한 Long 등 (2006) 의연구보다본연구대상자의말초신경병증정도가심한것으로나타났다. 또한말초신경병증정도는암진단기간, 말초신경병증을경험한기간과말초신경병증을유발하는항암제개수가많아질수록심해진다고하였다. 이는 Long 등의연구에서는대상자가사용한항암제총개수가 2개이며처음항암치료를받은대상자인반면, 본연구에서는평균 3.3개의항암제가사용되었고이전에항암치료를받아본경험이있는재발한대상자들도포함되었기때문인것으로보여진다. 또한부인암환자가주로사용하는항암제는말초신경병증을유발시키는특정항암제들이많기때문으로보여지며이는부인암환자의말초신경병증이혈액종양내과환자보다더심하게나타난다고한 Kim (2012) 의연구에서와도맥락을같이한다고할수있다. 본연구에서대상자가말초신경병증을경험한기간은평균 16.5개월로나타났으나 60개월이상지속된다고하는대상자도있었다. 이러한결과는항암치료로인한말초신경병증이치료가끝난후수개월동안지속되며 (Park, Kim, Bang, & La, 2009) 말초신경병증지속기간과관련이있다고한연구 (Verstappen, Heimans, Hoekman, & Postma, 2003) 와일치하는결과이다. 또한대부분의대상자들은말초신경병증이악화되는경우가잠자기전, 차가운것에닿았을때라고응답하였고이는 Tofthagen, McAllister와 McMillan (2011) 의연구결과와일치하는결과이다. 차가운것에닿았을때증상이심해지는것은말초신경병증의급성증상이며이는항암치료가끝나면좋아지지만신경병성통증 (neuropathic pain) 은저녁이나밤에심하게나타난다. 즉, 대상자들이경험하는증상은급성증상과신경병성통증이혼재된증상으로각시기별증상에따른사정과중재가필요함을알수있다. 따라서말초신경병증을유발하는항암치료를계획한대상자에게간호 Vol. 19. 4, 2013 205

정주현 노주희 김기숙등 Table 2. Neuropathy and Quality of Life by Characteristics related to Neuropathy Characteristics Cancer site Duration of cancer diagnosis (month) Stage 1 2 3 4 Surgery Number of total chemo agent Duration of neuropathy (month) Number of total chemo agent related to neuropathy Difficulty of housework Willing to discontinuity of chemotherapy Aggravating factor of neuropathy Intervention (the present) n-pharmacological intervention (since diagnosis, plural response) Categories Cervix Endometrium Ovary Other 12 13~24 25~36 37~48 49~60 61 2 3~4 5 5 a 6~11 12~17 18~23 24 b 2 3~4 5 Cold Hot Before sleeping After sleeping Other ne Pharmacology n pharmacology Dual Total Massage Hot pack Exercise Moxa Acupressure Hand acupuncture Others n(%) or M±SD 27(20.8) 20(15.4) 80(61.5) 3(2.3) 30.4±31.7 55(42.3) 19(14.6) 18(13.9) 9(6.9) 9(6.9) 20(15.4) 28(21.5) 15(11.5) 66(50.8) 21(16.2) 114 (87.7) 16(12.3) 3.3±1.5 59(45.4) 40(30.8) 31(23.8) 16.5±24.2 65(50.0) 21(16.2) 6(4.6) 6(4.6) 32(24.6) 2.7±0.8 65(50.0) 60(46.2) 5(3.8) 98(75.4) 32(24.6) 34(26.2) 96(73.8) 44(33.8) 5(3.8) 63(48.5) 27(20.8) 10 (7.7) 47(36.2) 47(36.2) 19(14.6) 17(13.0) 60(43.2) 60 (100.0) 48(80.0) 31(51.7) 6 (10.0) 6 (10.0) 3(5.0) 3(5.0) (N=130) FACT/GOG-Ntx subscale FACT/G M±SD t or F p M±SD t or F p 13.8±8.5 13.8±7.7 14.6±7.9 14.3±3.2 12.6±6.8 13.0±6.8 14.5±8.6 19.9±9.7 15.9±9.2 16.9±8.2 16.3±8.4 15.7±8.0 13.1±7.1 14.7±9.0 14.6±7.7 12.6±8.8 12.7±7.4 15.3±7.9 16.2±8.2 12.7±6.8 13.8±7.3 11.3±8.6 16.3±10.9 18.2±8.5 13.2±7.7 15.4±7.7 16.6±10.7 16.2±7.7 8.5±5.0 18.4±8.7 12.9±7.1 16.9±9.0 18.0±3.5 14.5±7.3 13.7±6.6 13.6±5.2 12.1±7.6 16.0±8.1 14.1±7.9 16.5±7.9 0.11.952 62.1±14.7 65.9±15.5 65.8±17.3 55.7±1.5 2.12.067 67.9±12.9 62.9±20.9 66.9±16.8 52.1±17.6 60.2±17.7 63.9±17.0 1.34.264 63.1±14.9 63.0±15.1 65.5±17.8 65.9±14.9 0.84.412 64.4±17.0 67.1±11.2 2.54.083 67.0±15.3 64.1±16.0 61.4±18.5 3.23.015 (b>a)* 67.4±14.0 63.6±20.0 65.0±18.5 72.7±13.6 58.7±17.3 1.47.234 67.0±15.7 62.3±16.4 64.8±22.9 5.31 <.001 62.0±16.4 73.3±13.0 3.67 <.001 61.1±15.6 66.1±16.5 62.8±16.38 51.8±18.6 64.3±15.4 62.6±18.0 73.2±8.3 2.40.071 63.5±17.5 63.7±17.6 67.8±13.9 67.6±12.2 0.67.574 1.79.116 0.23.878-0.83.413 1.28.281 1.99.101 1.29.278-4.00 <.001-1.56.133 0.54.657 FACT/GOG-Ntx subscale=functional assessment of cancer therapy/gynecologic oncology group neurotoxicity subscale; FACT-G=functional assessment of cancer therapy-general. Scheffe test. 206 Korean Journal of Women Health Nursing

부인암환자의말초신경병증과삶의질 Table 3. Correlation of Major Variables with Neuropathy, Quality of Life Variables FACT/GOG-Ntx subscale FACT-G Duration of cancer diagnosis (month).23 (.009) -.13 (.141) Number of total chemo agent.22 (.013) -.17 (.047) Duration of neuropathy (month).30 (<.001) -.16 (.063) Number of total chemo agent related to neuropathy.17 (.060) -.14 (.119) FACT/GOG-Ntx subscale - -.55 (<.001) FACT/GOG-Ntx subscale=functional assessment of cancer therapy/gynecologic oncology group neurotoxicity subscale; FACT-G=functional assessment of cancer therapy-general. (N=130) Table 4. Score of Neuropathy and Quality of Life Variables M±SD Measuring range Tool range FACT/GOG-Ntx subscale 14.3±7.9 0~34 0~44 FACT-G 64.8±16.4 20~93 0~108 PWB 16.9±6.9 2~28 0~28 SWB 17.5±5.2 5~28 0~28 EWB 15.9±4.9 1~24 0~24 (N=130) FWB 14.5±5.6 3~28 0~28 FACT/GOG-Ntx subscale=functional assessment of cancer therapy/gynecologic oncology group neurotoxicity subscale; FACT-G=functional assessment of cancer therapy-generall; PWB=physical well-being; SWB=social/family well-being; EWB=emotional well-being; FWB=functional well-being. Table 5. Factors affecting Quality of Life (N=130) Variables B SE β t(p) Adj. R 2 F(p) Neuropathy -1.14 0.15 -.54-7.42 (<.001).295 55.09 (<.001) 사는치료시작시기부터말초신경병증에대한사정과이에대한적절한중재를해야하며, 치료종료후에도이에대한사정과중재가지속되어야함을제시하고있다. 본연구에서는현재 36.2% 의대상자가말초신경병증에대한치료를받고있지않다고하였고오히려암진단후현재까지한번이라도비약물적중재인마사지, 온열요법, 운동등의방법을통해증상을조절해본경험이있다고응답한경우는 60명 (43.2%) 으로나타났다. 이는 Kwak 등 (2010) 의연구에서 40%, Kim (2012) 의연구에서는 70% 의대상자가비약물적요법을사용한적이있다고한결과와차이를보였다. 의료진들이호중구감소증, 오심, 구토등의신체적인증상보다말초신경병증의증상조절을적극적으로해주지않는경향이있고 (Kwak et al.,; Smith, Whedon, & Bookbinder, 2002) 증상조절을위해사용하는 gabapentin, amytriptyline 의효과 가크지않기때문에 (Rao et al., 2007) 대상자들이비약물적중재에접근한다고볼수있다. 또한본연구에서는비약물적중재가삶의질을향상시킨다는결과는나오지않았는데, 이는비약물적중재가말초신경병증증상감소에효과적이고 (Kaley & Deangelis, 2009; Kim, 2012) 삶의질이향상된다고한결과 (Kim et al., 2011; Kwak et al., 2010) 와상반되는결과이다. 이처럼다양한결과는말초신경병증의증상완화를위해사용되는약물적, 비약물적중재가다양하며정확한가이드라인이없기때문인것으로보이며, 추후말초신경병증을완화하는중재에대한효과를확인하는연구가필요할것으로본다. 본연구에서대상자들이집안일을수행하는데어려움이있다고응답한경우는 75.4% 로나타났다. 이는부인암환자들이항암화학요법으로일상적인활동에제한이있다고한연구 Vol. 19. 4, 2013 207

정주현 노주희 김기숙등 (Tofthagen, 2010) 의연구와맥락을같이한다. 본연구에서도 80% 이상이자녀가있는주부였고요리하기, 손빨래하기, 바느질, 청소, 자녀양육에어려움이있다고응답하였고, 집안일수행에어려움이있는경우말초신경병증정도가심하고이로인한삶의질이낮게나타났다. 이는말초신경병증으로인해걷는것, 운전, 직장에서업무수행저하같은기능적, 사회적제한으로인해심리적스트레스가발생하여환자들의삶의저하된다고한연구 (Bakitas, 2007; Hausheer, Schilsky, Bain, Berghorn, & Lieberman, 2006) 와같은결과이다. 여성의역할수행및치료의효율성을위해말초신경병증에대한적극적인중재가필요할것으로볼수있다. 이와더불어본연구에서말초신경병증으로인해항암치료를중단하고싶다고한경우가 26% 에달하였으며, 말초신경병증정도가심하게나타났다. 이는의료진이말초신경병증을항암화학요법으로인한단순한증상으로만간주할것이아니라항암제치료의중단으로인한생존율감소와도관련있는 (Wolf et al., 2008) 심각한증상으로고려해야할의미있는증상임을나타내는결과로볼수있다. 본연구에서부인암환자의삶의질은 Calhoun 등 (2003) 의연구보다낮게측정되었다. 삶의질의하위영역인신체, 사회 / 가족, 정서상태점수또한낮게측정되었다. 본연구에서는 Calhoun 등의연구에서보다질환종류도다양하고말초신경병증정도가심하며항암제투여개수또한많기때문인것으로볼수있다. 또한연구결과삶의질은말초신경병증정도가심하고항암제총투여개수가많을수록낮게측정되었다. 이는항암제투여횟수가말초신경병증에영향을주는요인이라고한연구들 (Wickham, 2007; Wolf et al., 2008) 과맥락을같이함을알수있다. 특히본연구에서부인암환자의삶의질에가장큰영향을미친요인은말초신경병증정도로부인암환자의삶의질에 30% 의영향을미치는주요한증상임을알수있다. 따라서부인암환자의말초신경병증은삶의질에큰영향을미치므로대상자가투여받는항암제에대한정확한파악으로항암제투여에따른말초신경병증에더많은관심을가지고접근해야할것이며이에따른적절한중재방안도고려해야할것이다. 본연구대상자는일개병원에입원한부인암환자만을대상으로선택하였으므로본연구의일반화에제한점이있다. 결론본연구는부인암여성의말초신경병증관련특성, 말초신 경병증정도와삶의질을확인하고삶의질에영향을미치는요인을파악하여삶의질향상을위한기초자료를제시하기위해시행되었다. 연구의결과에의하면부인암환자의말초신경병증은항암화학요법으로인해대상자의삶의질에영향을미치는주요한요인임을알수있다. 이러한결과는부인암환자의삶의질향상을위한간호중재개발시말초신경병증에대한고려가필요하며말초신경병증에대한의료진의적극적인관심과중재가필요하다는것을시사한다. 본연구는국내에서처음으로부인암여성들을대상으로하여항암치료로인해발생하는말초신경병증관련특성과정도및삶의질을파악하고이에대한관계를파악한연구라는것에의의를둘수있다. 본연구를바탕으로부인암환자의말초신경병증을정확히사정하여이를개선시킬수있는효과적인중재방안에대한연구가진행된다면부인암여성의삶의질향상에큰도움이될것으로사료된다. 이상의결과를바탕으로다음을제언하는바이다. 첫째, 부인암여성의말초신경병증을감소시킬수있는효과적인중재방안에대한연구를제언한다. 둘째, 부인암여성의말초신경병증을측정하기위하여개발된도구를임상에서사용할것을제언한다. REFERENCES Bakitas, M. A. (2007). Background noise: The experience of chemotherapy-induced peripheral neuropathy. Nursing Research, 56, 323-331. http://dx.doi.org/10.1097/01.nnr.0000 289503.22414.79 Bartlett, J. E., Kotrlik, J. W., & Higgins, C. C. (2001). Organizational research: Determining appropriate sample size in survey research. Information Technology, Learning, and Performance Journal, 19, 43-50. Berek, J. S. (2007). Berek & vak's Gynecology (14ed.). Philadelphia: Lippincott. Calhoun, E. A., Welshman, E. E., Chang, C. H., Lurain, J. R., Fishman, D. A., Hunt, T. L., et al. (2003). Psychometric evaluation of functional assessment of cancer therapy/gynecologic oncology group-neurotoxicity(fact/gog-ntx) questionnaire for patients receiving systemic chemotherapy. International Journal of Gynecologic Oncology, 13, 741-748. Cella, D. (1997). Manual of the functional assessment of chronic illness therapy (FACIT) measurement system. Evanston, IL: Center on outcomes, research and education (CORE), Evanston rthwestern Healthcare and rthwestern University. 208 Korean Journal of Women Health Nursing

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정주현 노주희 김기숙등 Summary Statement What is already known about this topic? Chemotherapy induced peripheral neuropathy (CIPN) is a common and often dose limiting side effect of chemotherapy. Gynecologic cancer patients with chemotherapy experience peripheral neuropathy. What this paper adds? The patients experienced difficulty of housework were low quality of life related CIPN and health. Also CIPN interferes with quality of life of gynecologic cancer patients. Implications for practice, education and/or policy The FACT/GOG-Ntx is a unique instrument for gynecologic cancer patients concern associated with neuropathy. Accurate assesment of neuropathy allows for improvement of quality of life. 210 Korean Journal of Women Health Nursing