ホルモン療法を開始する乳がん患者が治療開始後早期に体験する更年期症状とQOLの変化

Changes in Menopausal Symptoms and Quality of Life in Women with Breast Cancer in Early Phase of Hormonal Therapy

要旨

　本研究の目的は，乳がん患者がホルモン療法開始後早期に体験する更年期症状とQOLの経時的変化を明らかにすることである．ホルモン療法を開始する初発の乳がん患者41名に自記式質問紙を配布し，治療開始時，1カ月後，3カ月後の更年期症状とQOLを調査した．質問紙は郵送法で回収し，3時点の返送がすべて得られた31名のうち（回収率75.6％），タモキシフェンを服用する閉経前患者15名，アロマターゼ阻害剤を服用する閉経後患者15名の計30名を対象とした（有効回答率73.2％）．更年期症状とQOLの変化は，回答時期と閉経状況を2要因とし，分散分析を用いて検討した（多重比較法：Dunnettの方法）．またPearsonの相関係数を算出し，更年期症状とQOLの相関関係を検討した．

　更年期症状，QOLともに，要因間に交互作用はなく，時期のみ有意な主効果を示した．ホルモン療法を開始する患者は3カ月後に更年期症状の増強（p＜0.05）とQOLの低下（p＜0.01）を経験していた．しかし，この時点では正常範囲内もしくは軽度の更年期症状が多く，QOLとの間に有意な相関を示さなかった（p ＝ 0.054）．治療開始後3カ月は更年期症状が増強しはじめる初期の段階であり，QOLに影響を及ぼす前段階にあると考えられる．受診の機会が限られるホルモン療法において効果的に看護支援を提供するためには，治療開始後3カ月を目安に更年期症状をスクリーニングすることが有用であると期待される．

　Pre- or postmenopausal women with breast cancer completed a self-administered questionnaire to observe changes in menopausal symptoms and quality of life (QOL) in the early phase of hormonal therapy. Data on menopausal symptoms and QOL were collected by mail at the start of hormonal therapy and at 1 and 3 months after starting therapy.

　Of 41 eligible patients, 31 patients responded for all 3 questionnaires (response rate 75.6 ％). A total of 30 (73.2 ％) valid responses were obtained. The sample consisted of 15 premenopausal patients taking tamoxifen and 15 postmenopausal patients taking aromatase inhibitors. Two-way ANOVA followed by Dunnett's test revealed that menopausal symptoms and QOL significantly worsened at 3 months (p＜0.05 and p＜0.01, respectively). However, at this time, few patients experienced severe menopausal symptoms and no significant correlation was observed between menopausal symptoms and QOL (p = 0.054).

　The results of this study suggest that patients experience a deterioration of menopausal symptoms early after starting hormonal therapy. In addition, menopausal symptoms may deteriorate further in the following months during long-term therapy. QOL may correspond to these changes in menopausal symptoms. It is therefore crucial to assess patients' symptoms at around 3 months. Nurses have an important role to play in preventing menopausal symptoms from deteriorating and in minimizing their impact.