호스피스 癌患者의 餘命 期間에 따른 症狀 및 삶의 질의 變化

Symptoms and Quality of Life According to Length of Survival in Hospice Cancer Patients

연구배경: 호스피스ㆍ완화의료로 의뢰된 말기 암환자의 여명 기간에 따른 증상과 삶의 질의 변화를 조사하여, 향후 말기 암환자를 위한 올바른 치료중재 결정에 도움이 되기 위해 본 연구를 시행 하였다. 방법: 말기 암으로 수도권 6개 종합병원에 호스피스ㆍ완화의료를 위해 입원 사망한 137명을 대상으로 하였다, 입원 시 작성한 MDASI-K 설문지를 통해 증상들과 이들이 삶의 질에 미치는 영향을 기록하였고, 여명 기간에 따른 증상의 빈도 및 중등도, 삶의 질에 미치는 영향, 여명 기간에 따른 ECOG 기능지수의 연관성을 분석하였다. 결과: 여명 기간에 따른 증상 빈도 및 삶의 질 저하의 대한 평균 점수는 MDASI-K 19가지 항목 중 17가지 부문에서 여명 기간이 짦아질수록 높았다. 신체적 증상 및 정신사회적 증상 모두 대부분의 항목에서 여명기간과 유의한 연관성을 보였다. ECOG기능점수 악화에 따라 여명 기간은 유의하게 감소하였다. 결론: 7개의 증상과 삶의 질에 지장을 주는 1개의 항목이 여명기간이 짦아짐에 따라 빈도가 증가하였다. 여명기간이 짧아질수록 11개 증상과 6개 삶의 질 관련 항목의 점수는 악화되었다. 말기 암환자 진료 시 보다 적극적인 증상조절이 필요하다.

Background: Cancer had become the 1st leading cause of death in Korea since 1983. There were roughly 65,000 cancer deaths per year in 2006. Survival prediction is difficult even among experienced palliative care doctors. Appropriate symptom control and QoL are important in end of life. Methods: Eleven physicians of the Korean Palliative Medicine Research Group performed this study. We followed terminal cancer inpatients until their death between November 2006 and December 2007. A total 137 patients who completed a Korean version of MDASI before their death from 6 teaching hospitals were included in this cohort study. Basic data was obtained at the time of hospital admission. The subjects were divided into 3 groups according to length of survival. The first group A consists of patients who lived less than 14 days, group B patients lived between 15 and 34 days. Lastly, group C patients lived more than 35 days. Then symptom prevalence and severity, and quality of life were compared. Results: 46.7% were male. Mean age was 63.9 years old. The mean survival time was around 39 days. Survival duration was decreased by a lower ECOG score. There was no significant differences in survival duration according to age, type of primary cancer, or regular opioid use. Dry mouth, lack of appetite, fatigue were the most prevalent symptoms. General activity and mood were the most prevalent QoL impairments. There was no significant difference in prevalence by sex except sleep disturbance in which there was a higher frequency in females. There were seven items in the symptom category and one item in the QoL interference category where prevalence increased as length of survival was shortened with statistical significance. Dry mouth, lack of appetite, and fatigue were the most severe symptoms. Work, general activity, and walking were the most severe QoL impairments. 11 symptoms except remembering & numbness of tingling and all 6 QoL impairments were worsened by decreased survival duration. No significant difference in severity of both symptoms and QOL impairment was present by sex except three items. Conclusion: It is evident that prevalence and severity of symptoms was high in Korean terminal cancer patients. More active symptom management is needed.