癌症病人害怕疾病進展之因素、評估與照護

Fear of Disease Progression Among Cancer Patients: A Brief Introduction to Predisposing Factors, Assessments, and Care Strategies

10.3966/168395442016101603004

熊誼芳(Yvonne Hsiung)；蔡秀鸞(Shiow-Luan Tsay)；王怡人(Yi-Zen Wang)；李英芬(In-Fun Li)

癌症病人 ； 害怕疾病進展 ； 生活品質 ； 評估與措施 ； 心理健康 ； Fear of disease progress ； Cancer patients ； Assessments and intervention strategies ； Psychological wellbeing ； Quality of life

腫瘤護理雜誌

16卷增訂刊（2016 / 10 / 01）

43 - 56

繁體中文

害怕疾病進展（Fear of disease progression, FoP）是害怕或擔憂疾病在同一個器官或是在身體不同的部位持續進展，此心理困擾繼而影響病人生活品質各層面。此概念在一般癌症病人疾病歷程中常見，且是持續存在的負面情緒。雖然FoP是可理解之正常反應，強化病人對於自己身體變化之關注，但因癌病特有之擴散與復發性，病人被診斷後馬上就需面對多重不確定狀況，生命亦遭受威脅。一旦產生過度害怕情緒時，將影響其每日生活之功能、社交活動、甚至合併憂鬱或創傷後症候群、生活品質下降、可能產生悲傷失落、無法規劃未來的生活身心靈失調，影響整體存活期。年齡、社經地位、癌症診斷、身體功能狀態、症狀困擾、焦慮、憂鬱、樂觀人格特質、及社會支持等都會造成病人不同程度的害怕，醫療照護團隊可評估影響癌症病人害怕疾病進展之因素，確認害怕程度及影響，視情況提供個人化的相關照護措施，如：真誠關懷地進行治療性溝通、提供正確足夠資訊、教導問題解決技巧、搭配心理認知行為治療、或其他輔助療法如正念減壓與冥想等，都有助於癌症病人緩解害怕疾病進展感受，降低其對身心功能之影響，進而提升心理健康與生活品質。

Cancer recurrence in the same organ or other parts of the body has been one of the biggest sources of fear and negative thoughts experienced by the cancer patients. Such fear reportedly lasts for years with no significant intensity change over time; and this prevalent yet unmet psychological need has generally caused modest to severe physical, psychological, and spiritual distress. While fear of disease progress (FoP) at a future time is expected, cancer patients who understandably overly focus on their functional and symptomatic changes might lead a life of an overall decrease in daily function and social activities; a life that's filled with posttraumatic disorder syndromes, indications of anxiety and depressions, mental and physical fatigue, which all points to deteriorated quality of life. Furthermore, poor management of FoP might affect the total cancer survivorship. Groups of older age, with life's partner, higher education, childlessness, and some particular ethnic types seem to worry less about recurrence than their counterparts. Patients with neuroticism, anxiety and denial, stressful life events, more distressing symptoms, worse prognosis, and poorer general health were found to have higher FoP. On the other hand, optimism, self-esteem, and/or social support are determinants to reduce FoP. Only relatively recently have efforts been made to better understand FoP and assist patients to cope with such fear. Up to now successful strategies are mostly psychosocial interventions, including individual or group cognitive-behavioral therapy, relaxation/meditation, solutionfocused or problem-solving skills, supportive counseling, goal setting and stress reduction training, psychodynamic or existential therapy, mindfulness related instruction, acceptance and commitment therapy, and basic patient education in clinical settings. Health care providers for cancer patients need to recognize this prevailing phenomenon in order to properly assess and evaluate their cancer patients' FoP incidence and severity. Strategized and tailored interventions designed for various cancer groups are necessary to reduce the negative consequences of FoP and thus further optimize their psychological well-being and quality of life.

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