[[alternative]]Relation of cognitive function and functional health status in women receiving adjuvant hormonal therapy

[[abstract]]荷爾蒙治療是乳癌婦女的輔助治療之一。過去文獻發現荷爾蒙輔助治療可能影響認知功能。臨床上也常見乳癌婦女抱怨注意力及記憶力的改變。然而仍未有相關的研究佐證國內乳癌婦女的認知功能狀態。故本研究目的在於了解接受荷爾蒙輔助治療的乳癌婦女其認知功能及其相關影響因子，以增進醫護人員對認知功能問題的了解, 以增進臨床照護知能。 本研究採橫斷性觀察型設計。以連續性、方便取樣方式，於台灣北部某醫學中心腫瘤門診招募了正接受輔助性荷爾蒙治療至少3個月且未有腦轉移、頭部外傷、失智或精神病之早期乳癌婦女，收案時間為98年10月6日至99年3月25日，同意參與本研究共129人。本研究利用結構式問卷，經由面對面評估方式，以病歷查閱、EORTC C30-CF次量表及SF-36，了解接受荷爾蒙輔助治療之乳癌婦女人口疾病、自覺記憶力與注意力以及功能性健康狀態，並利用蒙特利爾認知評估工具(Montreal Cognitive Assessment, MoCA)來評估乳癌婦女記憶力、注意力、視覺空間、語言、抽象與定向感。此三項工具的Cronbach’s α 0.70 – 0.82。 本研究樣本平均為52.5歲(±10.02)，多數為已婚、具高中畢業之教育程度。其乳癌平均發病時間為2.5年 (0.13-9.22)、56.6% stage II、53.5%接受過MRM、74.4%接受過化學治療且75.2%接受Tamoxifen。結果發現本研究婦女較過去研究在自覺的認知功能困難高，平均分數為67.5(±21.44)。經由MoCA的標準化評估中發現，經校正教育程度之後，41.9%婦女總分低於過去失智族群常模的26分，其中24.0%為輕度。而婦女認知功能的困難主要在於記憶力與專注力面向，其中34%的婦女僅能達成少於1/2的記憶測試、25-29%無法完成較高階的視覺空間或專注力的測試。本研究也發現利用主觀性方式測量認知功能，自覺認知知功能較佳者，整體功能性健康狀態較好。[[abstract]]The adjuvant hormonal therapy is one of common treatments for breast cancer. The women with breast cancer often complained about memory loss and attention deficit after cancer treatment. There is limited information about the cognitive function and its relation with functional health. Thus, the purpose of this study was to describe relation of cognitive function and functional status in women receiving adjuvant hormonal therapy. This was a cross-section, descriptive study. A conveniences sample of 129 women with early-stage breast cancer was recruited in a medical center in Taipei. Cognitive function was measured by Montreal Cognitive Assessment (MoCA) to test the visuospatial, memory, attention, language, abstraction and orientation, and by EORTC-CF for perceived cognitive difficulty.. Functional health was measured by SF-36. All three instruments were in Traditional Chinese and demonstrated Cronbach’s α of 0.70 – 0.82. Data were analyzed by using SPSS 16.0. The women had a mean age of 52.2 and were 2.5 since diagnosis. A majority of them were married, with high-school-or-above education and had stage II breast cancer (56.6%), MRM (53.5%), chemotherapy (74.4%) and Tamoxifen (75.2%). Results showed that the women reported a mild to moderate cognitive difficulty (67.5±21.4); 41.9% of them performed less than 26 on MoCA after adjusted with education; and 24% were compatible with mild cognitive deficit and greater than 1/4 can’t perform visualspatial. After control with chronic illness, the visualspatial, memory, abstraction and EORTC-CF were significantly related to the role limitations due to physical function