[[alternative]]Effect of Mindfulness-Based Stress Reduction Program on Psychological Stress, Symptom Distress and Quality of Life in Non-Small Cell Lung Cancer Survivors

[[abstract]]背景：早期發現及治療增加非小細胞肺癌治癒率及提升存活率，但癌症存活者仍受癌症及治療的生理症狀與心理困擾而影響生活品質。正念減壓療法被證實可改善癌症病人因應生理及心理困擾，之於非小細胞肺癌存活者的效應則有待探討。目的︰本研究以完成肺癌治療，進入追蹤期的非小細胞肺癌存活者為研究對象，分兩階段進行。第一階段評估肺癌存活者知覺壓力、正念、心理困擾、症狀困擾與生活品質之狀況，並探討影響生活品質的因素。第二階段分兩組(課室團體組、網路組)分別進行正念減壓方案，比較在知覺壓力、正念、心理困擾、症狀困擾與生活品質的效應。方法︰第一階段進行橫斷式研究，以方便取樣招募完成肺癌治療達一個月以上，定期在醫院門診接受追蹤的存活者。以自填式問卷收集人口學資料、知覺壓力量表 (Perceived Stress Scale)、中文版止觀覺察注意量表（Chinese version of Mindful Attention Awareness Scale）、醫院焦慮和憂鬱量表(Hospital Anxiety and Depression Scale)、症狀困擾量表（Symptom Distress Scale）、及癌症病人生活品質量表（Functional Assessment of Cancer Therapy-General, FACT-G）等資料。第二階段以類實驗研究，非隨機分配進行分組，課室團體組(n=20)及網路組(n=34)，分組進行正念減壓方案(連續6週，每週2.5小時課程，及半日正念練習活動)。分別在課程方案開始前(Time1, T1)，6週課程結束時(Time2,T2)，與課程結束後一個月(Time3, T3)收集資料，採廣義估計方程式(Generalized estimating equations, GEE)分析正念減壓方案介入在課室團體組與網路組的成效。結果︰第一階段收集有85位肺癌存活者 (男性30位, 女性55位)，平均年齡為63.20歲(SD=9.01)，平均診斷年數為3.33年(SD=2.05)。73位(85.8 %)存活者為第一期肺癌病人，85位存活者都接受過外科手術，另有20位(23.5%)接受過化學治療。完成治療超過2年者占63%。85位存活者生活品質顯示好到極佳的程度(平均值為86.15分, SD=15.13)，知覺壓力不高(M=17.95分，SD=7.94)。症狀困擾(M=20.47，SD=5.07)顯示21.2% 存活者有中度以上症狀困擾，困擾較高的症狀是失眠、疲憊、咳嗽。心理困擾之焦慮平均值4.36分(SD=3.41)，憂鬱平均值4.79分(SD=3.53)，存活者中有13位(15.3%)的焦慮及21位(24.7%)的憂鬱測量高於8分，似有焦慮症或憂鬱症。以多元迴歸分析顯示知覺壓力、正念、心理困擾、症狀困擾變項對生活品質變異量的解釋力達53.2% (F ( 5,79 )=20.13, p< .0001)，其中焦慮對生活品質之解釋力最具顯著性(β=-.36, t= -3.37, p<.0001)，憂鬱次之(β=-.29, t= -3.34, p=.001)，知覺壓力亦具解釋力(β= -.25, t= -2.64 , p=.010)。但正念(β= -.13, t= -1.46 , p=.148)、症狀困擾 (β= -.15, t= -1.76, p=.083) 對生活品質不具顯著解釋力。第二階段研究發現兩組存活者的變項及個人特質在T1無顯著差異。介入方案實施後，兩組受試者的「知覺壓力」和「焦慮」程度並無組別間之差異，但兩組均於T2較T1時間點呈現明顯下降達統計上意義。其餘在正念、憂鬱、症狀困擾、生活品質等變項在組別間並無差異，但隨介入時間點有改善的趨勢，但未達統計上顯著差異。結論︰研究發現知覺壓力、正念、焦慮及憂鬱、症狀困擾對肺癌存活者的生活品質之變異具有53.2%的解釋力。其中，焦慮、壓力為重要解釋變項。正念減壓方案於課室團體組及網路組均顯示可隨介入時間有效降低「知覺壓力」和「焦慮」。依據本研究結果，正念減壓方案能改善早期非小細胞肺癌存活者的心理健康與生活品質。[[abstract]]Background: Early detection and proper treatment improve the cure rate and survival rate of non-small cell lung cancer. But cancer survivors are still affected by the physical symptoms and psychological distress from cancer and its treatment, which affect their quality of life. Mindfulness-based stress reduction therapy has been proved to ameliorate physical and psychological distress in cancer patients, but its effect on non-small cell lung cancer survivors remains to be explored。Purpose: This study recruited non-small cell lung cancer survivors who completed the lung cancer treatment and entered the follow-up period as the research objects. This research will aim into two phases. The first phase evaluates the level of perceived stress, mindfulness, psychological distress, symptom distress and quality of life of lung cancer survivors and explores the factors that affect quality of life. In the second phase, all participants will be divided into two groups to carry out the mindfulness-based stress reduction program respectively, and the effects on perceived stress, mindfulness, psychological distress, symptom distress and quality of life were compared after the end of intervention.Method: The first phase is a cross-sectional study designed to recruit patients with non-small cell lung cancer who have ended cancer treatment for at least one month. Demographic data and self-report questionnaires, including the Perceived Stress Scale, the Chinese version of the Mindfulness Attention and Awareness Scale, the Hospital Anxiety and Depression Scale, the Symptomatic Distress Scale, and the Quality-of-Life Scale (Functional Assessment of Cancer Therapy-General, FACT-G ) for investigation. The second phase was a quasi-experimental study with non-random assignment by object's willing to a small group, at the end classroom group(n=20) and internet group(n=34), mindfulness-based stress reduction program(6 consecutive weeks, 2.5 hours per week) and a silence-days of mindfulness practice activities. Data were collected before the start of the course (time 1, T1), at the end of the 6-week course (time 2, T2), and one month after the end of the course (time 3, T3). Generalized Estimating Equations (GEE) were used to analyze the effectiveness of mindfulness-based stress reduction program interventions in classrooms and internet groups.Result: We collected 85 lung cancer survivors (30 males, 55 females), with a mean age of 63.20 years (SD=9.01), a mean diagnosis of 3.33 years (SD=2.05). Seventy-three (85.8%) survivors were stage I lung cancer patients, all survivors had surgery, and 20 (23.5%) had received chemotherapy. Completion of treatment for more than 2 years accounted for 63%. The quality of life of the 85 survivors was excellent (mean, 86.15 , SD=15.13), and the perceived stress was not high (M=17.95, SD=7.94). Symptom distress score(M=20.47, SD=5.07) showed that 21.2% of the survivors had moderate or higher symptom distress. The average score of anxiety for psychological distress was 4.36 (SD=3.41), and the average score for depression was 4.79 (SD=3.53). Among the survivors,(n=13,15.3%) had anxiety (n=21, 24.7%) had a measure of depression higher than 8 likely to have anxiety or depression。 Multiple regression analysis showed that the variables of perceived stress, mindfulness, psychological distress, and symptom distress had an explanatory power of 53.2% (F ( 5,79 )=20.13, p< .0001) on the variance of quality of life. The explanatory power was the most significant (β=-.36, t= -3.37, p<.0001), followed by depression (β=-.29, t= -3.34, p=.001), and perceived stress also explained force (β= -.25, t= -2.64 , p=.010). However, mindfulness (β= -.13, t= -1.46 , p=.148) and symptom distress (β= -.15, t= -1.76, p=.083) had no significant explanatory power for quality of life. The second phase found no significant differences in variables and personal characteristics between the two groups of participants in the first survey(T1). After completion of the intervention program, there was no difference in the levels of &quot;perceived stress&quot; and &quot;anxiety&quot; between the two groups, but the time points T2 decreased significantly compared to time point T1, reaching statistical significance. There was no difference in mindfulness, depression, symptom distress, quality of life between groups, but the trend of improvement maintained with the intervention time point but did not reach statistical significance yet.Conclusion: The study found that perceived stress, mindfulness, anxiety, depression, and symptom distress had 53.2% explanatory power for the variance in quality of life among lung cancer survivors. Among them, anxiety and stress are important explanatory variables. Mindfulness-based stress reduction programs were shown to be effective in reducing &quot;perceived stress&quot; and &quot;anxiety&quot; in both classroom and internet groups. Study results show that a mindfulness-based stress reduction program can improve mental health and quality of life in survivors of early-stage non-small cell lung cancer