[논문]유방암 환자의 정신사회적 디스트레스에 대한 정신신체의학적 통합치료

양찬모; 장승호; 이혜진; 이상열

doi:10.22722/kjpm.2021.29.2.77

유방암 환자의 정신사회적 디스트레스에 대한 정신신체의학적 통합치료
Psychosomatic Integrative Care for Psychosocial Distress of Patients With Breast Cancer 원문보기

精神身體醫學 = Korean journal of psychosomatic medicine, v.29 no.2, 2021년, pp.77 - 85

양찬모 (원광대학교 의과대학 정신건강의학교실) , 장승호 (원광대학교 의과대학 정신건강의학교실) , 이혜진 (원광대학교 대학원 보건학과) , 이상열 (원광대학교 의과대학 정신건강의학교실)

초록
AI-Helper

유방암은 여성에서 가장 높은 유병율을 보이는 암으로, 진단과 치료과정 및 치료 후에도 다양한 정신사회적 디스트레스가 자주 나타난다. 유방암 환자의 치료에는 의학적 치료뿐만 아니라 정신신체의학적 통합치료가 필요하다. 유방암 환자는 스트레스, 불안장애, 우울장애, 적응 장애 등에 대한 취약성이 증가하고, 이러한 정신장애는 유방암의 악화 또는 재발과 연관이 있다. 유방암 환자의 불안과 우울에 대한 정신사회적 치료는 환자의 삶의 질을 증진시키고, 유방암의 재발과 악화를 감소시킨다. 본 연구에서는 5편의 유방암 치료 가이드라인에서 정신사회적 디스트레스에 대한 정신사회적 치료와 대체의학적 치료가 포함된 정신신체의학적 통합치료 부분에 초점을 맞추어 논의하였다. 5편의 가이드 라인에서 사용한 서로 다른 근거 기준은 US Preventive Service Task Force (USPSTF) 기준에 맞춰 연구자들이 평가하여 근거를 기술하였다. 또한 유방암 환자의 불안, 우울, 기분, 삶의 질에 대한 정신사회적 치료의 효과 크기를 요약하였고, 정신신체의학적 통합치료 서비스 제공에 대한 장벽과 이에 대한 대안을 제시하였다. 다학제 팀을 구성하고, 환자 요구도를 조사하며, 정신사회적 치료의 정보를 환자에게 제공하여 환자와 가족이 참여하는 것이 중요하다. 또한 준비된 계획에 따라 정기적으로 정신사회적 디스트레스를 평가하고, 정신신체의학 전문가 또는 자문조정 정신건강의학과 의사에 의한 정신신체의학적 통합치료가 환자에게 제공되는 것이 가장 중요하다.

Abstract ▼ AI-Helper

Breast cancer is the most prevalent oncological disease among women. Various psychosocial distress is common at the diagnosis, treatment, and posttreatment phase of breast cancer. For the treatment of breast cancer, not only medical treatment but also psychosomatic integrative care will be needed. Patients with breast cancer may lead to increased vulnerability to stress, adjustment disorder, anxiety disorder, and depressive disorder, and these psychiatric diseases and conditions are associated with recurrence or exacerbation of breast cancer. Psychosocial treatment of anxiety and depression could increase the quality of life of patients and decrease the recurrence and progression of breast cancer. In this article, we reviewed 5 clinical breast cancer survivorship guidelines focused on psychosomatic integrative care including psychosocial treatment and alternative treatment for psychosocial distress. Because 5 treatment guidelines were using various definitions of evidence, we confirmed evidence of various psychosocial treatments for patients with breast cancer based on the definition of evidence by the US Preventive Service Task Force (USPSTF) guideline. We also reviewed the effect size of psychosocial treatment for anxiety, depression, mood, and quality of life in patients with breast cancer. This article discusses the barrier to the delivery of psychosomatic integrative care and suggests integrative care planning for breast cancer. Multi-disciplinary teams, patient's needs assessment, information technology support, patient and caregiver engagement, planned periodic monitoring of psychosocial distress by a psychosomatic specialist or consultation-liaison psychiatrist are recommended as key features of a psychosomatic integrated care plan.

주제어

표/그림 (6)

표 Table 1. 5 Guideline for psychosocial distress of patients with breast cancer
표 Table 2. Defnition and levels of certainty regrading net beneft of US Preventive Service Task Force (USPSTF)
표 Table 3. Evidence of psychosomatic integrative care on emotional wellbeing, quality of life and lifestyle recommendations in patients with breast cancer
표 Table 4. Evidence of psychosomatic integrative care on anxiety in patients with breast cancer
표 Table 5. Evidence of psychosomatic integrative care on depression in patients with breast cancer
표 Table 6. Evidence of psychosomatic integrative care on fatigue and pain in patients with breast cancer

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