前言：乳癌存活者無論在急性期(Acute)、延長期(Extended)或永久期(Permanent)，都會因治療、副作用或其他生心理因素影響未滿足需求的差異，現今醫療資訊及照護給予，多集中在急性期之乳癌存活者，然而醫療進步，有越來越多乳癌存活者需長時間與疾病共處，5年存活的乳癌族群中，即使與小於五年者有相似的生心理症狀，其未滿足需求卻是具差異的。因此，若能探究乳癌存活者生、心理症狀與未滿足需求在不同存活階段的影響，乳癌存活者將能接受到最適切的個人化照護，進而提高乳癌存活者後續存活的生活品質。
目的：探討不同存活階段乳癌存活者的生理、心理症狀對未滿足需求影響的差異。
方法：本研究採用次級資料分析，母研究採橫斷式、方便取樣，分別針對無疾病存活期且無復發或轉移、已完成積極治療之存活期小於5年乳癌存活者157位，以及存活期大於5年乳癌存活者192位，進行未滿足需求探討。母研究於南部某兩所醫學中心門診、以婦女症狀困擾與健康照護需求問卷進行收案。問卷內容含個案基本資料、害怕復發程度、身體症狀評估、流行病學研究中心憂鬱量表(Center for Epidemiological Studies-Depression Scale; CES-D) 及華人癌症存活者未滿足需求量表(Chinese Cancer Survivors’ Unmet Needs; CaSUN-C)。以百分比或比率描述個案之人口學特性、與疾病治療相關等分佈情形，以皮爾森積差相關分析、t-檢定及one way ANOVA了解各觀察變項與基本資料的相關性，以及利用AMOS 24.0進行結構方程模型(Structural Equation modeling, SEM)多群組分析，探討存活期是否調節身體症狀、憂鬱及害怕復發對於未滿足需求的影響。
結果：(1) 存活期大於5年存活者的憂鬱程度顯著高於存活期小於5年之存活者(t=-3.43, p=.001)，身體症狀及害怕復發則無顯著差異; (2)兩族群的身體症狀(r=.317, p=.000/ r=.305, p=.000)、憂鬱(r=.302, p=.000/ r=.375, p=.000)及害怕復發(r=.451, p=.000/ r=.441, p=.000)皆和未滿足需求數目及強度有顯著相關; (3) 存活期於三個變項對未滿足需求數目影響的C.R.值皆在1.96以下，代表不具調節作用; (4) 存活期於身體症狀及憂鬱對未滿足需求強度的影響中亦不具調節作用，但存活期在害怕復發對未滿足需求強度的C.R.值大於1.96、具調節作用，且存活期大於5年者的影響較大。
結論：無論存活期為小於或大於5年，害怕復發皆與未滿足需求呈顯著正相關，尤其在存活期大於5年者，害怕復發的程度雖然與存活期小於5年者沒有差異，但影響未滿足需求強度卻是顯著較高。針對存活期大於5年之乳癌存活者，建議增設專門追蹤之個案管理師照護，評估其未滿足需求，並藉由與害怕復發相關的介入措施，幫助此族群緩解心理壓力。

The Impact of Physical Symptom and Psychological Distress on Unmet Needs among Breast Cancer Survivors with Different Survival Stage.
I-Hsuan Shih
Su-Ying Fang, PhD
Department of Nursing, NCKU

SUMMARY
Background/purpose: Breast cancer survivors in different survival duration have different unmet needs due to their side effects including physical or psychological impact from treatments. They may have similar physical and psychological symptom, their unmet needs may be different. The purpose of this article is to explore the impact of physical symptom and psychological distress on unmet needs among breast cancer survivors with different survival stage. Methods: Secondary analysis of two projects measured unmet needs for short (survival duration less than 5 years, n=157) and long term (survival duration more than 5 years, n=192) breast cancer survivors in southern Taiwan was conducted. Cross-sectional design with convenience sampling was used. Pearson correlation, t-test, one-way ANOVA, structural equation modeling and multigroups measurement was used. Results: Physical symptom, depression and fear of recurrence were correlated with unmet needs. The impact of fear of recurrence on the intensity of unmet needs was moderated by survival duration. The unmet needs of women survived more than 5 years had greater impact form fear of recurrence than women survived less than 5 years. Conclusion: Long-term survivors had similar degree of fear of recurrence to short-term survivors. However, the impact of their fear of recurrence on their unmet needs was different in which women survived more than 5 years had greater impact of their fear of recurrence on the intensity of unmet needs. As a result, long-term survivors need case manager to assess their unmet needs, and provide them a approiate intervention, especially on fear of recurrence.

Key words: Breast cancer, survivor, unmet needs, survival duration, fear of recurrence.

INTRODUCTION
Breast cancer survivors in different survival duration have different unmet needs due to their long-term side effects including physical or psychological impact from treatments. Women with different survival stage may have similar physical and psychological symptom, their unmet needs may be different. If we can explore the impact of physical and psychological symptom on unmet needs among breast cancer survivors with different survival stage, breast cancer survivors can receive more approiate health care, and increase their quality of life in terms of their survival stage. The purpose of this article is to explore the impact of physical symptom and psychological distress on unmet needs among breast cancer survivors with different survival stage.

MATERIALS AND METHODS
Secondary analysis of two projects measured unmet needs for short and long term breast cancer survivors in southern Taiwan was conducted. Cross-sectional design with convenience sampling was used in the orininal studies. The number of women in survival duration less than 5 years and more than 5 years were 157 and 193 repectively. Women who diagnosed with cancer stage 0-III, completed active treatments were currently disease-free and didn’t have any recurrence and cancer metastasis were recruited. Structure questionnaires included fear of recurrence, physical symptom, the Center for Epidemiological Studies-Depression Scale(CES-D) and Chinese Cancer Survivors’ Unmet Need(CaSUN-C) were administered. Pearson correlation, t-test and one-way ANOVA were used to analyz the correlation between interested variables and demographics. Finally, structural equation modeling(SEM) and multigroups measurement strategy using AMOS 24.0 was used to explore the survival stage as the moderator on the relationship between the physical symptoms, depression, fear of recurrence, and unmet needs.

RESULTS AND DISCUSSION
(1) Women survived more than 5 years had significant more depressive symptoms than women less than 5 years (t=-3.43, p=.001), but there was no significant difference in physical symptom and fear of recurrence between these groups. (2) Physical symptom (number of unmet needs: r=.317, p=.000/ intensity of unmet needs: r=.305, p=.000), depressive symptoms (number of unmet needs: r=.302, p=.000/ intensity of unmet needs: r=.375, p=.000) and fear of recurrence (number of unmet needs: r=.451, p=.000/ intensity of unmet needs: r=.441, p=.000) were all correlated with both of the number and intensity of unmet needs. (3) Survival duration was not a moderator between the impact of three varibles to the number of unmet needs and the impact of physical symptom and depression to the intensity of unmet needs(Critical ratio <1.96). Survival duration was not a moderator between the three varibles and the number of unmet needs, and also between two variables (physical symptom and depression) and the intensity of unmet needs (Critical ratio <1.96). (4) The impact of fear of recurrence on the intensity of unmet needs was moderated by survival duration (Critical ratio >1.96). And the unmet needs of women survived more than 5 years had greater impact form fear of recurrence than those of women survived less than 5 years.

CONCLUSION
The long-term survivors had similar degree of fear of recurrence to short-term survivors. However, the impact of their fear of recurrence on their unmet needs was different in which women survived more than 5 years had greater impact of their fear of recurrence on the intensity of unmet needs. As a result, long-term survivors need a special case manager to assess their unmet needs, and provide them a more approiate intervention, especially on fear of recurrence concern to decrease their long-term psychological distress.

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