臺灣博碩士論文加值系統

背景：乳癌是國人女性癌症好發第一位，也是台灣癌症死因排名第四位。研究顯示健康的生活方式與行為可以延長乳癌病人的生命及降低復發機率，但乳癌病人對維持健康的生活方式與行為的順從性低，因此提高病人執行健康行為的動機是醫護人員重要的照護目標。調查也顯示新診斷的乳癌病人曾尋求中醫療法比例超過80%，其相信中醫治療及體質調整可以增強抵抗力及減少西醫治療的副作用，更能達到預防復發之目的。從傳統中醫治未病的觀點也重視體質在疾病防治的重要性，然而國內外目前尚缺乏乳癌病人在治療或追蹤期的中醫體質實證資料。因此本研究期望從傳統中醫體質的觀點，了解乳癌病人體質狀態、體質與健康生活方式及行為的關係，以提供乳癌病人執行健康生活及行為動機的依據。
目的：探討乳癌病人在化療階段與追蹤期之中醫體質狀態及其變化，並了解影響化療前及追蹤階段乳癌病人中醫體質的相關因素。
方法：本研究分兩部分進行，第一部分採縱貫性研究設計，研究對象取自台灣中部某醫院新診斷及無遠端轉移的乳癌病人，且需接受靜脈注射CEF（Cyclophosphamide、Epirubicin、5-Fluorouracil）化療藥物的早期乳癌個案，願意參與研究者共20位。以結構式問卷收集資料，包括個案記錄表、中醫體質問卷(BCQ)，資料收集時間分別在化療前、第二次化療、第四次化療、第六次化療、化療結束後4週及16週，分別對乳癌病人使用結構式問卷進行訪談。第二階段以橫斷面的研究設計，選取全台乳癌病友協會的三十七個分會，收集已完成治療、處於追蹤階段，且無遠端轉移證據的乳癌會員共450位，以郵寄結構式問卷方式收集資料，包括研究說明書及個案記錄表、中醫體質問卷(BCQ)，最後同意參與，且完成研究資料填寫者有311位。
結果：化學藥物治療期乳癌病人之陰血虛、陽氣虛與痰濕瘀滯體質總得分，相較於化療前，其體質量表總得分越來越高；陽氣虛體質得分在治療第二週達最高，而陰血虛與痰濕瘀滯體質隨著化療療程至結束後四週時最高。三種體質於化療結束後16週下降至低於化療前的體質總得分。治療期乳癌病人治療前有無工作與陰血虛體質(p= 0.042)及痰濕瘀滯體質偏差(P=0.042)呈正相關。超過一半的追蹤期乳癌病人具有陽氣虛及陰血虛的偏差體質，且高達42.8％ 的個案同時合併有陽氣虛、陰血虛及痰濕瘀滯三種體質夾雜的情況。追蹤期乳癌病人有規律運動，是陰血虛、陽氣虛與痰濕瘀滯偏差體質的保護因子，而精神壓力、喜好油炸類食物、鹹性食物是造成體質偏差的危險因素。
結論與應用：本研究結果建立乳癌個案在化療前、後，及追蹤階段的中醫體質變化趨勢與影響中醫體質因素之實證資料。未來可提供醫護人員設計乳癌病人中醫體質保健介入措施之參考依據，以幫助乳癌病人達到預防疾病再發及健康促進的最終目的。

Background: Breast cancer is the number one cause of cancer among Chinese women and the fourth leading cause of cancer death in Taiwan.
Studies showed that healthy lifestyles and behaviors can prolong the life of breast cancer patients and reduce their chances of recurrence. However, breast cancer patients have a low compliance with maintaining healthy lifestyles and behaviors. Therefore, motivation for improving patients'' health behaviors is an important care target for health care staff. Studies also showed that there are over 80% of newly diagnosed breast cancer patients tend to seek traditional Chinese medicine (TCM) therapy who believe that body constitutions can enhance immunity and reduce Western medicine treatment side effects, more able to maintain the health purpose of recurrence prevention. From the TCM perspective of preventive treatment of disease, that concerned the importance of body constitution in the prevention and treatment diseases. However, not only in Taiwan but also abroad, there is still lack of empirical data of TCM body constitution during the treatment or follow-up period of breast cancer patients.
Therefore, this study expect from the TCM constitutional conditioning point of view. To explore the relationship between body constitution status, body constitution and healthy lifestyles and behaviors of breast cancer patients, which can provide breast cancer patients to carry out healthy life and behavior motivation basis.
Objective: To investigate the status and changes of TCM body constitution of breast cancer patients during the chemotherapy and follow-up period. To understand the impact of pre-chemotherapy and follow-up period of breast cancer patients related to body constitutional factors.
Methods: The study was divided into two parts. The first part was a longitudinal design study. Participants were breast cancer patients with newly diagnosed and without distant metastasis in a hospital of central Taiwan. Totally included 20 patients who were receving intravenous chemotherapy with CEF (Cyclophosphamide, Epirubicin, 5-Fluorouracil). Data were collected with a structured questionnaire, including case report form, BCQ questionnaire which before chemotherapy, the second chemotherapy, the fourth chemotherapy, the sixth chemotherapy, chemotherapy after 4 weeks and 16 weeks, respectively. For breast cancer patients were interviewed by structured questionnaires. The second part was a cross-sectional research. Select thirty-seven branch of Taiwan Association of breast cancer patients who have completed the treatment and without distant metastasis evidence, a total of 450 breast cancer members in the follow-up period. Data was collected by post structured questionnaire, including consideration of the specification and case report form, TCM body constitution Questionnaire (BCQ). Finally, 311 patients participated and completed the study information to fill in.
Results: The total score of yin and blood deficiency, yang deficiency and phlegm-dampness stasis in patients with breast cancer during the treatment period was higher than that before chemotherapy. The scores of yang deficiency were the highest in the second week of treatment, while yin deficiency and phlegm stasis constitution as four weeks after the end of chemotherapy treatment to the highest. The three body constitutions decreased to 16 weeks after the end of chemotherapy to be lower than the total body constitution score before chemotherapy. The treatment of breast cancer patients, before and after treatment with or without work was positively correlated of yin and blood deficiency (p = 0.042) and phlegm-dampness stasis deviation (P = 0.042). More than half of the follow-up period breast cancer patients had yang deficiency and yin deficiency, and up to 42.8% of the cases were complicated with yang deficiency, yin deficiency and phlegm-dampness stasis. Follow-up period breast cancer patients have regular exercise, which are yin and blood deficiency, yang deficiency and phlegm-dampness stasis deviation protection factor. The mental stress, favorite fried foods, salty foods are the risk factors of body constitutions deviation.
Conclusions and applications: The results of this study establish the breast cancer patients before chemotherapy, post chemotherapy, and follow-up period of the trend of TCM body constitution and empirical evidence of body constitution factors affecting Chinese medicine. In the future, these results can provide medical staff design breast cancer patients with physical health care intervention reference to help them achieve the ultimate goal of preventing disease recurrence and health promotion.

第一章 緒論 18
第一節 研究背景與動機 18
第二節 研究的重要性 21
第三節 研究目的 23
第二章 文獻查證 24
第一節 中西醫治療乳癌之現況 24
第二節 中醫體質概念與保健 30
第三節 乳癌病人的中醫體質 38
第四節 名詞界定 40
第五節 研究架構 43
第三章 研究方法 46
第一節 研究設計 46
第二節 研究對象 47
第三節 研究工具及信效度 49
第四節 研究步驟與資料收集 54
第五節 資料處理與統計分析 57
第六節 倫理考量 58
第四章 研究結果 59
第一節 化療期乳癌病人基本資料分布及其與化療前中醫體質的關係 59
第二節 化療期乳癌病人在化療前、中、後期之中醫體質狀態及變化 61
第三節 追蹤期乳癌病人之基本資料、生活因子及中醫體質狀態之分布 66
第四節 追蹤期乳癌病人的基本屬性、生活因子與中醫體質的關係 69
第五章 討論 76
第一節 化療期乳癌病人基本資料與化療前中醫體質之關係 76
第二節 化療期乳癌病人化療前後的中醫體質狀態及其變化 78
第三節 追蹤期乳癌病人的中醫體質狀態 82
第四節 追蹤期乳癌病人中醫體質之預測因子 86
第六章 結論與建議 88
第一節 結論 88
第二節 研究限制 90
第三節 建議 92
參考文獻 94
附錄一 體質問卷授權書 111
附錄二 第一階段專家效度 113
附錄三 個案基本資料表及個案紀錄表 120
附錄四 中醫體質量表 123
附錄五 第二階段專家效度 126
附錄六 第二階段個案基本資料表 133
附錄七 第一階段人體試驗委員會核准函 136
附錄八 第一階段參與研究同意書 137
附錄九 第二階段人體試驗委員會核准函 139
附錄十 第二階段研究說明書暨同意書 140

圖2.1 第一階段化療期乳癌病人研究架構 44
圖2.2 第二階段追蹤期乳癌病人研究架構圖 45
圖3.1 研究資料收集時間 55

表目次
表4.1.1化療期乳癌病人基本屬性資料分布 62
表4.1.2乳癌病人生活因子與化療前體質之關係 63
表4.1.3 乳癌病人接受化療前後有無陰血虛、陽氣虛及痰濕瘀滯體質之百分比變化情形 64
表4.1.4 乳癌病人化療前後在陰血虛、陽氣虛及痰濕瘀滯體質得分之變化情形及其檢定 65
表4.2.1. 追蹤期乳癌病人基本屬性分布情形 67
表4.2.2. 追蹤期乳癌病人基本屬性與陽氣虛、陰血虛及痰濕瘀滯體質關係之檢定 68
表4.3.1 生活因子與陽氣虛、陰血虛及痰濕瘀滯體質關係之檢定 71
表4.3.2 基本屬性與生活因子預測陽氣虛體質檢定 73
表4.3.3 基本屬性與生活因子預測陰血虛體質檢定 74
表4.3.4 基本屬性與生活因子預測痰濕瘀滯體質檢定 75

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