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研究生:張東杰
研究生(外文):Chang Joseph Tung-Chieh
論文名稱:鼻咽癌病患治療成果之評估-生活品質與經濟指標之研究
論文名稱(外文):The Outcome Measurement of Nasopharyngeal Carcinoma Patients after Radical Treatment - Quality of Life and Economic status
指導教授:文羽苹老師
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:89
中文關鍵詞:鼻咽癌生活品質經濟指標治療副作用
外文關鍵詞:nasopharyngeal cancer (NPC)quality of lifeeconomic statustheraputic complications
相關次數:
  • 被引用被引用:11
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  • 下載下載:81
  • 收藏至我的研究室書目清單書目收藏:1
放射治療是目前治療鼻咽癌的主要方式,且有不錯的治療效果,以病患五年期的追蹤來看,約有七成的病患得到成功的腫瘤控制,但也因施予病患高劑量的放射線而產生許多的治療副作用,如口乾、聽力變差等,這些副作用可能對病患造成生活品質的改變,也可能進而影響病患的經濟生產力。本研究即在評估鼻咽癌病患在治療後,其生活品質與經濟指標改變之情形,以作為臨床醫師的參考。
本研究中採用FACT-H&N繁體中文版來做問卷調查。研究首先測試問卷的信度。34位病患的前導測試肯定,FACT-H&N繁體中文第四版探討鼻咽癌病患生活品質之信度。
臨床實驗收集153位鼻咽癌病患的相關資料,樣本中約70%為男性,臨床癌症分期中四期的分佈相當平均,但所得高於全國平均,問卷測試在病患複診候診時填答,因此接受治療的時期長短不一,中位數約為4年,問卷資料收集內容包括生活品質、經濟狀況一般生活品質並根據FACT等分數,治療的副作用則以醫院病歷為準,病患的收入、工作時數及工作型態的改變,則依病患所敘述,分治療前、治療後的年數做紀錄,病患的治療副作用乃照醫院病歷資料做登錄,生活品質的分數則按FACT手冊之指導原則做計算與分析。
研究發現,治療後慢性副作用的嚴重度,如口乾、聽力受損、牙關緊閉、神經系統的副作用、與吞嚥困難卻與生活品質有顯著的相關。但病患的年齡、性別、職業、教育程度、臨床癌症分期、接受化學治療與否、及治療後的年數與一般生活品質並無相關。在經濟生活方面,有28.1%的病患在治療後年收入減少,只有4位(2.6%)病患在治療後收入增加,而這4位可能因他們在治療時是學生,在畢業後工作使收入增加。治療後副作用的嚴重度與收入的減少有相關,副作用輕的病患年收入減少的比例最低。
雖然受樣本收集和資料型態限制,無法對生活品質改變的現象作進一步因果推論,本研究發現,鼻咽癌病患治療後副作用的嚴重度,不只影響癒後的一般生活品質,同時也對經濟收入有顯著的影響。因此,在選擇醫療方式時,病患生活品質與經濟生活的改變都應為臨床醫師列為重要參考。
Radiotherapy is a major treatment modality for nasopharyngeal cancer (NPC). The tumor control rate is relatively good among all cancers. Approximately 70% of the NPC patients reach 5-year survival after tumor control. However, radiation-induced complications are not rare, including dry mouth, hearing impairment, and trismus. These complications may affect patients’ life quality as well as their economic status. In this study, we assessed the change of NPC patients’ life quality and economic status, after completion of radiotherapy.
The Functional Assessment of Chronic Illness Therapy for Head and Neck cancer (FACT-H&N) verse 4 was used to assess the life quality and income changes. In the beginning, 34 NPC patients were entered the pilot study to validate the questionnaire. Result showed high reliablity for use in NPC patients.
A total of 153 consequent follow-up NPC patients were interviewed the FACT questionnaire. In these patients, the median age was 46 (ranging from 25 to 79). About 70 % of patients are male. The distributions in different stage of disease severity are even. The income of these patients was slightly higher than the average of national population in Taiwan. The annual income, working hour and job pattern were all recorded according to each patient’s statement. The treatment complications were also recorded according to the information on hospital chart. The score of life quality was calculated according to the FACT manual.
After analysis, results show that the severity of radiation complications, including xerostomia, hearing impairment, trismus, neurological deficits and dysphagia, had significantly related to patients’ life quality. However, patient age, sex, occupation, education level, tumor stage, receiving chemotherapy or not, and the length of follow-up had no effect on life quality. For economic status, 43 patients (28.1%) decreased their annual income after treatment. Only 4 patients (2.6%) increased their income after treatment, and these 4 patients were all students when they received treatment. In additions, the severity of treatment complications was strongly associated to the income change.
Further analysis for the final cause-relationship of the life quality change and income alteration cannot be made because of the limitation of sample size and sample collection process. However, this study shows that the severity of treatment complications will decrease their life quality as well as annual income in NPC patients. Therefore, when assessing treatment cost, the long-term treatment effects of patients’ life quality and economic alteration must take into consideration.
目 錄
第一章、 緒論 -------------------------------------------- 1
第一節、 研究背景 ------------------------------------- 1
第二節、 研究假設與研究目的 --------------------------- 2
第二章、文獻探討 --------------------------------------- 4
第一節、鼻咽癌之流行病學概說 -------------------------- 4
第二節、鼻咽癌之臨床分期、治療與治療之副作用 ---------- 6
第三節、 生活品質及社經指標研究之重要性 ----------------12
第四節、生活品質與經濟指標研究方法與問卷簡介 --------- 19
第三章、 研究設計與方法 ---------------------------------- 23
第一節、鼻咽癌患者的問卷設計 -------------------------- 23
(1) 生活品質─FACT問卷 --------------------------- 23
(2) 社經指標問卷 --------------------------------- 25
第二節、FACT-H&N 分數的算法 --------------------------- 26
第三節、 研究架構 ------------------------------------- 26
第四節、 統計方法 ------------------------------------- 28
第五節、 研究實施 ------------------------------------- 28
第四章、 資料分析結果 ------------------------------------ 30
第一節、FACT-H&N信度研究 ----------------------------- 30 (1) 前導性信度研究 --------------------------------- 30
(2) FACT-H&N問卷信度分析--------------------------- 32 第二節、病患基本資料 --------------------------------- 33 (1) 病患基本狀況 ---------------------------------- 33
(2) 病患經濟狀況 -----------------------------------35
(3) 生活品質指標 ---------------------------------- 37
(4) 治療副作用,醫師與病人評估副作用嚴重度之情形 --- 38
第三節、 病患的基本狀況與生活品質之相關性 -------------- 40第四節、 治療前後病人工作狀況與經濟狀況之改變 ---------- 43
第五節、 醫師與病人評估副作用嚴重度之比較 -------------- 49
第五章、 討論 -------------------------------------------- 52
第一節、 FACT-H&N信度之比較及對鼻咽癌患者使用之建議 --- 52
第二節、 醫師與病人對副作用評估之差異 ------------------ 57
第三節、 經濟收入改變與生活品質指標關係之探討與建議 ---- 61
第五節、 研究限制 -------------------------------------- 65
第六章、 結論 -------------------------------------------- 67
第七章、 文獻參考 ---------------------------------------- 70
第八章、 附錄 -------------------------------------------- 79
第一節、 FACT-H&N問卷 --------------------------------- 79
第二節、 病患受訪記錄表 -------------------------------- 82
第三節、 經濟指標問卷 ---------------------------------- 87
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