本研究利用群集分析的方式，將接受化療之肺癌病患依四個症狀群集—不適症狀群(sickness cluster)、腸胃道症狀群(GI cluster)、心理症狀群(emotional cluster)及呼吸道症狀群(respiratory cluster)的表現加以分類，並探討不同類別之病患群在生活品質及存活期的差異。研究採縱貫性設計，於北部某醫學中心收案，共85位初次接受化學治療病患完成至少半年的追蹤。本研究以MSAS-SF測量各症狀群集的困擾程度，以KPS測量身體功能狀態，以EORTC-C30評估生活品質。運用階層式群集分析，依病患接受化療後第一療程時四個症狀群集的困擾分數，將病患分成四個病患群—低症狀群困擾病患群、呼吸道症狀困擾病患群、腸胃道症狀困擾病患群及多症狀困擾病患群。呼吸道群的女性比例較高，腸胃道病患群顯著比低症狀群困擾病患群來的年長。四群病患在生活品質上，除了於第六療程時，多症狀群比低症狀群病患有較差的認知功能外，其他療程的生活品質沒有統計上的顯著差異。存活期方面，多症狀群困擾病患群顯著的比低症狀群有較短的一年存活期。本研究發現，於化學治療早期評估肺癌病人各症狀群集的情況，有助於預測病人的存活，針對高危險的病患群，宜及早給予適當之措施。

The purpose of this longitudinal study was to identify lung cancer patients’ subgroups based on their presentation of four symptom clusters (sickness, GI, emotional, and respiratory symptom cluster), and to examine the differences on QOL and survival among identified patient subgroups. Symptom distress, performance status and QOL were assessed by MSAS-SF, KPS, and EORTC-C30, respectively. Using hierarchical cluster analysis, four patient groups were identified: low symptom group, respiratory symptom group, GI symptom group and multiple symptom group. Respiratory symptom group had higher proportion of female. Patients in GI symptom group were older than patient in low symptom group. Multiple symptom group ha s lower cognitive function at the sixth chemotherapy cycle and less 1-year survival rate than that of low symptom group. The study results suggested that assessment of symptoms at the early phase of chemotherapy may help to predict lung cancer patients’ survival time. For patients with high risk of early death, proper interventions should be developed.

論文指導教授推薦書
論文口試委員審定書
長庚大學碩士紙本論文著作授權書.......................iii
致謝..............................................iv
中文摘要...........................................vi
英文摘要...........................................vii
目錄...............................................viii
圖表目錄............................................x
表次目錄............................................xi
附錄目錄............................................xiii
第一章 緒論.........................................1
1.1研究動機及重要性...................................1
1.2研究目的..........................................4
1.3研究問題..........................................5
1.4名詞界定..........................................6
第二章 文獻查證.......................................7
2.1肺癌病患症狀經驗...................................7
2.2癌症病患症狀群集...................................13
2.3癌症病患次族群之相關研究............................24
2.4影響存活率之相關因素................................30
第三章 研究方法......................................32
3.1研究架構......................................32
3.2研究設計......................................33
3.3研究對象和場所.................................34
3.4研究工具......................................35
3.5研究收集過程...................................37
3.6資料分析......................................39
第四章 研究結果......................................41
4.1研究對象基本屬性及疾病治療特性...................41
4.2肺癌病患化療期間症狀、身體功能及生活品質之表現.....47
4.3接受化療之肺癌病患次族群呈現.........................62
4.4各次族群在基本特性上之差異.......................65
4.5各次族群在生活品質及症狀困擾之差異................70
4.6各次族群在存活期上之差異.........................73
第五章 討論...........................................81
5.1肺癌病患化療期間症狀、身體功能、生活品質之表現......81
5.2接受化療之肺癌病患次族群..........................84
5.3肺癌病患次族群在身體功能、生活品質及存活率之差異.....87
第六章 結論與建議......................................89
6.1結論...........................................89
6.2護理上的應用....................................90
6.3研究限制與建議..................................92
參考文獻..............................................93
附錄..................................................105

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