中文摘要
本研究目的為探討頭頸部癌症病患接受放射治療後，不同放射治療時間點之急性期口腔合併症嚴重度與生活品質變化，並檢驗急性期口腔合併症嚴重度對生活品質的影響。研究為描述性縱貫式研究設計，於北部醫學中心，採結構性問卷訪談，以連續性取樣共收案45位頭頸部癌症病患，於六個測量時間點：放射治療前、治療第二、四、六、八與十二星期時，分別以放射治療口腔合併症嚴重度量表及歐洲癌症研究治療組織之癌症病患生活品質核心量表進行資料收集，並以廣義估計方程式（Generalized Estimation Equations；GEE）進行資料分析。
研究結果（1）線性趨勢分析顯示，隨著治療時間增加，病患口腔合併症、口腔黏膜炎、口乾與味覺改變嚴重度明顯上升，而整體性生活品質、身體與認知功能則明顯下降（2）除味覺改變嚴重度，在治療第二星期時明顯上升外，口腔合併症、口腔黏膜炎與口乾嚴重度均於放射治療第四星期時開始明顯嚴重（3）整體性生活品質、認知與身體功能，分別在治療第二、四及第六星期時開始明顯下降，而心理與情緒、社會與角色功能無明顯變化（4）在控制其他影響生活品質因素後，口腔合併症嚴重度越高，除未對病患角色功能有影響外，其他層面均顯著較差。此外，不僅口腔黏膜炎與口乾嚴重度越高，分別造成整體性生活品質與社會功能顯著較差，且味覺改變嚴重度越高，病患心理與情緒及角色功能亦顯著較差。因此護理人員應正確評估口腔合併症及其生活品質，提供病患放射治療後相關副作用及其處理措施訊息，並提醒放射治療後定期追蹤之重要性，以增加病患接受癌症相關治療之成效。

The purposes of this study were to explore the change of severity in oral complications and quality of life in different treatment time point of radiotherapy for patients with head and neck cancer and to evaluate the impact of severity of oral complications on quality of life. This study used a descriptive longitudinal research design. Consecutive sampling was conducted at a medical center in northern Taiwan, and 45 head and neck cancer patients were sampled at six time points: before radiotherapy, and the second, fourth, sixth, eighth, and 12th week after radiotherapy. Severity of oral complications and quality of life was assessed by the Radiation Therapy Oral Complication Severity Scale and European Organization Research and Treatment of Cancer Core Questionnaire of Quality of Life (EORTC QLQ-C30 Chinese version), respectively. Generalized Estimation Equations (GEE) were used for data analysis.
The results showed that: (1) the linearity of trend test showed that the overall severity of oral complications and the subscales of symptom significantly increased over the treatment course; whereas the overall quality of life, physical and cognitive functions became significantly worse; (2) the overall severity of oral complications, oral mucositis and xerostomia significantly increased from fourth week of radiotherapy, and the severity of taste change significantly increased from second week of radiotherapy; (3) the overall quality of life, physical and cognitive functions became significantly worse, while there was no significant differences among emotional, social and role functions over the treatment course; (4) the overall severity of oral complications significantly influenced on overall quality of life, physical, emotional, social and cognitive functions but did not impact on the role function in multivariate analyses. In regard to individual oral complication, oral mucositis and xerostomia significantly influenced on overall quality of life and social functions, respectively, and the severity of taste change significantly influenced on emotional and role functions. Therefore, nurses should more carefully assess oral complications and quality of life of head and neck cancer patients during and immediately after their radiotherapy, continuously provide patients with information regarding oral complications of radiotherapy, and effectively manage suffering induced by oral complications of radiotherapy to improve the quality of life of patients with severe oral complications caused by radiotherapy.

目 錄
指導教授推薦書…………………………………………………………...
口試委員會審定書………………………………………………………...
授權書………………………………………………………………….......誌謝………………………………………………………………...……iv
中文摘要…...……………………………………………….….….……..v
英文摘要………………………………...…………………….………...vi
目錄……………..……………………...……………………………... viii
第一章 緒論
第一節 研究動機與重要性……………………………………… ...1
第二節 研究目的……………………………………………………9
第二章 文獻查證
第一節 頭頸部癌症病患接受放射治療後急性期口腔合併
症嚴重度變化……………………………………….….....10
第二節 生活品質概念……………………………………………..24
第三節 頭頸部癌症病患接受放射治療後生活品質變化............ .27
第四節 急性期口腔合併症嚴重度及其他影響頭頸部癌症
病患生活品質的因素……………………………………..41
第三章 研究方法
第一節 研究架構..............................................................................49
第二節 操作型定義..........................................................................51
第三節 研究設計..............................................................................52
第四節 研究場所與收案對象..........................................................52
第五節 研究工具..............................................................................55
第六節 資料收集過程與分析..........................................................71
第七節 預試研究結果......................................................................76
第四章 研究結果與分析……………………………………………..93
第一節 頭頸部癌症病患基本人口學、疾病特性與放射治療方法
………………………………………..……….…….……...94
第二節 不同放射治療時間點頭頸部癌症病患口腔黏膜炎、口乾、味覺改變及急性期口腔合併症嚴重度變化…..…….......96
第三節 不同放射治療時間點頭頸部癌症病患整體性生活品質及其各功能層面的變化………………...…………............101
第四節 雙變量分析探討頭頸部癌症病患生活品質之影響因素
………......…………………………..…………….……..108
第五節 多變量分析探討頭頸部癌症病患生活品質之影響因素
……………………………………………….……….....128
第五章 討論
第一節 頭頸部癌症病患接受放射治療後之急性期口腔合併症嚴
重度在不同放射治療時間點的變化…….……………..144
第二節 頭頸部癌症病患接受放射治療後之生活品質在不同放射
治療時間點的變化…………………………………..….147
第三節 頭頸部癌症病患接受放射治療後之急性期口腔合併症
嚴重度對生活品質的影響….…………………………..152
第四節 其他因素對頭頸部癌症病患接受放射治療後生活品質的影響……………………………………………………...155
第六章 結論與建議
第一節 結論……………………………………………………....156
第二節 研究限制……………………………………………........158
第三節 建議……………………………………......................…..160
參考文獻
中文文獻……………………………………………….………....163
英文文獻………………………………………….………………165表格目錄 頁數
第一章
1-1 口腔合併症之發生率 4
1-2 不同時間點的口腔合併症發生率上升 4
第二章
2-1 口腔疼痛嚴重度變化（1997~2005） 14
2-2 吞嚥困難嚴重度變化（1997~2005） 16
2-3 口乾嚴重度變化（1997~2005）
18
2-4 唾液黏稠嚴重度變化（1997~2005） 20
2-5 味覺改變嚴重度變化（1997~2001） 22
2-6 各學者生活品質定義表 25
2-7 整體性生活品質變化（1997~2005） 29
2-8 身體功能層面變化（1997~2001） 31
2-9 心理與情緒功能層面變化（1997~2001） 33
2-10 社會功能層面變化（1997~2001） 35
2-11 認知功能層面變化（1997~2001） 37
2-12 角色功能層面變化（1997~2001） 39
2-13 口腔疼痛、吞嚥困難與生活品質各層面之相關性 42
2-14 味覺改變與生活品質及其各層面之相關性 43
2-15 腫瘤與治療因素對口腔合併症與生活品質的影響 45
2-16 病患人口學相關因素對生活品質影響 47
表格目錄 頁數
第三章
3-1 重複測量統計檢力估計 54
3-2 複迴歸分析統計檢力估計 54
3-3 EORTC HN-35、HNRQ、EORTC QLQ-C30比較表 57
3-4 放射治療口腔合併症嚴重度量表內在一致性結果(n=45) 65
3-5 EORTC QLQ-C30標準化計分法 67
3-6 EORTC QLQ-C30量表信度檢測 68
3-7 EORTC QLQ-C30中文版量表內在一致性結果(n=45)
70
3-8 研究工具測量時間表 72
3-9 資料統計分析方法 74
3-10 資料統計分析步驟 75
3-11 頭頸部癌症病患人口學、疾病特性與放射治療方法 77
3-12 不同放射治療時間點病患急性期口腔黏膜炎嚴重度變化 79
3-13 不同放射治療時間點病患急性期口乾嚴重度變化 81
3-14 不同放射治療時間點病患急性期味覺改變嚴重度變化 83
3-15 不同放射治療時間點病患急性期口腔合併症嚴重度變化 85
3-16 不同放射治療時間點病患的生活品質 90
第四章
4-1 描述性統計分析病患人口學、疾病特性與放射治療方法 95
4-2 不同放射治療時間點病患放射治療口腔合併症嚴重度及其次量表平均值、標準差 97
4-3 不同放射治療時間點對病患口腔合併症嚴重度影響 97
4-4 不同放射治療時間點對病患口腔黏膜炎嚴重度影響 98

表格目錄 頁數
4-5 不同放射治療時間點對病患口乾嚴重度影響 99
4-6 不同放射治療時間點對病患味覺改變嚴重度影響 100
4-7 描述性統計分析不同放射治療時間點病患的整體性生活品質及其各功能層面平均值與標準差 102
4-8 不同放射治療時間點對病患整體性生活品質影響 102
4-9 不同放射治療時間點對病患身體功能的影響 103
4-10 不同放射治療時間點對病患心理與情緒功能影響 104
4-11 不同放射治療時間點對病患社會功能影響 105
4-12 不同放射治療時間點對病患認知功能影響 106
4-13 不同放射治療時間點對病患角色功能影響 107
4-14 雙變量分析病患整體性生活品質影響因素 109
4-15 雙變量分析病患身體功能影響因素 112
4-16 雙變量分析病患心理與情緒功能影響因素
115
4-17 雙變量分析病患社會功能影響因素 118
4-18 雙變量分析病患認知功能影響因素 121
4-19 雙變量分析病患角色功能影響因素 124
4-20 雙變量分析影響病患整體性生活品質及各功能層面因素 127
4-21 多變量檢定影響病患整體性生活品質因素 129
4-22 多變量檢定影響病患整體性生活品質因素 129
4-23 多變量檢定影響病患身體功能之因素 131
4-24 多變量檢定影響病患身體功能之因素 132
4-25 多變量檢定影響病患心理與情緒功能之因素- 133
4-26 多變量檢定影響病患心理與情緒功能之因素- 134

表格目錄 頁數
4-27 多變量檢定影響病患社會功能之因素 135
4-28 多變量檢定影響病患社會功能之因素 136
4-29 多變量檢定影響病患認知功能之因素 138
4-30 多變量檢定影響病患認知功能之因素 139
4-31 多變量檢定影響病患角色功能之因素 140
4-32 多變量檢定影響病患角色功能之因素 140
4-33 多變量分析病患口腔合併症嚴重度與其他因素對整體性生活品質及各功能層面的影響 142
4-34 多變量分析病患次量表症狀嚴重度與其他因素對整體性生活品質及各功能層面的影響 143
5-1 台灣頭頸部癌症研究與國外研究之病患生活品質比較 151

圖形目錄 頁數
2-1 口腔疼痛嚴重度變化圖形 14
2-2 吞嚥嚴重度變化圖形
16
2-3 口乾嚴重度變化圖形 18
2-4 唾液黏稠嚴重度變化圖形 20
2-5 味覺改變嚴重度變化圖形 22
2-6 口腔合併症嚴重度整合圖形 23
2-7 整體性生活品質變化圖形 29
2-8 身體功能變化圖形 31
2-9 心理及情緒功能變化圖形 33
2-10 社會性功能變化圖形 35
2-11 認知功能變化圖形 37

圖形目錄 頁數
2-12 角色功能變化圖形 39
2-13 生活品質及其各層面整合圖形 40
3-1 頭頸部癌症患者接受放射線治療之急性期口腔合併症嚴
重度變化及其對生活品質的影響之研究架構圖 50
3-2 急性期口腔黏膜炎嚴重度變化圖形 79
3-3 急性期口乾嚴重度變化圖形 81
3-4 急性期味覺改變嚴重度變化圖形 83
3-5 急性期口腔合併症嚴重度總分的變化趨勢 85
3-6 口腔黏膜炎、口乾、味覺改變及急性期口腔黏膜炎嚴重
度總平均值之變化趨勢 86
3-7 不同放射治療時間點病患的整體性生活品質及其各功
能滿意度之變化趨勢圖
92

附錄目錄 頁數
附錄一 口腔合併症之嚴重度變化相關研究 176
附錄二 放射治療前後生活品質變化相關研究 182
附錄三 影響生活品質之相關因素 189
附錄四 McMaster HNRQ Reliability & Validity Data 191
附錄五 Dr. Browman授權使用同意書 192
附錄六 語意翻譯一致性專家名單 193
附錄七 放射治療口腔合併症嚴重度量表翻譯一致性專家
檢定統計總表 194
附錄八 放射治療口腔合併症嚴重度量表
英翻中翻譯專家一致性檢定統計總表 195
附錄目錄 頁數
附錄九 放射治療口腔合併症嚴重度量表
反向翻譯專家一致性檢定統計總表 196
附錄十 放射治療口腔合併症嚴重度量表
病患專家對題意的瞭解程度 200
附錄十一 個案基本資料 201
附錄十二 放射治療口腔合併症嚴重度量表 202
附錄十三 EORTC QLQ C30 Reliability & Validity Data 203
附錄十四 EORTC QLQ-C30 (v3）授權使用書 204
附錄十五 EORTC QLQ-C30 (v3）台灣中文版生活品質問卷 205

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