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研究生:黃詩尹
研究生(外文):Shih Yin Huang
論文名稱:肺癌病患治療前生活品質與存活狀況之相關探討
論文名稱(外文):Relationship between Pre-treatment Quality of Life and Survival Situation in Patients with Lung Cancer
指導教授:馬素華馬素華引用關係
指導教授(外文):S. H. Maa
學位類別:碩士
校院名稱:長庚大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
論文頁數:118
中文關鍵詞:肺癌治療前生活品質存活狀況
外文關鍵詞:lung cancerpre-treatment quality of lifesurvival situation
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肺癌隨著疾病進展常伴隨有咳嗽、呼吸急促、呼吸困難等症狀,影響患者生活品質甚鉅。治療前的生活品質可能與日後存活狀況有關。本研究目的為探討肺癌病患治療前生活品質與日後存活狀況之相關性。
本研究為二次資料分析,資料來源為兩份研究的前測資料。一份為手術治療前肺癌病患,另一份為化學治療前肺癌病患。先從兩份研究中確認研究對象、治療前的基本資料和生活品質量表,再根據自擬的研究變項紀錄表,以病歷回溯法得到疾病特性及存活狀況資料。以描述性統計、廣義線性模式、存活分析進行資料分析。
結果發現對手術治療前肺癌病患而言,整體生活品質的主要影響因素為教育程度、癌症分期;存活狀況的主要影響因素為身體功能狀態(Eastern Cooperative Oncology Group performance status, ECOG)、生活品質量表內的疼痛症狀及財務困難。對化學治療前肺癌病患而言,整體生活品質的主要影響因素為職業、宗教信仰;存活狀況的主要影響因素為體重減輕、生活品質量表內的身體功能及吞嚥困難。結論為治療前生活品質與日後存活狀況有相關。
As the progress of the disease, lung cancer may accompany with the cough, tachypnoea, dyspnea, repeated infection of the airway and other symptoms. Such situation will impact the quality of life in patients a great deal. The pre-treatment quality of life may predict the survival situation afterwards. The purpose of this study was to investigate the relationship between pre-treatment quality of life and survival situation in patients with lung cancer.
The research was an secondary data analysis. The source was from two pre-measured data of researches which one was surgery patients and the other one was chemotherapy patients. In the beginning, we selected appropriate subjects by their demographic data and the score of the quality of life questionnaires from such two studies mentioned above. Then we reviewed each subjects medical records by researcher self to get their characteristics of disease and the information of survival situation. We carried out the statistic data analysis via Generalized linear models, Kaplan-Meier survival curves and Cox proportional hazards model.
Results of the study showed that for the surgery group, the major impacting factors for pre-treatment quality of life were education and cancer stages. The main impacting factors of survival situation were performance status (Eastern Cooperative Oncology Group performance status, ECOG), and pain symptom and financial difficulty measured by European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). For chemotherapy group, the major impacting factors for pre-treatment quality of life were occupation and religion. The survival conditions were mainly affected by weight loss, physical function measured by EORTC QLQ-C30, and dysphagia symptom measured by EORTC QLQ-LC13. Pre-treatment quality of life was associated with survival condition of patients with lung cancer.
論文指導教授推薦書
論文口試委員審定書
授權書 iii
致謝 iv
中文摘要 v
Abstract vi
目錄 viii
第一章 緒論 1
第一節 研究動機與重要性 1
第二節 研究目的 3
第三節 待答問題 3
第四節 研究假設 4
第五節 名詞界說 4
第六節 研究限制 5
第二章 文獻探討 7
第一節 肺癌概述 7
第二節 生活品質概述 22
第三節 有關肺癌病患生活品質之相關研究 32
第四節 有關肺癌病患生活品質與存活率之相關研究 37
第三章 研究方法 43
第一節 研究架構 43
第二節 研究設計 44
第三節 研究對象 46
第四節 研究工具 46
第五節 資料收集過程及研究倫理考量 51
第七節 資料處理 51
第四章 研究結果 55
第一節 研究對象之基本資料 55
第二節 治療前生活品質之得分情形 64
第三節 治療前生活品質之主要影響因素 69
第四節 存活狀況 74
第五節 治療前生活品質與存活狀況之關係 80
第五章 討論 87
第六章 結論與建議 95
參考文獻 99
中文文獻 99
英文文獻 103

表目錄
表2-1 台灣肺癌死亡統計 9
表2-2 民國91年新診斷非小細胞肺癌期別之個案數、死亡數與存活率 9
表2-3 非小細胞肺癌的分期 14
表2-4 癌症別的生活品質測量工具 28
表2-5 有關肺癌患者治療前生活品質的實證研究摘要 33
表2-6 有關肺癌患者治療後生活品質的實證研究摘要 36
表2-7 有關肺癌病患治療前生活品質與存活狀況之實證研究摘要 38
表2-8 國內有關肺癌病患治療後生活品質與存活狀況之實證研究摘要 41
表3-1 原始研究之研究方法 45
表3-2 EORTC QLQ-C30生活品質量表摘要 49
表3-3 EORTC QLQ-LC13生活品質量表摘要 50
表4-1.1 手術組之社會人口學變項次數分配情形 57
表4-1.2 化療組之社會人口學變項次數分配情形 59
表4-1.3 手術組之疾病特性變項次數分配情形 61
表4-1.4 化療組之疾病特性變項次數分配情形 63
表4-2.1 手術組之EORTC QLQ-C30得分情形 65
表4-2.2 化療組之EORTC QLQ-C30得分情形 66
表4-2.3 手術組之EORTC QLQ-LC13得分情形 67
表4-2.4 手術組EORTC QLQ-LC13第13題得分情形 67
表4-2.5 化療組之EORTC QLQ-LC13得分情形 68
表4-2.6 化療組EORTC QLQ-LC13第13題得分情形 69
表4-3.1 手術組社會人口學與整體生活品質的關係 70
表4-3.2 手術組疾病特性與整體生活品質的關係 70
表4-3.3 手術組治療前生活品質之主要影響因素 71
表4-3.4 化療組社會人口學與整體生活品質的關係 72
表4-3.5 化療組疾病特性與整體生活品質的關係 72
表4-3.6 化療組治療前生活品質之主要影響因素 73
表4-4.1 手術組存活情形 74
表4-4.2 化療組存活情形 75
表4-4.3 手術組社會人口學與存活狀況的關係 77
表4-4.4 手術組疾病特性與存活狀況的關係 77
表4-4.5 手術組人口學與疾病特性對存活狀況的主要影響因素78
表4-4.6 化療組社會人口學與存活狀況的關係 79
表4-4.7 化療組疾病特性與存活狀況的關係 79
表4-4.8 化療組人口學與疾病特性對存活狀況的主要影響因素80
表4-5.1 手術組EORTC QLQ-C30與存活狀況之關係 81
表4-5.2 手術組EORTC QLQ-LC13與存活狀況之關係 81
表4-5.3 手術組治療前生活品質與存活狀況之關係 82
表4-5.4 化療組EORTC QLQ-C30與存活狀況之關係 83
表4-5.5 化療組EORTC QLQ-LC13與存活狀況之關係 84
表4-5.6 化療組治療前生活品質與存活狀況之關係 85

圖目錄
圖3-1 研究架構圖 43
圖4-1 手術組的存活曲線圖 75
圖4-2 化療組的存活曲線圖 76

附錄目錄
附錄一:EORTC QLQ-C30台灣中文版生活品質核心問卷 112
附錄二:EORTC QLQ-LC13台灣中文版肺癌生活品質問卷 114
附錄三:歐洲癌症治療與研究組織生活品質問卷的分數換算 115
附錄四:研究變項紀錄表 117
附錄五:人體試驗委員會同意書 118
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