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研究生:李書帆
研究生(外文):Su-Fung Li
論文名稱:探討不同治療方式對早期子宮頸癌病患生活品質之影響
論文名稱(外文):An investigate of treatments impact on quality of life in cervical cancer patients
指導教授:李亞欣李亞欣引用關係
指導教授(外文):Ya-Hsin Li
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫療產業科技管理學系碩士班
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:2013
畢業學年度:101
語文別:中文
論文頁數:80
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研究目的:子宮頸癌治療方式於2000年美國癌症協會(American national cancer institute;NIC)提出同步化學放射線治療後,此新治療方式目前已廣泛的被採用,而該治療方式與僅進行放射治療比較,CCRT治療能增加百分之三十到五十的存活率,在存活率大幅增加後病患生活品質的議題也成為重要的研究項目。針對子宮頸癌第一期與第二期的病患,治療方式有較多選擇及爭議性,故本研究希望藉由問卷訪問方式,了解早期子宮頸癌病患於接受不同治療方式後對生活品質之影響。

研究方法:本研究採歐洲癌症研究及治療中心(European Organization for Research and Treatment Center)發展之問卷EORTC QLQ-C30及EORTC QLQ-Cx24於4家醫療院所婦產科門診進行問卷調查。研究對象為治療後早期子宮頸癌病患,訪問期間為2013年1月至2013年5月,共回收99份有效問卷,分析方法除描述性統計外,利用雙變項分析了解不同治療方式下生活品質;利用複迴歸分析了解各項人口統計變數與疾病情況影響生活品質之情形。

研究結果:接受CCRT治療及手術後CCRT治療病患生活品質普遍較手術治療病患生活品質差。接受CCRT治療及手術後CCRT治療患者症狀以呼吸困難、失眠、嘔吐與噁心、潮熱影響生活品質最劇,手術治療及手術後CCRT治療的病患會有較嚴重的淋巴水腫情況產生。病人生活品質部份以有宗教信仰、切除子宮、家庭月收入較高、無個人病史、可正常活動、70歲以下的患者有較佳的生活品質。

結論:在總體生活品質而言以接受手術治療患者較接受CCRT治療及手術後CCRT治療患者佳。


Objective:Concurrent Chemoradiation (CCRT), after being proposed by the American National Cancer Institute (NIC) in 2000, has now become a widely-applied new treatment for cervical cancer. CCRT therapy compared with radiation therapy only, CCRT therapy can increase survival rate thirty to fifty percent, a substantial increase in the survival rate of patients after the issue of the quality of life has also become an important research projects. Considering that there has been controversy on the treatment options of cervical cancer stage I and stage II patients, this study aims to understand the post-treatment influence of different treatments on the lifestyle of early-stage cervical cancer patients through the questionnaire interview method.

Method:This study used two questionnaires EORTC QLQ-C30 and EORTC QLQ-Cx24, which was developed by the European Organization for Research and Treatment Center, to interview early stage cervical cancer patients after treatment at the outpatient service of Department of Obstetrics and Gynaecology in four hospitals. The interview period was from January 2013 to May 2013, and a total of 99 valid questionnaires were collected.

Results:The comprehensive analysis found that the life quality of patients receiving CCRT treatment and surgical treatment followed by CCRT is poorer than the life quality of patients receiving surgical treatment. Among the symptoms of patients who receive CCRT and surgical treatment followed by CCRT, dyspnea, insomnia, vomiting and nausea, and menopausal symptoms have been found to have the most severe impact on their quality of life. Surgical treatment and surgical treatment followed by CCRT of patients would have more serious situation arising lymphedema. Partly in the quality of life of patients with religious beliefs, hysterectomy, family income is higher, no personal history, the normal activities of patients under 70 years of age have a better quality of life.

Conclusion: In terms of overall life quality of patients receiving CCRT treatment and surgical treatment followed by CCRT is poorer than the life quality of patients receiving surgical treatment.


目錄
致謝 I
中文摘要 II
Abstract III
目錄 V
表目錄 VI
圖目錄 VII
第一章 緒論 1
第一節 背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 子宮頸癌流行病學 4
第二節 國內子宮頸癌防治政策 7
第三節 子宮頸癌患者治療方式 11
第四節 EORTC QLQ-C30及EORTC QLQ-Cx24介紹 14
第五節 影響癌症病患生活品質相關因素 15
第三章 研究方法 20
第一節 研究架構 20
第二節 研究假設 21
第三節 研究設計 22
第四節 研究變項內容及操作型定義 23
第五節 資料統計與分析 28
第四章 研究結果 29
第一節 人口統計變項及疾病情況 29
第二節 不同治療方式下各項生活品質指標狀態 33
第三節 不同人口統計變數影響各項生活品質 35
第五章 討論 38
第一節 探討不同治療方式對於各項生活品質之影響 38
第二節 人口統計變項及疾病情況影響生活品質分數探討 41
第六章 結論與建議 43
第一節 結論 43
第二節 建議 44
參考文獻 69
中文文獻 69
英文文獻 72
附錄 78

表目錄
表3-1 生活品質變項內容 23

表3-2 人口統計變項及疾病情況操作型定義 26

表3-3 治療方式變項操作型定義 27

表4-1 人口學變項與功能項目生活品質分數之關係 46

表4-2 人口學變項與症狀項目生活品質分數之關係 49

表4-3 治療方式與功能項目生活品質分數之關係 55

表4-4 治療方式與症狀項目生活品質分數之關係 56

表4-5 不同人口統計變數影響生活品質分數複迴歸分析 58


圖目錄
圖2-1 2011年女性主要癌症死亡率(行政院衛生署,2012) 6

圖2-2 1979-2011年子宮頸癌標準化死亡率 6

圖2-3 子宮頸癌自然史(國民健康局,2011) 10



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