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

中文文獻
行政院衛生署國民健康局(2009)。中華民國98年子宮頸癌篩檢登記報告。


行政院衛生署(2012)，中華民國100年死因統計。

行政院國民健康局(2007)，1991-2008年30歲以上子宮頸癌標準化發生率及死亡率長期趨勢。

行政院國民健康局(2011) 子宮頸癌自然史。

王雅容(2002)。白血病患者之希望、憂鬱與生活品質之相關性探討‧台北護理學院。

江靜儀、陳美伶、余文彬、黃慈心（2001），接受放射治療之腦瘤病患其身心困擾之探討，長庚護理，12（4），271－280。

吳香達（2002）。子宮頸癌的手術治療：於子宮頸癌 (初版)。台北：茂昌圖書公司出版。

李翠鳳、郭旭崧、陳錫忠、陳天順、周碧瑟(1997)。金門縣婦女子宮頸癌抹片檢查的影響因素。中華公共衛生雜，16（3），198-209。

李靜芳，(2007) 以婦女健康論子宮切除術。亞東學報，27(6)，145-150。

周繡玲、顧乃平、劉雪娥、白璐（1997），成人急性白血病病患生活品質及其相關因素之探討，護理研究，5（2），182－193。

林玲華、陳景彥、劉嘉逸、陳美伶（2002），癌症住院病患憂鬱狀態的盛行率及預測因素，台灣醫學，6（4），535－544。

林政道、吳宜鴻(2009)。中西醫會診-子宮頸癌(二版)，書泉出版社。

邱燕甘、許玲女、郭美玲（2002），化學治療病患接受護理指導之改善方案，長庚護理，13（4），359－367。

洪福建、鄭逸如、邱泰源、胡文郁、陳慶餘、吳英璋(1999) ，癌末患者的心理社會問題、因應策略與負向情緒，應用心理研究，3，79-104。

胡玉玲、楊慶忠、吳云燕(2010) ，子宫頸癌卵巢移位後放射治療患者生活品質的之探討與干預 南昌大學學報，50(1)。

財團法人國家衛生研究院(2007)。30歲以上婦女年齡別子宮頸侵襲癌發生率長期趨勢。

財團法人國家衛生研究院(2007)。子宮頸侵襲癌年齡別死亡率。

財團法人國家衛生研究院(2007)。子宮頸鱗狀細胞侵襲癌年齡標準化長期趨勢。

財團法人國家衛生研究院(2007)。子宮頸腺細胞侵襲癌年齡標準化長期趨勢。

財團法人國家衛生研究院(2011)。婦癌臨床診療指引。

陳佩靖（2003）。口腔癌病患治療後生活品質及其相關因素探討—橫斷式研究。碩士論文，高雄醫學大學護理研究所。

許逸欣、張文君、許博欽(2004)。子宮頸癌，於周松男總校閱，婦產科學精要。125－133。

許維中、鍾娜娜、陳宇嘉、詹淑卿、丁禮筣、蔡崇煌、王雪鳳、王博民、林高德(2004)。早期子宮頸癌病患治療後長期的生活品質之研究。中華放射醫誌，29，21-28。

許文憲、王理剛、謝志華、劉健德、吳文綺、曾國宏(2008)。慢性下肢淋巴水腫外科治療的經驗。台灣醫界，51(12)。

陳亞萍、葉淑惠、龔福財、何美瑤(2007)。子宮頸癌住院病人症狀困擾、憂鬱及
生活品質之相關性研究。實證護理，3(2)。

陳秀熙(2002)。「子宮頸癌、乳癌、口腔癌」社區到點篩檢服務計畫之經濟評估。行政院衛生署。

陳怡如，陳淑卿，林上青(1999)。社區設站子宮頸抹片檢查之成本及利用情形分析。中華家醫誌，9(3)，150-157。

陳錫忠、周碧瑟(1995)。台灣鄉村婦女對『子宮頸防癌抹片檢查』的認知及參予之調查研究。中華衛，14，494-501。

陳慈怡(2002)。全民健康保險實施前後影響子宮頸抹片篩檢之因素及成果(碩士論文)。國立台北護理學院醫護管理學系。

楊思標、林昭庚(2001)。中西醫會診-子宮頸癌，書泉出版社。

癌症登記資料庫(2009)，1979-2009年台灣女性標準化發生率。

癌症登記資料庫(2009)，子宮頸癌ICD-O-3 C53女性相對存活率。

癌症登記資料庫(2009)，1981-2005年台灣女性子宮頸癌年齡別發生率。

癌症登記資料庫(2009)，2007-2008年30歲以上婦女子宮頸癌年齡別發生率。

羅惠敏、徐南麗、蕭正光、劉雪娥（2003），比較疼痛及非疼痛癌症病患不確定感、症狀困擾、社會支持與生活品質關係，慈濟護理雜誌，2（3），70－75。


英文文獻
Armstrong, T. S. (2003). Symptoms experience: A concept analysis.Oncology Nursing Forum, 30(4), 601－606.

Badger, T. A., Braden, C. J., & Mishel, M. H. (2001). Depression burden, self-help intervention, and side effect experience in women receiving treatment for breast cancer. Oncology Nursing Forum, 28(3), 567－574.

Baker. C. (1995). A fuiictional stanis scale for measuring quality of life outcomes in head and neck cancer patients. cancer Nursing. 18(6,). 452-457.

Beer, J. (1995). Body Image of Patient With ESRD and Following Renal Transplantation. British Journal of Nursing, 4, 591-598.

Browne. J.P.. McGee. H.M.. & O’Boyle. C.A. (1997). Conceptual approaches to the assessment of quality of life. Psychology and Health. 12. 737-751.

Carlos A. Peres,Claudia Baider, & Robert P. Freckleton. (2003). Demographic Threats to the Sustainability of Brazil Nut Exploitation. Science Magazine, 302(5653), 2112-2114.

Chang TC, Lai CH, Hong JH, et al. (2000). Randomized trial of neoadjuvant cisplatin, vincristine, bleomycin, and radical hysterectomy versus radiation therapy for bulky stage IB and IIA cervical cancer. J Clin Oncol. 18(8),1740-7.

Chi-Ping Huang, Lin-Yang Chi, Hung-Jen Chang, and Pesus Chou(1999). Cognition and Utilization of Papanicolaou Testing after the Implementation of National Health Insurance in Rural Taiwan. Journal of the Formosan Medical Association,98,19-23.

Christman, N. J., Oakley, M. G., & Cronin, S. N. (2001). Developing and using preparatory information for women undergoing radiation therapy for cervical or uterine cancer. Cancer Nursing Forum, 28(1), 93－98.

Cimprich, B. (1999). Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nursing, 22(3), 185－194.

Cleeland, C. S. (2000). Cancer-related symptoms. Seminars in Radiation Oncology, 10(3), 175－190.

Ell, K., Sanchez, K., Vourlekis, B., Lee, P. J., Dwight-Johnson, M., Lagomasino, I., et al. (2005). Depression, correlates of depression, and receipt of depression care among lowincome women with breast or gynecologic cancer. Journal of Clinical Oncology, 23(13), 3052－3060.

Ferrans, C. E., & Powers, M. J. (1985). Quality of life: Development and psychometric properties. Advances in Nursing Science, 8(1), 15-24.

Green JA, Kirwan JM, Tierney JF, et al.( 2001). Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet, 358, 781-6.

Haie C, Pejovic MH, Gerbaulet A, et al. (1988)Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group. Radiother Oncol, 11, 101-12.

Heather Lawrence., Kennedy Lishimpi. (2011). QUALITY OF LIFE IN ZAMBIAN CERVICAL CANCER WOMEN POST CHEMO-RADIOTHERAPY. Department of Radiography.

Held-warmkessel, J. (1998). Chemotherapy complications. Nursing, 28(4), 41－45.

Hitoshi Ikushima, & Kyousuke Osaki. (2006). Chemoradiation therapy for
cervical cancer: Toxicity of concurrent weekly cisplatin. Radiation Medicine, 24, 115-121.

Ingvild Vistada,Sophie D. Fossa, Alv A. Dahl. (2006). A critical review of patient-rated quality of life studies of long-term survivors of cervical cancer. Gynecologic Oncology, V102, 3(9), 563–572.

Keys HM, Bundy BN, Stehman FB, et al. (1999). Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med, 340, 1154-61.

Korfarge, I.J., Essiknk-Bot, & M.L., Mols, F. (2009). Health-related quality of life in cervical cancer survivors: A population based survey. International Journal of Radiation Oncology Biology and Physics, 73(5),1501-1509.

Lai CH, Huang KG, Hong JH, et al. (2003). Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecol Oncol, 89, 160-7.

Landoni F, Maneo A, Colombo A, et al.( 1997) Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet, 350, 535-40.

Lehto, U. S., Ojanen, M., & Kellokumpu-Lehtinen, P. (2005). Predictors of quality of life in newly diagnosed melanoma and breast cancer patients. Annals of Oncology, 16(5), 805－816.

McCartney, C. F., & Larson, D. B. (1987). Quality of life in patients with gynecologic cancer. Cancer, 60(Suppl.8), 2129－2136.

McClain, C., Rosenfeld, B., & Breitbart, W.(2003). Effect of spiritual well-being on end-of-life depair in terminally-ill cancer patients. The Lancet,361(9369),1603-1608

McClement, S. E., Woodgate, R. L., & Denger, L. (1997).Symptom distress in adult patients with cancer. Cancer Nursing, 20(4), 236－243.

McCorkle, R., & Young, K. (1978). Development of a symptom distress scale. Cancer Nursing, 1(5), 373－378.

Michelson, H., Bolund, C., Nilsson, B., & Brandberg, Y. (2000). Health-related quality of life measured by the EORTC QLQ-C30. Reference values from a large sample of the Sweedish population. Acta oncologica, 39, 447-484.

Morris M, Eifel PJ, Lu J, et al.( 1999) Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med, 340, 1137-43.

Naughton, M. J., & Mcbee, W. L. (1997). Health-related quality of life after hysterectomy. Clinical Obstetric and Gynecologic Nursing, 40(4), 947-957.

Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials.( 2003). European Journal of Cancer, 39, 2470-86.

Paccagnella, A., Morello, M., Da Mosto, M. C., Baruffi, C., Marcon, M. L., Gava, A., et al. (2009). Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer.

Pasacreta, J. V. (1997). Depressive phenomena, physical symptom distress, and functional status among women with breast cancer. Nursing Research, 46(2), 214－221.

Patnick J(2000).Cervical cancer screeing in England. Eur J Cancer, 36, 2205-8.

Pearcey, R., Brundage, M., Drouin, P., Jeffrey, J., Lukka, H., Maclean, G., Souhami, L., Stuart, G. & Tu, D. (2002). Phase III trial comparing radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. Journal of Clinical Oncology, 20: 966 – 972.

Peters WA, Liu PY, Barrett RJ, et al.(2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol, 18(8), 1606-13.

Reactions Weekly. (2009). Cisplatin/docetaxel Fatal aorto-oesophageal fistula. Reactions, V1240, 1(2), 14.

Rhodes, V., & Watson, P. (1987). Symptom distress-the concept: Past and present. Seminars in Oncology Nursing, 3(4), 242－247.


Rose PG, Bundy BN, Watkins EB, et al.(1999). Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med, 340, 1144-53.

Rotman M, Pajak TF, Choi K, et al.(1995). Prophylactic extended-field irradiation of paraaortic lymph nodes in stages IIB and bulky IB and IIA cervical carcinomas. Ten-year treatment results of RTOG 79-20. JAMA, 274, 387-93.

Rutledge, D. N., & Raymon, N. J. (2001). Change in well-being of women cancer survivors following a survivor weekend experience. Oncology NusingForum, 28(1), 85－91.

Sadovsky, R.(1997).Identification of barriers to cervical cancer screening. American Family Physician, 54, 481-483.

Saslow D, Runowicz C, Solomon D, et al.(2002). American cancer society guideline for the early detection of cervical neoplasia and cancer. CA: A cancer Journal for Clinicians, 52, 342-76.

Sedlis A, Bundy BN, Rotman MZ, et al.( 1999). A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol, 73, 177-83.

Sigurdesson, K. (1993).Effect of organized screening on the risk of cervical cancer: Evaluation of screening activity in Iceland. International Journal of Cancer, 54, 563-570.

Smets EM, Visser MR, Willems-Groot AF,Garssen B, Schuster-Uitterhoeve AL, deHaes JC(1998). Fatigue and radiotherapy: (B)experience in patients 9 months followingtreatment. Br J Cancer, 78, 907-912.

Tan G.,Waidman K, & Bostick R. (2002).Psychosocial is-sues, sexuality, and cancer. Sexuaility and Disability, 20(4),297-318.

Tavio M, Milan I, Tirelli U(2002). Cancer-relatedfatigue. Int J Oncol, 21, 1093-1099.

Wade, J., Pletsch, P. K., Morgan, S. W., Menting, S. A. (2000). Hysterectomy: Wjat do women need and want to know.Journal of Obstetric, Gynecologic, and Neonatal Nursing, 29(1), 33-42.

Whitney CW, Sause W, Bundy BN, et al.(1999). Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol, 17,1339-48.

Wong, L. P., Wong, Y. L., Low, W. Y., Khoo, E. M., & Shuib, R.(2009). Knowledge and awareness of cervical cancer and screening among Malaysian women who have never had a Pap smear: A qualitative study. Singapore Medical Journal, 50(1),49－53.

Wyatt, G. K., & Friedman, L. L. (1998). Physical and psychosocial outcome of midlife and old women following surgery and adjuvant therapy for breast cancer. Oncology Nursing Forum, 25(4), 761－768.

Yan, H., & Sellick, K. (2004). Symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal cancer. Cancer Nursing, 27(5), 389－399.

Zittoun, R., Achard, S., & Ruszniewski, M. (1999). Assessment of quality of life during intensive chemotherapy or bone marrow transplantation. Psycho-Oncology, 8(1), 64－73.