跳到主要內容

臺灣博碩士論文加值系統

(44.200.194.255) 您好!臺灣時間:2024/07/20 14:56
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:蘇意庭
研究生(外文):Yi Ting Su
論文名稱:以職能治療觀點介入頭頸癌病人化放療期間 癌因性疲憊及吞嚥功能之成效探討
論文名稱(外文):The effects of supportive intervention with occupational therapy perspectives on cancer-related fatigue and swallowing dysfunction in patients with head and neck cancer during chemo-radiation
指導教授:陳貞夙陳貞夙引用關係謝妤葳謝妤葳引用關係
指導教授(外文):J. S. ChernY. W. Hsieh
學位類別:碩士
校院名稱:長庚大學
系所名稱:職能治療學系
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:151
中文關鍵詞:頭頸癌職能治療放化療吞嚥困難癌因性疲憊生活品質
外文關鍵詞:head and neck canceroccupational therapydysphagiacancer-related fatiguephysical and psychological wellnessquality of life
相關次數:
  • 被引用被引用:0
  • 點閱點閱:340
  • 評分評分:
  • 下載下載:42
  • 收藏至我的研究室書目清單書目收藏:2
近三十年來,癌症一直是台灣10大死因之首,其中頭頸癌名列第5。頭頸癌為頭頸部惡性腫瘤的總稱,以上呼吸消化道表皮鱗狀上皮細胞癌為主;除口腔癌外,包含鼻咽、口咽、下咽癌多使用放射治療合併化學治療介入。接受放射治療合併化學治療的病患在治療過程中及治療後常須面對多項伴隨癌症治療而來的急、慢性副作用。
吞嚥困難、癌因性疲憊、治療部位疼痛是頭頸癌病人接受治療期間常見的副作用,除了造成生、心理負擔,三者交互作用,限制了病患日常職能活動的參與及表現,進一步影響生活品質。基於職能治療全人照護觀點,本研究為這一群患者設計針對吞嚥困難及癌因性疲憊的支持性介入方案,透過實驗組與對照組的研究設計,探討介入方案之成效。
本研究透過放射腫瘤科醫師的轉介,招募自願參與本研究之56位僅接受放射治療合併化學治療之頭頸癌患者,實驗組除了接受癌症治療期間照護衛教與諮詢外同時接受吞嚥運動介入以及癌因性疲憊運動介,對照組則僅接受衛生教育及諮詢,探討介入對於吞嚥困難及癌因性疲憊症狀是否有顯著效益以及對疼痛、情緒及生活品質的影響。
結果發現,提供吞嚥介入之實驗組相比於對照組於治療結束後測量吞嚥功能(p=.019)具有統計顯著效益,此效益並符合受試者於生活品質問卷中自評之結果。但此結果受到組間淋巴結轉移程度及疼痛症狀的影響程度仍待釐清。提供癌因性疲憊運動介入之實驗組相比對照組於治療後疲憊程度具有顯著的正向影響(p=.001-.000),且對整體生活品質有顯著的正面成效(p=.07),但本研究結果受到組別間疼痛的影響程度尚待釐清。
本研究以職能治療的觀點,藉由活動分析以及全人觀點已以及全人觀點為病患所設計之支持性介入方案對頭頸癌病患接受放、化療期間的疲憊、吞嚥困難與疼痛有正向且顯著的影響,且對生活品質有正面的影響,這樣的支持性介入,未來可建議納入常規的頭頸癌病患之醫療照護中。本研究限制為受試者依照個人意願選擇進入組別,無法排除實驗組受試者自我照顧較佳,較願意配合臨床醫療人員所給予之建議之情形。

Background and purposes
Cancer is a compelling public health issue worldwide. Cancer also known as carcinoma, is the leading cause of death for decades in Taiwan, and the head and neck cancer (HNC) were ranked the fifth. Concurrent radiotherapy and chemotherapy (CCRT) is the most popular and effective cancer therapy for patients with many type of HNC, including nasopherangel, oralpharyngeal, and hypopharyngeal cancer. CCRT causes less tissue damage than operation. However, side effects accompanying RT and CT are unavoidable.
Dysphagia and cancer-related fatigue (CRF) at treating sites are the common side effects during cancer therapy process. Dysphagia is the risk factor for pneumonia, and even lead to death. But only a few studies investigate the effectiveness of early intervention. With high percentages of cancer patients receiving CCRT have CRF symptoms. Different from the fatigue caused by intense exercise, patients cannot reduce CRF by taking a rest. Those side effects not only cause physical and psychological stress, but also limit patients’ participation in daily activities. The quality of life is therefore deteriorated.
This dissertation consisted of two parts of study: effectiveness of treatment for dysphagia, and effectiveness of treatment for CRF. The purpose of this study was to design a supportive and client center intervention program based on the values of occupational therapy for this population and examine the effects of the side effects, emotion, and quality of life.

Method
The current study recruited 54 HNC patients who were referred by oncologist and the patients were allocated to either experimental group or control group by their choice. Participants in experimental group follow the swallowing and aerobic exercise protocol designed by an occupational therapist (OT), while the OT provided only education and consulting regarding the daily care of the side effects to the participants in the control group. Primary outcome measures, including modified water swallowing test for scoring swallowing function , and Brief fatigue inventory-chinese version (BFI-C) for scoring level of CRF. Secondary outcomes, including chinese version of the brief pain inventory (BPI-C) for scoring level of pain, PROMIS item bank v. 1.0 – emotional distress for scoring anxiety and depression, and functional assessment of Cancer Therapy - Head and Neck Nasopharyngeal (FACT-H&NNP) for scoring quality of life. BFI-C was administered to patients before, at midterm, and after CCRT. Modified water swallowing test, BPI-C, PROMIS item and FACT- H&NNP were administered to patients before and after CCRT. The differences between groups before and after treatment was examined by non-parametric inferential statistics. Statistical significance was set as p < 0.05.





Results
Each group had 27 patients who participated in the dysphagia study, and 23 patients joined in the experimental group, 31 patients joined in the control group in the CRF study. For the primary outcome measures, significant differences between groups after intervention was found in swallowing performance (p=.019), swallowing performance of the experimental group had significantly better than the control group . The fatigue level of both groups in CRF study varies with time, and shows significant difference (p=.001-.000) at midterm and after CCRT. The fatigue level of the experimental group had significantly lower than the control group at midterm and after CCRT. For the secondary outcomes, a significant pain level between groups. The emotion level had no significant differences between groups in both studies. A trend to increase the quality of life (QoL) was also found in both studies.

Conclusions
These results indicated promising effects of the supportive intervention program on not only physical but also psychological well-being and might increase the daily occupation participation. Applying HNC patients' dysphagia and CRF early intervention have positive effects on maintain swallowing function and reduce fatigue level. We recommended that the supportive program be included in regular medical care of patients of HNC going through cancer therapy.
目錄
指導教授推薦書
口試委員會審訂書
致謝 iii
摘要 v
Abstract vii
目錄 x
表目錄 xii
圖目錄 xiii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 文獻探討 5
壹、癌症簡介 5
貳、頭頸癌之盛行率及死亡率 6
叁、頭頸癌分期及治療方式 8
肆、頭頸癌治療急性副作用簡介 19
第二章 研究方法 36
第一節 研究對象及來源 36
第二節 實驗設計 37
第三節 研究工具 39
壹、病歷紀錄之基本資料表 39
貳、主要結果評估(primary outcome measures) 40
參、次要結果評估(secondary outcome measures) 42
第四節 統計分析 44
第三章 結果 47
第一節 吞嚥困難介入之各變項之描述性統計 51
第二節 吞嚥困難介入之實驗組吞嚥功能與對照組之差異 54
第三節 吞嚥困難介入之次要結果實驗組及對照組之差異 55
第四節 疲憊運動介入之各變項描述性統計 63
第五節 疲憊介入之實驗組及對照組治療後疲憊症狀差異 66
第六節 全受試者治療結束後各變數值相關 77
第四章 討論 80
第一節 吞嚥困難介入之吞嚥功能 80
第二節 吞嚥困難介入之次要結果 84
第三節 癌因性疲憊介入疲憊症狀 86
第四節 疲憊介入之次要結果 89
第五節 臨床觀察討論 90
壹、使用活動分析協助受試者決定運動項目及運動內容 90
貳、疼痛出現時間 91
叁、疲憊主訴症狀 92
肆、鼻胃管使用以及所衍生之臨床問題 93
伍、頸部經放射線照射後出現的放射性皮膚炎(radiation dermatitis) 94
第五章 結論與建議 96
第六章 研究限制與待研究方向 98
第七章 參考資料 99
第一節、中文文獻 99
第二節、英文文獻 99
附件一 台灣版簡明疲憊量表 117
附件二 情緒困擾-憂鬱簡表 118
附件三 情緒困擾-焦慮簡表 119
附件四 FACT鼻咽癌生活品質量表 120
附件五 受試者介入手冊 123

表目錄
表 一、頭頸癌主要腫瘤分期方式 22
表 二、頭頸癌區域內淋巴結分期方式 23
表 三、頭頸癌區域遠端轉移分期方式 24
表 四、各腫瘤分期方式 24
表 五、癌因性疲憊症狀 46
表 六、吞嚥困難介入組別之治療前描述性統計 66
表 七、吞嚥困難介入實驗組及對照組治療後吞嚥功能表現 68
表 八、吞嚥困難介入實驗組及對照組治療後使用鼻胃管之人數 68
表 九、吞嚥困難介入實驗組及對照組治療中、治療後之疼痛最嚴重程度、最輕微程度以及平均程度 69
表 十.、吞嚥困難介入實驗組及對照組治療後憂鬱及焦慮程度 70
表 十一、 吞嚥困難介入實驗組及對照組之治療前、治療後之生活品質總分及治療前後生活品質總分差異 71
表 十二、比較放射治療後吞嚥困難介入實驗組及對照組之生理健康狀況、社交健全狀況、情緒健康狀況、功能健全狀況及附加關注事項 72
表 十三、 吞嚥困難介入實驗組及對照組之生理健康狀況、功能健全狀況及附加關注事項之子項目治療後數值 74
表 十四、 吞嚥介入實驗組及對照組之前後身體質量指數(BMI)數值改變量 76
表 十五、疲憊介入組別之治療前描述性統計 78
表 十六、疲憊介入之實驗組及對照組組內於治療前、治療中及治療後疲憊程度 81
表 十七、疲憊介入之實驗組及對照組組間於治療中、治療後之疲憊當下程度、疲憊平均程度及疲憊最嚴重程度 81
表 十八、 疲憊介入實驗組及對照組之疲憊症狀對一般活動、情緒、行走能力、正常工作、與他人關係以及享受生活等項目影響程度 83
表 十九、疲憊介入實驗組及對照組治療中、治療後之疼痛最嚴重程度、最輕微程度以及平均程度 85
表 二十、疲憊介入實驗組及對照組治療後之憂鬱及焦慮程度 86
表 二十一、 運動介入實驗組及對照組之治療前、治療後之生活品質總分及治療前後生活品質總分差異 87
表 二十二、疲憊介入實驗組及對照組之生理健康狀況、社交健全狀況、情緒健康狀況、功能健全狀況及附加關注事項之組間差異 88
表 二十三、 疲憊介入實驗組及對照組之生理健康狀況、功能健全狀況及附加關注事項之子項目生活品質程度 89
表 二十四、疲憊介入實驗組及對照組之前後身體質量指數(BMI)數值差異 91
表 二十五、 全受試者治療結束後各變數值相關性(均為治療後數值) 93
表 二十六、粘膜炎分級系統 96

圖目錄
圖 一、鼻咽癌進行放射治療之放射劑量梯度圖 30
圖 二、口咽癌進行放射治療之放射劑量梯度圖 31
圖 三、下咽癌進行放射治療之放射劑量梯度圖 31
圖 四、吞嚥困難介入之實驗流程圖 62
圖 五、癌因性疲憊介入之實驗流程圖 63
圖 六、進行疲憊介入之實驗組及對照組於治療前、治療中及治療後之疲憊之平均折線圖 82
圖 七、疲憊介入治療前、治療中及治療後之簡明疲憊量表次項目平均折線圖 84

許文林.放射治療的基本原理.國防醫學第七卷第四期1988,pp 331-334
趙基安, 許名雅, 陳虹汶, 蘇文浩, 黃麗卿, & 鄒孟婷. (2011). 癌因性疲憊相關之病理生理機轉. 安寧療護雜誌, 16(3), 348-360.
癌症登記小組(2016)。102年癌症登記年報。臺北市:衛生福利部國民健康署。
李青蒨, & 莊銀清. (2004). 動物與細胞研究模式在抗生素抗發炎相關研究之應用. 感染控制雜誌, 14(6), 383-389.
傳正思, & 戴堯種. (2007). 細胞激素 IL-6 在運動指標上的應用. 中華體育季刊, 21(4), 9-17.
Affleck, A., Bianchi, E., Cleckley, M., Donaldson, K., McCormack, G., & Polon, J. (1984). Stress management as a component of occupational therapy in acute care settings. Occupational therapy in health care, 1(3), 17-41.
Ahlberg, K., Ekman, T., Gaston-Johansson, F., & Mock, V. (2003). Assessment and management of cancer-related fatigue in adults. The Lancet,362(9384), 640-650.
American Occupational Therapy Association. (2014).Occupational therapy practice framework: Domain & process 3 rd edition. American Occupational Therapy Association.
Avery, W. (2011). Dysphagia. In Smith-Gabai, H(Ed.), Occupational therapy in acute care (pp. 471-497). Bethesda, NJ: The American Occupational Association.
Aynehchi, B. B., Obourn, C., Sundaram, K., Bentsianov, B. L., & Rosenfeld, R. M. (2013). Validation of the Modified Brief Fatigue Inventory in head and neck cancer patients. Otolaryngology--Head and Neck Surgery, 148(1), 69-74.
Barsevick, A. M., Whitmer, K., Sweeney, C., & Nail, L. M. (2002). A pilot study examining energy conservation for cancer treatment–related fatigue. Cancer Nursing, 25(5), 333-341.
Bensinger, W., Schubert, M., Ang, K. K., Brizel, D., Brown, E., Eilers, J. G., ... & Treister, N. S. (2008). NCCN Task Force Report. prevention and management of mucositis in cancer care. Journal of the National Comprehensive Cancer Network: JNCCN, 6, S1-21.
Bjordal, K., Kaasa, S., & Mastekaasa, A. (1994). Quality of life in patients treated for head and neck cancer: a follow-up study 7 to 11 years after radiotherapy. International Journal of Radiation Oncology Biology Physics, 28(4), 847-856.
Bonner, J. A., Harari, P. M., Giralt, J., Azarnia, N., Shin, D. M., Cohen, R. B., ... & Ove, R. (2006). Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. New England Journal of Medicine, 354(6), 567-578.
Bower, J. E. (2007). Cancer-related fatigue: links with inflammation in cancer patients and survivors.Brain, behavior, and immunity, 21(7), 863-871.
Bratttleboro memorial hospital (2015) Energy Conservation and Work Simplification. Retrieved July 7, 2015,
from: http://www.bmhvt.org/
Brown, J. C., Huedo-Medina, T. B., Pescatello, L. S., Pescatello, S. M., Ferrer, R. A., & Johnson, B. T. (2011). Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer Epidemiology Biomarkers & Prevention, 20(1), 123-133.
Brown, L. F., & Kroenke, K. (2009). Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics, 50(5), 440-447.
Carlaw, C., Finlayson, H., Beggs, K., Visser, T., Marcoux, C., Coney, D., & Steele, C. M. (2012). Outcomes of a pilot water protocol project in a rehabilitation setting. Dysphagia, 27(3), 297-306.
Caudell, J. J., Schaner, P. E., Meredith, R. F., Locher, J. L., Nabell, L. M., Carroll, W. R., ... & Bonner, J. A. (2009). Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. International Journal of Radiation Oncology* Biology* Physics,73(2), 410-415.
Cella, D., Choi, S., Garcia, S., Cook, K. F., Rosenbloom, S., Lai, J. S., ... & Gershon, R. (2014). Setting standards for severity of common symptoms in oncology using the PROMIS item banks and expert judgment. Quality of Life Research, 23(10), 2651-2661.
Chang, J. T., Chang, C. H., Juang, Y. Y., Hsiao, J. C., Lin, C. Y., Huang, S. F., ... & Chen, I. H. (2008). Internal consistency of the traditional Chinese character version of the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N). Chang Gung Med J, 31(4), 384-394.
Chaudhry, H. M., Bruce, A. J., Wolf, R. C., Litzow, M. R., Hogan, W. J., Patnaik, M. S., ... & Hashmi, S. K. (2015). The Incidence and Severity of Oral Mucositis among Allogeneic Hematopoietic Stem Cell Transplantation Patients: A Systematic Review.Biology of Blood and Marrow Transplantation.
Chaudhuri, A., & Behan, P. O. (2000). Fatigue and basal ganglia. Journal of the neurological sciences, 179(1), 34-42.
Cooper, J. (2014). What is the cancer patient's own experience of participating in an occupational therapy-led relaxation programme?. Progress in Palliative Care, 22(4), 206-211.
Curt, G. A., Breitbart, W., Cella, D., Groopman, J. E., Horning, S. J., Itri, L. M., ... & Vogelzang, N. J. (2000). Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. The oncologist, 5(5), 353-360.
Deantonio, L., Masini, L., Brambilla, M., Pia, F., & Krengli, M. (2013). Dysphagia after definitive radiotherapy for head and neck cancer.Strahlentherapie und Onkologie, 189(3), 230-237.
Decker, J., & Goldstein, J. C. (1982). Risk factors in head and neck cancer. New England Journal of Medicine, 306(19), 1151-1155.
Dimeo, F., Schwartz, S., Fietz, T., Wanjura, T., Böning, D., & Thiel, E. (2003). Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy.Supportive care in cancer, 11(10), 623-628.
Dulguerov, P., & Allal, A. S. (2006). Nasal and paranasal sinus carcinoma: how can we continue to make progress?. Current opinion in otolaryngology & head and neck surgery, 14(2), 67-72.
Eisbruch, A., Schwartz, M., Rasch, C., Vineberg, K., Damen, E., Van As, C. J., ... & Balm, A. J. (2004). Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT?.International Journal of Radiation Oncology* Biology* Physics, 60(5), 1425-1439.
Eyigor, S., Eyigor, C., & Uslu, R. (2010). Assessment of pain, fatigue, sleep and quality of life (QoL) in elderly hospitalized cancer patients. Archives of gerontology and geriatrics, 51(3), e57-e61.
Fang, F. M., Liu, Y. T., Tang, Y., Wang, C. J., & Ko, S. F. (2004). Quality of life as a survival predictor for patients with advanced head and neck carcinoma treated with radiotherapy. Cancer, 100(2), 425-432.
Fearon, E. R., & Vogelstein, B. (1990). A genetic model for colorectal tumorigenesis. Cell, 61(5), 759-767.
Fialka-Moser, V., Crevenna, R., Korpan, M., & Quittan, M. (2003). CANCER REHABILITATION.Journal of rehabilitation medicine, 35(4), 153-162.
Forastiere, A., Koch, W., Trotti, A., & Sidransky, D. (2001). Head and neck cancer. New England Journal of Medicine, 345(26), 1890-1900.
Groher, M. E. (1997). Dysphagia: diagnosis and management. Butterworth-Heinemann Medical.
Hills, P., & Argyle, M. (1998). Positive moods derived from leisure and their relationship to happiness and personality. Personality and individual differences, 25(3), 523-535.
http://www.bmhvt.org/services/rehab-services/occupational-therapy/energy-conservation-and-work-simplification
Jensen, K., Lambertsen, K., & Grau, C. (2007). Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters.Radiotherapy and Oncology, 85(1), 74-82.
Karagiannis, M., & Karagiannis, T. C. (2014). Oropharyngeal dysphagia, free water protocol and quality of life: an update from a prospective clinical trial update from a prospective clinical trial. Hellenic journal of nuclear medicine, 26.
Lai, Y. H., Chang, J. T. C., Keefe, F. J., Chiou, C. F., Chen, S. C., Feng, S. C., ... & Liao, M. N. (2003). Symptom distress, catastrophic thinking, and hope in nasopharyngeal carcinoma patients. Cancer nursing, 26(6), 485-493.
Lee, N., Xia, P., Quivey, J. M., Sultanem, K., Poon, I., Akazawa, C., ... & Fu, K. K. (2002). Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. International Journal of Radiation Oncology* Biology* Physics, 53(1), 12-22.
Levendag, P. C., Teguh, D. N., Voet, P., van der Est, H., Noever, I., de Kruijf, W. J., ... & Heijmen, B. J. (2007). Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship.Radiotherapy and Oncology, 85(1), 64-73.
Lin, C. C., Chang, A. P., Chen, M. L., Cleeland, C. S., Mendoza, T. R., & Wang, X. S. (2006). Validation of the Taiwanese version of the Brief Fatigue Inventory. Journal of pain and symptom management, 32(1), 52-59.
List, M. A., D'Antonio, L. L., Cella, D. F., Siston, A., Mumby, P., Haraf, D., & Vokes, E. (1996). The performance status scale for head and neck cancer patients and the functional assessment of cancer therapy‐head and neck scale: A study of utility and validity. Cancer, 77(11), 2294-2301.
List, M. A., Mumby, P., Haraf, D., Siston, A., Mick, R., MacCracken, E., & Vokes, E. (1997). Performance and quality of life outcome in patients completing concomitant chemoradiotherapy protocols for head and neck cancer. Quality of Life Research, 6(3), 0-0.
Manikantan, K., Khode, S., Sayed, S. I., Roe, J., Nutting, C. M., Rhys-Evans, P., ... & Kazi, R. (2009). Dysphagia in head and neck cancer. Cancer treatment reviews, 35(8), 724-732.
Manzullo, E., Liu, W., & Escalante, C. (2003). Treatment for cancer-related fatigue: an update.Expert review of anticancer therapy, 3(1), 99-106.
Manzullo, E., Liu, W., & Escalante, C. (2003). Treatment for cancer-related fatigue: an update.Expert review of anticancer therapy, 3(1), 99-106.
Montazeri, A. (2009). Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008.Health and quality of life outcomes, 7(1), 1.
National Cancer Institute (2015) What is cancer. Retrieved May 21, 2015, from http://www.cancer.gov/about-cancer/what-is-cancer
National Cancer Institute (2016) Fatigue. Available at: http://www.cancer.gov/about-cancer/treatment/side-effects/fatigue Accessed on 19.06.2016
National Cancer Institute, Common Terminology Criteria for Adverse Events v4.0. NIH publication # 09-7473. May 29 2009, NCI, NIH, DHHS.
National Comprehensive Cancer Network. (2016). NCCN clinical practice guidelines in oncology: head and neck cancers, V. 1.2016.
National Comprehensive Cancer Network. (2016). NCCN clinical practice guidelines in oncology: cancer-related fatigue, V. 1.2016.
National Comprehensive Cancer Network. (2016). NCCN clinical practice guidelines in oncology: Adult cancer Pain, V. 1.2016.
Nguyen, N. P., Moltz, C. C., Frank, C., Vos, P., Smith, H. J., Karlsson, U., ... & Sallah, S. (2004). Dysphagia following chemoradiation for locally advanced head and neck cancer. Annals of Oncology, 15(3), 383-388.
Nguyen, N. P., Smith, H. J., Dutta, S., Alfieri, A., North, D., Nguyen, P. D., ... & Nguyen, L. M. (2007). Aspiration occurence during chemoradiation for head and neck cancer. Anticancer research, 27(3B), 1669-1672.
Nishiwaki, K., Tsuji, T., Liu, M., Hase, K., Tanaka, N., & Fujiwara, T. (2005). Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables.Journal of Rehabilitation Medicine, 37(4), 247-251.
Nuyts, S., Dirix, P., Clement, P. M., Vander Poorten, V., Delaere, P., Schoenaers, J., ... & Van den Bogaert, W. (2009). Impact of adding concomitant chemotherapy to hyperfractionated accelerated radiotherapy for advanced head-and-neck squamous cell carcinoma. International Journal of Radiation Oncology* Biology* Physics, 73(4), 1088-1095.
Okamura, H. (2011). Importance of rehabilitation in cancer treatment and palliative medicine. Japanese journal of clinical oncology, 41(6), 733-738.
Pandey, M., & Thomas, B. C. (2012). Rehabilitation of the Cancer Patient. World Journal of Psycho-Social Oncology, 1(5).
Panther, K. (2005). The Frazier free water protocol.SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 14(1), 4-9.
Pauloski, B. R., Rademaker, A. W., Logemann, J. A., Lazarus, C. L., Newman, L., Hamner, A., ... & Stachowiak, L. (2002). Swallow function and perception of dysphagia in patients with head and neck cancer. Head & neck, 24(6), 555-565.
Penner, J. L., McClement, S. E., & Sawatzky, J. A. V. (2007). Management of dysphagia in advanced oropharyngeal cancer. International journal of palliative nursing, 13(5), 206-212.
Peponi, E., Glanzmann, C., Willi, B., Huber, G., & Studer, G. (2011). Dysphagia in head and neck cancer patients following intensity modulated radiotherapy (IMRT). Radiation Oncology, 6(1), 1.
Pfister, D. G., Spencer, S., Adelstein, D., Adkins, D., Brizel, D. M.,Burtness, B., et al. (2016). NCCN practice guidelines in oncology for the head and neck cancers. (version 1), U.S. National comprehensive cancer network.
Pignon, J. P., Bourhis, J., Domenge, C. O., & Designe, L. (2000). Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. The Lancet, 355(9208), 949-955.
Pignon, J. P., Le Maitre, A., Maillard, E., & Bourhis, J. (2009). Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiotherapy and Oncology, 92(1), 4-14.
Platteaux, N., Dirix, P., Dejaeger, E., & Nuyts, S. (2010). Dysphagia in head and neck cancer patients treated with chemoradiotherapy. Dysphagia, 25(2), 139-152.
Portenoy, R. K., & Itri, L. M. (1999). Cancer-related fatigue: guidelines for evaluation and management. The oncologist, 4(1), 1-10.
Powell, C., Schick, U., Morden, J. P., Gulliford, S. L., Miah, A. B., Bhide, S., ... & Nutting, C. M. (2014). Fatigue during chemoradiotherapy for nasopharyngeal cancer and its relationship to radiation dose distribution in the brain. Radiotherapy and Oncology, 110(3), 416-421.
Pureell, A., Fleming, J., Haines, T., & Bennett, S. (2009). Cancer-related fatigue: A review and a conceptual framework to guide therapists' understanding. The British Journal of Occupational Therapy, 72(2), 79-86.
Radiological Society of North America(2014) Intensity-Modulated Radiation Therapy (IMRT). Retrieved June 9, 2015, from http://www.radiologyinfo.org/en/info.cfm?pg=imrt
Radomski, M. V., & Latham, C. A. T. (Eds.). (2008). Occupational therapy for physical dysfunction. Lippincott Williams & Wilkins.
Roe, J. W., Drinnan, M. J., Carding, P. N., Harrington, K. J., & Nutting, C. M. (2014). Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia?. Oral oncology, 50(12), 1182-1187.
Ryan, J. L., Carroll, J. K., Ryan, E. P., Mustian, K. M., Fiscella, K., & Morrow, G. R. (2007). Mechanisms of cancer-related fatigue. The oncologist, 12(Supplement 1), 22-34.
Sawada, N. O., de Paula, J. M., Sonobe, H. M., Zago, M. M. F., Guerrero, G. P., & Nicolussi, A. C. (2012). Depression, fatigue, and health-related quality of life in head and neck cancer patients: a prospective pilot study. Supportive Care in Cancer, 20(11), 2705-2711.
Schwartz, A. L., Mori, M. O. T. O. M. I., Gao, R. E. N. L. U., Nail, L. M., & King, M. E. (2001). Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Medicine and Science in Sports and Exercise, 33(5), 718-723.
Servaes, P., Verhagen, C., & Bleijenberg, G. (2002). Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. European journal of cancer, 38(1), 27-43.
Seyidova-Khoshknabi, D., Davis, M. P., & Walsh, D. (2010). A systematic review of cancer-related fatigue measurement questionnaires. American Journal of Hospice and Palliative Medicine, 1049909110381590.
Siegel, R. L., Miller, K. D., & Jemal, A. (2015). Cancer statistics, 2016. CA: A cancer journal for clinicians.
Silver, J. K., & Gilchrist, L. S. (2011). Cancer rehabilitation with a focus on evidence-based outpatient physical and occupational therapy interventions. American Journal of Physical Medicine & Rehabilitation, 90(5), S5-S15.
Smith-Gabai, H. (2011). Oncology. In Smith-Gabai, H(Ed.), Occupational therapy in acute care (pp. 407-442). Bethesda, NJ: The American Occupational Association.
Sonis, S. T. (2004). The pathobiology of mucositis.Nature Reviews Cancer, 4(4), 277-284.
Sonis, S. T., Peterson, R. L., Edwards, L. J., Lucey, C. A., Wang, L., Mason, L., ... & Bedrosian, C. (2000). Defining mechanisms of action of interleukin-11 on the progression of radiation-induced oral mucositis in hamsters. Oral oncology, 36(4), 373-381.
Starkie, R., Ostrowski, S. R., Jauffred, S., Febbraio, M., & Pedersen, B. K. (2003). Exercise and IL-6 infusion inhibit endotoxin-induced TNF-α production in humans. The FASEB Journal, 17(8), 884-886.
Stone, P. C., & Minton, O. (2008). Cancer-related fatigue. European journal of cancer, 44(8), 1097-1104.
Stone, P. C., & Minton, O. (2008). Cancer-related fatigue. European journal of cancer, 44(8), 1097-1104.
Tang, Y., Shen, Q., Wang, Y., Lu, K., & Peng, Y. (2011). A randomized prospective study of rehabilitation therapy in the treatment of radiation-induced dysphagia and trismus. Strahlentherapie und Onkologie, 187(1), 39-44.
Tilg, H., Trehu, E., Atkins, M. B., Dinarello, C. A., & Mier, J. W. (1994). Interleukin-6 (IL-6) as an anti-inflammatory cytokine: induction of circulating IL-1 receptor antagonist and soluble tumor necrosis factor receptor p55. Blood, 83(1), 113-118.
Visser, M. R. M., & Smets, E. M. A. (1998). Fatigue, depression and quality of life in cancer patients: how are they related?. Supportive Care in Cancer, 6(2), 101-108.
Vockins, H. (2004). Occupational therapy intervention with patients with breast cancer: a survey. European journal of cancer care, 13(1), 45-52.
Vokes, E. E., Weichselbaum, R. R., Lippman, S. M., & Hong, W. K. (1993). Head and neck cancer. New England Journal of Medicine, 328(3), 184-194.
Wagner, L. I., & Cella, D. (2004). Fatigue and cancer: causes, prevalence and treatment approaches. British Journal of Cancer, 91(5), 822-828.
Wagner, L. I., & Cella, D. (2004). Fatigue and cancer: causes, prevalence and treatment approaches.British journal of cancer, 91(5), 822-828.
Wang, X. S. (2008). Pathophysiology of cancer-related fatigue. Clinical journal of oncology nursing,12(5 Suppl), 11.
Wang, X. S., Mendoza, T. R., Gao, S. Z., & Cleeland, C. S. (1996). The Chinese version of the Brief Pain Inventory (BPI-C): its development and use in a study of cancer pain. Pain, 67(2), 407-416.
Watson, T., & Mock, V. (2004). Exercise as an intervention for cancer-related fatigue. Physical therapy, 84(8), 736-743.
Wei, W. I., & Sham, J. S. (2005). Nasopharyngeal carcinoma. The Lancet,365(9476), 2041-2054.
World Health Organization (WHO). (2014). Global battle against cancer won’t be won with treatment alone Effective prevention measures urgently needed to prevent cancer crisis. Lyon, London: International Agency for Research on Cancer.

連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top