背景
乳癌位居台灣女性癌症發生率之冠，死亡率為第四；五年存活率可達89%以上，現今紫杉醇治療的助益已被證實，但伴隨而來的副作用影響乳癌婦女的生活品質。其中，周邊神經病變是常見卻也易被長期忽視的副作用，影響個人的生理、心理與社會功能狀態，甚至延誤或中斷治療。國外已有探討周邊神經病變造成癌症病人各方面之影響，而國內尚無女性乳癌族群本土化資料。
目的
本研究旨在探討乳癌婦女接受紫杉醇治療後引發周邊神經病變、功能狀態與生活品質的現況，分析各研究變項間之相關性，並了解生活品質的預測因子。
方法
採橫斷面研究設計，以立意取樣於台北市某醫學中心門診、化學注射室及一般外科病房，使用結構式問卷進行資料收集，研究對象為至少經歷過一次以上紫杉醇治療的乳癌婦女，共收案123人。研究工具包括個人基本資料表、病人神經毒性問卷、臨床版神經病變量表、周邊神經病變量表與乳癌治療功能性評估。資料以SPSS 20.0統計套裝軟體建檔，採描述性及推論性統計分析。
結果

研究結果顯示研究對象接受docetaxel藥物為主要配方占最大宗（88.6%），平均年齡為51.50±9.74歲。周邊神經病變的現況，一、主觀評估方面：71.5%有感覺症狀，66.7%有運動症狀，將近半數呈輕微程度，僅4.9%至7.3%為嚴重程度；二、客觀評估方面：87.0%發生周邊神經病變，以針刺感與震顫感變弱為主。腳的功能狀態變差比手嚴重，且麻木感比刺痛感嚴重。生活品質程度在中等以上。主觀周邊神經病變與功能狀態呈顯著正相關（rho值為0.674，p值小於0.001）；與生活品質呈顯著負相關（rho值為-0.302，p值為0.001）。客觀周邊神經病變與功能狀態亦呈顯著正相關（r值為0.633，p值小於0.001）；與生活品質呈顯著負相關（r值為-0.364，p值小於0.001）。功能狀態與生活品質呈顯著負相關（r值為-0.490，p值小於0.001）。經階層式迴歸分析得知，接觸化學物品風險、因病辭去工作、合併慢性病、嚴重的主觀周邊神經病變運動症狀與低功能狀態，五個變項為降低生活品質之預測因子，總解釋變異量為37.6%。
結論
乳癌婦女接受紫杉醇治療後會引發周邊神經病變，影響功能狀態與生活品質呈負向趨勢，護理人員應搭配主客觀工具評估周邊神經病變，期望達到早期發現，及時處置之成效，進而提升個案化療後的整體生活品質。

Background: Breast cancer is the most frequent female cancer in Taiwan, while its mortality rate is the forth and overall five year survival is 89%. The taxane including paclitaxel and docetaxel is benefitical for breast cancer survivorship demonstrated by numerous randomized trials. However, side effects from taxane because chemotherapy diminished these women’s quality of life. Taxane-induced peripheral neuropathy (TIPN) is a common side effects and negatively influences women’s physical, psychological and social status. There are many studies to survey the phenomenon of TIPN in other countries, but no study to investigate its impact on Taiwanese women with breast cancer up to now.
Purpose: The primary purpose of this study was to investigate the distribution and relationship among peripheral neuropathy, functional status and quality of life in women with breast cancer after taxane treatment. Additionally, it was also to examine the predicting factors of quality of life in this population.
Methods: This study utilized a cross-sectional study design and purposive sampling. A total of 123 women with breast cancer received at least one treatment with taxane were recruited in this study from a medical center in northern Taiwan. Instruments included demographic and clinical characteristic questionnaires, Patient Neurotoxicity Questionnaire, Total Neuropathy Score-clinical version, Peripheral Neuropathy Scale and Functional Assessment for Cancer Treatment-Breast.SPSS 20.0 software was used for data entry and analysis. The data were analyzed utilizing descriptive statistics and inferential analyses.
Results: Majority of the participants received docetaxel therapy. The average age was 51.50 (SD=9.74). The TIPN subjective measure found sensory symptoms and motor symptoms were 71.5% and 66.7%, respectively. Nearly half of the participants were with slight symptoms but only 4.9 to 7.3% of them were with a severe degree. The objective method indicated that 87.0% had peripheral neuropathy. Moreover, two of the most common symptoms were the deterioration of sensation on pinprick and vibration tests. The domain of functional status revealed that the symptoms in feet were more serious than they were in hands; numbness was more severe than tingling. The quality of life in this study was above the moderate level. There was a positive correlation between subjective TIPN and functional status (rho=0.674, p<0.001), a negative correlation between subjective TIPN and quality of life (rho=-0.302, p=0.001), a positive correlation between objective TIPN and functional status (r=0.633, p<0.001), and then a negative correlation between objective TIPN and quality of life (rho=-0.364, p<0.001). In additional, there was a negative correlation between functional status and quality of life (r=-0.490, p<0.001). The hierarchical multiple regression analysis detected that the risk of exposure to chemical materials, quit their job due to illness, with chronic diseases, the severe degree of subjective TIPN motor symptoms and poor functional status were the predictors of negative quality of life. The aforementioned factors explained 37.6% of the variance of quality of life.
Conclusion: Women with breast cancer after taxane treatment induced peripheral neuropathy negatively affected functional status and quality of life. In order to improve patients’ quality of life oncology nurses need to have skills utilizing the TIPN subjective and objective tools to early detect and timely manage the TIPN.

目次
致謝 i
中文摘要 ii
Abstract iv
目 錄 v
表目錄 viii
圖目錄 ix
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 5
第二章　文獻查證 6
第一節　乳癌 6
第二節　周邊神經病變 13
第三節　功能狀態與相關研究 29
第四節　生活品質與相關研究 35
第五節　周邊神經病變、功能狀態與生活品質的關係 45
第三章 研究方法 47
第一節　研究設計 47
第二節　研究架構 48
第三節　名詞界定 49
第四節　研究假設 52
第五節　研究對象與抽樣方法 53
第六節　研究工具 54
第七節　資料收集過程 59
第八節　資料分析與統計方法 60
第九節　研究倫理 63
第四章 研究結果 64
第一節　接受紫杉醇治療的乳癌婦女之個人基本屬性分布情形 64
第二節　乳癌婦女接受紫杉醇治療引發周邊神經病變之現況 71
第三節　接受紫杉醇治療的乳癌婦女之功能狀態與生活品質分布情形 75
第四節　乳癌婦女接受紫杉醇治療後周邊神經病變、功能狀態與生活 　　　　品質之關係 78
第五節　乳癌婦女接受紫杉醇治療後生活品質之預測因子 95
第五章 討論 100
第一節　探討乳癌婦女接受紫杉醇治療之個人基本屬性的現況 100
第二節　探討乳癌婦女接受紫杉醇治療引發周邊神經病變的現況 103
第三節　探討接受紫杉醇治療的乳癌婦女之功能狀態與生活品質分布 　　　　情形 106
第四節　探討乳癌婦女紫杉醇治療後周邊神經病變、功能狀態與生活 　　　　品質之關係 109
第五節　探討乳癌婦女接受紫杉醇治療後生活品質之預測因子 114
第六章 結論與建議 116
第一節　結論 116
第二節　研究限制 119
第三節　建議與應用 120
參考文獻 123
中文部分 123
英文部分 126
附 錄 143
附錄一 個人基本資料表 143
附錄二 病人神經毒性問卷 145
附錄三 臨床版神經病變總評分 146
附錄四 周邊神經病變量表 147
附錄五 乳癌治療功能性評估 148

表目次
表2-1　TNM系統分類細則 8
表2-2　神經病變嚴重度評估量表等級意義 22
表3-1　本研究使用之研究工具綜整表 57
表3-2　各變項分類、性質與描述性統計方法 61
表3-3　推論性統計分析方式 62
表4-1　乳癌婦女接受紫杉醇治療之人口學屬性分布情形 66
表4-2　乳癌婦女接受紫杉醇治療之生活習慣變項分布情形 68
表4-3　乳癌婦女接受紫杉醇治療之醫療相關資訊分布情形 69
表4-4　病人神經毒性問卷主觀測量研究對象周邊神經病變之狀態 72
表4-5　臨床版神經病變總評分客觀測量研究對象周邊神經病變之狀態74
表4-6　本研究測量周邊神經病變各量表之內在一致性信度 74
表4-7　接受紫杉醇治療的乳癌婦女功能狀態與生活品質之得分情形 77
表4-8　本研究測量功能狀態與生活品質之內在一致性信度 77
表4-9 「病人神經毒性問卷 (PNQ)」主觀評估周邊神經病變的影響因素
79
表4-10「臨床版神經病變總評分 (TNSc)」客觀評估周邊神經病變的　
　　　　影響因素 85
表4-11「周邊神經病變量表（PNS）」評估功能狀態的影響因素　88
表4-12「乳癌治療功能性評估 (FACT-B)」評估生活品質的影響因素 　　　　91
表4-13 主客觀評估周邊神經病變、功能狀態與生活品質之相關性分析 　　　　94
表4-14　接受紫杉醇治療乳癌婦女相關係數矩陣圖 96
表4-15　四層面階層式迴歸分析報表 98
表4-16　接受紫杉醇治療乳癌婦女對生活品質的預測因子之階層式迴歸
　　　　摘要表 99


圖目次
圖3-1　研究架構圖 48
圖4-1　研究參與者招募流程圖 65

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