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研究生:詹雅惠
研究生(外文):Ya-Hui Tsan
論文名稱:探討頭頸癌病患診斷到完成治療後生活品質變化之預測因子
論文名稱(外文):Exploring the change in quality of life of patients newly diagnosed with head and neck cancer across the cancer trajectory
指導教授:王雅容王雅容引用關係
指導教授(外文):Ya-Jung Wang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床護理研究所
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:2017
畢業學年度:105
語文別:中文
論文頁數:115
中文關鍵詞:頭頸癌症狀負擔希望生活品質
外文關鍵詞:Head and neck cancersymptom burdenhopequality of life
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背景:頭頸癌中的口腔、口咽、下咽癌在十大癌症排名第五位,好發於青壯年男性,也連帶影響家庭與社會。一旦確立診斷,接下來可能要接受手術、放射治療、化學治療或標靶治療等。由於疾病本身及治療副作用影響外觀、吞嚥、語言、呼吸等功能,造成症狀負擔,降低生活品質;而希望可以調適疾病及治療所帶來的限制及威脅,維持生活品質。針對頭頸癌病患診斷到完成治療後這段期間的研究,國內外文獻多為探討與生活品質相關的橫斷性研究,比較缺乏生活品質變化的預測因子及縱貫性研究。
目的:探討頭頸癌病患診斷到完成治療後症狀負擔、希望及生活品質的變化趨勢,以及生活品質變化的預測因子。
方法:採縱貫性研究設計,以立意取樣方式於臺北市某醫學中心口腔外科、耳鼻喉科、腫瘤科病房及腫瘤醫學部門診進行資料收集。研究對象為首次診斷口腔癌、口咽癌、下咽癌、喉癌者,以及接受首次同步化學放射治療者,總共收案62位。研究工具包括頭頸癌患者基本屬性問卷、安德森症狀量表臺灣版、赫氏希望指標中文版、癌症治療功能性評估-頭頸癌量表中文版。四次資料收集的時間為:頭頸癌病患診斷後接受同步化學放射治療前(T1)、治療後第三至四週(T2)、治療結束當週(T3)及治療結束後一個月(T4)。資料以SPSS 22.0 for Window套裝軟體進行建檔,採描述性與推論性統計分析。
結果:本研究樣本以男性居多(90.3%),平均年齡為53.29±7.98歲,結果顯示診斷(F=3.52, p=0.04)及手術方式(F=4.43, p=0.01)對於T1的生活品質有顯著影響,標靶治療對於T2的生活品質有顯著影響(t=2.61, p=0.01)。症狀負擔與生活品質(T1-T4)有顯著負相關,希望與生活品質(T1-T4)有顯著正相關。症狀負擔的變化趨勢為先上升後下降,希望的變化趨勢為先下降後上升,生活品質的變化趨勢為先下降後上升。能顯著預測生活品質變化的因素有因病辭掉工作(β=-4.48, p=0.006)、症狀負擔的變化(β=-0.47, p<0.001)及希望的變化(β=0.60, p<0.001)。
結論:本研究期望提供臨床實務工作者瞭解頭頸癌病患診斷到完成治療後生活品質變化的預測因子,包括因病辭掉工作、症狀負擔的變化及希望的變化。建議在治療前給予完善的護理指導,症狀出現時以跨團隊合作方式給予適當的照護措施,幫助維持正向的希望感,進而改善其生活品質,以順利完成整個治療過程。
Background: Head and neck cancer is the fifth cancer incidence in Taiwan. It often occurs in the middle-aged, male adults with a negative impact on the family and society. Once the cancer diagnosis is established, the treatment may include surgery, radiotherapy, chemotherapy, and target therapy. Side effects from cancer and its treatment may affect patients’ appearance, swallowing, speaking, and breathing functioning. The aforementioned cause patients’ symptom burden and decline their quality of life (QOL). However, evidence shows that hope may help patients maintaining their QOL through a better adjustment from the limitation and threatening of cancer. Lot of cross-sectional studies explore the QOL in head and neck cancer, but still few longitudinal studies discover the QOL change and its predictors across the cancer trajectory.
Purpose: The primary objective of this study was to investigate the predictors of QOL change in patients with head and neck cancer from the diagnosis to completion of treatment. The secondary one was to understand the trends of symptom burden, hope and the QOL in these patients.
Methods: This was a longitudinal design with purposive sampling study. A total of 62 patients newly diagnosed with oral cancer, oropharyngeal cancer, hypopharyngeal cancer or laryngeal cancer done with the first concurrent chemoradiotherapy (CCRT) were recruited form a medical center located in Taipei. The demographic and medical information sheets, M.D. Anderson Symptom Inventory, Herth Hope Index, and Functional Assessment of Cancer Therapy-Head and Neck Cancer Scale were collected. The four measurement time points were as followings; before the CCRT (T1), the 3rd to 4th week after treatment (T2), one week after the end of treatment (T3), and one month after the end of treatment (T4). Data were analyzed with SPSS 22.0 for Window software package utilizing of descriptive and inferential statistics.
Results: The majority of participants were male (90.3%) with an average age of 53.29 (SD=7.98) years old. Results indicated that types of diagnosis (F=3.52, p=0.04) and surgery (F=4.43, p=0.01) significantly influence the T1 QOL. The target therapy (t=2.61, p=0.01) significantly impacts on the T2 QOL. A negative correlation between symptom burden and the QOL was detected at T1-T4. While, a positive correlation between hope and the QOL was detected at T1-T4. The trend of symptom burden was raised first and then declined. However, the trends of hope and QOL were declined first and then raised. The predictors of QOL change were the employee status (β=-4.48, p=0.006), the change of symptom burden (β=-0.47, p<0.001), and the change of hope (β=0.60, p<0.001).
Couclusions: Results of this study provided the information regarding the QOL change and its predictors in patients with head and neck cancer across the cancer trajectory. The predictors of QOL change were the employee status, the change of symptom burden, and the change of hope. In order to help patients complete the entire cancer treatment successfully, the supreme patient education and interdisciplinary cooperation care should be employed during the cancer trajectory. Maintaining a positive sense of hope would improve one’s QOL and with the help in completion of cancer treatment.
目 錄
致謝 i
中文摘要 ii
Abstract iv
目錄 vi
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 4
第三節 研究問題 4
第四節 研究假設 4
第二章 文獻查證 6
第一節 頭頸癌 6
第二節 症狀負擔 11
第三節 希望 17
第四節 生活品質 22
第五節 頭頸癌病患生活品質變化的預測因子 31
第三章 研究方法 34
第一節 研究架構 34
第二節 名詞定義 35
第三節 研究設計 37
第四節 研究場域與對象 37
第五節 研究工具與信效度 38
第六節 研究步驟 39
第七節 資料分析 40
第八節 研究倫理考量 41
第四章 研究結果 43
第一節 頭頸癌病患之人口學屬性與疾病相關資訊 43
第二節 頭頸癌病患之人口學與疾病相關變項對於生活品質的影響 51
第三節 頭頸癌病患之各時間點症狀負擔對於各時間點生活品質的影響 60
第四節 頭頸癌病患之各時間點希望對於各時間點生活品質的影響 61
第五節 頭頸癌病患之各時間點症狀負擔與各時間點希望之間的影響 62
第六節 頭頸癌病患症狀負擔的變化趨勢 64
第七節 頭頸癌病患希望的變化趨勢 66
第八節 頭頸癌病患生活品質的變化趨勢 68
第九節 頭頸癌病患生活品質變化的預測因子 70
第五章 討論 72
第一節 頭頸癌病患之基本屬性 72
第二節 頭頸癌病患之基本屬性對於生活品質的影響 75
第三節 頭頸癌病患之症狀負擔與生活品質的關係 79
第四節 頭頸癌病患之希望與生活品質的關係 81
第五節 頭頸癌病患之症狀負擔與希望之間的關係 83
第六節 頭頸癌病患生活品質變化之預測因子 84
第六章 結論與建議 87
第一節 結論 87
第二節 限制 88
第三節 建議 89
參考文獻 92
中文部分 92
英文部分 94
附錄 105
附錄一 頭頸癌患者基本屬性問卷 105
附錄二 安德森症狀量表台灣版 107
附錄三 赫氏希望指標中文版 109
附錄四 癌症治療功能性評估-頭頸癌量表中文版 110
附錄五 量表授權書 112

表目錄
表3-1 研究工具與信效度 39
表3-2 描述性統計分析方法 40
表3-3 推論性統計分析方法 41
表4-1 研究對象之人口學屬性分布情形 45
表4-2 研究對象之疾病相關資訊分布情形 47
表4-3 人口學變項對於各時間點生活品質的影響 52
表4-4 疾病相關變項對於各時間點生活品質的影響 55
表4-5 人口學及疾病相關變項與各時間點生活品質的相關 59
表4-6 各時間點症狀負擔與各時間點生活品質的相關 60
表4-7 各時間點希望與各時間點生活品質的相關 61
表4-8 各時間點症狀負擔與各時間點希望之間的相關 63
表4-9 症狀負擔T1至T4重複測量結果 65
表4-10 症狀負擔以廣義估計方程式分析四個時間點的變化 65
表4-11 希望T1至T4重複測量結果 67
表4-12 希望以廣義估計方程式分析四個時間點的變化 67
表4-13 生活品質T1至T4重複測量結果 69
表4-14 生活品質以廣義估計方程式分析四個時間點的變化 69
表4-15 生活品質變化以廣義估計方程式分析預測因子 71

圖目錄
圖3-1 頭頸癌病患診斷到完成治療後生活品質變化之預測因子研究架構圖 34
圖4-1 研究參與者招募及追蹤流程圖 44
圖4-2 症狀負擔T1至T4變化趨勢 65
圖4-3 希望T1至T4變化趨勢 67
圖4-4 生活品質T1至T4變化趨勢 69
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