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研究生:余家慧
研究生(外文):YU CHIA-HUI
論文名稱:子宮內膜癌存活者之健康生活型態、疲倦與生活品質探討
論文名稱(外文):Exploring the Relationships among Healthy Life Style, Fatigue, and Health Related Quality of Life in Endometrial Cancer Surviors
指導教授:王采芷王采芷引用關係
指導教授(外文):WANG JYY-TSAE
口試委員:張志隆劉介宇
口試委員(外文):CHANG CHIH-LONGLIU CHIEH-YU
口試日期:2017-11-15
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱: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:106
語文別:中文
論文頁數:147
中文關鍵詞:子宮內膜癌健康生活型態肥胖程度睡眠品質疲倦生活品質
外文關鍵詞:Endometrial cancerhealthy life styleover weightsleep qualityfatiguequality of life
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子宮內膜癌是常見的婦科癌症,依據2013年癌症登記報告,台灣前十大癌症發生率,在女性,子宮內膜癌排名第六位,且其發生率有逐漸增加的趨勢。研究顯示子宮內膜癌發生與飲食、運動、肥胖等危險因子有關,子宮內膜癌存活者若遵行健康的生活型態,可減少增加心血管疾病的危險性,進而減少死亡率的發生,且國外研究顯示子宮內膜癌存活者多數肥胖和多未遵行健康生活型態。但少有研究探討國內子宮內膜癌存活者遵行健康生活型態及其對疲倦與健康相關生活品質的影響。因此,本研究目的為探討子宮內膜癌存活者之健康生活型態及其對疲倦程度及生活品質的影響。採描述預測性研究設計,以完成起始治療之子宮內膜癌存活者為研究對象,採方便取樣,於北部某醫學中心婦產科門診招募符合收案條件之子宮內膜癌存活者參與研究,以結構式問卷進行資料收集,內容包括人口學、疾病與治療特性、蔬果攝取量問卷、台灣活動量調查短版量表、匹茲堡睡眠品質指數問卷、疲倦量表、子宮內膜癌生活品質問卷。研究對象疲倦平均得分為44分(SD=7.09)。不同婚姻狀態(F = 4.08, p = 0.019)及腰臀比 (t = 2.26, p = 0.025)的研究對象在疲倦得分上有顯著差異。疲倦得分與年齡(r = 0.217, p = 0.05)、共病指數(r = -0.294, p = 0.01)及睡眠(r = -0.424, p = 0.001)顯著相關。研究對象生活品質平均得分為88.14分(SD = 12.85)。不同婚姻狀態(F = 4.95, p = 0.008)及收入狀態 (F = 3.20, p = 0.026)的研究對象在生活品質得分上有顯著差異。生活品質與共病指數(r = -0.176, p =0.05)、睡眠(r = -0.369, p = 0.001)與疲倦程度(r = 0.614, p = 0.001)顯著相關。而肥胖、抽菸、喝酒、運動與蔬果攝取量等健康生活型態則與疲倦程度及健康相關生活品質無統計上的顯著關係。線性複回歸分析結果顯示年齡、共病指數與睡眠為疲倦的重要預測因子,共可解釋26%的變異度(F = 9.02)。年齡小、共病指數高與睡眠品質差的子宮內膜癌病人有較高的疲倦感。另外,疲倦、經濟狀況及不同婚姻狀態為健康相關生活品質的重要預測因子,共可解42%的變異度(F = 13.02)。疲倦程度高、未婚及收入≦20000的子宮內膜癌病人有較低的生活品質。因此特別留意評估年齡小、共病指數高與睡眠品質差的子宮內膜癌病人疲倦程度,因其為疲倦的高危險群。而改善子宮內膜癌病人的疲倦程度、經濟狀況及提供社會支持將有助於改善其健康相關生活品質。雖然健康生活型態在疲倦及生活品質上並未有顯著差異,但研究結果顯示符合美國癌症協會健康行為建議標準的比率過低,因此協助此一族群病人維持健康生活型態,進而預防癌症復發、第二種癌症或慢性疾病的產生,仍是刻不容緩。
Endometrial cancer is a common gynecologic cancer. According to the cancer registry annual report of 2013, endometrial cancer was the sixth most common cancer for women in Taiwan. Endometrial cancer incidence is increasing gradually. Studies showed that diet, exercise, obesity were related to the incidence of endometrial cancer. Following a healthy life style may reduce the risks for cardiovascular diseases and mortality in endometrial cancer survivors. Previous studies showed that the majority of endometrial cancer survivors were obesity and not follow a healthy lifestyle. However, few studies have been conducted in Taiwan to investigate the relationships among health life style, fatigue, and health-related life quality in endometrial cancer survivors. Therefore, the purpose of the study is to explore the influences of healthy life style on fatigue, and health related quality of life in endometrial cancer survivors. The study is a descriptive predictive design. 134 endometrial cancer survivors were recruited from gynecology clinics of a medical center in Taiwan. Data were collected by using the study questionnaires, including questions on demographics, disease and treatment, Fruit and Vegetable Intake questionnaire, Taiwanese version of the International Physical Activity Questionnaire, the Pittsburgh Sleep Quality Index questionnaire, Functional Assessment of Chronic Illness Therapy-Fatigue, and the Functional Assessment of cancer therapy-General Scale. The participants’ average score of fatigue was 44 (SD=7.09). Results of t-test or ANOVA tests showed that the participants’ fatigue scores were significantly different among different marital status (F = 4.08, p = 0.019), and between waist-hip ratio groups (t = 2.26, p = 0.025). The participants’ fatigue scores were significantly related to age(r = 0.217, p = 0.05), comorbidity(r = -0.294, p = 0.01), and sleep quality(r = -0.424, p = 0.001). The participants’ average score of health-related quality of life was 88.14(SD = 12.85). Results of ANOVA tests showed that the participants’ quality of life scores were significantly different among different marital status (F = 4.95, p = 0.008), and income groups (F = 3.20, p = 0.026). The participants’ life quality was significantly related to comorbidity(r = -0.294, p = 0.01), sleep quality(r = -0.369, p = 0.001)and fatigue (r = 0.614, p = 0.01).Obesity, smoking, drinking, exercise and fruit and vegetable intake were not statistically significant related to fatigue, nore health-related quality of life. Multiple linear regression analysis showed that age, comorbidity index and sleep quality were important predictors of fatigue and these three variables explained 26% (F = 9.02) of varianc in fatigue. Endometrial cancer patients with a younger age, higher comorbidity, and poor sleep quality of reported a higher level of fatigue. Fatigue, different marital status and economic status were important predictors of health-related quality of life and the three varibales explained 42% (F =13.02) of variance in health-related quality of life. Patients with poor sleep quality, unmarried and income ≦20000 reported a lower level of life quality. Special attention shoulde be paid to those who were younger, had a greater comorbidity, and poor sleep quality were at the greatest risk for fatigue. Additionally, improving fatigue, economic status and social support may help to improve o health-related quality of life in endometrial cancer surviors. Although the healthy lifestyle were not significantly related to fatigue nor quality of life, the results showed that only small percentages of endometrial cancer surviors met the exercsie or diet recommendations of the American Cancer Society. This results indicate the needs for promting the healthy life style in endometrial cancer surviors for preventing cancer recurrence or the second cancer occur.
目  次
摘  要 I
英文摘要 III
目  次 V
表  次 IX
圖  次 X
第一章 緒論 1
第一節 背景與動機 1
第二節 研究目的 2
第三節 研究假設 2
第四節 研究架構 3
第五節 名詞定義 5
第二章 文獻探討 9
第一節 子宮內膜癌的流行病學 9
第二節 子宮內膜癌的診斷與治療 10
第三節 健康生活型態及其對癌症存活者的重要性 11
第四節 子宮內膜癌存活者的健康生活型態及其影響 14
第五節 睡眠品質 16
第六節 疲倦 17
第七節 健康相關生活品質 19
第三章 研究方法 22
第一節 研究設計 22
第二節 研究對象與場所 22
第三節 研究步驟與資料收集方式 23
第四節 研究工具 23
第五節 資料處理與分析方法 29
第六節 研究倫理考量 30
第四章 研究結果 31
第一節 研究對象之人口學與疾病特性 31
第二節 研究對象之肥胖程度、健康生活型態、睡眠、疲倦與生活品質 33
第三節 不同人口學、疾病特性與健康生活型態的研究對象在疲倦程度與生活品質的差異情形 35
第四節 年齡、術後時間、共病指數、睡眠情形、疲倦程度與健康相關生活品質之相關性 37
第五節 疲倦的預測因子 38
第六節 健康相關生活品質的預測因子 39
第五章 討論 41
第一節 研究對象之人口學與疾病特性 41
第二節 肥胖程度、健康生活型態、睡眠、疲倦與生活品質 41
第三節 疲倦程度之影響因素 43
第四節 健康相關生活品質之影響因素 44
第五節 研究限制 46
第六章 結論與與建議 48
第一節 結論 48
第二節 建議 49
參考文獻 50
中文部分 50
英文部分 51
附錄 64
附錄一 IRB受試者同意書 64
附錄二 G Power 研究樣本數預估參數 65
附錄三 研究問卷 66
一、專家邀請函 66
二、個人基本資料 68
三、飲酒失常識別試驗 74
四、慢性病史:Charlson 共病症(comorbidity)加權指數表 75
五、IPAQ台灣活動量調查_短版問卷 76
六、匹茲堡睡眠品質量表 79
七、慢性疾病治療功能性評估-疲憊量表 82
八、癌症治療功能性評估 83
九、蔬果攝取量問卷 85
附錄四 蔬果攝取量問卷計分方式 127
附錄五 量表使用同意書 128
一、匹茲堡睡眠品質量表使用同意書 128
二 、IPAQ同意活動量調查_短版問卷使用同意書 129
三、慢性疾病治療功能性評估-疲憊量表使用同意書 130
四、癌症治療功能性評估使用同意書 132
五、中文版「飲酒失常識別試驗」量表使用同意書 134


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