不同種類癌症病患於不同治療狀態之健康相關生活品質

Abstract

癌症為臺灣十大死因之首，發生率和死亡率都呈現逐年增加，而癌症的疾病症狀，治療方式及其副作用更會影響病患的生活品質，生活品質是很重要的臨床指標之一，可以更好的幫助臨床療效評估，以及發展應用到各項醫療經濟評估，進而成為衛生決策的基礎。對不同種類癌症患者在接受治療時期和在追蹤期的生活品質比較，以及相關的重要影響因子分析，是本研究所希望討論的重點。 方法：本研究為橫斷式研究設計，以立意取樣的方式利用結構式問卷對北部一家醫學中心正在接受治療和已經在追蹤的乳癌、肺癌以及鼻咽癌患者進行健康相關生活品質調查，收集了患者的年齡、性別、教育程度資料，並以歐洲癌症研究與治療組織癌症病人特定生活品質量表（EORTC QLQ-C30）來測量患者的健康相關生活品質，再界定功能性題組為指標變項（Indicator variable），而症狀困擾及單獨問題為原因變項 （Casual variable）。在預測癌症患者健康相關生活品質之重要影響因素，以及分析原因變項對指標變項的影響，是利用皮爾森相關係數檢定各個自變項，將達統計上顯著性意義之變項，納入進行逐步迴歸分析（stepwise regression）。 結果：共有288位受訪患者參與研究，女性占54.51%，全部受訪者平均年齡是50.72±11.83歲，以大學程度為最多占31.94%。以「整體生活品質」來看，追蹤組的平均分數65.6±21.4分要比接受治療組的55.4±20.6分來得高，2組之間在「角色功能」、「社會功能」、「疲倦」、「噁心嘔吐」、「疼痛」、「食慾不振」、「便秘」，以及「整體生活品質」等各項分數上，有達到統計上顯著的差異。通過皮爾森相關係數檢定以及逐步迴歸分析，在接受治療組中發現疲倦、呼吸困難、噁心嘔吐以及社會功能等變項，是整體生活品質的預測因子，而且乳癌患者會比鼻咽癌患者的整體生活品質較差，具高中學歷者會比大學以上學歷者整體生活品質較好；而在追蹤組方面，可以看到疲倦、情緒功能、角色功能、認知功能、以及疼痛等變項是整體生活品質的預測因子。在兩組中都可以看到整體生活品質與功能性表現呈正相關，而和症狀困擾及單獨問題呈負相關，但是和人口學特性並沒有顯著的相關性。原因變項中以「疲倦」的影響最明顯，在2組各自的5個功能性表現中都有影響。 結論：處於正在接受治療時期的患者，整體生活品質會比處於追蹤期的患者來得差，而在不同治療時期內對整體生活品質影響之重要因子並不相同，每個時期內指標變項會受到不同原因變項不同程度的影響。

Cancer was the first of ten leading causes of death in Taiwan with the increased incidence rate and death rate year by year. The symptoms of the cancer and the treatment itself or the side effect of treatment all influenced the patient’s quality of life. Health-related quality of life (HRQOL) is one of the important clinical indices to evaluate clinical result of treatment and is further implied to other medical economic evaluation as base of medical policy. The differences of HRQOL in patients with different cancer receiving chemotherapy or follow-up as well as the relative factor analysis were the purposes of present study. Method: The present study is a cross-section study design with purposive sampling. 3 groups of patients of breast cancer, lung cancer and nasopharyngeal cancer receiving chemotherapy or follow-up in a medical centre in Taipei were interviewed by structured questionnaire. Patients’ demographic data, including age, gender, and education was collected and EORTC QLQ-C30 questionnaire were used to assess the patients’ HRQOL. The 5 functional scales are defined as indicator variables and the other symptom scales and single items are defined as causal variables. To predict the cancer patients’ HRQOL and analyze the influence to indicator variables, Pearson’s correlation and stepwise regression were employed. Results: Two hundred and eighty-eight patients completed the study. There were 54.51% female, and mean age of whole group was 50.72±11.83 years old. In the HRQOL, the patients receiving follow-up have better score of 65.6±21.4 than receiving chemotherapy. There were significance differences between two groups in role functioning, social functioning, fatigues, nausea/vomiting, pain, appetite loss, constipation, and global health status/quality of life. By Pearson’s correlation and stepwise regression, fatigues, dyspnea, nausea/vomiting, and social function were the predictors of HRQOL in receiving chemotherapy group; and, the breast cancer patients’ HRQOL may be worse than the nasopharyngeal cancer patients’. Besides, the HRQOL was better in patient with a grade 12 educational level than the colleges. In follow-up group, fatigues, emotional functioning, role functioning, cognitive functioning, and pain were the predictors of the HRQOL. In both groups, the HRQOL was positive correlated to function scales but negative to symptom scales and each single item, and there is no significant association with demographic factors. In casual variables, fatigue was the most significant factor in all domains. Conclusion: HRQOL in patient receiving chemotherapy was worse than receiving follow-up. The factors influenced HRQOL were different between two groups as well as indicator variables were also influenced by different casual variables.