白血病病人接受異體造血幹細胞移植後之身體心像 與生活品質之相關因素探討

Abstract

白血病病人在異體造血幹細胞移植後，因移植前接受高劑量調適療程、移植後多重用藥，及移植後的植體對抗宿主疾病(Graft versus Host Disease, GVHD)，造成身體功能及外觀的改變，影響其生活品質。本研究目的在探討白血病人接受造血幹細胞移植後之人口學特性、移植前調適療程的不同、移植後出現相關症狀和身體心像與生活品質之間的相關性，以便瞭解其生活品質與身體心像改變之影響預測因子。採橫斷面描述性相關性設計，以立意取樣，使用結構性問卷，針對北部某醫學中心之血液腫瘤及幹細胞移植後門診的異體造血幹細胞移植後之白血病人進行問卷資料收集，研究工具包含癌症治療功能性評估-骨髓移植第四版中文版(FACT-BMT)及Cash 和Brown 1995年發展的多向度自我身體關係問卷(multidimensional body-self relations questionnaire- Appearance Scale, MBSRQ-AS)。 本研究總收案量為84人，以SPSS第20版進行資料統計分析，以獨立樣本t檢定、變異數分析、斯皮爾曼等級相關分析及線性迴歸進行資料分析，研究結果發現：移植後病人於多向度自我身體關係問卷-外表量表(MBRSQ-AS)測量身體心像平均分數為100.35±13.07分，是滿分的58.8%，表示病人的身體心像狀態不甚理想；FACT-BMT生活品質總量表平均分數為103.37±23.9，是滿分的69.8%，表示病人的生活品質為中高程度；以逐步回歸分析，找出FACT-BMT生活品質的重要預測因子為身體心像、年齡、頭髮改變、移植後月數，可解釋量為46.2%。 結論：白血病病人於異體造血幹細胞移植後身體心像變化是生活品質的預測因子，身體心像愈正向，生活品質愈好，醫護人員若能在病人移植完出院前事前提供相關身心靈層面護理指導及其他醫療資源服務，並長期追蹤協助病人了解其身體心像變化乃治療後必經之路，可能有助提升移植後初期的適應及生活品質滿意度。

After receiving stem cell transplantation, leukemia patients went through a high- dose chemotherapy conditioning protocol, polypharmacy, and graft-versus-host-disease (GVHD) and had experienced changes of body function and image. Moreover, these changes may affect their quality of life. The purpose of this study was to investigate the relationships among demographic characteristics of stem cell transplantation, conditioning protocol before stem cell transplantation, complications and symptoms after stem cell transplantation, body image, and quality of life. A descriptive, cross-sectional, correlational design was used to recruit leukemia patients who have done allogeneic stem cell transplantation from post-transplantation and hematology outpatient clinics in a stem cell transplantation medical center in northern Taiwan. Instruments used for structured questionnaire data collection were Multidimensional Body-self Relations Questionnaire-Appearance Scale (MBSRQ-AS), the traditional Chinese version of The Functional Assessment of Cancer Therapy- Bone Marrow Transplant version 4 (FACT-BMT), and demographic questionnaire. There were 84 valid samples in this study. The data were analyzed by SPSS 20.0 window and descriptive statistic, t test, ANOVA, Spearman rank correlation, and linear regression analysis. The major findings of this study were as follow: An average of MBSRQ-AS total score were 100.35±13.07, and the mean of patients’ body image were not very satisfied . An average of FACT-BMT total score were 103.37±23.9, and the mean of patients’ quality of life were between middle level and upper level. In order to identify the essential predictors of FACT-BMT, stepwise regression analysis was used in this study. The predictors include MBSRQ-AS total score, age, changes of hair, and months after transplantation. As a result, the total amount of (R2) could explain to 46.2%. Result: Body image change is a predictor of quality of life for leukemia patients who have received allogeneic stem cell transplantation. Healthcare providers could provide holistic care before patient discharge, and give long-term follow-up on their body image changes in order to help patients acknowledge their body image changes. Hope that we can help leukemia patients adapt to and promote the quality of life after transplantation.