胃癌患者術後一個月之疲倦及生活品質改變及其相關因素

Abstract

背景：手術為早期胃癌患者達治癒性效果之主要治療方式，隨著接受手術治療後患者治癒率增加、癌症存活期延長，生活品質議題受到重視，而影響生活品質的許多因素中，疲倦為術後主要因素之一。除此，綜合過去國內外研究，近年來人格特質開始被討論，但針對胃癌接受手術患者，同時探究D型人格特質、疲倦及生活品質之相關性議題仍著墨不多。 目的：本研究目的為(1)了解接受腹部手術之胃癌病患的基本屬性、疾病特性、D型人格特質、疲倦及生活品質之現況及其相關性；(2)探討此族群於不同階段(手術前、手術後七天、手術後二十八天)其疲倦及生活品質之變化與差異性；(3)了解影響此族群疲倦與生活品質之相關影響因素。 研究設計：本研究採相關性、縱貫式之研究設計，自2017年9月21日至2018年5月25日止於台北市某醫學中心一般外科門診及病房進行收案，選取預計接受胃癌腹部手術病患為收案對象，分別於手術前、手術後七天、手術後二十八天以結構式問卷收集資料，包括台灣版簡明疲倦量表、台灣版D型人格量表、歐洲癌症治療與研究組織生活品質核心問卷台灣中文版、歐洲癌症治療與研究組織胃癌生活品質核心問卷台灣中文版。統計分析方法採描述性統計分析基本屬性、疾病特性、D型人格特質、疲倦及生活品質各變相現況，以無母數分析及皮爾曼統計分析D型人格特質、疲倦與生活品質之相關性，並藉由廣義估計方程式分析影響疲倦與生活品質之重要因子。 結果：本研究共51位個案完成三次問卷收集，資料收集完成率分別為手術前(T0) 54份、手術後七天(T1) 51份、手術後二十八天(T2) 51份，問卷流失率為5.9%。研究結果顯示：(1)整體疲倦程度變化以手術前最高，手術後七天逐漸下降，手術後二十八天最低；影響疲倦的重要因子分析中，手術前身體活動功能(Karnofsky performance status, KPS)與疲倦呈負相關(β = -0.067, p = 0.001)，而喘(β = 0.019, p = 0.010)、腹瀉(β = 0.024, p = 0.001)和飲食限制(β = 0.019, p = 0.028)與疲倦呈正相關；而疲倦程度於不同階段則無顯著的差異(2)整體生活品質狀態變化以手術前最好，手術後七天達最差，手術後二十八天平均逐漸上升，但仍未能回復至術前程度；影響整體生活品質的重要因子分析中，疲倦(β = -2.386, p = 0.016)與整體生活品質呈負相關，癌症分期第三期(β = -13.209, p = 0.003)與第四期(β = -16.601, p =0.013) 與第一期比較下，整體生活品質較差；整體生活品質狀態於不同階段有顯著的差異，手術後七天(β = -9.678, p = 0.008)、手術後二十八天(β = -8.016, p = 0.020)與手術前相比，整體生活品質較差。(3)具有D型人格特質者有7位(13.7%)，其中負向情感(Negative Affectivity, NA)特質與手術前疲倦干擾程度呈正相關(rho = 0.446, p = 0.001)，而是否具有D型人格特質者在整體生活品質之統計上無顯著差異性。 結論：本研究發現，疲倦程度於不同階段無顯著的差異，整體生活品質狀態手術後七天與二十八天皆較手術前差，症狀困擾是影響胃癌病患手術前後疲倦程度增加與生活品質變差的重要因素。臨床照護上需著重評估影響疲倦及生活品質的疾病特性，包括癌症期別、手術前身體活動功能狀態、相關症狀困擾以及D型人格特質，整合飲食衛教、疲倦和不同症狀的處置，依病人需要提供適切建議以及心理照護與情緒支持，降低疲倦干擾帶來的影響，提升胃癌存活者手術後短期整體生活品質。期本研究能提供臨床照護此族群之醫護人員參考，共同提升胃癌病患照護品質。

Background: Surgery is the main curative treatment for the patients with gastric cancer. Since the cure rate and survival rate increased, quality of life become an important issue. Fatigue is one of the most related factors that impact quality of life. In addition, personality has been involved in cancer research recently, several studies have reported that Type D personality had negative effects on cancer patients. However, there are less studies to explore the correlations between fatigue, Type D personality and quality of life. Purpose: The purposes of this study were to (1) analyse the correlation between demographic and clinical characteristics, Type D personality, fatigue and quality of life in patients with gastric cancer; (2) explore the changes of fatigue and quality of life during one months after operation, and (3) identify the relative factors that impact fatigue and quality of life. Methods: A longitudinal designed study was conducted by recruiting the gastric cancer patients with undergoing the surgery at the surgery outpatient and inpatient wards. The data was collected three times at peri-operation (T0), post-operation 7th day(T1) and 28th day (T2) from 21 November in 2017 to 25 May in 2018. A set of structured questionnaire was used to collect data including the demographic, clinical characteristics, the Brief Fatigue Inventory-Taiwan Form (BFI-T), Type D scale14 -Taiwanese version (DS14-T), The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-Cancer 30 (EORTC-QLQ-C30) and Quality of Life-Stomach Cancer 22 (EORTC-QLQ-STO22). The data was analyzed by using descriptive statistics, nonparametric statistics, Spearman’s correlation statistics and the Generalized Estimating Equations (GEE). Results: Totally, 51 patients completed this survey and the attribution rate was 5.9% during the period of data collecting. The results showed that (1) fatigue level was the highest at T0 and gradually decreased. Karnofsky performance status (KPS) (β = -0.067, p = 0.001) was positively correlated with fatigue. Dyspnea (β = 0.019, p = 0.010), diarrhea (β = 0.024, p = 0.001), and eating restriction (β = 0.019, p = 0.028) were negatively correlated with fatigue. (2) The overall quality of life significantly decreased at T1 and increased at T2 that it was still lower than T0. Fatigue (β = -2.386, p = 0.016) was negatively correlated with overall quality of life. Cancer stage III (β = -13. 209, p = 0.003) and stage IV (β = -16.601, p = 0.013) had worse overall quality of life than stage I. The time of 7th day (β = -9.678, p = 0.008) and 28th day (β = -8.016, p = 0.020) after operation had worse overall quality of life than preoperation. (3) The prevalence of Type D personality was13.7%, Negative Affectivity (NA) (rho= 0.446, p = 0.001) was the significant factors positively increased fatigue interference. Conclusions: Symptom distress, advanced cancer stage and KPS are the significant factors that increase fatigue and further impact QoL within one month after operation. In addition, Negative Affectivity (NA) is strongly associated with fatigue interference before operation. Therefore, the health providers should pay more attention to the patients with symptom assessment. To improve patinets’ quality of life, diet education, fatigue and symptom management should be integrated and provided to this population according to individual needs.