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標題: | 接受同步化學放射治療之頭頸癌病人睡眠困擾變化與症狀嚴重度及創傷後壓力症狀之相關性探討 Change of Sleep Disturbance and Its Relationship with Symptoms Severity and Post-Traumatic Stress Symptoms in Head and Neck Cancer Patients During and Post-Concurrent Chemoradiotherapy |
作者: | Yu-Chieh Su 蘇郁捷 |
指導教授: | 賴裕和(Yeur-Hur Lai) |
關鍵字: | 頭頸癌,症狀嚴重度,創傷後壓力症狀,睡眠困擾, Head and neck cancer,Symptom severity,PTSS,Sleep disturbance, |
出版年 : | 2018 |
學位: | 碩士 |
摘要: | 背景:新診斷為頭頸癌病人,可能因治療相關的症狀及疾病衝擊造成的創傷後壓力影響睡眠問題,然而現有的研究對此的討論有限。
目的:探討新診斷頭頸癌病人接受同步化學放射治療或僅接受放射線治療三個月期間之:(1)症狀嚴重度、創傷後壓力症狀和睡眠困擾的變化;及(2)症狀嚴重度及創傷後壓力症狀與睡眠困擾的相關性。 研究設計:本研究為縱貫式前瞻性設計,分別在病人接受同步化學放射治療前(T1)、治療第一個月(T2)、第二個月(T3)以及第三個月(T4),採問卷收集資料,包括: 症狀嚴重度量表、事件衝擊量表、睡眠困擾量表。使用Mann-Whitney U及Kruskal-Wallis H檢定人口學及疾病特性與睡眠困擾的差異;Spearman’s相關分析四個時間點身體功能、症狀嚴重度、創傷後壓力症狀與睡眠困擾的相關性;最後選取與睡眠困擾有顯著差異的人口學、疾病特性變項以及任一個時間點與睡眠困擾有顯著相關的身體功能、症狀嚴重度、創傷壓力症狀變項進入廣義估計方程式(General Estimating Equation, GEE),分析影響睡眠困擾變化的相關因素。 結果: 60位受試者完成三個月的評估,研究結果發現:(1)疾病特性的不同與睡眠困擾無關;(2)整體症狀嚴重度、創傷壓力症狀及睡眠困擾在治療第二個月達高峰,治療第三個月症狀嚴重度下降,但仍顯著高於治療前;(3)身體功能與睡眠困擾變化呈負向相關,疲倦、口乾、口腔黏膜炎、創傷後壓力症狀與睡眠困擾變化呈正向相關。 結論:提升臨床醫護人員對於接受同步化學及放射治療的頭頸癌病人睡眠問題的了解,並針對干擾睡眠的因素進行評估,包括治療相關的症狀,如: 口乾、口腔黏膜炎以及疲倦,適時予以症狀處理之協助,並注意創傷後壓力症狀之程度。面對癌症診斷及治療帶來的痛苦所產生的衝擊反應,除了面對以及接受疾病之外,因治療帶來日常生活上的改變,醫療人員應協助病人調適疾病的過程。 Background: Head and neck (HNC) cancer patients experience symptoms severity and post-traumatic stress symptoms (PTSS), which might influence sleep disturbance. However, limited research has explored how they affect sleep disturbance simultaneously. Aim: (1)Explore changes of symptoms severity, post-traumatic stress symptoms and sleep disturbance. (2)The relationship in symptoms severity, post-traumatic stress symptoms and sleep disturbance in HNC patients. Study design: A longitudinal prospective study was designed to collect data since pre-concurrent chemoradiotherapy (CCRT) to receiving CCRT for three month. The questionnaires we used were Symptom Severity Scale, Impact Event Scale-Revised, and Medical Outcome Study- Sleep Scale. The Generalized Estimating Equations was used to analyze the factors that influence change in sleep disturbance. Result: Sixty eligible subjects completed this survey. The results indicated: (1) no significant difference in disease characteristics and sleep disturbance. (2) The overall symptoms severity, post-traumatic stress symptoms and sleep disturbance reached a peak in the second month of radiotherapy and then decreased significantly in the third month of treatment, but still higher than before radiotherapy. (3) Performance status (KPS), Fatigue, dry mouth, oral mucositis, and post-traumatic stress symptoms significantly correlated with sleep disturbance. Conclusion: Medical professionals should understand sleep problems in HNC patients, and pay more attention to evaluate factors that interfere with sleep disturbances, including symptoms severity and the impact of cancer, during and post treatment. With appropriate symptom control, and help patients to cope with the changes in daily life. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/71740 |
DOI: | 10.6342/NTU201804377 |
全文授權: | 有償授權 |
顯示於系所單位: | 護理學系所 |
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