早期肺癌患者手術前後復原力與生活品質之研究

Abstract

研究背景肺癌為全球最常見癌症死亡的主因，也是國內癌症死因之首位。隨著我國早期肺癌疾病手術比例逐年增加，其中以楔型切除手術占最大宗。從初診斷到手術切除，肺癌患者在身心常面臨壓力衝擊與挑戰。維持良好的生活品質已被視為衛生政策的重要目標，並且與健康結果密切相關。過去研究指出，癌症患者的復原力會影響其生活品質，但針對早期肺癌患者在手術前後復原力與生活品質變化，以及手術後復原力與生活品質相關因素之研究甚少。研究目的本研究之目的是探討早期肺癌患者在手術前後復原力與生活品質的差異，以及手術後復原力和生活品質的影響因素。研究方法本研究為量性縱貫追蹤研究設計，於2023年1月至12月在北部某醫學中心收案方便取樣。研究進行兩次測量，分別在入院手術前(T1)，和手術出院兩週後(T2)，共收集到117名有效樣本。研究工具包括中文版康納-戴維森復原力量表(CD-RISC-10)、歐洲五維健康生活品質量表(EQ-5D-5L)、以及人口學和疾病特性問卷。資料處理使用SPSS 28.0版軟體，統計方法包括描述性統計、配對樣本t檢定及單變項和多變項迴歸分析等。研究結果本研究的問卷回收率達到97.9%。所有參與者均接受了肺楔形切除術(Wedge resection)，平均年齡為51.7歲，女性佔85.47%。結果顯示，早期肺癌患者手術後的平均復原力分數，較術前下降了22.5分（p< 0.0001），手術後的平均生活品質分數，較術前下降了15.9分（p< 0.0001）。多變項迴歸分析結果顯示，60-69歲患者的手術後復原力高於50-59歲患者(β= 0.18 , P< 0.03)，手術前復原力分數高，手術後復原力較好(β= 0.50 , P< 0.001)。手術後生活品質分數較高的患者，其手術後復原力也較高(β = 0.32 , P< 0.001)。此外，與50-59歲患者相比，30-39歲患者的手術後生活品質分數較差(β = -0.19 , P< 0.04)。有慢性病的患者，手術後的生活品質較無慢性病的患者差(β= -0.21 , P< 0.02)。肺部毛玻璃數量多於3顆的患者，其手術後生活品質較只有單顆結節的患者差(β= -0.22 , P< 0.01)。手術後復原力較高的患者，其術後生活品質也比較好(β= 0.43 , P< 0.001)。結論本研究發現，手術後復原力的相關因素包括：年齡、手術前的復原力以及手術後的生活品質。手術後生活品質的相關因素則包括：年齡、是否患有慢性病、肺部毛玻璃結節的數量(≥3顆)以及手術後復原力等。此外，早期肺癌患者在手術後的復原力和生活品質均顯著下降，這結果具臨床重要性。建議醫護團隊，在手術前後進行復原力和手術後生活品質的評估和監測，並追蹤這些指標，應及早識別高風險和分數下降的患者，尤其是有慢性疾病或較年輕的早期肺癌族群，並提供相應的介入計畫。

Background Lung cancer is the leading cause of cancer-related deaths worldwide and the primary cause of cancer mortality in our country. The proportion of early-stage lung cancer surgeries has been increasing annually, with wedge resection being the most common procedure. From initial diagnosis to surgical resection, lung cancer patients endure significant physical and psychological stress and challenges. Good quality of life is an important focus of health policy and is also linked to health outcomes. Previous studies have indicated that the resilience of cancer patients affects their quality of life. However, there are few research on the difference in resilience and quality of life before and after surgery in early-stage lung cancer patients, and to explore the associated factors of resilience and quality of life after surgery. Objectives The study aims was to explore the differences in lung cancer patients’ resilience and quality of life before and after surgery, and associated factors in resilience and quality of life of patients with early-stage lung cancer after operation. Method This study employed a quantitative longitudinal design with convenience sampling, conducted at a medical center in northern Taiwan from January to December 2023. Two measurements were taken: one before the surgery upon hospital admission (T1) and another two weeks after discharge (T2). A total of 117 valid samples were collected. The research instruments included the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC-10), the European Quality of Life-5 Dimensions-5 Levels (EQ-5D-5L), and a demographic and disease characteristics questionnaire. Data were processed using SPSS version 28.0, with statistical methods including descriptive statistics, paired sample t-tests, and univariate and multivariate regression analyses.Results The response rate for the research questionnaire was 97.9%. All participants underwent pulmonary wedge resection surgery, with an average age was 51.7 years, and females accounting for 85.47% of the sample. Results showed that after surgery, the average resilience score significantly decreased by 22.5 points (p< 0.0001). Similarly, the average quality of life score significantly decreased by 15.9 points after surgery (p< 0.0001). Multiple regression analysis showed that patients aged 60-69 years had higher resilience than those aged 50-59 years (β= 0.18, P< 0.03). Patients with higher postoperative resilience also had significantly better quality of life (β= 0.50, P< 0.001). Additionally, patients with better quality of life after surgery had higher postoperative resilience scores (β=0.32, P< 0.001). Patients aged 30-39 years had significantly worse quality of life compared to those aged 50-59 years (β = -0.19, P< 0.04) after surgery. Patients with chronic diseases had significantly worse quality of life after surgery (β=-0.21, P<0.016). Patients with more than three ground-glass lung nodules had worse postoperative quality of life compared to those with only a single nodule (β = -0.22, P< 0.01). Higher resilience in surgical patients was associated with significantly better postoperative quality of life (β= 0.43, P< 0.001). Conclusions This study found that factors related to postoperative resilience include age, preoperative resilience, and postoperative quality of life. Factors related to postoperative quality of life include age, presence of chronic diseases, number of ground-glass lung nodules (≥3), and postoperative resilience. Additionally, early-stage lung cancer patients experience a significant decline in resilience and quality of life after surgery, which is clinically important. It is recommended that healthcare teams assess and monitor resilience and postoperative quality of life before and after surgery. High-risk patients and those with declining scores, especially those with chronic diseases or younger early-stage lung cancer patients, should be identified early and provided with appropriate intervention plans.