結直腸癌存活期患者身體活動及其相關性之探討-以人格特質為中介變項

Abstract

近幾年台灣結直腸癌死亡率及發生率扶搖直上，成為值得重視的議題。身體活動已證實能有效降低其發生率、復發率及死亡率，並減少存活期患者的症狀困擾；儘管益處很多，但仍約有46%的結直腸癌患者過著久坐不動的生活型態。綜合過去國內外研究發現造成結直腸癌存活期患者身體活動障礙包含許多因素，其中人格特質在近幾年開始被探討，由過去文獻已知人格特質在影響身體活動上可能扮演多種角色，但至今尚未被確定，故此研究目的為: (1)瞭解結直腸癌存活期患者症狀困擾及身體活動現況，(2)影響結直腸癌存活期患者身體活動之重要因素，以及(3)探討人格特質現況及所扮演的角色。 本研究自2012年10月8日至2013年10月31日於台北市某醫學中心大腸直腸外科及腫瘤科門診進行收案，採橫斷式研究設計，針對目前已完成癌症相關治療至少3個月以上之結直腸癌存活期患者進行收案，利用結構式問卷收集資料，包括個人基本屬性資料表、疾病相關資料、症狀困擾量表、D型人格量表、國際身體活動問卷。資料分析中使用描述性統計了解個案之個人基本屬性、疾病相關資料、症狀困擾、人格特質及身體活動；以t-test及斯皮爾曼等級相關係數分析相關統計方式分析研究變項之相關性；再將上述與身體活動相關之變項投入階層廻歸分析模式分析，找出影響身體活動之重要因素及人格特質是否扮演中介變項的角色。本研究共完成199位個案，研究結果顯示：(1)目前在結直腸癌存活期患者中發現最常見的症狀困擾依序為：疼痛、疲倦、失眠、便秘、腹瀉，而症狀困擾程度均為輕度；身體活動方面，參與者一週身體活動總當量(MET*分鐘/週)平均為2506.87 ± 2675.17 MET，而未達癌症身體活動建議標準超過一半以上；(2)影響結直腸癌存活期患者身體活動之重要因素包括「過去三個月有無運動習慣」、症狀困擾中的「失眠」及人格特質中的「負向情緒」有顯著相關，與基本屬性、疾病特性、症狀困擾嚴重度及D型人格特質沒有顯著的相關性；(3)結直腸癌存活期患者診斷為D型人格特質者僅占12.6%，分別在女性及教育程度較低者佔有較多比例，其對症狀困擾嚴重度的感受度較高，其中與疼痛、疲倦、失眠呈顯著相關性，另外分析發現，D型人格特質並未於症狀困擾及身體活動之間扮演中介變項的角色。 由本研究發現影響身體活動的因素包含失眠、負向情緒及運動習慣，因此，於臨床照護上不但要主動評估患者失眠症狀並減輕困擾，以及了解負向情緒的原因並適時提供心理支持及輔導，還要培養患者養成規律運動的良好習慣，以降低國人結直腸癌的復發率。

The mortality rate and incidence of colorectal cancer [CRC] recently are increased quickly in Taiwan and its care has become the important issue. Physical activity [PA] could decrease the symptom distress and may reduce the early death, incidence and the risk of recurrence in CRC. In spite of the benefit of physical activity was found, but about 46% CRCS stay in completely sedentary. Based on literature review, there are many barrier of PA in CRCS including the personality that discussed in recently. How-ever, the role of personality between PA and symptom distress in CRCS has not be con-firmed. Therefore, the purpose of this study were to (1) investigate the symptom distress and PA of CRCS, (2) explore the important affecting factors of PA status in CRCS, and (3) identify the role of personality. A cross-sectional study design was conducted to recruit the CRCS from one medical center outpatient clinics in Taipei from 8 October in 2012 to 31 October in 2013. Eligible Participants were those have completed cancer related treatment over 3 months. A set of structured questionnaire was used to collect data including the basic infor-mation, the disease status, the Symptom Distress Scale (SDS), the Type D Scale-14 (DS-14), and the International Physical Activity Questionnaire (IPAQ). The collected data were analyzed with descriptive statistics and inferential statistics including t-test and Spearman’s rank correlation coefficient. Besides, multiple hierarchical regression analysis was used to analyze if the type D personality trait as the mediator. A total of 199 CRCS were completed the survey. The result showed that (1) The rank of the symptom distress were painful, fatigue, insomnia, constipation and diarrhea. They were all mild intensity The mean level of the physical activity amount in one week was 2506.87 ± 2675.17 MET. Even though the patients had done excise, there were over half participant not meeting the moderate level based on public heath PA guidelines; (2) The important factors affecting PA included the behavior of exercise (p < 0.01), in-somnia (p < 0.05), and negative affective of personality trait (p < 0.05). There were no significant relationship between PA and demographic information and the disease status; (3) About 12% participant were diagnosed with type D personality. Those patients with type D personality were tend to with female and higher level if education. The patients with type D personality perceived higher level of symptom distress, especially in pain, fatigue and insomnia. The type D personality trait has been confirmed as not the role of mediator in this study. In the study, the factors affecting PA included (1) the exercise behavior, (2) in-somnia, and (3) negative affective. Thus, the health provider should not only to assess the insomnia, but also understand their negative affective and provide mental support. It is also suggested to encourage the patient to exercise regularly to decrease the risk of recurrence of CRC.