探討影響分化型甲狀腺癌病人之睡眠品質相關因素

Abstract

分化型甲狀腺癌為常見之預後良好癌症，即使預後良好，卻因癌症診斷、治療及相關症狀等可能影響此族群病人之睡眠品質。睡眠為維持基本生活功能之重要因素，長期睡眠不足對健康造成不良影響，本研究目的為(1)探討分化型甲狀腺癌病人睡眠品質之現況、病人生理症狀、身體活動量、害怕癌症復發程度，(2)分析分化型甲狀腺癌病人睡眠品質之相關因素。 本研究設計為橫斷式研究，收集182位診斷三年內完成甲狀腺切除手術之分化型甲狀腺癌病人，以結構式問卷進行資料蒐集，於台北某醫學中心之外科門診收案。問卷內容包含：「匹茲堡睡眠品質指標」、「症狀嚴重程度量表」、「Godin休閒時間運動量表」、「害怕癌症復發嚴重度子量表」、「疾病基本資料」，收集之資料以描述性統計、Spearman's相關係數檢定、單因子變異數分析和複回歸分析。 本研究結果發現，依照匹茲堡睡眠品質指標發現分化型甲狀腺癌病人有72%屬睡眠不佳，病人呈現輕度症狀嚴重度，僅有19.2%的病人達到世界衛生組織建議身體活動量，有45.8%的病人有明顯之害怕癌症復發的問題。以複回歸分析發現，睡眠品質主要相關因子為病人診斷前有無使用助眠藥物(β=0.18，p=0.05)、症狀嚴重度(β=0.45，p<0.01)、害怕癌症復發(β=0.20，p=0.05)、身體活動量(β=-0.16，p=0.01)、受教育年數(β=0.13，p<0.05)，整體解釋力可達40.4%。 整體而言，雖分化型甲狀腺癌病人多為受到輕度症狀困擾，但病人仍有害怕癌症復發之擔憂且多數病人身體活動量不足，導致睡眠品質不佳，本研究可了解影響病人睡眠品質之相關因子，經由適當評估進而可介入措施，提升病人睡眠品質。

Differentiated thyroid cancer (DTC) is a common cancer around the world. Although it has relatively good prognosis, patients might be still under stress and influence their sleep quality. Unfortunately, relatively limited research has explored the issue. The purposes of this study are to (1) examine the current status of sleep quality, physical activity, physiological symptoms, and fear of cancer recurrence (FCR), and (2) examine the above factors and related disease-treatment related factors of sleep quality in patients with DTC. This is a cross-sectional study to recruit patients from a medical center in Northern Taiwan. Eligible subjects were patients with DTC who had undergone thyroidectomy within three years of diagnosis. Patients were assessed by a set of questionnaires, including “Pittsburgh’s Sleep Quality Index”, “Symptom Severity Scale”, “Godin Leisure-Time Exercise Questionnaire”, “Fear of Cancer Recurrence Inventory-Severity” and background information form. The data was analyzed by descriptive statistics, Spearman’s correlation coefficient, t-test, ANOVA and multiple linear regression. A total of 182 patients were recruited. Results show that 72% of subjects reported impaired sleep quality according to the Pittsburgh’s Sleep Quality Index. Patients’ symptom severity is mild severity. Only 19.2% of the patients reached the World Health Organization recommended physical activity level. 45.8% of the patients had significant level of FCR. From regression analysis, patients used sleep medicine before diagnosis (β=0.18, p=0.05), symptom severity (β=0.45, p<0.01), physical activity (β=-0.16, p=0.01), and years of education(β=0.13, p<0.05) were the most important factors related to sleep impairment and accounted for 40.4% of the variance of sleep quality. In conclusion, there are close to half of patients with DTC are worried about fear of cancer recurrence and lack of sufficient physical activity. Relatively high proportion of patients having sleep dysfunction should be an issue to be further concerned. Future research to develop and test the interventions related to sleep impairment in patients with DTC is strongly suggested.