頭頸癌患者接受放射治療後之口腔健康狀況與生活品質

Oral Health Status and Quality of Life of the Patients with Head and Neck Cancer after Radiotherapy

黃寶貞(Pao-Chen Huang)

指導教授 ： 嚴雅音

共同指導教授 ： 黃曉靈(Hsiao-Ling Huang)

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2011年)

摘要

背景：現今健康照護政策理念，已由疾病治療轉為健康促進。頭頸癌患者接受治療後所產生的不適影響其生活品質。因此，提升其生活品質變成重要的議題。
目的：瞭解頭頸癌患者放射治療後之口腔健康狀況及生活品質，並分析影響患者生活品質之重要因素。
材料與方法：為橫斷性研究設計，地點為南部某醫學中心放射腫瘤科門診，以方便取樣方式，選取181位曾接受治癒性放射治療且療程結束超過三個月以上之頭頸癌患者。採用癌症患者一般性生活品質問卷(EORTC QLQ-C30)與頭頸癌特殊性生活品質問卷(EORTC QLQ-H&N35)來收集資料。使用t 檢定或單因子變異數分析及複迴歸分析來探討患者接受放射治療後之生活品質及其影響因素。
結果：頭頸癌患者在整體健康生活品質平均分數為68.9±22.1分，而特殊性生活品質在口腔健康方面最困擾的症狀為口乾。患者放射治療前曾接受過牙科門診之口腔評估及治療佔81.8%，但在治療後牙科門診追蹤次數則下降至34.5%。對一般生活品質之顯著因素為腫瘤發生部位與放射治療技術。針對口腔健康生活品質，其中顯著影響牙齒問題生活品質因素為女性、口腔/口咽與下咽/喉癌患者、治療後3-12個月、傳統放療技術與三維順形放療技術等；顯著影響張口困難生活品質因素則為年齡>50歲、口腔/口咽患者、治療後3-12個月及三維順形放療技術等。
結論：頭頸癌患者生活品質多數受口腔相關症狀困擾為主，如口乾與牙齒問題，而放療後之牙科回診率亦偏低。臨床醫護人員應多注意患者接受治療後之口腔健康問題，給予相關衛教並加強患者對於定期牙科門診追蹤之重要性以提升患者接受治療後的生活品質。

關鍵字

放射治療頭頸癌 ； 口腔健康 ； 生活品質

並列摘要

BACKGROUND: The modern medical policy has shifted from cure disease to health promotion. The treatment related morbidity usually profoundly affects the QOL of these patients. Thus, the issue of health-related quality of life (QOL) has become more important.
OBJECTIVE: The study was designed to evaluate the QOL, oral health status and its prognosticators of head and neck cancer (HNC) patients after radiotherapy (RT).
MATERIALS AND METHODS: A cross-sectional study was conducted at a medical center in southern Taiwan. A total 181 patients with completion of RT more than 3 months were enrolled. The questionnaire of EORTC QLQ-C30 and HNC module (EORTC QLQ-H&N35) were used. The prognosticators of QOL were assessed by using t-test or ANOVA and multiple regression.
RESULTS: The mean score of “global health status” is 68.9 (SD: 22.1). “Dry mouth” was the most common head and neck related symptoms (53.4±30.9). 81.8% of patients had received initial pre-RT dental care. The regular dental care after RT declined to 34.5%. The factors of significantly affecting general QOL were tumor sites and techniques of RT. For the oral-health related QOL, the factors of significantly affecting teeth problem were female, oral/ oropharynx and hypopharynx/ larynx, posttreatment 3-12 months, conventional RT and 3-D conformal RT; trismus were age >50 years, oral/ oropharynx, posttreatment 3-12 months and 3-D conformal RT.
CONCLUSION: QOL of HNC patients was mainly affected by some oral-related symptoms, especially dry mouth and teeth problems. Low compliance of persistent dental care was commonly found. The clinicians should pay more attention to the problems of oral health for the patients to improve their QOL.

並列關鍵字

Radiotherapy ； Head and neck cancer ； Oral health ； Quality

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