鼻咽癌病人經治療後生活品質及副作用之變化

Alterations in the Quality of Life and Complication for Patients with Nasopharyngeal Carcinoma Status Post-treatment

許維中(Wei-Chung Hsu) ； 王俊毅(Jiun-Yi Wang) ； 陳宇嘉(Yu-Chia Chen) ； 丁禮莉(Lai-Lei Ting) ； 詹淑卿(Shu-Ching Chan) ； 王博民(Po-Ming Wang) ； 鍾娜娜(Na-Na Chung)

《放射治療與腫瘤學》 21卷3期 (2014/09) Pp. 201-209

https://doi.org/10.6316/TRO/201421(3)201

摘要

目的：描述鼻咽癌病人治療後生活品質及副作用的變化。材料與方法：總共有兩機構288位鼻咽癌患者被邀請參與研究。所有病人均符合鼻咽部接受放射劑量不低於70 Gy、頸部接受放射劑量不低於50 Gy。於治療前、治療結束、治療結束後1、3、6、12、18和24個月，使用歐洲癌症研究與治療組織（European Organization for Research and Treatment of Cancer, EORTC）的EORTC QLQ-C30及EORTC QLQ-H&N35量表評估其健康相關的生活品質及副作用。以概化估計方程式（generalized estimating equation）分析時間、病人個人因素、疾病與治療相關變項對治療後生活品質及副作用之影響效果。結果：與治療前相較，鼻咽癌於治療結束時之整體生活品質與功能狀況最差。整體生活品質於治療結束後1個月即迅速恢復且穩定增加，然而病人的整體功能狀況，則直至放射治療後12個月才恢復，形成延遲效應。主要副作用的減緩呈現很大差異：說話問題於治療後12個月緩解，疼痛與張嘴問題分別於18及24個月減緩，部分副作用如口乾、唾液黏稠及吞嚥問題直至治療後24個月仍然較治療前為高。結論：放射治療後生活品質與副作用呈現很大差異且與時間相關。本研究可幫助臨床醫師評估治療相關之副作用風險，並對其提供鼻咽癌病人治療後的復健、心理諮商及衛教照護有所助益。

關鍵字

副作用 ； 概化估計方程式 ； 鼻咽癌 ； 生活品質

並列摘要

Purpose: To describe the change of quality of life (QoL) and complications in patients with nasopharyngeal carcinoma (NPC) after treatment. Materials and Methods: Total 288 NPC patients in two institutions were invited to participate; all the patients received radiation doses of at least 70 Gy to the nasopharynx and at least 50 Gy to the neck. Health-related QoL and complications of the patients were evaluated by the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) and the EORTC head and neck module (QLQ-H&N35) before treatment, end of treatment, and 1, 3, 6, 12, 18 and 24 months after treatment. The effects of time, demographic, disease-related and treatmentrelated variables to QoL and complications were analyzed by the generalized estimating equation. Results: Comparing to pre-treatment, the NPC patients had the worst global QoL and functional status after completion of radiotherapy. The global QoL status improved rapidly at 1 month post-treatment and increased steadily, however, the global functional status had a delayed effect that patient recovered until 12 months after radiotherapy. The alleviations of the major complications were quite different. Speech problem was resolved at 12 months after treatment, pain at 18 months, the problem of open mouth at 24 months, but some complications such as dry mouth, sticky saliva and difficult swallowing still persist even 24 months after treatment. Conclusion: The QoL and complications show wide variations and time dependent. Our study can aid clinical physicians in assessing the risk of complications related to treatment, and help them in providing rehabilitation, consultation and supportive care to NPC patients after completion of treatment.

並列關鍵字

Complication ； Generalized estimating equation ； Nasopharyngeal carcinoma ； Quality of life