腦下垂體腫瘤病人接受立體定位放射手術後之症狀困擾與生活品質

Symptom disturbance and quality of life for patients with pituitary tumor after stereotactic radiosurgery

楊青儒(Ching-Ju Yang)

指導教授 ： 羅美芳

國立臺灣大學/醫學院/護理學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.01883

摘要

背景：腦下垂體腫瘤(pituitary tumor)約佔所有顱內腫瘤病人的10-15%，立體定位放射手術(stereotactic radiosurgery, SRS)主要運用在手術後殘餘病灶或是腫瘤復發病人。立體定位放射手術的相關併發症，目前研究常探討新產生的視野及內分泌功能缺損症狀。這些持續存在的症狀困擾及接受治療後的相關合併症，均與病人不同層面的生活品質有相關。
目的：本研究旨在暸解腦下垂體腫瘤病人接受立體定位放射手術後的症狀困擾及生活品質，並探討個人特性、症狀困擾與生活品質的相關性及差異性。
方法：本研究以橫斷式調查研究法，採立意取樣方式。收案來源為臺北市某醫學中心電腦刀放射手術治療中心，自2008年2月至2011年12月接受立體定位放射手術之腦下垂體腫瘤病人名單。研究工具包括：研究對象個人特性資料表、腦下垂體腫瘤術後病人之症狀困擾量表、世界衛生組織生活品質問卷─臺灣簡明版。
結果：共有60位個案參與本研究，平均年齡為51.17歲，功能性及無功能性腦下垂體腫瘤病人分別佔49%及51%。研究結果顯示，腦下垂體腫瘤病人接受立體定位放射手術後，目前平均有5.95±5.05項症狀困擾，最常見的五項症狀困擾為「記憶變差」、「容易感覺疲倦」、「視力模糊」、「停經」和「頭痛」。生活品質得分最低為心理範疇，得分最高為環境範疇。若與國內一般人常模數據相比，腦下垂體腫瘤病人在生活品質─生理健康範疇得分顯著較低(t=-2.81, p=0.01)。在症狀困擾方面，平均症狀困擾程度總分為7.62±9.96分，症狀困擾程度與年齡為顯著負相關(Spearman ρ= -0.36, p=0.00)；藥物使用數目與症狀困擾程度為顯著正相關(Spearman ρ= 0.32, p=0.01)；功能性腦下垂體腫瘤病人，症狀困擾程度顯著高於無功能性腦下垂體腫瘤病人(Z=-2.73, p=0.01)。在生活品質方面，年齡與綜合健康(Spearman ρ=0.51, p=0.00)、心理範疇(Spearman ρ=0.33, p=0.01)為顯著正相關；症狀困擾程度與生活品質─綜合生活品質(Spearman ρ=-0.57, p=0.00)、綜合健康(Spearman ρ=-0.69, p=0.00)、生理健康(Spearman ρ= -0.55, p=0.00)、心理(Spearman ρ= -0.54, p=0.00)、社會關係(Spearman ρ= -0.43, p=0.00)為顯著負相關；男性病人在心理(Z=-2.33, p=0.02)、環境範疇(Z=-2.08, p=0.04)得分顯著高於女性。症狀困擾總數≦6項的病人其綜合生活品質(Z=-4.06, p=0.00)、綜合健康(Z=-4.69, p=0.00)、生理健康(Z=-5.33, p=0.00)、心理(Z=-4.69, p=0.00)、社會關係(Z=-3.11, p=0.00)範疇得分顯著高於症狀困擾總數＞6項的病人。
結論：腦下垂體腫瘤病人在接受立體定位放射手術後，可能會有持續存在或新發生的症狀困擾，且症狀困擾與病人不同層面的生活品質有相關。建議未來可針對腦下垂體腫瘤病人常見之症狀困擾，進行症狀管理，以提升病人生活品質。

關鍵字

腦下垂體腫瘤 ； 症狀困擾 ； 生活品質 ； 立體定位放射手術

並列摘要

Background: Approximately 10-15% of intracranial tumors are pituitary tumors. Stereotactic radiosurgery (SRS) is a common treatment for recurrent or residual pituitary adenomas. The most frequent complications from SRS are impairments of visual function and hypopituitarism. The persistence of theses symptom disturbances and treatment related complications may impair the patient’s quality of life.
Purpose: The purpose of this study was to explore the correlation between the level of pituitary tumor post stereotactic radiosurgery-related symptom disturbances and the quality of life in the patients.
Methods: This study used a cross-sectional design and purposive sampling. We enrolled patients who were diagnosed with a pituitary tumor and also underwent stereotactic radiosurgery at the Cyberknife Unit of the Medical Center in Northern Taiwan. All participants had SRS between February 2008 and December 2011. Our data consisted of three parts, including the Pituitary Tumor Symptom Disturbance Scale, World Health Organization Quality of Life Instrument Short-Form (WHOQOL-BREF) and a demographic questionnaire.
Results: Sixty patients enrolled in our study. The mean age of participants was 51.17 years. Functional and non-functional pituitary tumors accounted for about 49% and 51%, respectively. The total number of symptom disturbances were 5.95±5.05 post stereotactic radiosurgery. Five of the most common symptom disturbances were poor memory, fatigue, blurred vision, amenorrhea and headache. The mean scores of symptom disturbance was 7.62±9.96. These symptom disturbances were negatively associated with age (Spearman ρ=-0.36, p=0.00) and positively associated with the
total number of medication (Spearman ρ=0.32, p=0.01). Patients with a functional pituitary tumors reported more symptoms disturbance as compared to the
non-functional tumor group (Z=-2.74, p=0.01). The lowest score of WHOQOL was in the psychological domain and the highest score was in the environmental domain. Patients with pituitary tumors had a lower physical health QOL as compared with the normative population (t=-2.81, p=0.01). Age was positively associated with general health (Spearman ρ=0.51, p=0.00) and psychological domain (Spearman ρ=0.33, p=0.01). Symptom disturbances were negatively associated with general QOL (Spearman ρ=-0.57, p=0.00) , general health (Spearman ρ=-0.69, p=0.00), physical health (Spearman ρ=-0.55, p=0.00), psychological (Spearman ρ=-0.54, p=0.00) and social relationship domains (Spearman ρ=-0.43, p=0.00). Compared with females, males had higher scores in the psychological (Z=-2.33, p=0.02) and environmental (Z=-2.08, p=0.04) domains. Compared to patients with 6 or more symptom disturbances, patients with≦6 symptom disturbances experienced better general QOL(Z=-4.06, p=0.00), general health(Z=-4.69, p=0.00), physical health(Z=-5.33, p=0.00), psychological(Z=-4.69, p=0.00) and social relationship QOL(Z=-3.11, p=0.00).
Conclusion: Patients with pituitary tumors can have persistent or new symptom disturbances after stereotactic radiosurgery. These disturbances can affect different aspects of the patient's quality of life. These findings can be used to design educational and interventional programs for symptom management, thereby improving the patients’ quality of life.

並列關鍵字

pituitary tumor ； symptom disturbance ； quality of life ； stereotactic radiosurgery

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