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  • 學位論文

肝癌術後生活品質、憂鬱及焦慮長期趨勢之探討:前瞻性研究

Depression, Anxiety and Quality of Life among Hepatocellular Carcinoma Surgery Patients: A Prospective Study

指導教授 : 許弘毅
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摘要


研究目的 癌症治療前後的健康生活品質是近年來臨床及學術單位探討的重點,而肝癌(HCC)在亞洲的發生率,居高不下,肝癌又為國人的十大死因。因此,本研究探討肝癌病患接受手術前及術後健康相關生活品質、焦慮與憂鬱症狀之兩年長期改變趨勢、探討肝癌病患手術前及術後健康相關生活品質、焦慮與憂鬱症狀之最小臨床重要差異以及探討肝癌病患手術後健康相關生活品質、焦慮與憂鬱症狀之重要預測因子。 研究方法 本研究為前瞻及縱貫性研究,以問卷方式進行資料蒐集,於2010年11月至2015年01月,選取台灣南部某二間教學醫院接受肝切除術之原發性肝癌病患做為研究樣本。分別以FACT-Hep、QLQ-C30和SF-36健康生活品質問卷及貝克焦慮、憂鬱量表做為生活品質之測量,追蹤時間點分別為術前、術後3個月、術後6個月、術後1年以及術後2年,共為5個時間點。研究工具採用廣義估計方程式(GEE)進行趨勢分析,並探討肝癌病患手術後健康相關生活品質、焦慮與憂鬱症狀之重要預測因子及最小臨床重要差異。 研究結果 本研究納入409位肝癌手術病患進行研究分析,平均年齡為61.1歲,男性占69.9%。FACT-Hep:術後三個月相較於術前的情緒穩定、肝膽癌附加事項、肝癌治療功能評估檢驗指標、一般癌症治療功能評估總分及肝癌治療功能評估總分,統計上皆達顯著差異;生理健全、家庭/社會健全及功能健全,則未達統計上顯著差異。術後六個月相較於術後三個月,除了肝膽癌附加事項外,其它構面皆未達顯著差異。術後一年相較於術後六個月的各構面在統計上皆未達顯著差異。術後兩年相較於術後一年,除了術後兩年的家庭/社會健全外,其它構面皆未達顯著差異。QLQ-C30:術後三個月相較於術前的整體生活品質、生理功能、情緒功能、認知功能、社交功能、疼痛和財務困難之構面,在統計上皆有達到顯著差異。術後六個月相較於術後三個月的認知功能、疼痛、呼吸困難之構面,在統計上皆有達到顯著差異。術後一年相較於術後六個月的社交功能、疼痛、呼吸困難之構面,統計上皆有達到顯著差異。術後兩年相較於術後一年除了整體生活品質外,其它構面皆未達顯著差異。SF-36:術後三個月相較於術前的生理功能、生理角色受限、一般自覺健康、社會功能、心理健康、生理健康層面總分及心理健康層面總分,在統計上皆有達到顯著差異。術後六個月相較於術後三個月,除了身體疼痛,在統計上有達到顯著差異外,其它構面皆未達到顯著差異。術後一年相較於術後六個月,除了生理角色受限,在統計上有達到顯著差異外,其它構面皆未達到顯著差異。術後兩年相較於術後一年,除了社會功能,在統計上有達到顯著差異外,其它構面皆未達到顯著差異。BAI及BDI:在術後三個月皆有顯著改善。肝癌病患之性別、婚姻狀況、親屬同住、抽菸習慣、喝酒習慣、B型肝炎、C型肝炎、腫瘤大小、腫瘤分期、麻醉風險ASA、住院天數及術後30天再入院對健康相關生活品質及焦慮憂鬱情形皆有影響。 結論與建議 整體生活品質及焦慮憂鬱症狀在術後三個月時都有明顯改善,而在六個月時整體生活品質仍然持續改善,到術後一年時,改善幅度不大,大致呈現穩定狀況。肝癌有很多因素會對生理及心理生活品質造成影響,因此,家人、朋友及醫療人員給予病患術前術後的關心及支持都是非常重要的。

並列摘要


Purposes: Health-related quality of life before and after hepatocellular carcinoma (HCC) treatment is the recent clinical and academic important health issue to explore. Incidence of HCC in Asia remains high, and it is the leading cause of death in Taiwan. Thus, the study was conducted to evaluate longitudinal trends pre-operative and post-operative health-related quality of life, anxiety and depression symptoms in HCC patients receiving operation and to define the significant predictors. Research Methods: This was a prospective and longitudinal study collecting information with questionnaire from November 2010 through January 2015, with HCC patients underwent liver resection in two teaching hospitals in southern Taiwan. Quality of life was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep), the Short Form (36) Health Survey (SF-36), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory-II (BDI-II) with follow-up at five points in time: pre-operation, three months, six months, one year and two years after surgery respectively. Statistical analysis with trends by using generalized estimating equations (GEE); define significant predictors and minimal clinically important difference in Health-related quality of life of post-operative HCC patients. Results: The study enrolled 409 patients underwent HCC surgery with the average age was 61.1 years of age and male gender accounted for 69.9%. There was significant improvement in emotional stability, additional matters hepatobiliary cancer, liver cancer therapy functional assessment test indicators, general cancer therapy functional assessment and liver cancer therapy score as compared as pre-operation, however, cognitive and family/society function did not have significant difference. Cognitive function, facet pain and breathing difficulties at six months after surgery compared to three months after surgery had significant differences. There was significant differences in social function, facet pain, breathing difficulties at one year after surgery compared to six months after surgery. The overall quality of life except social function had significant difference at two years after surgery compared to one year after surgery. The predictors of health-related anxiety, depression and quality of life included gender, marital status, living with family, smoking habits, drinking habits, hepatitis B, hepatitis C, tumor size, tumor stage, the risk of anesthesia ASA, hospital length of stay and re-admission within 30 days after surgery. Conclusions and Recommendations: Health-related quality of life, anxiety and depression at three months after HCC surgery have significant improvement and continue to improve at six months after surgery, however, no more change at one year after surgery. HCC patients had lots of physical and psychological factors that would affect their health-related quality of life. Therefore, it is very important to family, friends and medical staff to provide support before and after surgery.

參考文獻


參考文獻
中文文獻
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