口腔癌病人術後症狀困擾、照護需求及生活品質情形之探討

Investigation of Postoperative Symptoms, Care Needs and Quality of Life of Oral Cancer Patients

涂淑玲(Shu-Ling Tu) ； 曾淑怡(Shu-Yi Tseng) ； 林耀仁(Yaw-Jen Lin) ； 相青琪(Chin-Chi Hsiang) ； 溫永頌(Yung-Sung Wen) ； 胡月娟(Yueh-Juen Hwu)

《The Changhua Journal of Medicine》 15卷4期 (2017/12) Pp. 204-213

https://doi.org/10.6501/CJM.1504.004

摘要

背景：臺灣口腔癌每年約增加4,000人，主要治療方式是手術治療，術後常造成結構缺損，影響進食、降低身體機能及生活品質。瞭解口腔癌病患的症狀困擾、照護需求和生活品質，可據以擬訂適當的護理計畫，減少病人不適及提高生活品質。目的：探討口腔癌病人術後症狀困擾、照護需求和生活品質情形及其影響因素。材料與方法：採橫斷相關研究，以中部某醫學中心耳鼻喉科病房口腔癌手術後病患為對象，立意取樣收取100位個案。問卷內容包括：基本屬性、疾病特性、症狀困擾、照護需求及生活品質。結果：過半數的口腔癌病患(58%)認為手術後的健康狀態好，症狀困擾前兩名是痰太多及張口困難；術後照護需求以資訊需求最高(4.35 ± 0.52)；心理情緒及生活問題之生活品質衝擊最大；婚姻會影響生活品質(F = 2.589, p ＜ 0.05)，有無職業會影響照護需求(t = -2.691, p ＜ 0.05)，同時接受下顎骨切除及重建手術、癌症分期會影響症狀困擾(t = -3.319, p ＜ 0.05)及生活品質(t = -2.837, p ＜ 0.05)；症狀困擾與生活品質呈顯著相關(p ＜ 0.01)，而照護需求則與症狀困擾及生活品質無顯著相關。結論：術後痰液多及張口困難是口腔癌病患最多的困擾，且會影響生活品質，顯示提供口腔照護與口腔訓練改善症狀困擾，對病患的生活品質有重要影響。建議護理人員配合衛教影片，提供連續且完整的口腔護理、口腔運動訓練，以減少病患不適，提高生活品質。

關鍵字

口腔癌 ； 症狀困擾 ； 健康相關生活品質

並列摘要

Background: The number of oral cancer cases in Taiwan is increasing by 4,000 people each year, most of whom are treated by surgery. Postoperative symptoms often cause structural defects that affect oral intake and physical function, and demotivate patients from complying with treatment. Understanding the distressing symptoms of oral cancer patients, their care needs and factors affecting their quality of life is beneficial in terms of providing an appropriate care plan, reducing patient discomfort and improving quality of life. Objectives: The objectives of this study were to investigate the postoperative symptoms, care needs, and quality of life of oral cancer patients, and to ascertain influential factors. Methods: A cross-sectional study was conducted, in which 100 patients with oral cancer after ENT surgery were enrolled from a medical center in central Taiwan. Items on the questionnaires included demographic data, disease characteristics, symptoms of distress, care needs and quality of life. Results: More than half (58%) of the subjects thought that their postoperative health status was good. The two most disturbing symptoms were too much sputum and trismus. Health care information was ranked highest (4.35 ± 0.52, p ＜ 0.05) in terms of postoperative care. Psychological status and daily oral hygiene had great impacts on quality of life. Marital and employment status influenced quality of life and care needs, respectively (F = 2.589; p ＜ 0.05). Mandibular osteotomy and re-operation (t = -3.319; p ＜ 0.05) and the cancer stage could affect postoperative symptoms and quality of life (t = -2.837; p ＜ 0.05). Distressing symptoms were highly correlated with quality of life (p ＜ 0.01), and care needs were not significantly associated with distressing symptoms or quality of life. Conclusions: Too much sputum and trismus were the most troublesome problems for oral cancer patients, which affected their quality of life. The results of this study showed that oral care and oral training are beneficial in terms of improving postoperative symptoms and have much influence on patients' quality of life. It is suggested that nurses provide continuous and complete oral care and oral exercise training to reduce discomfort and improve health-related quality of life.

並列關鍵字

oral cancer ； symptoms ； health-related quality of life