統合分析晚期非小細胞肺癌病人化學治療期間生活品質變化及其影響因素

A Meta-Analysis of Changes and Determinants of Quality of Life in Advanced Non-Small Cell Lung Cancer Patients undergoing Chemotherapy

戴鈺娌(Yu-Lee Dai) ； 陳貞秀(Chen-Hsiu Chen) ； 楊政達(Cheng-Ta Yang) ； 陳綱華(Kang-Hua Chen) ； 江明珠(Ming-Chu Chiang) ； 唐秀治(Siew-Tzuh Tang)

《台灣癌症醫學雜誌》 2卷3期 (2015/09) Pp. 224-233

https://doi.org/10.6323/JCRP.2015.2.3.05

摘要

化學治療是晚期非小細胞肺癌病人目前最主要的治療方式之一，2011年在臺灣有將近六成的初診斷晚期非小細胞肺癌病人接受化學治療，接受化學治療雖有增加晚期非小細胞肺癌病人存活率和存活期以及改善部分肺癌症狀之優點，但化學治療亦可能衝擊其身體、心理、人際社會互動功能以及造成經濟負擔，導致生活品質下降。因此，本統合分析研究，針對五個資料庫的文獻進行搜尋，統整目前國內外以歐洲癌症治療與研究組織癌症生活品質核心問卷（EORTC QLQ-C30）進行之研究，探討晚期非小細胞肺癌病人於化學治療期間之整體生活品質變化及其影響因素。統合11篇研究，結果顯示病人之整體生活品質和身體功能層面於化學治療前至化學治療第1－6個週期僅有輕微起伏變化，未呈現出臨床顯著差異，而在角色、情緒、認知及社會等功能層面則有部分之改善程度達臨床顯著差異。影響晚期非小細胞肺癌病人於化學治療期間生活品質因素統整結果顯示：病人之年齡越輕、經濟狀況越佳、擁有職業和宗教信仰、身體功能狀況越好、化學治療藥物劑量越低、療效越佳、身體症狀及其發生頻率、嚴重度和困擾程度越少、焦慮與抑鬱情緒越低、社會支持越強，則其整體生活品質越佳。而教育程度、癌症診斷時間、和癌症分期三項因素之影響則未有一致之定論。此統合分析研究結果建議醫護人員需增加照護的敏感度，在高危險晚期非小細胞肺癌病人接受化學治療期間，及早發現及處理其身體症狀、焦慮與抑鬱情緒，強化其社會支持，以提升晚期非小細胞肺癌病人化學治療期間之整體生活品質。

關鍵字

生活品質 ； 化學治療 ； 晚期非小細胞肺癌

並列摘要

Patients with advanced non-small cell lung cancer (NSCLC) are currently treated primarily with chemotherapy. In 2011, almost 60% of newly diagnosed advanced NSCLC patients in Taiwan received chemotherapy. In these patients, chemotherapy increases survival rate and time and relieves some symptoms, but it also affects their physical and psychological functioning, impacts on social interaction, causes economic burden, and decreases quality of life (QOL). We conducted a meta-analysis of the English and Chinese (both simplified and traditional) literature on the changes and determinants of QOL measured by the EORTC QLQ-C30 in advanced NSCLC patients undergoing chemotherapy. Results from our meta-analysis of 11 studies identified from 5 databases indicated that overall QOL and physical function did not change significantly from pre-chemotherapy through cycles 1-6 of chemotherapy, but there were significant improvements in the domains of role, emotion, cognition, and social function. Our systematic review showed that better QOL was associated with younger age, better economic status, employment, religious beliefs, better performance status, low chemotherapy doses, better treatment responses, less frequent, severe, and distressing symptoms, less anxiety and depression, and stronger social support. QOL was not consistently associated with educational attainment, time since cancer diagnosis, and cancer stage. The findings of this meta-analysis and systematic review suggest that by appropriately managing high-risk NSCLC patients' symptom distress, alleviating their anxiety and depressive symptoms, and enhancing their social support, health care professionals can improve the QOL of advanced NSCLC patients undergoing chemotherapy.

並列關鍵字

quality of life ； chemotherapy ； advanced non-small cell lung cancer