影響頭頸部癌症病患在化學治療期間疲憊程度之探討

Investigation the Related Factors about Fatigue during Chemotherapy of Head and Neck Cancer Patients

賴俊宏(June-Hung Lai) ； 黃采薇(Tsai-Wei Huang)

《弘光學報》 49期 (2006/11) Pp. 59-69

摘要

化學治療在整體癌症治療的角色很重要，可單獨治療，亦可成爲手術及放射線治療的輔助療法，對許多癌症有不錯的療效。但化學治療可能產生許多副作用，其中，疲憊爲化學治療過程中病人自覺最嚴重副作用之一，病人可能因此而中斷治療。本研究目的即爲了瞭解頭頸部癌症患者在接受化學治療期間疲憊的變化情形及影響疲憊的相關預測因子。本研究採縱貫性、相關性研究設計，選取接受化學治療之頭頸部癌症病患爲研究對象，利用症狀困擾量表、情緒狀態量表─焦慮、憂鬱及疲憊次量表，及視覺類比量表收集資料。利用SAS統計軟體，以獨立t檢定、ANOVA、皮爾森積差相關及廣義估計方程組(Gee)等統計法分析資料。研究結果發現：(1)在症狀困擾部分，發現噁心、嘔吐、食慾影響、失眠、疲憊、腹脹、焦躁不安及胃灼熱等症狀，在經過化學治療後有明顯增加情形，達到統計上顯著意義；其中，口乾、疼痛、焦躁不安及疲憊在化學治療前、後均嚴重困擾病人；(2)焦慮及憂鬱困擾情形在接受化學治療期間有增加情形，但並未達到統計上顯著差異；(3)疲憊程度在接受化學治療第二天、第三天、第四天的疲憊程度明顯高於化學治療前；(4)在化學治療前及後，憂鬱、焦慮及症狀困擾程度越高，疲憊程度愈高(r-0.799，r=0.712，及r-0.689，p＜0.001)。在基本屬性部分，發現不識字的病人在化學治療後的疲憊程度較高中職以上病人高；(5)化學治療之憂鬱量表及症狀困擾量表爲疲憊的預測因子。本研究結果能瞭解影響頭頸部癌症病患在接受化學治療期間疲憊的變化及其預測因子，可協助護理人員增進對病患的了解，進而協助病患減少痛苦。

關鍵字

化學治療 ； 憂鬱 ； 疲憊 ； 症狀困擾

並列摘要

Chemotherapy plays an important role in cancer therapy. Chemotherapy is effective for many cancers whenever it is used alone or adjuvant used with surgery and radiotherapy. Clinically, some cancer patients want to abandon chemotherapy because they are afraid of chemotherapy itself or intolerant of its side effects. Some patients can accept complete course of chemotherapy. But some cancer patients accept chemotherapy intermittently due to hesitating about it. The study is a descriptive, longitudinal research design. The subjects are adult head and neck cancer patients who receiving chemotherapy in a medical center. Symptoms distress scales, Anxiety and Depression scales, Fatigue scales and VAS were used. The SAS will be used for computation and analysis of data. Independent t-test, Pearson' s Product-Moment Correlation analysis and Generalized estimating equations (GEE) will be used to assessment the related factors about fatigue of cancer patients. The results of our study reveal: (1) About Symptoms distress scales The symptoms including nausea, vomiting, appetite charge, insomnia, fatigue, abdominal distended, irritability, and stomach burning sensation were decreased significantly after chemotherapy compared with those before chemotherapy. (P＜0.05); (2) About anxiety and Depression Anxiety and depression were increased in patients after chemotherapy compared with those before chemotherapy. But there were no significant difference; (3) About fatigue The fatigue level was increased significantly on the 2nd, 3rd, 4th day of chemotherapy compared with that before chemotherapy. (P＜0.05);(4)Before chemotherapy, the more severe of depression and anxiety, the more severe of fatigue. After chemotherapy, it was same as the result before chemotherapy. About general characters The fatigue level after chemotherapy was increased significantly in the education (5) Depression and symptom distress were predictive of fatigue during chemotheragy. The results of our research can help us to understand the fatigue change and it s predict factors in head and neck cancer patients during receiving chemotherapy. It can help nurses to know the fatigue level in cancer patients, and leads to decrease patients suffering.

並列關鍵字

chemotherapy ； fatigue ； depression ； symptom distress

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