早期肺癌術後患者之疾病衝擊及照護需求探討

Disease Impact and Unmet Needs in Postoperative Early Stage Lung Cancer Patients

林晏汝(Yaun-Ju Lin)

指導教授 ： 賴裕和

共同指導教授 ： 陳晉興 ； 李芸湘

國立臺灣大學/醫學院/護理學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201703023

摘要

背景及研究目的
肺癌患者於疾病進程與治療期間常經歷許多衝擊，並產生未滿足的照護需求，然而，現況對於早期肺癌術後患者的罹病經驗了解程度相當有限，因此，本研究的主要目的為:（1）探討早期肺癌患者於術後三個月的症狀與功能狀態、疾病衝擊以及照護需求之現況；（2）探討照護需求的相關因素（潛在相關的變項包括:人口學特性、疾病治療特性（疾病分期、手術術式、癌症組織型態）、症狀嚴重度、身體活動功能以及疾病衝擊（侵入經驗、逃避反應、高度警覺））。
研究方法、工具及分析
本研究採橫斷性量性研究法，主要探討早期肺癌術後患者之（1）症狀嚴重度、（2）身體活動功能、（3）疾病衝擊、（4）照護需求、（5）疾病和基本資料。依據上述探討變項，採用以下研究工具測量:（1）歐洲癌症治療與研究組織生活品質量表及肺癌模組；（2）Karnofosky氏身體功能量表；（3）事件衝擊量表修訂版；（4）支持性照護需求量表；（5）疾病及基本資料。蒐集之結果將採用描述性統計、斯皮爾曼相關性（Spearman’s correlation）以及迴歸模型進行分析。本研究以G-power之F test統計法估算樣本數，預估測量108位早期（I-IIIA期）肺癌術後患者。
結果
本研究結果顯示早期肺癌術後患者之症狀嚴重度屬輕度程度，其中嚴重度較高之前五項症狀為咳嗽、失眠、疲憊、其他部位疼痛以及呼吸喘/困難；而疾病衝擊部分，整體來說屬於輕度疾病衝擊，各疾病衝擊面向當中，以逃避反應程度最高，接著為侵入經驗以及高度警覺層面；針對照護需求現況，整體來說有低至中度照護需求，依程度排序分別為「健康系統與資訊需求層面」、「心理需求層面」、「病患照護與支持需求層面」、「生理與日常生活需求層面」與「性需求層面」，而最具照護需求的項目為「可被告知能讓自己變更好的事情」。
「整體照護需求層面」與症狀嚴重度（r=0.43, p<0.01）、身體活動功能（r=-0.23, p<0.05）、整體疾病衝擊（r=0.49, p<0.01）、侵入經驗（r=0.43, p<0.01）、逃避反應（r=0.36, p<0.01）、高度警覺（r=0.55, p<0.01）有所相關，進一步以羅吉斯迴歸分析探討其預測因子，為教育程度、癌症分期、癌症組織型態、症狀嚴重度以及高度警覺。
討論與結論
早期肺癌患者雖有較長之存活期，但仍可能於追蹤期間存在許多症狀困擾以及感受到疾病之衝擊，尤其需注意患者逃避反應以及高度警覺層面之症狀，以避免造成情緒癒治之困難及高度照護需求未滿足之困擾。而健康系統與資訊層面則有較高需求未滿足之情形，未來應加強對於該族群疾病與治療相關資訊的規劃，以期給予早期肺癌患者適切的協助，降低需求未滿足之狀態，提升照護之品質。

關鍵字

早期肺癌 ； 症狀 ； 身體功能 ； 疾病衝擊(創傷後壓力症狀) ； 照護需求

並列摘要

Background and purpose
Lung cancer patients often experience great impact and many unmet supportive care needs during the course of the disease and during treatment. However, the current status of the experience of patients with early lung cancer is limited. Therefore, the main objectives of this study are: (1) to explore the symptoms and functional status, impact of disease and care needs of patients with early lung cancer at three months after surgery; (2) to analyze the related factors of care needs, including demographic characteristics, disease treatment characteristics (stage, operation type, histological form of cancer), physical function (symptom severity, performance status) and impact of disease (intrusion, avoidance, hyperarousal).
Method and materials
This is a cross-sectional study conducted in a medical center in Northern Taiwan. This study focused on (1) symptom severity, (2) performance status, (3) impact of disease, (4) care needs, and (5) demographic information and disease characteristics of early stage lung cancer patients. Those variables that we wanted to explore were assessed by (1) The European Organization for Research and Treatment of Cancer QLQ-C30 and Lung Cancer module (EORTC QLQ-C30; LC 13); (2) Karnofosky performance scale (KPS); (3) Impact of Event Scale-Revised (IES-R); (4) Supportive care needs survey-screening tool 9 (SCNS-ST9); and (5) Background and Disease / Treatment Information Form (BDIF). The results of the collection were analyzed by using descriptive statistics, Spearman's correlation, and regression models. In this study, the sample size was estimated by G-power F test statistic, and 108 patients with early stage (I-IIIA) lung cancer were estimated recruited.
Results
The results of study showed that early stage lung cancer patients after surgery experienced mild symptom severity with top five severe symptoms as cough, insomnia, fatigue, pain in other parts and dyspnea. The level of impact of disease which patients experienced was also mild and the levels of IES-R sub-dimensions as their descending order were avoidance, intrusion and hyperarousal, respectively. According to the results, in general, patients had low to moderate levels of care needs, ranking as their mean score as "Health System and Information Needs", "Psychological Needs", "Patient Care and Support Needs", "Physical and Daily Living Needs" and "Sexual Needs", while the most care needs are " To be informed about things you can do to help yourself get well."
Patients’ overall care needs were associated to symptom severity ( r=0.43, p<0.01)、physical function (r=-0.23, p<0.05), overall impact of disease (r = 0.49, p <0.01), intrusion (r = 0.43, p <0.01), avoidance ( r=0.36, p<0.01) and hyper-arousal (r = 0.55, p <0.01), and further explore the predictive factors by using the Logistic regression analysis, cancer staging, histological types of cancer, symptom severity, and hyper-arousal were predictive factors of care needs.
Conclusion
Although patients with early stage lung cancer have a longer survival period compared with advanced cancer, they may still have several symptoms and perceive impact of disease during follow-up period. We need to pay attention in particular on the patient with higher avoidance and hyper-arousal symptoms to prevent them from the difficulties of emotional healing and high levels of unmet care needs. In addition, we need to strengthen the planning of information on the disease and treatment in order to give appropriate assistance to patients with early stage lung cancer and to reduce the unmet needs of health system and information for improving the quality of care.

並列關鍵字

Early stage lung cancer ； Symptoms ； Performance status ； Impact of disease (PTSS) ； Care needs

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