胃癌術後病人的症狀、害怕癌症復發及照護需求之探討

早期胃癌治療以手術切除為主，因術後胃腸道重建，使得腸胃道症狀存在產生困擾，手術後高復發率以及腸胃道症狀，病人可能有害怕復發的心理壓力，進而產生相關需求，故本研究目的主要探討胃癌病人術後症狀、害怕癌症復發與照護需求之現況及相關性。本研究以橫斷式描述性相關研究設計，以台北市某醫學中心一般外科門診為收案地點，採立意連續取樣方式選取三年內診斷胃癌，並曾接受全胃、亞全胃及楔形切除之病人，利用結構式問卷，包括：「歐洲癌症研究與治療組織生活品質量表合併胃癌補充問卷」、「害怕復發量表」及「支持性照護需要合併胃癌特殊性照護需求調查量表」進行資料收集，以SPSS 22.0版統計軟體進行描述性與推論性統計（曼-惠特尼U檢定、克-瓦氏單因子等級變異數分析、斯皮爾曼等級相關係數與羅吉斯迴歸分析）檢測變項之相關性與主要預測因子。結果發現，其收152位病人，病人手術後症狀屬於輕度，其前五大主要症狀依序為失眠、疲倦、口乾、上消化道疼痛/不舒服與便祕；害怕癌症復發中有105位（69.1%）受試者有此心理困擾；於照護需求中，依其照護需求分數之平均值由高至低排序為：（1）症狀與營養照護需求、（2）健康系統與資訊需求、（3）遠距照護需求、（4）病人照護與支持需求、（5）心理需求、（6）生理與日常生活需求、（7）認知與心理適應需求、（8）日常功能需求、（9）性需求；而在一般支持性整體照護需求中，害怕癌症復發為主要的預測因子，另外胃癌特殊性整體照護需求為手術方式、距離手術治療時間及害怕癌症復發也可預測之。探討胃癌病人相關照護需求，可協助臨床護理人員了解病人需求，成為出院前介入護理措施之憑據，有助於發展胃癌病人術後照護準則，並可依據此結果，設計相關的介入措施，以改善病人照護品質。

關鍵字

胃癌；症狀嚴重度；害怕癌症復發；支持性照護需求

並列摘要

Surgery is one of the major treatments for patients with early stage gastric cancer. These patients usually suffer from gastrointestinal (GI) related symptoms after surgery and experience psychological distress because of concerning of high recurrences rate after surgery. However, there are limited studies exploring patients’ distress, related care needs and needs to use tele-health after surgery. Thus, the purposes of this study is to (1) explore the current status of post-operative gastric cancer patients’ symptom, fear of cancer recurrence, and care needs, and (2) to further examine the relationship among distress and needs. A cross-sectional study was conducted at the GI surgical OPD in a medical center in Northern Taiwan. Eligible patients are those post-surgery gastric cancer patients within 3 years, and adult patients with age 20 or older. Instruments used to assess patients included: “EORTC QLQ-C30 and STO22”, “Fear Of Recurrence, FOR” and “Supportive Care Needs Survey-34 (SCNS-34) with added newly developed 17-item gastric cancer module Chinese versions SCNS-STO17”. We used Mmann-Whitney U-test, Kruskal-wallis H test, Spearman’s rank correlation coefficient, and logistic regression. There are 152 subjects were recruited and analyzed. The results showed: (1) the top 5 symptoms as their descending order were insomnia, fatigue, dry month, pain/ discomfort and constipation; (2) 69.1% of the participants reported the fear of cancer recurrence; (3) the domains of needs as their descending order were: symptoms and nutrition needs, health system and information needs, E-health needs, care and support needs, psychological needs, physical and daily living needs, cognitive and psychological needs, daily functional needs, and sexuality needs; (4) fear of cancer recurrence (OR=1.143, p=0.052) was the were significant factor to predict gastric patients’ overall care needs. Patients with less completion treatment (OR=0.951, p=0.021), open surgery type of surgical resection (OR=0.228, p=0.025), and higher fear of cancer recurrence (OR=1.138, p=0.024) together are factors to predict the overall GI specific care needs. The study found the some specific unmet care needs in gastric cancer patients after surgery. We suggest that we need to assess gastric patients’ care needs in each treatment or medical transition time to provide more personalized nursing care interventions. Psychological interventions and symptom management are needed to support these patients.