- 學位論文
女性頭頸癌病人的疾病衝擊及感受汙名化程度之現況探討
Disease Impact and Stigma in Female Head and Neck Cancer Patients
摘要
背景: 過去頭頸癌的相關文獻多以男性病人為主，女性病人罹病率遠低於男性，對女性罹病經驗之了解程度相當有限，因為兩性的生理與心理結構有相當程度的差異，也可能會使男、女性病人對疾病適應及需求有所不同，故本研究之目的為針對女性頭頸癌病人（1）探討疾病與治療帶給研究對象之衝擊程度（2）探討研究對象對疾病汙名化之感受程度（3）探討疾病汙名化之相關因素，包括人口學特性、疾病分期、疾病診斷、接受治療的方式、手術有無包括重建術式、身體症狀與疾病衝擊是否會影響汙名化之感受。 方法:本文為採用連續取樣方式之橫斷式研究，研究對象為台灣北部地區某醫學中心耳鼻喉科門診已接受過主要治療（包括手術、化療合併放射線治療等）且未有明顯復發之女性頭頸癌病人，年齡在20歲以上，使用問卷調查法，工具包括醫院焦慮憂鬱量表（HADS）、事件衝擊量表修訂版（IES-R）、症狀嚴重度量表（SSS）及頭頸部癌症羞恥與汙名化量表（SSS），利用SPSS統計軟體與Pearson’ s相關分析、獨立T檢定、單因子變異數分析檢定及線性迴歸之逐步分析方式，了解個案在經歷診斷及接受治療後到追蹤期的期間對汙名化的感受程度，再由研究者整理並歸納其結果。 結果:本研究結果顯示於結束治療後之階段，女性頭頸癌病患對汙名化的感受在人口學或疾病相關特性上不會有顯著差異，而病患的焦慮憂鬱程度、整體的身體症狀嚴重度與汙名化感受沒有相關性，但疾病衝擊會與汙名化感受出現顯著相關（p=0.007）。經過迴歸分析後可得知汙名化感受之顯著影響因子為焦慮程度（p=0.005）、面對疾病衝擊的逃避感受（p=0.000）及病患有手術（合併重建術式）之治療方式（p=0.014），在迴歸模式下可得到最佳之解釋力（調整後R2=.377）。 結論:頭頸癌病患因其疾病特性及治療方式易導致身體外觀產生變化，此改變將伴隨他人對病患產生汙名化感受，癌症帶來的汙名化衝擊並不亞於罹癌診斷或癌症帶來之不確定感，會影響病患在存活階段的心理健康狀態與生活品質，故心理之汙名化感受應與身體不適症狀受到同等程度的重視。
並列摘要
Background: Head and neck cancer is more prevalent in male than female, so previous researches of head and neck cancer only focused on male patients. Due to the different physical structures and psychological feelings, adaptation to disease and demands may be different between male and female. We conducted this study to survey several points of female head and neck cancer patients: (1) the degree of impact caused by cancer and treatment (2) explore the stigma feeling of patients (3) identify the significant factors of stigma in demographics, disease, treatment characteristics, and physical symptoms. Method: This was a cross sectional study. 71 female head and neck cancer patients were enrolled from a medical outpatients department in northern Taiwan. All of them were older than 20 year-olds, had already received treatments (included surgery, chemotherapy or radiotherapy), and were confirmed no obvious metastases or cancer recurrence. Data were collected by structured questionnaires. Multiple scoring systems were used in this study including Hospital Anxiety and Depression Scale (HADS), Impact Event Scale-Revised version (IES-R), Symptom Severity Scale (SSS), and Shame & Stigma Scale in Head & Neck cancer (SSS). Data were analyzed with Pearson’ s correlation, independent t-test, One Way ANOVA (Analysis of Variance) and linear regression. All analyses were conducted using the Statistical Package for the Social Sciences (SPSS, v. 18.0; SPSS Inc, Chicago, IL). Statistical significance was set at p<0.05. Result: The result of this study showed feeling of stigma weren’t significant different in demographics, disease, and treatment characteristics. Physical symptoms, degree of anxiety and depression didn’t correlate to stigma feeling, but disease impact did (p=.007). After linear regression analysis, the significant factors associated with stigma were anxiety (p=.005), avoidance from disease impact (p=.000), and patients had received reconstruction surgery (p=0.014). And the adjusted R square score was 0.377. Conclusion: Because of disease characteristics and surgical intervention, head and neck cancer patients easily got disfigurement that would lead to stigma feeling. Impact of the visible change was even larger than being told of cancer and uncertainty of cancer outcome. The impact will affected their quality of life and mental health during alive. Therefore, stigma feeling caused by disfigurement should be emphasized as physical symptoms.