- 學位論文
頭頸癌病人的口乾症狀及口腔黏膜炎與生活品質相關性之探討
Relationships of Xerostomia and Oral Mucositis to Quality of Life in Patients with Head and Neck Cancer
摘要
本研究主要目的為(1)分析影響頭頸癌病人口乾的相關因素。(2)分析影響頭頸癌病人口腔黏膜炎的相關因素。(3)分析口乾及口腔黏膜炎之間的相關性。(4)分析頭頸癌病人的疾病特性，對口乾、口腔黏膜炎及生活品質所造成之影響。(5)分析頭頸癌病人的治療狀況，對口乾、口腔黏膜炎及生活品質所造成之影響。本研究採縱貫式、相關性研究設計，於北部一家醫學中心的放射腫瘤科治療室選取符合條件的個案，共計38人。於病人進行放射線治療前(當週)、治療中每週(6~7週)及治療後每週(1~3週)分別填寫「口乾問卷」和以「NCI CTCAE V3.0版之口腔黏膜炎評估表」進行口腔黏膜炎之臨床檢查分級評估。以及於放射線治療前(當週)、治療中(第5週)及治療後(第3週)填寫「EORTC QLQ-H&N35生活品質問卷」，以評估病人在接受放射線治療過程中，口乾、口腔黏膜炎之間的相關性及生活品質的變化。資料收集後以描述統計、廣義線性模式(G.E.E.)及皮爾森相關等統計分析。結果發現：(1)人口學變項不影響口乾程度(p>0.05)。(2)抽菸者的生活品質較未抽菸者差(p<0.1)，治療前有喝酒者，其口乾狀況較嚴重(p<0.05)，以治療中4~6週的口乾分數最高(p<0.05)，治療後第3週時，有抽菸者的口腔黏膜炎情形較嚴重(p=0.011)。診斷部位以口腔癌及口咽癌的口乾分數最高(p<0.05)。(3)治療狀況部份，以放射線治療總劑量高於6600cGY及有使用口腔黏膜炎治療藥物者的口乾分數較高(p<0.05)，僅接受CCRT治療的口乾分數越高越傾向發生2-5級口腔黏膜炎。(4)有喝酒的口乾分數愈高，其口腔黏膜炎則愈嚴重(p<0.1)。(5)口乾分數不影響生活品質，口腔黏膜炎為2~5級者的生活品質較差(p<0.05)，年紀較大的頭頸癌病人，其生活品質較年輕者為佳(p<0.05)，有嚼檳榔者的生活品質較差(p<0.001)，治療期間有使用麻醉性止痛劑者的生活品質較佳(p<0.028)，CCRT治療組的生活品質較佳(p<0.001)。
並列摘要
The main purposes of this study are:(1)Analysis of the relevant xerostomia factors in the head-neck cancer patients; (2)Analysis of the relevant mucositis effecting factors in the head-neck cancer patients;(3) Analysis of the correlation between xerotomia and mucositis;(4)Analysis of the disease characteristics in the head-neck patients, as well as the resulted effects to the xerostomia, mucositis, and living qualities;(5) Analysis of the therapy conditions, as well as the resulted effects to the xerostomia, mucositis, and living qualities. This study adopted the longitudinal and correlative research designs. It selected the cases that were complied with the conditions in the treatment room of Radiation Oncology Department in the northern medical center; with totally 38 persons. The “Xerostomia Questionnaire” and “NCI-CTCAE V3.0 Version of Mucositis Evaluation Scale” were filled-in respectively before the performances of radiation therapies in patients (the current weeks), as well as filled-in every week during the therapies(6~7weeks) and after the therapies(1~3weeks); in order to conduct the grading evaluation of clinically inspections on mucositis. Also, the “EORTC QLQ-H&N35 Living Quality Questionnaire” was filled-in before the radiation therapies(the current weeks), during the therapies(Week 5), and after the therapies(Week 3); in order to evaluate the changes of correlations and living qualities of patients during the subjected radiation therapeutic process, xerostomia, and mucositis. After the data were collected, they were statistically analyzed through the descriptive statistics, generalized estimating equation(G.E.E.), and Pearson correlation. The results found that: (1)The demographic variables did not affect the xerostomia levels (p>0.05).(2)The living qualities of smokers are less than the non-smokers (p<0.1). For those who drank before the therapies, their xerostomia conditions are more severe (p<0.05). The highest xerostomia score was reached during the 4~6 weeks of therapies (p<0.05). In the third week after therapies, the mucositis conditions of smokers are more sever (p=0.011). For the diagnosed regions, the scores of oral cancer and oropharyngeal cancer were the highest scores (p<0.05). (3) For the part of therapeutic conditions, the xerostomia scores of those who subjected to the total dose of radiation therapy higher than 6600cGY and those who medicated with mucositis treatment drugs were the highest scores (p<0.05). The more higher xerosomia scores of those who only subjected to CCRT therapy, the more tendency to occur the level 2-5 mucositis. (4) The higher xerostomia scores of those who drank, the more sever of their mucositis (p<0.1). (5) The xerostomia scores did not affect the living qualities. The living qualities of those who have mucositis of grade 2-5 had poorer living qualities (p<0.05). For those elder head-neck patients, their living qualities are better than those younger patients (p<0.05). Those who chewed betel nuts had the poorer living qualities (p<0.001). The living qualities of those who used the Narcotic analgesics had the better living qualities (p<0.028). The living qualities of CCRT therapeutic group had the better living qualities (p<0.001).