肝癌病患接受肝切除術與經導管肝動脈化學栓塞之健康相關生活品質之探討

Health-Related Quality of Life of Hepatocellular Carcinoma Patients Underwent Hepatectomy and Trans-arterial Chemo Embolization

王湘茹(Shiang-Ru Wang)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/醫務管理學研究所/碩士(2009年)

摘要

研究目的：本研究目的主要在探討肝癌病患接受肝切除術及TACE治療前後之健康相關生活品質變化情形，並且預測肝切除及TACE治療健康相關生活品質之重要影響因子。最後為探討分析肝癌病患接受肝切除術及TACE治療之健康相關生活品質差異。
研究方法：本研究為前瞻性設計，利用問卷測量方式探討分析肝癌病患健康相關生活品質(HRQOL)，研究工具採用EORTC QLQ-C30及EORTC QLQ-HCC18進行訪問評估。研究樣本為高雄市某醫學中心肝膽內外科接受肝切除術及TACE治療之原發性肝癌病患。肝切除肝癌病患蒐集時間自2007年7月至2008年11月止，針對術前、術後6週、術後3個月、術後6個月(n=66)，四個時間點進行問卷評估；接受TACE治療肝癌病患蒐集時間自2008年8月至2009年3月止，針對治療前、治療後1週、治療後6週(n=67)，三個時間點進行問卷評估。並且藉由病歷審查表蒐集臨床上相關資料。
統計分析：數據資料以平均值±標準差或次數(%)來呈現，連續性資料以獨立樣本T檢定分析，類別變項以卡方檢定及Fisher’s exact tests進行分析。以複迴歸分析(Multiple linear regression analysis)分析健康相關生活品質之影響因子，最後利用GEE模式預測肝切除術及TACE(栓塞)兩群組在控制時間因素後之HRQOL影響因子。
研究結果：肝切除術病患在術前、術後6週、術後3個月、術後6個月之整體生活品質分別為57.32±14.80、55.93±12.12、58.71±14.43、59.22±10.45，術後6週整體生活品質較差，在情緒構面則是術前最差：78.91±23.08，術後情緒已有所改善。疼痛構面以術後6週情況較差：20.20±19.51，而四個訪問時間點皆發現病患有睡眠困難的問題。在肝切除病患中影響HRQOL因子為性別、年齡、教育程度、抽菸、合併症、TNM分期、腫瘤大小等。TACE病患在治療前、治療後1週、治療後6週之整體生活品質分別為47.64±8.92、45.15±10.37、51.99±11.70，治療後1週整體生活品質較差，在情緒構面則是治療前最差：80.60±22.26與肝切除病患相同。接受TACE病患在訪問三個時間點中，發現疲倦及睡眠困難問題影響甚鉅。接受TACE影響HRQOL因子為性別、年齡、婚姻狀況、抽菸、喝酒、合併症、肝硬化、治療次數等。
結論與建議：接受肝切除術與TACE肝癌病患在訪問前情緒構面皆受到很大影響，病患也容易產生疲倦的問題，整體來說接受肝切除術的病患在術後6週呈現較差的HRQOL，TACE病患則為治療後1週較差。但是肝切除術後3-6個月病患，部份HRQOL已逐漸恢復術前之功能，而TACE治療後6週HRQOL明顯較治療前好，代表病患在治療後6週已恢復治療前水準。本研究結果發現接受肝切除術病患健康相關生活品質不論在治療前或是治療後6週，明顯較TACE治療病患好。本研究樣本在治療後HRQOL受影響程度不大，若病情受到好的照顧與治療，在健康相關生活品質上不致於受太大影響。建議醫療提供者若主動傾聽及關懷，給予適當的情緒支持，降低病患不確定感，應可改善HRQOL。

關鍵字

肝癌 ； 肝切除術 ； 栓塞 ； 健康相關生活品質

並列摘要

Objective：The main aims of this research are to investigate the changes of health-related quality of life of the Hepatocellular Carcinoma(HCC) patients who received hepatectomy and TACE treatment, and to predict the important influential factors. The last part is to examine and analyze the differences of of health-related quality of life of the HCC patients who received hepatectomy and TACE treatment.
Methods：This research study is a prospective design, using questionnaire to measure the health-related quality of life of the HCC patients. EORTC QLQ-C30 and EORTC QLQ-HCC18 were employed as the tools for conducting interviews and evaluations. The participants were the primary HCC patients who received hepatectomy and TACE treatment in a medical center in Kaohsiung City. The data of the underwent hepatectomy of HCC patients were collected from July 2007 to August 2008, and questionnaire were conducted at the following four points: Baseline, 6 weeks,3 months and 6 months after treatment. The data of the HCC patients who received TACE treatment were collected from August 2008 to March 2009, and questionnaire were conducted at the
following 3 points: Baseline, one week and 6 weeks after the treatment. Besides, clinical relevant data were gained through medical chart review.
Statistical analysis：The statistical data are presented with Mean±SD or percentages of patients. Statistical analyses were performed using univariate tests (Student’ s T test ,Chi-square tests and Fisher’s exact tests) to test for differences in variables. Multiple linear regression analysis was employed to analyze the influential factors of health-related quality of life. Finally, useing GEE model to predict the factors associated with HRQOL of the two groups after the variable of time was controlled.
Results：Overall, the values of the HCC patients who underwent hepatectomy quality of life at the four time points were 57.32±14.80, 55.93±12.12, 58.71±14.43, and 59.22±10.45, respectively. The overall quality of life was poorer at the point of six weeks after treatment, while emotional was the worst before the operation (78.91±23.08), and emotions would get better after the operation. Pain was also poorer at the point of six weeks after the operation: 20.20±19.51. The patients were found to have sleeping difficulty across all the four time points. Among the HCC patients who underwent hepatectomy, the factors that affected HRQOL were gender, age, education, smoking, comorbidity , TNM Stage System, tumor size , etc.. The overall values of the quality of life of the TACE patients were 47.64±8.92, 45.15±10.37, and 51.99±11.70. The overall quality of life was poorer one week after the treatment, and emotional was worst before the treatment, i.e. 80.60±22.26, the same as that of the HCC patients who underwent hepatectomy. Across the three time points, it was found that tiredness and sleeping difficulty had great influences on those TACE-receiving patients. The factors influencing the HRQOL of those who receiving TACE were gender, age, marital status, smoking, drinking, comorbidity, cirrhosis, times of treatment, etc..
Conclusion and suggestion：The emotional of the HCC patients who received hepatectomy and TACE was significantly affected before the interview, and the patients tend to get tired. Overall, the patients receiving hepatectomy had poorer HRQOL six weeks after the operation, while those receiving TACE had poorer HRQOL one week after the treatment. However, for the patients who had hepatectomy, after three to six months part of the HRQOL gradually bounced back to what it was like before the operation. The HRQOL became even better than before after 6 weeks of the TACE treatment, representing that it bounced back to the before-treatment level. The results have found that the HRQOL of the patients who receive hepatectomy is apparently better than that of those who had TACE treatment, whether it be 6 weeks before or after the treatment. The HRQOL of the subjects was not significantly affected after the treatment. If one’s illness can receive good care and treatment, the HRQOL may not be greatly affected. The suggestion is that if medical treatment providers can actively listen and show care, give appropriate emotional support, and lessen the patients’ feeling of uncertainty, the HRQOL could be improved.

並列關鍵字

Hepatocellular Carcinoma ； Hepatectomy ； TACE ； Health-Related Quality of Life

參考文獻

參考文獻

中文部份

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