頭頸癌病人口腔功能、心理狀態及生活品質與存活預測之研究

Oral Function and Mental Condition Associated with Quality of Life and Survival Prognosis for Head and Neck Cancer Patients

林任芬(Jen-Fen Lin)

指導教授 ： 黃曉靈

高雄醫學大學/口腔醫學院/口腔衛生學系碩士在職專班/碩士(2017年)

摘要

背景：現今已有許多關於頭頸癌橫斷性研究關於口腔健康康狀態及生活品質，甚少探討不同療程與其生活品質變化及影響相關性之縱貫性研究，了解頭頸癌病人生活品質其各階段變化，有助設計各階段合宜的介入措施。
目的：瞭解頭頸癌患者治療前及治療後之口腔健康狀況心理狀態及生活品質之現況及變化，分析不同癌別及治療方式組合對頭頸癌患者生活品質之影響，最後探討治療前後生活品質對整體存活預測。
材料與方法：前瞻性縱貫性研究設計，採用癌症患者一般性生活品質問卷(EORTC QLQ-C30)與頭頸癌特殊性生活品質問卷(EORTC QLQ-H&N35)及簡式健康量表（The five-item Brief Symptom Rating Scale;BSRS-5）探究頭頸癌患者於不同階段（治療前、治療3個月）口腔功能、心理調適狀態以及生活品質之變化和影響因子，運用t檢定及變異數分析(ANOVA)分析不同人口學屬性及臨床屬性在生活品質各構面之平均差異；線性迴歸分析BSRS-5及口腔張口度對治療前後整體生活品質的影響；Kaplan-Meier計算存活率，並用Cox-regression Hazard model對存活進行多變項分析。
結果：頭頸癌病人治療前後口腔最大張口度平均下降0.44公分，達顯著差異（P<0.001）；BSRS-5與治療前及治療3個月整體健康生活品質有影響 (95%C.I.= -4.49,-2.42)，BSRS-5每上升1分，整體健康生活品質於治療前及治療三個月分別下降3.35及6.36；而口腔癌病人治療前BSRS-5≧6分者，其死亡風險比是<6之5.01倍（95%C.I.=1.41-17.71）；治療後3個月BSRS-5≧6分者，其死亡風險比卻是<6之22.44倍（95%C.I.=7.87-80.44），故BSRS-5可做為口腔癌病人二年存活預測因子；另外，治療前生活品質主要構面之「角色功能」、「財務困難」及「社交接觸」，治療後之「體重減輕」為口腔癌病人存活重要預測因子。
結論：治療前後BSRS-5分數影響口腔癌病人整體存活，應列入臨床常規評估，生活品質構面中「角色功能」、「財務困難」及「社交接觸」為口腔癌病人整體存活顯著影響變項，應盡早轉介社服介入協助；而影響治療後整體存活之生活品質構面為「體重減輕」，更應及時安排營養師介入，以增加其生活品質，進而提升治療後整體存活率。
關鍵字：頭頸癌生活品質、口腔癌存活預測

關鍵字

頭頸癌生活品質 ； 口腔癌存活預測

並列摘要

Introduction: Nowadays, many cross-sectional studies on patients with head and neck (H&N) cancer focus on oral health status and their quality of life, but few studies has paid attention to longitudinal studies. Better understanding of the changes of quality of life before and after treatment can help us come up with different intervention strategies for the target group based on different phrases of the study.
Purpose: This study was to demonstrate the change of oral health status, mental health status and quality of life on H&N cancer patients before and after treatment. Furthermore, we would like to analyze whether different H&N cancer staging and different therapeutic methods affect patient’s quality of life. And also, we would like to know if changes of their life quality may affect patient’s overall survival rate.
Materials and Methods: We conducted a prospective longitudinal study. The quality of life of these patients was evaluated by using the general quality of life questionnaire (EORTC-QLQC30) and the quality of life questionnaire (QLQ-H&N35). In this study, H&N cancer patients who received treatment (including curative surgery, chemotherapy or chemotherapy in combination with radiotherapy) in a medical center of southern Taiwan were recruited.The assessment of health-related quality of life (QOL) of the patients as well as oral assessment (maximal mouth opening degree, MMO) was both conducted before treatment and 3-months after treatment. To analyze different aveage value of the demographic features of population and clinical attributes to the quality of life, t-test and ANOVA were adopted.Besides, BSRS-5 and MMO were evaluated to assess the impact on the overall quality of life before and after treatment by conducting Linear Regression Analysis. Furthermore, calculate the surval rate of patients by Kaplan-Meier method and use multivariate analysis in a Cox-regression Hazard mode on the analysis of the survival rate.
Results: The maximal mouth opening degree (MMO) of H&N cancer patients significantly decreased by an average of 0.44 cm after treatment (P<0.001). Changes of BSRS-5 scores(95% CI=-4.49,-2.42) related to the overall healthy living quality showed significant impact on the overall quality of healthy living before and three months after treatment. The increasing score, commonly referred to as one score, means the overall qulity of healthy living decreased to 3.35 and 6.36 before and three months after treatment respectively.Before treatment, oral cancer patients with BSRS-5 score ≧6 had 5.01 times higher mortality rate than those with BSRS-5 score < 6. ((95% CI=1.41-17.71) while three months after treatment, those with BSRS-5 score ≧6 had 22.44 times higher mortality rate than those with BSRS-5 score < 6. (95% CI=7.87-80.44). Therefore, BRSS-5 can be used as an indicator of the 2-year survival prediction in patients with oral cancer. In addition, the dimensions of "Role function", "Financial difficulties" and “social interaction” before treatment and “ Weight Loss” after Treatment in the Quality of Life are identified as important prediction factors of the survival rate of oral cancer patients.

Conclusions: According to our study, BSRS-5 scores of H&N cancer patients were highly related to the overall quality of life and this evaluation should be included in the regular assessment of oral cancer patients before and after treatment. The indicator Quality of life can predict the survival of patients with oral cancer. Before treatment,the following three indictors such as “role function of patients " and "financial difficulties " “and social contact” had significantly associated with the overall survival rate of oral cancer patients. It is advisable to help them with the intervention of social workers. On the other hand, after treatment, the indicator of the dimension of Quality of Life of the the overall survival rate is “Weight Loss” and it is suggested that the nutritionists should provide timely assistance when in needed so that the quality of life can be improved and their suvaival rate can be further enhanced.
Key Word：Quality of Life of Head and Neck Cancer、Survival prediction of Oral Cancer

並列關鍵字

Quality of Life of Head and Neck Cancer ； Survival prediction of Oral Cancer

參考文獻

參考文獻

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