轉移性大腸直腸癌病患以UGT1A1基因多型性作為Irinotecan劑量提高前瞻性分析與生活品質之研究

研究目的主要探討轉移性大腸直腸癌病人以基因多型作為Irinotecan劑量提高以及正常劑量兩組病患之健康相關生活品質的差異，進而探討影響病患的生活品質預測因子，期望藉由本研究結果能提供臨床單位、學術單位、公共行政單位以及等相關議題時,整體性評估之參考及未來政策考量方向。研究方法本研究為前瞻性研究設計，針對南部某醫學中心2015年10月至2017年3月期間收集98位接受Irinotecan治療的轉移性大腸直腸癌病患的問卷，病患依照醫療特性分為正常劑量及加強劑量兩組進行追蹤，時間點分為治療前、治療後三個月及六個月。利用SF-36、FACT-C、EQ-5D-3L與貝克焦慮量表(BDI)以及貝克憂鬱量表(BAI)，評估病患健康相關生活品質。利用廣義預估方程模式(GEE)評估病患在不同時間點健康相關生活品質的改變狀況與其影響因素。研究結果本研究Irinotecan正常劑量有59位病患(60.2%)，Irinotecan劑量提高組有39位病患(39.8%)，兩組的平均年齡分別是61.54歲及55.77歲。兩組病人在SF-36、FACT-C、EQ-5D，分數皆沒有達顯著不同，推測病患並不會因為藥物劑量加強進而影響日常的生活品質，與接受正常劑量的病患生活品質狀況是一樣的水準。兩組病患在BAI(焦慮)、BDI(憂鬱)最差為治療後三個月，治療後六個月則維持穩定。病患生活品質之預測因子包含BMI、教育程度、年齡。結論與建議轉移性大腸直腸癌病患根據基因型態的不同，使用Irinotecan劑量加強的病患，生活品質並不會比正常劑量的差，其他文獻指出使用加強劑量組病患有較長的生存年限，而本研究發現加強劑量組與標準劑量組生活品質並無顯著差異，代表延長生存年限期間，劑量多但並不會影響生活品質。研究發現兩組病患在焦慮與憂慮最差為治療後三個月，治療後六個月則維持穩定。因此，在轉移性大腸直腸癌病患接受治療期間，需要多關注治療情形，並給予輔導，提升生活品質及心情。

關鍵字

轉移性大腸直腸癌； Irinotecan劑量提高；健康相關生活品質

並列摘要

Purpose: This research is focus on metastatic colorectal cancer patients’ quality of life with genetic polymorphism for irinotecan dose escalation group and standard group. And further, it discusses the predictive factors which influence patient’s life quality . We expect that the research of the result can be a direction of the policy for clinical units, academic units, public administration units and other related issues. Methods: The prospective study is from October 2015 to March 2017. Questionnaire data was collected 95 patients with metastatic colorectal cancer had irinotecan in the southern medical center. The patients are in two groups, which is irinotecan dose escalation and standard group. All of patients completed in the Short Form 36 (SF-36), Functional Assessment of Cancer. Therapy-Colorectal (FACT-C), European Quality of life scale (EQ-5D-3L), Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-Ⅱ(BDI). All patients were examined at medical pretreatment, three months and six months after treatment. The research tools use the generalized estimation equation (GEE) to analyze the quality of life and the factors of influence. Results: There are 59 patients (60.2%)in the dose standard group, and 39 patients(39.8%) in the dose escalation group. Their average age is 61.54 years old and 55.77 years old individually. Both groups have no significant difference in the SF-36, FACT-C and EQ-5D. We can assume that it doesn’t influence the patient’s life quality to take more amount of medicine and the patient’s life quality in the dose standard is the same as the one in the dose escalation group. Both groups reach the worst level in the BAI (anxiety) and BDI (depression) after having been treated for three months. However, after they have been treated for six months, they are stable. Predictive factors of patient life quality include BMI, education and age. Conclusion: This study clarifies the condition of healthy quality of life, anxiety and depression of metastatic colorectal cancer patient with genetic polymorphism for irinotecan dose escalation on the different time. The healthy quality of life among metastatic colorectal cancer patients with different genetic types in the irinotecan dose escalation group isn’t worse than the one in the dose standard group. Other references indicate that the patients in the dose escalation group extend lifespan, and this study demonstrates that there is no significant difference on quality of life between these two groups. Overall, dose escalation does not affect quality of life during the extension of the lifespan. The research shows that both groups fell anxious and depressed to the highest level. But after six months, they feel less anxious and depressed and they are stabler. Thus, paying more attention to transfer colon cancer patients is necessary during their treatment period; and it’s also important to offer more counsel to promote their life quality and mood.