- 學位論文
大腸直腸癌手術病患療效與存活分析之探討
Health Outcomes and Survival Analysis in Colorectal Cancer Patients Undergoing Surgery
摘要
研究目的 近幾年來，隨著醫藥的進步，癌症治療也日新月異，使得大腸直腸癌患者存活年限得以綿延，相對患者所延續的生命裡更易受到疾病的影響。因此，本研究旨在探討大腸直腸癌患者術後生活品質改善趨勢，以及影響術後存活與生活品質之相關因素，期望透過對患者生活品質的瞭解，能輔佐臨床醫護人員醫療照護之制定，與術後患者療效評估。 研究方法 本研究為前瞻性設計，以南部某家醫學中心自2008年10月19日至2009年3月31日確診為大腸直腸癌且進行手術切除94位患者為研究樣本。使用疾病別量表FACT-C與整體性量表SF-36收集患者術前與術後健康相關生活品質，利用Effect Size (ES)、Standardized Response Means(SRM)分析患者整體收案期間生活品質改善趨勢與幅度，並利用Bootstrapping與Minimal Clinically Important Difference(MCID)比較兩量表反應性之差異，最後使用Cox Regression與GEE模式探討影響術後患者生活品質與存活之影響因子。 研究結果 大腸直腸癌患者於手術後，除了「社會功能」構面外，其餘構面皆於術後3個月獲得顯著性改善(p<0.05)且維持至穩定術後1年。綜觀術前與術後1年兩時間點，患者獲得最大改善幅度為「心理健康」構面(ES:0.71, SRM:0.83)，其餘除了「社會功能」構面外，患者皆於術後1年獲得小幅度改善。FACT-C於「生理功能」構面較SF-36顯著具有反應性(ES差:0.25, 95%CI:0.10-0.39)。此外，發現術前生活品質構面具有預測術後患者存活能力，在控制了其他人口學、臨床特性與醫療照護品質等變項後，發現術前FACT-C量表中「大腸直腸相關事項」、「試驗結果指標」構面與SF-36量表「身體疼痛」構面為術後患者存活之預後因子(p<0.05)。在探討影響患者術後生活品質相關因素上，整體而言，研究發現性別、年齡、教育程度、BMI、期別、造口、術式、術前輔助性治療、術後30天再入院、術前功能狀況等變項為主要顯著影響因子。 結論 本研究發現術後3個月為大腸直腸癌患者主要生活品質改善時間點，且疾病別量表較整體性量表更具反應性，更能量測出大腸直腸癌患者改善情形。除了患者人口學與手術相關變項，病人術前生活品質為顯著影響術後存活以及生活品質改善之重要預測因子，因此醫護人員不僅應該注意病人術前相關因素，以協助判斷患者預後可能情形，並能供患者與家屬衛教之參考，促進患者自我照護，進而適時透過相關介入以提升術後存活率與生活品質。
並列摘要
Purpose: Colorectal cancer is the most common malignancy in many developed countries and represents a significant global disease burden. Besides disease-free and overall survival time, the health-related quality of life (HRQOL) has been regarded an important outcome measure for cancer survivors. For this purpose, the purposes of this study are to evaluate postoperative HRQOL changes before and after colorectal cancer surgery, and simultaneously to identify the predictive factors of patients’ HRQOL and mortality after the operation. Methods: In this prospective study, 94 patients undergoing colorectal cancer resection in one medical center in southern Taiwan from October 2008 to March 2009 were included into this study. HRQOL data were collected by using one cancer-specific (FACT-C) and one generic instrument (SF-36). Effect size (ES), Standardized Response Means(SRM), Bootstrapping and Minimal Clinically Important Difference(MCID) were used to examine changing trends of the HRQOL, and responsiveness of the FACT-C and the SF-36. GEE Model and survival analysis were employed to assess the impact factors on HRQOL and mortality. Results: The overall HRQOL, except social function subscale, had significant improved from baseline to the 3rd mouth and maintained until the 1st year. From baseline to the 1st year, emotional function subscale showed the largest ES and SRM(ES:0.71, SRM:0.83), and other subscales, except social function, had small effect sizes. Moreover, the FACT-C exhibited better responsiveness in the physical function than the SF-36(0.25,0.10-0.39). The study also found that the baseline colorectal cancer subscale, Trial Outcome Index and body pain subscales were associated with mortality. It also showed that gender, age, education, BMI, stage, colostomy, surgical type, preoperative neoadjuvant therapy, re-hospitalized in 30 days and preoperative functional status could significantly predict HRQOL through this study. Conclusions: The study indicated that HRQOL improved in the 3rd mouth postoperatively, and disease-specific instrument was more responsive than generic-specific instrument. Preoperative HRQOL, demographic and related surgical variables were predictors of mortality and HRQOL. Patients should be advised that their postoperative HRQoL may depend not only on their postoperative health care but also on their preoperative functional status. These analytical results should be applicable to other Taiwan hospitals and to other countries with similar social and cultural practices.
參考文獻
延伸閱讀
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