探討大腸直腸癌手術患者生活品質及存活長期縱貫性分析

研究目的本研究針對大腸直腸癌手術患者進行長期縱貫性的追蹤研究，首先了解大腸直腸癌手術患者術後生活品質改善趨勢及其影響因素，接著探討影響大腸直腸癌手術患者存活之影響因素，最後比較各國執行大腸直腸癌手術病患健康相關生活品質改善之差異性分析，期望藉由本研究結果可以給予適當臨床及出院後的照護。研究方法為前瞻性研究，以南部某醫學中心且於2008年10月至2009年3月期間收集104位接受大腸直腸切除的患者問卷，每個病患至少追蹤兩年。利用SF-36與FACT-C(Functional Assessment of Chronic Therapy-Cancer)測量病患術前與術後之健康相關生活品質之評估工具。使用Effect Size(ES) 與Bootstrapping研究方法及GEE評估病患在不同時間點生活品質的改變幅度與其影響因素，最後利用Cox Regression找出影響存活之相關因素。研究結果大腸直腸癌手術患者在術前至術後三個月在SF-36「生理功能」、「情緒角色限制」、「心理健康」有達顯著改善(P<0.05)；術後三個月至術後一年在「生理功能角色限制」有達顯著差異(P<0.05)；術後一年至術後兩年在「疼痛情況」、「活力狀況」、「心理健康」、「一般健康」有達顯著差異(P<0.05)。FACT-C，術前至術後一個月在「社會家庭功能」、「情緒穩定」、「大腸直腸癌相關事項」有達顯著差異(P<0.05)；術後一年至術後兩年在「生理健康」、「臨床試驗結果」、「一般功能評估」、「整體生活品質評估」有達顯著差異(P<0.05)；術前至術後一年改善幅度比術後兩年至術後一年更佳。性別、年齡、抽菸、術前輔助性治療、術後30天再入院、腫瘤分期、腫瘤位置均是生活品質影響因子。年齡、30天再入院、腫瘤分期、術前FACT-C之「情緒功能構面」、SF-36「身體疼痛」、「生理健康」是影響存活之相關因素。結論與建議術後三個月及術後兩年為大腸直腸癌患者改善生活品質的時間點，又透過兩問卷反應性比較下，因此更能測量出大腸直腸癌改善趨勢，另外，患者在術前的生活品質亦是影響術後活品質以及存活的最重要影響因素，因此建議已罹患大腸直腸癌患者應提早接受治療，進而在臨床單位能夠建立一套完整的照護系統來提供評估術後結果的參考，也藉此資訊能協助醫療單位可以給予患者與家屬衛教，適時做相關介入措施以降低死亡率以及提高生活品質。

關鍵字

大腸直腸癌；存活分析；健康相關生活品質(HRQOL) ； SF-36 ； FACT-C

並列摘要

Purpose： In this study, we took patients with colorectal cancer surgery to do long-term longitudinal study. At first, we evaluate changing trend of patients and influencing factors after colorectal cancer surgery, and then, we discuss the relationship of important factors that influence patients’ survival with colorectal cancer surgery. Last, we compare the improvement of quality of life in different countries. Also, we expect that the results of this study could be a reference for clinical units. Method： This prospective study started from October 2008 to March 2000. We collected 104 patients who accepted colorectal cancer surgery. All patients in this research were traced 2 years at least. We use SF-36 and FACT-C(Functional Assessment of Chronic Therapy-Cancer) as our tools to measure patients’ quality of life. In addition, the methods included Effect Size (ES), Bootstrapping methods and GEE that can evaluate change of patients’ quality of life at different time points and important factors. Finally, we use Cox Regression to find the important factors of patients’ survival. Result： In the SF-36, the result showed the significant improvement (P <0.05)on physical function, emotional role limitations, and mental health at 3 months; the significant improvement (P <0.05) on limited role of physiological functions at 1 year; the significant improvement (P <0.05) on painful situation, dynamic conditions, mental health ,and general health at 2 year. In the FACT-C, the result showed the significant improvement (P <0.05)on social family function, emotional stability, and colorectal cancer-related matters at 1 months; the significant improvement (P <0.05) on physical health, clinical trials, general function evaluation, and overall quality of life assessment at 2 year. In addition, the result showed that gender, age, smoking, preoperative treatment, 30 days after readmission, tumor stage, tumor location are significant factors; age, 30-day readmission, tumor stage, emotional function dimension, physical pain, and physical health at preoperative are the significant factors of patients’ survival. Conclusion： The colorectal cancer patients have improved at 3 months and 2 years. With the comparison between two questionnaires, the study can measure the improvement trend of patients. Moreover, the preoperative status is also the most important factor. Therefore, we suggest the colorectal cancer patients should accept treatment as quickly as possible and clinical units should establish an integral care system to provide patients with a reference and educate patients. It will reduce mortality and improve quality of life.