數位傳統養生運動介入對頭頸癌患者接受放射線治療中生活及睡眠品質的影響

The Impact of the Digital Traditional Qigong Regimen Exercises on Quality of Life and Sleep Disturbance in Head and Neck Cancer Patients Undergoing Radiotherapy

方本詞(Pen-Tzu Fang)

指導教授 ： 賴秋蓮

高雄醫學大學/醫學院/醫學研究所碩士班/碩士(2018年)

摘要

頭頸癌發生率約占台灣癌症發生率前六名，死亡率是全癌症的第五位。頭頸癌患者的治療常需多科聯合治療，包含手術、化學治療及放射線治療；不管是在治療中或治療後，均會造成患者的功能及生活品質下降。在這些治療當中，放射線治療因療程長，及急性副作用的不適，對治療中患者的功能及生活品質會造成極大的不適，甚至會使療程中斷或拖延。本研究針對接受放射線治療療程中的頭頸癌患者，藉由數位傳統養生運動的介入，探討對療程中情緒、睡眠及生活品質的影響及測量心律的變異性，探討對心血管自律神經的影響。
研究對象包括34位頭頸癌男性，平均年齡55.2歲，均接受臨床相關資料登錄，及治療前後的問卷調查及心律分析檢查。在意圖治療分析(intention-to-treat；ITT)中控制組有15人，數位傳統養生運動組(簡稱氣功組)有19人，氣功組有兩人並無接受氣功，僅有接受完放射線治療及各項前後測試，因此進一步以控制組有17人，氣功組有17人，進行實際治療分析(per-protocol；PP)。
在焦慮憂鬱的部分，意圖治療分析及實際治療分析中傳統養生運動均可有意義降低焦慮，在意圖治療分析中傳統養生運動還能有效降低憂鬱程度。睡眠品質部分，意圖治療分析及實際治療分析中傳統養生運動可有效增加睡眠總時數；實際治療分析發現傳統養生運動可改善睡眠品質總分及日間功能部分，而意圖治療分析則有改善的傾向。生活品質部分，傳統養生運動可改善焦慮，而在影響病人最重要的次分項中，傳統養生運動可改善語言品質，整體生活品質部分，傳統養生運動可改善綜觀的社交品質；不過客觀之心律變異部分兩組並無顯著的差異。另外觀察到傳統養生運動可改善發炎指標之嗜中性球與淋巴球的比率 (neutrophil-lymphocyte ratio；NLR)。整體來說，傳統養生運動對正在接受放射線治療的頭頸癌患者是一可行的、安全的身心靈調節運動，可再進行大規模試驗及長期追蹤確認其效益。

關鍵字

數位傳統養生運動 ； 頭頸癌 ； 放射線治療 ； 睡眠品質 ； 生活品質

並列摘要

The incidence of head and neck cancers is the 6th in Taiwan, and head and neck cancers are the 5th leading cause of cancer death. Head and neck cancers patients usually require multimodality treatments, including surgery, chemotherapy and radiotherapy. These treatments can cause functional deterioration and worsened quality of life during or after the treatment, and bring tremendous effects on patient’s life. When radiotherapy is indicated, it requires 6 to 7 weeks treatment, and most patients suffered from different degrees of acute adverse effects during radiotherapy. This study aimed to explore the effects of traditional qigong regimen exercises on mood, sleep quality and quality of life for head and neck cancer patients undergoing radiotherapy, and the effects of traditional qigong regimen exercises on autonomic nervous system through the measurement of heart rate variability.
Thirty-four patients (mean age: 55.2 years) were included in this randomized controlled trial. The quality of life, sleep quality, depression and anxiety status were accessed by questionnaire performed before and after radiotherapy courses. Heart rate variability were measured before and after radiotherapy courses. There were 15 patients included in waitlist control (WLC) group, 19 patients in traditional qigong regimen exercises (qigong) group. There were two patients in the qigong group who never received qigong. We also conducted per-protocol analysis, in which there were 17 patients each in WLC group and qigong group.
For anxiety and depression survey, qigong group expressed lower level of anxiety in the intention-to-treat ITT) and the per-protocol (PP) analysis；in ITT analysis, the qigong was able to reduce depression status. For sleep quality survey, both analyses showed positive effects of qigong on extended sleep duration. Improved daytime dysfunction and total sleep quality were observed in PP analysis. For quality of life survey, qigong alleviated anxiety status, and associated with less reported significant problem related to speech. The qigong also brought positive effects on social-emotional function. There were no statistic differences on heart rate variability in both groups. Another interesting finding is that, Qigong group showed significant lowered neutrophil-lymphocyte ratio than WLC group after treatment, which is an indicator for inflammation. In summary, traditional qigong regimen exercises are feasible and beneficial for head and neck patients undergoing radiotherapy, large scaled trials with longer follow up can be conducted.

並列關鍵字

Digital Traditional Qigong Regimen Exercises ； Head and Neck Cancer Patients ； Radiotherapy ； Sleep Disturbance ； Quality of Life

參考文獻

Pizzi, C., Manzoli, L., Mancini, S., & Costa, G. M. (2008). Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function. Eur Heart J, 29(9), 1110-1117. doi: 10.1093/eurheartj/ehn137

Tsai, P. S., Wang, S. Y., Wang, M. Y., Su, C. T., Yang, T. T., Huang, C. J., & Fang, S. C. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res, 14(8), 1943-1952. doi: 10.1007/s11136-005-4346-x

Bergenthal, N., Will, A., Streckmann, F., Wolkewitz, K. D., Monsef, I., Engert, A., . . . Skoetz, N. (2014). Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database Syst Rev, 11, Cd009075. doi: 10.1002/14651858.CD009075.pub2

Bernier, J., Domenge, C., Ozsahin, M., Matuszewska, K., Lefebvre, J. L., Greiner, R. H., . . . van Glabbeke, M. (2004). Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med, 350(19), 1945-1952. doi: 10.1056/NEJMoa032641

Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res, 52(2), 69-77.