口腔癌及癌前病變患者口腔照護需求、口腔功能與生活品質之相關性研究

Investigated the association between the oral care demands, oral function and oral health-related quality of life among patients with oral cancer and pre-cancer lesion

張文玲(Wen-Ling Chang)

指導教授 ： 謝天渝博士

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2004年)

摘要

中文摘要
背景：
口腔癌及癌前病變患者從疾病最初診斷到開始執行外科手術、化學和放射線治療等一連串的衝擊，是否會影響其生理、心理、社會等多層面之生活品質？目前國內尚無關於口腔癌及癌前病變患者，口腔照護需求和口腔功能與生活品質相關的研究報告，因此欲深入探討此議題，藉此提供醫護人員於口腔照護上的參考，進而提升患者之生活品質。

研究目的：
為了解口腔癌及癌前病變患者基本特性、口腔照護需求及口腔功能
與口腔健康相關生活品質的分佈情形，以及探討相關影響因素。

研究方法：
透過「與口腔健康相關生活品質 (OHIP-49)」結構式問卷，以高雄醫學大學附設中和紀念醫院「口腔顎面外科」門診之口腔癌及癌前病變患者為對象，收案期間約2.5個月，有效樣本數共計306份，並以t-檢定、卡方檢定、單變項變異數分析及逐步複迴歸分析法進行統計分析。

結果：
在「口腔評估」方面，口腔癌患者整體得分為11.89±2.40分（平均值±標準差）；癌前病變患者為10.88±1.67分，意即口腔癌患者口腔狀況較差。在「口腔功能」方面，兩者皆以「最大開口度」大於等於2公分及「口外流涎」為每日無口外流涎者居多，另外，口腔癌患者以無吞嚥困難及構音可接受者居多；癌前病變患者則完全無吞嚥困難及構音模糊情形。在「整體生活品質」方面，口腔癌患者得分87.99±50.64分；癌前病變患者得分70.96±40.06分。並且，男性、已婚、認為疾病對工作無影響之口腔癌患者，其平均分數皆顯著高於癌前病變患者。最後，經逐步複迴歸分析得知，口腔癌患者「採取化學治療、放射線治療或二者合併者」，其整體生活品質比「有採取手術治療者」差（OHIP多29.44分）；「未執行上或下顎骨切除術者」則比「有執行上或下顎骨切除術者」佳（OHIP少26.91分）；「無口外流涎者」亦比「有口外流涎者」生活品質佳（OHIP少8.29分）；而「有吞嚥困難者」則比「無吞嚥困難者」差（OHIP多21.83分）。在癌前病變患者方面，「疾病對工作有影響者」其整體生活品質比「疾病對工作無影響者」差（OHIP多24.68分）；「手術次數一次以上者」亦比「僅手術一次者」差（OHIP多32.24分）。

結論：
口腔癌患者在口腔評估、最大開口度和口外流涎、以及整體生活品質皆顯著比癌前病變患者差。然而，就口腔癌患者而言，認為疾病對工作有影響、癌症分期屬第IV期、採取化學治療或放射線治療或二者合併療法、有嚼食檳榔、口腔評估為17-24分及口腔功能不良者，整體生活品質較差，其中「治療方式」、「手術方式」、「口外流涎」和「吞嚥功能」為重要之影響因素。就癌前病變患者而言，全家月平均收入為1-3萬元、認為疾病對工作有影響、手術一次以上及每日有口外流涎者，整體生活品質較差，其中「疾病對工作的影響」及「手術次數」為重要之影響因素。

關鍵字

口腔功能 ； 口腔照護需求 ； 生活品質

並列摘要

Abstract
Background:
During the time from obtaining an initial diagnosis to receiving surgery operations, will a series of treatment procedures such as C/T and R/T have a severe impact on patients with oral cancer and pre-cancer lesion in their quality of life related to physical, psychological, and social aspects? To date, there was no study investigating the relationships between dental care demands, oral function and quality of life in patients with oral cancer and pre-cancer lesion. We would like to examine this area and look for findings to serve as clinical references in oral health care and further promote the quality of life for these patients.

Study objective:
The purpose of this study was to determine 1) the characteristics of patients with oral cancer and pre-cancer lesion; 2) the relationships between their dental care demands, oral function and oral health-related quality of life, and other relative factors.

Methods
Patients with oral cancer and pre-cancer lesion in Oral Maxillofacial Surgery Department of KMUH were recruited to complete the constructive questionnaire: Oral Health Impact Profile (OHIP-49) interview. Three hundred and six valid samples of questionnaire were obtained during two and a half months. The statistic methods utilized to analyze the data were t-test, Chi-square test, ANOVA, and multiple regression method.

Results:
In “oral assessment”, the total rating of oral cancer group was 11.89 ± 2.40(M ± SD) and the total rating of pre-cancer group was 10.88 ± 1.67(M ± SD). That means oral cancer patients in this study have poorer oral health condition than the pre-cancer group. In oral function, most patients in both groups achieved maximum in mouth open≧2 cm and their drooling condition was “non-drooling” . Many patients in the oral cancer group were “non-dysphasia” and “acceptable articulation” but no “dysphasia” and “unclear articulation” were found in the pre-cancer group. In “general quality of life,” the oral cancer group rating was 87.99 ± 50.64(M ± SD) and the pre-cancer group rating was 70.96±40.06(M ± SD). The average scores in the subgroups of “male,” “married,” and “no influence to work” in the oral cancer group were significantly higher than in the pre-cancer group. Significant differences were noted from these scores between the two groups. Thereafter, the scores of “general quality of life” in the oral cancer group were analyzed through the analysis from multiple regression method. The score of OHIP in the subgroup of “patients received C/T, R/T, or C/T combined R/T” was 29.44 more, which means a worse quality of life, than “patients received surgery.” The OHIP score in the subgroup of “non-ostectomy patients” was 26.91 less, which means a better quality of life, than the subgroup of “ostectomy patients.” The OHIP score in the “non-drooling” subgroup was 8.29 less, which means a better quality of life, than in the “drooling patients” subgroup. The OHIP score in the “dysphasia” subgroup was 21.83 more, which means a worse quality of life, than “non-dysphasia patients”. In the pre-cancer group, the score of “general quality of life” in the “disease influence to work” subgroup was 24.68 more, which means a worse quality of life, than in the “non influence to work” subgroup. The score in the “more than one time surgery” subgroup was 32.24 more, which means a worse quality of life, than in the “only one time surgery” subgroup.

Conclusion:
The oral cancer group was significantly worse than the pre-cancer group in “oral health status”, “maximum in mouth open”, “drooling”, and “general quality of life”. For general quality of life, poorer quality of life was found in the oral cancer group with the characteristics of “influence to work”, “staging IV”, “received C/T or R/T or combined C/T and R/T”, “betel nut chewing”, “OAG score from 17 to 24”, and “poor oral function”. Then “Treatment modality”, “type of surgery”, “drooling,” and “swallowing” were the major related factors. In the pre-cancer group, poorer quality of life was noted with the characteristics of “ten to thirty thousands average monthly income”, “influence to work”, “more than one surgery”, and “drooling”. Then “influence to work” and “surgery requirement” were the major related factors.

並列關鍵字

oral function ； oral care demands ； quality of life

參考文獻

參考文獻

1. Armstrong TS. Stomatitis in the bone marrow transplant patient.

Cancer Nurs 1994; 17: 403-10.

2. Blaney GM. Mouth care-basic and essential. Geriatric Nurs 1986;

September/October: 242-3.