以前瞻性方式探討肝癌手術病人憂鬱、焦慮與生活 品質之研究

研究目的手術後病患的生活品質優劣對其預後能力有明顯的影響，而心理狀態也會影響到生活品質之狀況，由其以焦慮、憂鬱為普遍症狀。因此，本研究主要目的為評估肝癌病患健康相關生活品質各構面長期改變趨勢，並探討憂鬱、焦慮與健康生活品質之關係。研究方法本研究對象為三間教學醫院的肝癌手術病人，共有284位病患，其病患皆有在術前、術後六個月、術後一年與術後兩年完成癌症治療功能評估─肝膽(FACT-Hep)、歐洲組織癌症生活品質研究與治療問卷(EORCT QLQ- C30)、SF-36、貝克憂鬱量表第二版(BDI-II)與貝克焦慮量表(BAI)。在生活品質問卷中分數越高表示功能狀態越好，而憂慮和焦慮分數越高表示症狀問題越糟。研究工具採廣義估計方程式(GEE)模型進行趨勢分析與術前憂鬱、焦慮、生活品質對整體憂鬱、焦慮與生活品質預測能力之檢驗。研究結果本研究發現術後追蹤兩年之健康生活品質構面有顯著的改善，如FACT-Hep量表分數從159.5分至163.05分(p<0.05)。經GEE校正時間影響與基準預測值後，術前憂鬱與焦慮症狀皆顯著預測健康生活品質之功能量表為負相關，如術前憂鬱、焦慮症狀分別對FACT-Hep為-0.91 (P< 0.001)和-0.79 (P=0.013)，並預測健康生活品質症狀量表為顯著的正相關，如術前憂鬱對生活品質症狀─疲勞(0.89, P< 0.001)；術前健康生活品質功能量表皆對憂鬱與焦慮症狀具有顯著的負相關，如術前FACT-Hep對焦慮與憂鬱症狀分別為-0.10(P=0.001)和-0.06(P<0.001)，且術前健康生活品質症狀量表皆對憂鬱與焦慮症狀具有顯著的正相關，如QLQ-C30對焦慮與憂鬱症狀分別為0.03(P<0.001)和0.06(P<0.001)。結論與建議當評估肝癌術後健康相關生活品質改變趨勢，顯示出健康相關生活品質量表分數從術後六個月到術後一年皆有改善，但在術後兩年的分數卻相對於術後一年來的低，其表示我們應該更關注肝癌病患在術後一年之生活品質狀況。此外，本研究也發現到肝癌手術後，健康相關生活品質分數較低者之病患，其與憂鬱、焦慮症狀有明顯的關係，因此，我們需要更關注於術後病患心理症狀之狀態，並減少健康相關生活品質之負面影響結果。而研究也發現術前健康相關生活品質、焦慮與憂鬱為病患整體的生活品質與心理症狀的重要因子，因此在病人照護上，我們需要更關注術前病患之照護。

關鍵字

肝癌；焦慮症狀；憂鬱症狀；健康相關生活品質；趨勢分析

並列摘要

Purpose: Despite the impact of medical advances, the quality of life (QOL) of cancer patients remains a tough issue, including the dimension of psychological symptoms. Associated with QOL is metal status, where anxiety and/or depression are common. Therefore, this study aims to provide trend analysis of depression, anxiety, and QOL after hepatoma surgery and to explore the relationship between anxiety, depression, and QOL. Research Methods: A total of 284 hepatocellular carcinoma (HCC) surgery patients from three affiliated teaching hospitals in southern Taiwan were included in the study. Collected for each patient are the preoperative, 6 months, 1 year, and two years postoperatively, comprising hepatobiliary (FACT-Hep), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORCT QLQ-C30), SF-36, the second edition of the Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). As for QOL questionnaire, the higher the scores, the better functional status, and the higher the scores for anxiety and depression, the the worse the symptoms. Generalized estimating equations (GEE) model is used for trend analysis and asses how preoperative depression, anxiety and quality of life could predict overall depression, and anxiety. Results: The study found that in postoperative two-year follow-up of QOL significant improvements occurred, including the FACT-Hep scale scoring from 159.5 points to 163.05 points (P<0.05). After controlling time and demographic variables, preoperative depression and anxiety symptoms were significantly associated with FACT-Hep -0.91 (P<0.001) and -0.79 (P=0.013), respectively. Preoperative FACT-Hep is significantly associated in a negative manner with -0.10 (P=0.001) for anxiety symptom and -0.06 (P<0.001) for depressive symptom. Preoperative QLQ-C30 were significantly and positively correlated with 0.03 (P<0.001) for anxiety symptom and 0.06 (P<0.001) for depression symptom. Conclusions and Recommendations: It showed a significant improvement of QOL in HCC patients from six months to two years after surgery. But the magnitude of improvement is less in the second year than that in the first year, which means more attention should be paid to QOL in HCC patients one year after surgery. In addition, the lower the scores for QOL, the more likely the symptoms of depression and anxiety, so we need to focus on the psychological status in HCC patients after surgery, and minimize negative impact on QOL. The study also found that preoperative QOL, anxiety and depression are significantly associated with overall QOL and psychological status, so in patient-centered care, preoperative care plays a crucial role.