肝癌末期患者身體心像改變、憂鬱症狀與生活品質的相關性

Correlation among body image change, depression symptoms and quality of life in patients with terminal liver cancer

王敏淑(Min-Shu Ｗang)

指導教授 ： 江純瑛

義守大學/醫學院/護理學系/碩士(2020年)

摘要

背景：肝癌是2018年全球第五大常見之癌症，更是全球癌症死亡的第二大原因，肝癌是台灣常見且預後差及死亡率極高的癌症，在疾病初期通常沒有症狀，當出現臨床症狀時通常已較末期，肝癌末期患者須面對疾病的變化與治療的成效，加上肝癌有著易復發的特性，患者不僅會有身體心像改變之困擾，心理層面也會受到嚴重的衝擊產生憂鬱症狀，如此會干擾每日的生活功能，進而影響生活品質。
目的：探討肝癌末期患者在罹病過程中所產生的身體心像改變、憂鬱症狀及生活品質間相互關係，並找出影響因素。
研究方法：選擇南部某區域教學醫院肝膽腸胃科病房及門診為研究地點，凡符合研究對象均納入收案，本研究收案條件為: (1) 經醫師確診為肝癌末期患者；(2) 達法定成年年滿20歲以上；(3) 意識清晰、能清楚表達自身意見及身體狀況者；(4) 能用國、台語溝通；(5)同意參與本研究且簽署完成「臨床試驗受試者同意書」者。排除有本身為憂鬱傾向患者。 總共收108位肝癌末期患者，研究以結構式問卷調查，包括：基本資料問卷、身體心像量表 (Body Image Scale)、流行病學研究中心憂鬱症狀量表（CES-D）、歐洲癌症治療與研究組織之生活品質問卷(EORTC QLQ-C30)和肝癌患者生活品質量表(EORTC HCC-18)進行收案，將收集資料以 SPSS 19.0 統計軟體進行分析，針對研究對象個人背景屬性、身體心像改變、憂鬱症狀、生活品質方面，以描述性統計了解其分布情形，接著以皮爾森積差相關分析 (Pearson’s product-moment correlation)、無母數統計分析方法Mann-Whitney U與Kruskal-Wallis H檢定、多元迴歸分析(multiple regression)等檢定方法，了解個人背景屬性、身體心像改變、憂鬱症狀及生活品質間之關係與其影響因素。
結果：本研究顯示108位肝癌末期患者，平均65.67歲(SD = 11.34)。體重平均為65.3公斤(SD = ±11.52)。研究對象教育程度以高中(高職)36位(33.3%)最多，72.2%肝癌末期患者有呈現憂鬱情緒;身體心像改變、憂鬱症狀與生活品質間有相關，經過多元迴歸分析發現，教育程度、生病後工作是否受影響、宗教信仰、癌症分期、罹患內科疾病、疾病轉移狀況，為影響身體心像改變之重要預測因子，解釋肝癌末期患者身體心像改變之總變異量為33%；教育程度、婚姻狀況、生病後工作是否受影響、家庭月收入、癌症分期、疾病轉移狀況為影響憂鬱症狀之重要預測因子，解釋肝癌末期患者身體心像改變之總變異量為52%；教育程度、生病後工作是否受影響、宗教信仰、癌症分期、罹患內科疾病、疾病轉移狀況、罹癌時間為影響肝癌末期患者生活品質之總變異量為72%。
結論與建議：本研究發現患者生活品質除與個人背景屬性相關變項有相關外，亦與身體心像改變、憂鬱症狀間存在相關性，因此建議臨床在職教育或學校養成教育中應加強相關癌症照護專業知識及溝通觀察能力，邁向高度品質化之癌症照護。

關鍵字

身體心像改變 ； 憂鬱 ； 生活品質 ； 肝癌末期病患

並列摘要

Background: Liver cancer is the fifth most common cancer in the world in 2018, and the second leading cause of cancer deaths worldwide. Liver cancer is a common and poor prognosis and extremely high mortality cancer in Taiwan. It is usually asymptomatic at the beginning of the disease. In the later stages, terminal liver cancer patients at the end have to face the changes in the disease and the effectiveness of treatment. In addition, liver cancer has the characteristics of recurrence. Patients will not only suffer from physical and psychological changes but also suffer from severe shocks at the psychological level to produce the depression symptoms. This will interfere with daily life functions and affect the quality of life.
Objectives: To investigate the relationships among changes in body image , depression and quality of life in patients with terminal liver cancer during the course of the disease and find out the factors affect those three variables.
Methods: Cross-sectional with a correlational design was used in this study. Data were collected from hepatobiliary and gastroenterology wards and outpatient departments in Southern Taiwan. The total of 108 patients with terminal liver cancer were admitted. The inclusion criteria for this study are: (1) confirmed by the doctor as terminal liver cancer patients; (2) reaching the legal adult age of 20 years or older; (3) clear-minded, able to express their opinions and physical conditions; (4) can communicate in Chinese and Taiwanese; (5) agree to participate in the research after explaining the purpose of the study and have signed and completed the informed consent. Those patients with history of depression were excluded. A self-reported questionnaire was used, including background information, Body Image Scale, Center for Epidemiologic Studies Depression Scale (CES-D), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 Version 3 in Chinese (EPRTC QLQ-C30).and Quality of Life Questionnaire-Hepatocellular Carcinoma (QLQ-HCC18). The data were analyzed using the SPSS 19.0 software package. First, the variables of background information, body image, depression, and quality of life were used to understand the distribution with descriptive statistics. Then, Pearson's product-moment correlation, Nonparametric tests (Mann-Whitney U Kruskal-Wallis H), multiple regression analysis to understand the relationships between background information, medical-related variables, body image, depression and quality of life, as well as influence factors.
Results: Total 108 patients with terminal liver cancer participated in this study，Patient’s mean age was 65.67 years (SD = ± 11.34). The mean body weight was 65.3 kg (SD = ±11.52). One-third of the participants held a high school degree (n=36, 33.3%). Seventy-two percent of the participants had a CES-D score > 16 which met clinical depression criteria. The results found that there was a significant correlation between body image change, depression, and quality of life. There were six factors put into the multiple regression model to predict the variable of body image change, which included education level, whether work was affected after illness, religious, cancer stage, suffering from medical diseases, disease metastasis. This model accounted for 33.3% of the variance. There were six factors put into the multiple regression model to predict the variable of depression, which included education level, marital status, whether work was affected after illness, monthly income, cancer stage, disease metastasis. This model accounted for 52% of the variance. There were seven factors put into the multiple regression model to predict the variable of quality of life, which included education level, whether work was affected after illness, religious, cancer stage, suffering from medical diseases, disease metastasis. This model accounted for 72% of the variance.
Conclusion: This study found that the quality of life of patients is not only related to personal background and medical-related variables but also related to body image change and depression. Therefore, it is recommended that clinical education or school development education should strengthen relevant cancer care professional knowledge, communication, and observation ability to provide high-quality cancer care and medical care.

並列關鍵字

body image change ； depression ； quality of life ； terminal liver cancer patients

參考文獻

中文文獻

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