不同時期結直腸癌病人症狀困擾、憂鬱與生活品質關係之探討

Symptom Distress, Depression, and Quality of Life in Colorectal Cancer Patients at Different Disease Stages

吳淑芬(Shu-Fen Wu) ； 井慶芸(Ching-Yun Ching) ； 李(女惠)燕(Hui-Yen Lee) ； 董弘一(Hong-Yi Tung) ； 阮建維(Chien-Wei Juan) ； 趙東波(Tung-Bo Chao)

《護理雜誌》 62卷6期 (2015/12) Pp. 68-80

https://doi.org/10.6224/JN.62.6.68

摘要

背景：癌症及其治療計畫常對病人的生活品質產生影響，不同的癌症病程階段所產生之身、心不適症狀及身心調適與生活品質間常有持續性的相關性，而生活品質已被視為癌症治療成效的重要指標。因此醫療人員若能暸解病人在病程階段的生活品質差異，將有助於在不同時期提供更適切的醫療照護。目的：分析治療期與存活期之結直腸癌病人症狀困擾、憂鬱與生活品質之差異以及生活品質重要影響因素之探討。方法：採橫斷性研究設計，以方便取樣選取南部某區域醫院138位結直腸癌病人為研究對象，使用「台灣版安德森症狀困擾量表」、「流行病學研究中心憂鬱症狀量表」、「歐洲癌症治療與研究組織之生活品質問卷」及「基本屬性相關變項」結構式問卷進行資料收集。資料以百分比、平均數、標準差呈現描述性統計資料，並以卡方檢定、獨立樣本t檢定、單因子變異分析及階層複迴歸進行推論性統計。結果：存活期病人整體健康生活品質顯著高於治療期（68.68 vs. 59.54, p＜.05）。階層複迴歸分析顯示，生活品質各構面之影響因子，治療期病人以憂鬱傾向與最多構面有關，其次依序為症狀困擾，症狀干擾生活活動功能、及家庭月收入。存活期病人則以憂鬱傾向與最多構面有關，其次依序為是否復發、症狀干擾生活活動功能及是否接受手術治療。當控制相關顯著變項後，治療期與存活期病人生活品質之解釋變異量在整體健康生活品質分別為38.5%及40.9%。結論／實務應用：本研究結果發現結直腸癌病人生活品質除與基本屬性相關變項有相關外，憂鬱傾向與症狀困擾對治療期的生活品質影響較多，而存活期的病人則以憂鬱傾向與生活品質之構面有相關。臨床照護上針對不同時期的癌症病人皆應給予情緒支持以改善憂鬱傾向，針對治療期的病人則應多給予症狀處置之衛教，協助緩解其症狀困擾、憂鬱，以提高病人在不同時期之生活品質。

關鍵字

結直腸癌 ； 症狀困擾 ； 憂鬱 ； 生活品質

並列摘要

Background: Quality of life is increasingly used as a primary outcome measure in studies that are designed to evaluate the effectiveness of treatment in cancer survivors. Purpose: Analyze the symptom distress, depression, and quality of life in colorectal cancer patients and explore the relationship of related variables with changes in QoL (quality of life) during and after treatment. Methods: A cross-sectional study design was used for the present study. Patients (N=138) with colorectal cancer were recruited from a district hospital in southern Taiwan. Data were collected using a self-report questionnaire. Questionnaire scales included the M.D. Anderson Symptom Inventory-Taiwan Form, the Center for Epidemiologic Studies Depression Scale, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 Version 3 in Chinese as well as a demographic and disease-related variables datasheet. Descriptive data were presented using percentage, mean, and standard deviation. Chi-square test, independent t-test, one-way ANOVA, and hierarchical multiple regression were used for inferential statistics. Results: The post-treatment group showed a significantly higher average global health QOL score (68.68 vs. 59.54; p＜.05). Hierarchical regression showed that the impact factor of quality of life has a depressive effect in many dimensions. The second most significant variable was symptom distress. Symptoms interfered with life activity functions and family income and impacted negatively on patient treatment. In survivorship, depressive tendencies was the variable that was most affected, followed by recurrence, symptoms interference, and surgical treatment, respectively. When controlling for the relevant variables, these predictors accounted for 38.5% and 40.9% of the total variance of global health quality of life. Conclusions/Implications for Practice: This study demonstrates that personal characteristics variables, depressive tendencies, and symptom distress all impact on the quality of life of colorectal cancer patients in terms of receiving treatment and survivorship. These findings imply that healthcare professionals must provide appropriate emotional support in order to decrease depression tendency at different stages. Thus, these patients should receive nursing interventions that effectively decrease depression and symptom distress and enhance quality of life at different disease stages.

並列關鍵字

colorectal cancer ； symptom distress ； depression ； quality of life

參考文獻

吳淑芬、林佑樺、李來涼、簡婉儀（2014）．婦科癌症患者的疾病不確定感與憂鬱之相關性探討．護理暨健康照護研究，10（2），83–93。[Wu, S. F., Lin, Y. H., Lee, L. L., & Kan, Y. Y. (2014). The relationship between illness uncertainty and depression in gynecologic cancer patients. Journal of Nursing and Healthcare Research, 10(2), 83–93.] doi:10.6225/JNHR.10.2.83

林育儀、林佳靜（2014）．結腸直腸癌病人疼痛、憂鬱、焦慮與睡眠品質之相關性探討．新臺北護理期刊，16（1），29–40。[Lin, Y. Y., & Lin, C. C. (2014). A correlational study of pain, depression, anxiety and sleep quality in patients with colorectal cancer. New Taipei Journal of Nursing, 16(1), 29–40.] doi:10.6540/NTJN.2014.1.004

江淑華、林佳靜（2010）．頭頸癌病人術後接受放射化學治療之症狀困擾與生活干擾程度探討．新臺北護理期刊，12（2），17–26。[Chiang, S. H., & Lin, C. C. (2010). Effects of symptom distress and symptom interference of daily life in CCRT patients with head and neck cancer. New Taipei Journal of Nursing, 12(2), 17–26.] doi:10.6540/NTJN.2010.2.003

季瑋珠、楊志新、許　駿、賴佳君（2002）．癌症病人特定疾病EORTC生活品質量表簡介．台灣醫學，6（2），220–227。[Chie, W. C., Yang, C. H., Hsu, C., & Lai, C. C. (2002). Introduction of the EORTC disease-specific quality of life questionnaires for cancer patients. Formosan Journal of Medicine, 6(2), 220–227.]

Alacacioglu, A., Binicier, O., Gungor, O., Oztop, I., Dirioz, M., & Yilmaz, U. (2010). Quality of life, anxiety, and depression in Turkish colorectal cancer patients. Supportive Care in Cancer, 18(4), 417–421. doi:10.1007/s00520-009-0679-2