頭頸部癌症病人於放射線治療期間之皮膚炎及相關生活品質探討

Skin Reaction and Skin-related Quality of Life in Head and Neck Cancer Patients Receiving Radiotherapy

劉景萍(Ching-Ping Liu)

指導教授 ： 賴裕和

國立臺灣大學/醫學院/護理學研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.01676

摘要

頭頸部癌症為台灣最常見之癌症之一，放射線治療是頭頸部癌症主要治療方式之一，約有95%病人會出現皮膚炎的症狀，本研究目的為探討(1) 接受放射線治療病人皮膚炎與皮膚相關生活品質於治療過程的變化，及(2)探討放射性皮膚炎及生活品質的影響因子。本研究採前瞻性縱貫式設計，以連續性取樣進行資料收集，針對首次接受放射線治療病人，從放射線治療前至治療結束，利用CTCAE 放射線治療皮膚炎評估準則，每週進行放射性皮膚炎之評估及照相，另以Skindex-16另於治療前、治療40Gy、治療結束及治療28天候進行皮膚相關生活品質調查。於台北某醫學中心進行收案，收案時間為101年5月至102年5月，收案數共計33名，其中3位病人因為出現嚴重合併症及採用冰敷照護，故未繼續收案，最後完成收案為30位病人。研究結果以SPSS 17.0版軟體，以重複測量統計瞭解症狀及生活品質差異，並以GEE統計模式，進行相關因子檢定。研究結果發現，放射性皮膚炎於治療劑量累積至40Gy，發生率及嚴重度明顯增加，於治療劑量累積至60Gy，放射性皮膚炎嚴重度及發生率最高。病人的皮膚相關生活品質干擾變化亦逐步升高，於放射線治療結束影響最高，於放射線治療完成後28天統計上已與治療前皮膚炎症狀及生活品質無差異。放射性皮膚炎與皮膚相關生活品質皆呈現二次線性關係且有顯著差異，但經由Spearman's相關性統計檢定，皮膚損傷與病人的皮膚相關生活品質無顯著相關。病人接受放射線治療期間，皮膚炎相關顯著包括年紀長及接受放射線治療期間同時接受cisplatin & 5-FU(PF)治療的病人較嚴重，皮膚相關生活品質以Skindex-16量表進行測量，女性及年紀輕較高於男性及年紀大的病人差，於症狀次量表中，放射線皮膚炎愈嚴重者，其生活品質干擾有愈大之趨勢，接近統計顯著差異(p=0.086)。本研究有助於臨床人員了解頭頸癌部癌症病人，於皮膚相關的問題可能影響因素，可做為臨床照護及未來放射線皮膚炎研究的臨床參考依據。

關鍵字

頭頸癌 ； 放射線治療 ； 放射性皮膚炎 ； 癌症治療 ； 皮膚相關生活品質

並列摘要

Head and neck cancer (HNC) is one of the major cancers in Taiwan. Currently, radiotherapy (RT) has been identified and proved to be effective to treat these patients after surgery. For HNC patient who receive RT, most of them might experience radiation induced dermatitis. However, it is lack of sufficient information about how the changes of the dermatitis and how it is related to patients’ quality are not clear. Thus, the purposes of this study were to (1) explore the changes of dermatitis severity and skin related life quality of changes in HNC patients receiving radiation therapy, and (2) identify risk factors related to the severity of dermatitis and skin related quality of life over the period from receiving RT to 1 month after RT. A prospective longitudinal study with consecutive sampling was conducted in a RT OPT treatment center in a medical center in Taipei. Newly diagnosed HNC patients who received RT were eligibly recruited. Patients were assessed once a week from pre-treatment to 4 weeks after completing RT. CTCAE radiation therapy skin assessment tool and photography taking were documented (Canon G10 general mode) every week. Skin related quality of life (QoL) was measured by the 16 item version of Skindex-16. There had 4 times data collection (Pre-radiotherapy(To), receiving 40 Gy(T1), end of RT(T2), post RT 28days(T3). A total of 30 patients eligible head and neck cancer patients were recruit from a medical center in north of Taiwan. Statistics analysis was use of SPSS 17.0 repeat measure and generalized estimating equation method.
The results show that RT induced dermatitis happened and reach to a considerable severity while accumulating the RT dosage up to 40Gy. The peak severity stage was around 60Gy. Patients reported to have RT dermatitis and skin related QoL similar as the pre-treatment stage in 4 weeks post-RT. Quadratic trend analysis of RT dermatitis and skin related QoL were significant. Patients with older age and those concurrently receiving both Cisplatin and 5-FU are the risk group to develop RT dermatitis. Overall, younger and female were found to be significant change in overall, emotion and function subscale of Skindex-16. In the symptom subscale of Skindex-16 radiation dermatitis was a borderline factor (p=0.086). Our results suggest that the changes of dermatitis during and after RT are important to be monitored. Further intervention which include those related risk factors, needs to be developed and tested to better enhance HNC patients’ QOL.

並列關鍵字

head and neck cancer ； radiotherapy ； radiation dermatitis ； cancer treatment ； skin related quality of life

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