術後頭頸部癌症病人之症狀群集現象

Symptom Clusters in Post-operative Patients with Head and Neck Cancer

江淑華(Su-Hua Chiang)

指導教授 ： 林佳靜

臺北醫學大學/護理學院/護理學研究所/碩士(2006年)

摘要

論文摘要 疾病症狀會干擾病患的生活功能，影響病患對於治療的需求與意願，症狀的重要性不只是干擾病人生活品質，也可以是疾病狀態、感染或治療的指標，或是提供疾病癒後的成效及存活率的預測（Hickok et al., 2005）。頭頸部癌症病人接受放射線治療導致的疼痛、口乾、睡眠障礙等相關的研究已有相當的數量，但是，較少針對放射線治療過程中症狀困擾嚴重度、症狀數及群集現象之探討，而腫瘤病人有極高的比例出現症狀群集現象。本研究之目的在於探討頭頸部癌症病人術後接受放射線治療第一至第六週其症狀困擾程度之改變情形為何？頭頸部癌症病患接受放射線治療後第一至第六週放射線累積劑量與症狀困擾的相關性為何？頭頸部癌症病患接受放射線治療後第一至第六週症狀群集現象為何？採縱貫性研究設計，研究工具為台灣版安德森症狀量表（MDASI-T），以方便取樣於北市某教學醫院進行收案，共有100位頭頸部癌症病患。以描述性統計、皮爾森相關、回歸分析、因素分析、群集分析及廣義線性模式（G.E.E）進行資料分析。結果發現治療前的症狀困擾為心裡難過、鬱悶，治療過程口乾、疼痛、睡眠混亂及沒胃口成為頭頸部癌症患者最主要的症狀困擾項目。症狀數與症狀困擾之間，以及症狀數與生活干擾總分間皆具有顯著相關，症狀數平均數為10.50。在放射線治療累積劑量上與症狀困擾總分具有統計上的意義，在放射線治療累積劑量中，累積劑量增加，則症狀困擾總分相對提高。在放射治療第一至第六週過程中噁心、呼吸急促、健忘、嘔吐、麻木感等症狀形成一個群集，而以疼痛、疲勞、睡眠混亂、鬱悶、胃口差、思睡、口乾、心裡難過等十一個癌症症狀形成另一群集。 癌症病人因為疾病本身或是治療過程常導致病人出現複雜的症狀困擾，而癌症症狀多變且成群集出現，藉著症狀群集的概念適時的提供介入措施，可以有效的緩解疾病症狀，改善病人疾病預後。

關鍵字

頭頸部癌症、症狀困擾、症狀群集

並列摘要

Abstract Symptoms may affect the function and quality of life of cancer patients and affect the patient’s compliance to cancer treatment. It’s commonly acknowledged for patients experienced pain、dry mouth、sleep disturbance during radiotherapy, but lack of knowledge about the symptom distress severity、symptom numbers and symptom cluster. A symptoms was highly prevalent across tumor types, the purpose of this study is to analysize the symptom cluster in operation head and neck cancer patients who receive radiotherapy from the first to sixth week by using a Longitudinal design study and the M.D.Anderson Symptom Inventory-Taiwan Form (MDASI-T). There are one hundred head and neck cancer patient at a medical center in Taipei were enrolled in this study. Data were analyzed using descriptive statistics, pearson’s correlation, regression analysis, factor analysis, Hierachical cluster analysis, and GEE (Gereralized Estimating Equation). Results revealed that the main symptom clusters in head and neck cancer patients during radiotherapy are sad, distress, dry mouth, pain, sleep disturbance and loss of appetite. There are correlation among the symptoms. There are correlation between numbers of symptom and symptom distress as well as numbers of symptom and symptom interference of daily life. The least numbers of symptom ranged from 5 to 13, with an average of 10.50. There is a significant relationship between radiation accumulative doses. During the first to sixth week of radiation therapy, there are two group of clusters, firstly include nausea, dyspnea, remembering, vomiting and numbness or tingling; secondly include pain, fatigue, disturbed sleep, distress, lack of appetite, drowsy, dry mouth and sad. Results from this study have provided important implications for clinical practice and future research.

並列關鍵字

Head and Neck Cancer, Symptom Distress, Symptom Clusters

參考文獻

林曜祥、任益民、李日清、林朝榮、高全祥(2002)•頭頸癌的國際疾病分類歸碼•耳鼻喉科醫學雜誌，37(4)，279-283。

陳修宜、徐茂銘(2002)•台灣地區頭頸部癌症綜論•當代醫學， 29(4)，269-272。

洪瑞隆(1998)•頭頸部腫瘤•當代醫學，25(11)，909-910。

成佳憲(2003)•癌症放射療法•台灣醫學，7(2)，242-247。

鄭鴻鈞(1998)•癌症之放射線治療•台灣醫學，2(3)，316-320。