口腔癌病患手術重建及放射線治療期間照護需求改變及相關因素之探討 — 長期追蹤研究

The Changes of Care Needs and Its Correlated Factors in Oral Cancer Patients Receiving Surgery and Radiotherapy Cross Over Treatment Period — Longitudinal Study

陳淑卿(Shu-Ching Chen)

指導教授 ： 林佳靜

共同指導教授 ： 賴裕和(Yeur-Hur Lai)

臺北醫學大學/醫學院/醫學科學研究所/博士(2008年)

摘要

口腔癌是台灣高盛行率的癌症，主要以手術及放射線治療為主，此類病人以青壯年人口居多，病人從診斷的衝擊、經歷切片手術治療，往往造成病人身心極大的衝擊。本研究主要目的為：(一)探討口腔癌病患接受手術重建及放射線治療期間身體困擾之改變 (身體活動功能狀態、症狀嚴重度、口腔疼痛嚴重度、傷口狀況)。(二)探討口腔癌病患接受手術重建及放射線治療期間心理困擾之改變 (疾病衝擊、焦慮、憂鬱)。(三)探討口腔癌病患接受手術重建及放射線治療期間不同層面照護需求之改變。(四)控制〝時間〞，探討口腔癌病患手術重建及放射線治療期間疾病相關因素(年齡、診斷分期)、身體困擾之改變 (身體活動功能狀態、症狀嚴重度、口腔疼痛嚴重度、傷口狀況)、心理困擾之改變 (疾病衝擊、焦慮、憂鬱) 對不同層面照護需求的預測因子。研究採前瞻性縱貫性研究設計，共有5次收案時間點，分別為出院當天(T0)、放射線治療前(T1)、放射線治療第四週結束時(T2)、放射線治療結束時(T3)、放射線治療結束後四週(T4) 以“癌症需求量表精簡版”、“身體功能狀態量表”、“症狀嚴重度量表”、 “UCSF口腔癌疼痛量表”、 “傷口狀況評估表”、及“醫院焦慮憂鬱量表”，分別評估病人在出院當天、放射線治療前、放射線治療第四週結束時、放射線治療結束時、放射線治療結束後四週不同時間點的身體困擾、心理困擾、及不同層面照護需求變化情形。收案地點於北部某醫學中心耳鼻喉科病房、重建整形外科病房、及放射腫瘤科門診，針對符合收案條件之口腔癌病人進行方便取樣。研究資料以描述性統計及廣義估計方程式 (General Estimating Equation, GEE) 等方式進行分析，共收得54位個案，研究結果發現：(一)身體困擾的變化，放射線治療結束時身體活動功能、症狀嚴重度、口腔疼痛強度達到最高峰，放射線治療結束時最為嚴重的症狀為食慾問題、口腔不舒服、吞嚥困難、疼痛、及疲倦問題，而傷口狀況隨時間有逐漸癒合的趨勢。(二)心理困擾的變化，放射線治療結束時疾病衝擊、焦慮、憂鬱達到最高峰。(三)照護需求的變化，放射線治療結束時除人際溝通照護需求之外，其他的照護需求：身體與日常生活照護需求、心理照護需求、醫療支持與照顧照護需求、健康照顧相關訊息照護需求、口腔癌疾病相關照護需求均達到最高峰。(四)照護需求的預測因子，(1)年齡越輕、傷口癒合情況越差、疾病衝擊越強烈、焦慮程度越嚴重、憂鬱程度越低其整體照護需求程度越高。(2)傷口癒合情況越差、症狀嚴重度越嚴重其身體與日常生活照護需求程度越高。(3)身體活動功能越差、傷口癒合情況越差、疾病衝擊越強烈、焦慮程度越嚴重其心理照護需求程度越高。(4)年齡越輕其人際溝通照護需求程度越高。(5)傷口癒合情況越差、疾病衝擊越強烈其醫療支持與照護需求程度越高。(6)年齡越輕、傷口癒合情況越差、疾病衝擊越強烈、焦慮程度越嚴重、憂鬱程度越低其健康照顧相關訊息照護需求程度越高。(7)年齡越輕、口腔疼痛越嚴重其口腔癌疾病相關照護需求程度越高。本研究結果證實口腔癌病患在放射線治療期間會經歷到身體困擾、心理困擾、及照護需求，可提供專業人員更多照護訊息，發展適合的護理措施協助症狀處理、情緒支持鼓勵，以協助病患面對放射線治療期間的身體困擾、心理困擾、照護需求之護理措施。

關鍵字

口腔癌 ； 手術 ； 放射線治療 ； 照護需求 ； 身體困擾 ； 心理困擾 ； 縱貫性研究

並列摘要

Oral cancer is one of the major cancers in Taiwan. Surgery and radiotherapy are major treatment. These oral cancer patients are mostly younger and meridian population, patient had experience physical and psychological distress from diagnosis, biopsy, and treatment. The purposes of the study were to (1) explore the physical distress (performance status, symptom severity, pain, and wound status) changes in oral cancer patients receiving surgery and radiotherapy. (2) explore the psychological distress (disease impact, anxiety, and depression) changes in oral cancer patients receiving surgery and radiotherapy. (3) explore the each domain care needs changes in oral cancer patients receiving surgery and radiotherapy. (4) explore the predictive factors of disease related factors (age, cancer stage), physical distress (performance status, symptom severity, pain, and wound status), psychological distress (disease impact, anxiety, and depression) for each domain care needs, under control “time” variable. This study is a prospective longitudinal design five times of data collection time point will be arranged to collect data. It includes Discharge Day (T0), Day before Radiotherapy (T1), Complete 4 Week Radiotherapy (T2), Complete Radiotherapy (T3), and Complete Radiotherapy 4 Week (T4). Patients will be also assessed by using Cancer Needs Questionnaire short-form (CNQ-SF), Karnofsky Performance Status Index (KPS), Symptom Severity Scale (SSS), UCSF Oral Cancer Pain Questionnaire (UCSF OCPQ), Bates-Jensen Wound Status Tool (BWST), and Hospital Depression and Anxiety (HADS) in T0, T1, T2, T3 and T4. Patients will be recruited from ENT inpatient ward, plastic surgery inpatient ward, and radiationtherapy outpatient department of a medical center at Northern Taiwan. A total of fifty-four eligible subjects were recruited by convenience sampling. Data was analyzed by descriptive statistics, and General Estimating Equation (GEE). The results were as following: (1) physical distress, the peak level of physical performance, symptom severity, and oral pain intensity were in the complete radiotherapyand it decrease in the complete radiotherapy 4 week, the major physical distress were lose of appetite, oral mucositis, swallowing difficulty, pain, and fatigue, however, wound condition was healing progressively by the time. (2) psychological distress, the peak level of disease impact, anxiety, and depression were in the complete radiotherapyand it decrease in the complete radiotherapy 4 week. (3) care needs, the peak level of care needs except the interpersonal communication care needs, including the physical and daily living care needs, psychological care needs, patient care and support care needs, health information care needs, and oral cancer related care needs were in the complete radiotherapyand it decrease in the complete radiotherapy 4 week. (4) the predictive factors of care needs, patients with younger age, poor wound healing, higher disease impact, anxiety, lower depression had more likely overall care needs; patients with poor wound healing, higher symptom severity had more likely physical and daily living needs; patients with lower performance status, poor wound healing, higher disease impact, anxiety had more likely psychological needs; younger age patients had interpersonal communication care needs; patients with poor wound healing, higher disease impact had more likely patient care and support care needs; patients with younger age, poor wound healing, higher disease impact, and anxiety, lower depression had more likely health information care needs; patients with younger age, higher oral pain intensity had more likely oral cancer related care needs. Results of this syudy supported that physical distress, psychological distress, and care needs are common experienced problem in oral cancer patients received radiotherapy. The results of this study provide more information to medical professionals to develop adaptable nursing interventions when patients need symptom management, emotional supports and encouragements, and to help patients to cope the physical and psychosocial distress.

並列關鍵字

oral cancer ； surgery ； radiotherapy ； care needs ； physical distress ； psychological distress ； longitudinal study.

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