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  • 學位論文

探討口腔癌手術病患生活品質:系統性回顧與整合分析

Quality of Life After Oral Cancer Surgery:Systematic Review and Meta-Analysis

指導教授 : 許弘毅

摘要


研究目的 台灣地區最近幾年口腔癌佔男性十大癌症發生率的第四位,為我國青壯年(25-44 歲)男性最容易發生的癌症,而此年齡層卻是家庭經濟或是國家主要生產力來源,可見口腔癌對於家庭、社會及國家的重大影響。因此,本研究目的一為探討口腔癌病患手術前後健康相關生活品質之短期改變趨勢分析,目的二為探討口腔癌病患手術前後健康相關生活品質之長期改變趨勢分析。 研究方法 本研究乃搜集自西元1990 年1 月迄2014 年10 月,所有有關手術治療對於口腔癌病患健康相關生活品質影響的文獻。資料搜集主要包含二種方式:電腦化的資料庫搜尋和人工檢索。檢索相關研究資料庫包含:Medline、Pubmed、Cinahl、Cochrane library 及Google scholar。依據測量工具的數量統計,選取最常被使用的測量工具納入本研究: SF 36、EORTC-QLQ C30、UW-QOL 及EORTC-QLQ H&N 35。經過篩選共有11 篇文獻符合標準而納入分析。本研究使用Comprehensive meta-analysis (CMA)第二版統計軟體,以隨機效應模式整合分析取得術前術後生活品質改變趨勢。 研究結果 一、 短期改變趨勢 (一) EORTC-QLQ C30 顯示功能構面,情緒功能有極大幅度的改善,認知功能及社交功能小幅度變差,角色功能中等幅度變差,生理功能大幅度變差;症狀構面,身體疼痛有大幅度的改善,疲倦感、食慾喪失及噁心嘔吐小幅度變差。 (二) EORTC-QLQ H&N 35 顯示頭頸部疼痛有小幅度的改善,社交接觸小幅度變差,語言中等幅度變差,社交進食、張口及咳嗽有大幅度變差,吞嚥、味嗅覺、口乾及唾液黏稠則有極大幅度變差。 二、 長期改變趨勢 (一) EORTC-QLQ C30 顯示整體生活品質中等幅度變差;功能構面,認知功能中等幅度變差,角色及生理功能大幅度變差,社交功能極大幅度變差;症狀構面,身體疼痛有小幅度的改善,噁心嘔吐、呼吸困難、便祕及腹瀉小幅度變差,食慾喪失中等幅度變差,疲倦感及經濟困難大幅度變差。 (二) EORTC-QLQ H&N 35 顯示除了頭頸部疼痛有小幅度的改善,牙齒及咳嗽問題有大幅度變差,其他構面均有極大幅度變差的情形,包含吞嚥、味嗅覺、語言、社交進食、社交接觸、性生活問題、張口、口乾、唾液黏稠、及病態感。 (三) UW-QOL 顯示焦慮有小幅度的改善,疼痛有中等幅度的改善,吞嚥問題及肩部功能有中等幅度的變差,唾液分泌有大幅度變差,語言及顏面畸形有極大幅度變差。 結論與建議 綜合短期及長期改變趨勢可知疼痛及焦慮是術前最嚴重的問題,口腔癌治療所造成嚴重且持久的口腔障礙,幾乎影響了所有構面的生活品質。本研究期望提供口腔癌病患,了解術後不同時間點健康相關生活品質可能發生的生理、心理、社交及功能的損害程度,並做好心理準備。希望醫療單位能針對口腔癌手術病患,建立一套完整的照護系統,提供病患各項照護及復健。

並列摘要


Purpose In Taiwan, oral cancer is the fourth leading cause of cancer incidence and death for males in recent years. In addition, oral cancer is diagnosed at a relatively young age (25~44 year old for males). It also has great socio-economic impact on family and country. Thus, this study purposed to conduct a systematic review and meta-analysis of short- and long-term quality of life after oral cancer surgery. Methods A systematic review of clinical studies published between January 1990 and October 2014 was performed using strict eligibility criteria, including MeSH keyword and manual searching on Medline, Pubmed, Cinahl, Cochrane library and Google scholar. Key outcomes measures were post-operative HRQOL compared to pre-operative levels from four commonly used head and neck questionnaires (SF 36, EORTC-QLQ C30, UW-QOL and EORTC-QLQ H&N 35). Data were synthesized by narrative review, and random-effect meta-analysis was performed on comprehensive meta-analysis (CMA) version 2. Tau2 and I2 values and Funnel plots were analysed for consistency and bias. Results In total, eleven eligible studies were included and analyzed. In the short-term period, EORTC-QLQ C30 emotional functioning was improved drastically, bodily pain was improved largely, cognitive and social functioning were deteriorated a little, role functioning was deteriorated moderately, physical functioning was deteriorated largely. Fatigue, loss of appetite, and nausea and vomiting were deteriorated a little. EORTC-QLQ H&N35 pain was improved a little, social contact was deteriorated a little, speech was deteriorated moderately, social eating, mouth opening and coughing were deteriorated largely, swallowing, taste, dry mouth and sticky saliva were deteriorated drastically. In the long-term period, EORTC-QLQ C30 bodily pain was improved a little, overall quality of life was deteriorated moderately, cognitive functioning was deteriorated moderately, role and physical functioning were deteriorated largely, and social functioning was deteriorated drastically. Symptoms of nausea/vomiting, dyspnea, constipation and diarrhea deteriorated a little, loss of appetite deteriorated moderately, fatigue and financial impact were deteriorated drastically. EORTC-QLQ H&N 35 pain was improved a little, but teeth and cough problem were deteriorated greatly. Other symptoms were deteriorated drastically. UW-QOL anxiety was improved a littly. Pain was improved moderately, swallowing and shoulder function were deteriorated moderately, sticky saliva was deteriorated largely, and speech and appearance were deteriorated drastically. Conclusion Treatment of oral cancer can confer severe and long-lasting side effect on oral related function. Pain and anxiety were most severe problem before surgery. Health care providers should set up a series of supportive care services for oral cancer surgery patients.

參考文獻


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