癌症惡化對頭頸癌倖存者疾病適應的影響之追蹤研究─探討害怕復發、負向情緒與因應型態的效果

The Prospective Study of the Influence of Cancer Progression on Head and Neck Cancer Survivors’ Illness Adaptation: the Effect of Fear of Recurrence, Negative Emotions, and Coping Styles.

陳惠翎(Hui-Ling Chen)

指導教授 ： 洪福建

中原大學/理學院/心理學研究所/碩士(2013年)

https://doi.org/10.6840/cycu201300353

摘要

研究背景與目的：隨著醫療檢驗及治療技術之進步，癌症存活率的提升與慢性病化趨勢，使得癌症倖存者終其一生需面對癌症壓力，影響整體疾病適應。本研究依據共通信念模式的概念，將害怕復發與負向情緒分為認知和情緒兩平行路徑，探討癌症倖存者的壓力因應歷程，了解此歷程如何影響疾病適應結果(健康生活品質)，並探討癌症惡化經驗對以上因素的影響。
研究方法：本研究為順溯式研究設計，研究對象為追蹤賴世華(2010)於北部某醫學中心放射腫瘤科門診研究之207位患者，有效問卷共有120份。研究工具為「基本資料表」、「簡明因應量表」、「害怕惡化量表」、「醫院焦慮憂鬱量表」及「癌症治療指標之功能性評估表」等五份問卷。
研究結果：惡化經驗、疾病心理表徵、因應與疾病適應結果間存在顯著關聯性。主要研究結果如下：(1)惡化組與未惡化組在害怕復發、負向情緒和健康生活品質上達顯著差異，惡化經驗對整體疾病適應歷程具有負向影響效果。(2)負向情緒與逃避情緒因應有最高正相關，害怕復發亦受到伴隨而來的負向情緒影響，與逃避情緒因應的正相關最高；控制負向情緒的影響後，高害怕復發與積極主動的問題焦點因應和主動情緒因應的正相關顯著高於逃避情緒因應。(3)問題焦點因應和主動情緒因應會增加害怕復發對健康生活品質的預測力，而逃避情緒因應為憂鬱和健康生活品質的中介因子；整體壓力因應歷程中，兩時間點的害怕復發、負向情緒和第一時間點的因應型態能顯著預測第二時間點的健康生活品質。
討論：本研究發現惡化經驗、害怕復發和負向情緒為影響癌症倖存者健康生活品質的重要因子，且共通信念模式中的認知和情緒因應路徑獲得進一步的支持。藉由改善害怕復發和負向情緒來協助癌症倖存者的疾病適應，可做為未來研究和臨床介入之建議。

關鍵字

害怕復發 ； 健康生活品質 ； 癌症惡化 ； 因應型態 ； 負向情緒 ； 頭頸癌

並列摘要

Background and purpose: Advances in the early medical detection and cancer treatment resulted in increased survival rates and led cancer as a chronic illness. As the result, cancer survivors faced the stress of cancer across life span and affected their illness adaptation. The purpose of this study was to use Leventhal’s common sense model (CSM) to explore the fear of recurrence (FoR), negative emotions and coping styles in cancer survivors’ stress-coping process which had an impact on health related quality of life (HRQOL) and also to examine the influence of cancer progression on these factors.
Methods: A prospective design was used in this study. One hundred and twenty participants were recruited from head and neck cancer patients in Lai’s (2010) research. Participants completed the Personal Demographic Data, the Brief Coping Orientations to Problems Experienced Scale (Brief COPE), the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy Scale-Head and Neck(FACT-H & N).
Results: There were significant correlations among cancer progression, mental representation of illness (FoR and negative emotions), coping styles, and HRQOL. The major findings were as follows: (a) FoR, negative emotions and HRQOL showed a difference between the progression group and the progression-free group. The experience of cancer progression had a negative impact on cancer survivors’ stress-coping process. (b) Negative emotions were most highly associated with avoidant emotional coping. Also, FoR with the impact of negative emotions was most highly associated with avoidant emotional coping. When controlling for negative emotions, FoR was most highly associated with problem-focus coping and active emotional coping than avoidant emotional coping. (c) At follow-up, problem-focus coping and active emotional coping elevated the effect of FoR on HRQOL. Avoidant emotional coping was a mediator of the relations between depression and HRQOL. At whole stress-coping process, Coping styles at baseline, FoR and negative emotions at follow-up and baseline could significantly predict HRQOL at follow-up.
Discussions: Findings of this study showed that cancer progression, FoR and negative emotions were determinants of HRQOL. There was evidence to support the idea about the cognitive and emotional processes in CSM. Helping cancer survivors’ illness adaptation by lessening FoR and negative emotions may prove to be a useful suggestion for future research and clinical interventions.

並列關鍵字

negative emotions ； head and neck cancer ； fear of recurrence ； health related qulity of life ； coping styles ； cancer progression

參考文獻

邱素鳳(2011)。對罹病自責的乳癌患者自我寬恕、因應、情緒與生活品質的研究(未出版之碩士論文)。中原大學，桃園縣。

蔡紫暄(2010)。口腔癌患者術後症狀困擾、憂鬱、生活品質之相關探討(未出版之碩士論文)。高雄醫學大學，高雄市。

陳佩英、郭素青、張惠甄、徐一瑱、林麗玉、楊桂美(2004)。口腔癌術後病患之身心症狀與調適。安寧療護，9(2)，153-164。

羅淑芬、胡文郁(2008)。癌症病人健康相關生活品質之概念與測量工具之評析。安寧療護雜誌，13(1)，42-57。

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)，17-25。