研究背景與目的 癌症患者主觀最常抱怨的症狀是疲勞(fatigue),但患者鮮少對醫療人員提出抱怨,因患者認為醫療處置未能提供改善的成效,但疲勞在諸多研究中卻被認為會嚴重影響後續的生活品質(quality of life),因此本研究欲以心理學觀點探討有關癌症關連疲勞的議題,從具有癌症特殊性的疾病表徵、情境特殊性的情緒狀態與個人穩定性的因應機制等概念做為基礎,探討復發擔憂(Fear of Recurrence,FOR)、負向情緒狀態與因應型態,對癌症關連疲勞的影響。 研究方法 本研究根據立意取樣方式決定參與之受試者,研究對象為頭頸部癌症患者。收案來源以桃園某醫學中心放射腫瘤科門診病患。研究工具為問卷的形式,共包含六個部份,分別為:基本資料、害怕惡化量表、簡明因應量表(Brief COPE)、醫院焦慮憂鬱量表(Hospital Anxiety and Depression Scale, HADS)、中文版癌症疲勞量表(Chinese versions of the Cancer Fatigue Scale,CFS)。完成全部量表需20至25分鐘左右,正式研究中共222人願意填寫問卷,有效問卷共213份,有效率達88%,其中男性為165人,女性為48人平均年齡為53.73歲,平均存活月數為55.94個月。其中罹患癌症部位為:鼻腔共107人(50.2%)、口腔31人(14.6%)、咽喉23人(10.8%)、舌部17人(8.0%)、其他部位32人(10.5%)及未知部位共3人(1.4%)。 研究結果 研究結果如研究假設所示,復發擔憂會影響癌症關連疲勞,且因應型態及負向情緒均為中介變項,且也因應型態也會影響癌症關連疲勞,而負向情緒狀態為兩者間的中介變項。 由迴歸分析得知使用趨近因應型態能減少因復發擔憂所帶來的疲勞感,相反的使用逃避因應型態則會增加疲勞反應,此與過乳癌等其他相關癌症研究結果相似;復發擔憂所帶來的憂鬱及焦慮情緒均會使得疲勞感增加;最後不管趨近或逃避因應型態的使用均會增加負向情緒狀態而使得癌症關連疲勞增加。 討論 本研究結果說明,以頭頸部癌症患者為例,影響癌症關連疲勞的因素不囿於生理因素,而心理因素也佔了相當重要的一部份,其中本研究所使用的復發擔憂的疾病表徵,便為一個重要的因素。頭頸部癌症患者在面臨復發擔憂所產生的疲勞會使用各種方式去因應,雖有效果,但卻不及復發擔憂所帶來強烈的負向情緒困擾所增加的疲勞感;同時患者不因治癒時間越久,復發擔憂所產生的癌症關連疲勞有所減少,顯示在其中仍有其他可能的因素在其中有待未來持續探討。
Fatigue was the most complaint in cancer patients but they were rarely talking to their physicians. One of the reason s for not communicating was that they thought physicians could not solve this problem. However, there was a quantity of research reporting fatigue has its effect on the quality of life (QoL). In this research we use cancer related illness representation (fear of recurrence), emotion states (anxiety & depression) & coping approach(approach & avoidance) in common sense model (CSM) which seeks to understand how these factors impact Cancer related Fatigue (CRF). Participants were previously diagnoses with head and neck cancer and agreed to answer questioners who were understanding, had obtained informed consent and did not violate personal right. But excluded psychiatry history and they could not use any verbal or non-verbal communication. Participants use semi-structured, self-reporting to fill with Demographic & clinical data. Brief COPE scale, FoP-Q-SF, HADS, CFS-Chinese version. These scales needed about 20-25 minutes to filling up. We collected 222 participants who agreed to write a questionnaire, but excluded nine questionnaires that did not respond, Thvs we had 213 valid questionnaires, Most of these participants were male(165, 77.5%) and they ranged in age from 18 to 82 years old, with a mean age of 5.73 years old(SD=10.9). All subjects finished their treatment. They were diagnosed cancer location that were nasal (107, 50.2%), oral (31, 14.6%), throat (23,10.8%), tongue cancer (17, 8.0%), other cancer(32, 10.5%), & missing (3, 1.4% .). Fear of recurrence (FOR) had direct effect with Cancer Related Fatigue (CRF). And Fear of recurrence (FOR) contributed to fatigue indirectly, whilst negative emotion & coping approach was mediated. Negative emotions (anxiety & depression) ehanced cancer related fatigue, causing fear of recurrence strongly in head and neck cancer. Approach coping reduced fatigue, and avoidance coping had enhanced fatigue. This result was consistent with previous studies. But we found two special phenomenona. The first was that no matter what kind coping approach was used, we still improved cancer related fatigue. The second was that cancer related fatigue did not reduce by time. Instead, Cancer related Fatigue (CRF) will be increase over time by Fear of Recurrence. The results proved to impact factors of cancer related fatigue was not confined to physiological factors. Psychological factors also played a very important part of it. In this research we found Fear of recurrence (FOR) which is a kind of illness representation for cancer that was a factor impacting Cancer related Fatigue(CRF). Negative emotion played an importantly as a mediator in head & neck cancer and cancer related fatigue did not reduce by time. In future research we can find what factor in it and how it work
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