癌症病患化學治療期間身心困擾相關因素探討

本研究目的主要探討癌症病患在化學治療期間的症狀困擾、焦慮、憂鬱及其相關因素之關係。採橫斷式相關性研究設計，並以結構式問卷收集資料，自2013年9月4日至2014年2月26日採立意取樣方式，研究樣本取自於南部某醫學中心癌症中心門診目前正接受化學治療之癌症病患共計242位。研究工具包括基本資料問卷、症狀困擾量表(SDS scale)、情境-特質焦慮量表(STAI scale)、流行病學研究中心憂鬱量表(CESD scale)及社會支持量表（ISEL scale），以SPSS 21.0套裝軟體統計分析，並將所得資料以描述性統計及推論性統計進行分析。結果顯示癌症病患在化學治療期間最常發生之五項症狀困擾依序為:「外觀改變」、「疲倦」、「食欲不振」、「口乾」、「失眠」。在化學治療期間有56.6%癌症病患有中度焦慮及49.6%有憂鬱情形，其症狀困擾與焦慮、憂鬱及來自醫護人員社會支持三者呈顯著正相關。迴歸分析發現有三個預測因子(依序為疼痛程度、性別及主要照顧者)共可解釋癌症病患於化學治療期間症狀困擾總變異數之27%，有二個預測因子(依序為症狀困擾及主要照顧者)共可解釋癌症病患於化學治療期間焦慮總變異數之21%，有七個預測因子(依序為焦慮、症狀困擾、職業、注射血管種類選擇、來自醫護人員社會支持、疼痛程度及性別)共可解釋癌症病患於化學治療期間憂鬱的總變異數為59.4%。本研究結果期望可以提供給醫療專業人員了解癌症患者的在化學治療期間除了身體症狀困擾外，應其注重心理之需求及社會性支持提供；實證資料亦可提供臨床護理人員及癌症個案管理師能適時提供個別及適當的照護參考，減少因身心困擾症狀中斷化學治療的情形，使其能以正向的態度面對疾病並順利完成整個治療的療程。

關鍵字

癌症病患；化學治療；症狀困擾；焦慮；憂鬱；社會支持

並列摘要

This study was to examine the relationship between symptom distress, anxiety, social support and depression among cancer patients receiving chemotherapy (CT). Using a cross-sectional design, 242 patients who were diagnosed cancer, and recruited from a medical center in southern Taiwan. Data was collected from September 4, 2013 to February 26, 2014 by face to face interview using a self - reported structured questionnaires. Outcome measurements included symptom distress, situational - Trait Anxiety Inventory (STAI scale), the Social Support Scale (ISEL scale), and Center for Epidemiologic Studies Depression Scale (CESD). The results indicated that top five symptom distress items as ordering were the appearance of change, fatigue, loose appetite, dry mouth, and Insomnia. 56% cancer patients were suffering from moderate anxiety and the prevalence of depression was 49.6%. There were a significant positive correlation between the severity of distress, anxiety, depression, and the social support (from health caregiver). In stepwise regression model, three factors were the predictors of symptom distress, included pain level, gender, and primary caregiver, and account for 27.1% total variance. Two factors were the predictors of anxiety, included symptom distress, and primary caregiver, and account for 21.1% total variance. Seven factors were the predictors of depression, included anxiety, symptom distress, Job, CT infusion route choice, support from health caregiver, pain level, and gender, and account for 59.4% total variance.This study might provide healthcare professionals to understand the various symptoms of cancer patients during chemotherapy, and aware to pay attention to the psychological and social support needs of these cancer patients. Health care professionals are responsible to provide appropriate nursing intervention to decrease the symptom distress, and to improve patient’s anxiety, and depression.