頭頸部癌症術後存活者身體功能、症狀嚴重度與就業現況相關性之探討

Physical Function , Symptom Severity and Employment Status in Head and Neck Cancer Survivors

李雅婷(Ya-Ting Li)

指導教授 ： 賴裕和

國立臺灣大學/醫學院/護理學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.10147

摘要

台灣地區頭頸部癌症發生率已佔所有癌症發生率的第四位，頭頸部癌症主要以手術為治療方式，因治療造成的身體症狀如外觀毀損、語言溝通障礙及肩頸部功能、肌耐力、體力受損等會造成與他人互動或重回職場困難度增加，亦會造成日常生活的混亂，包括經濟危機等，此顯示出頭頸部癌症在國內所造成的嚴重社會與經濟問題。故本研究主要目的為探討頭頸部癌症病患手術治療後之存活者基本屬性、身體功能狀態、症狀嚴重度和職業現況之相關性。
本研究為橫斷式描述性相關研究，以北部地區一醫學中心腫瘤科門診和耳鼻喉外科門診之頭頸部癌症且接受外科手術治療後之存活者為可及母群體，共取得183名個案資料，以結構式問卷評估個案功能狀態，分析基本資料、疾病治療特性、症狀嚴重度、身體功能狀態、肩部功能不良之生活影響和職業現況情形，並搭配實際體適能測量，包括肌力、身體組成、柔軟度及張口程度，收集資料以描述性統計及推論式統計（邏輯式迴歸、皮爾森相關係數、獨立樣本T檢定）檢測變項間之差異及相關性。
結果發現人口學及疾病治療特性中以教育程度、年齡、治療方法影響就業機率最多；身體功能狀況及體適能測驗（肌力、頸部柔軟度及張口程度）與就業現況皆呈顯著相關，而肩部功能不良中以拿高處物品最為影響就業現況，但研究結果中，身體運動與肩頸復健運動與就業現況不達顯著，可見病患復健或運動頻率與方法、強度等正確性未達標準，故臨床照護應在治療過程中教導並監測病患復健運動執行率，維持肌力與柔軟度之狀態，以減少就業危機；在症狀嚴重度中以「講話困難」可預測就業現況，由此可知語言訓練對於就業危機之影響，藉由了解頭頸部癌症存活者就業情形與身體功能狀態、症狀嚴重度之相關性和其實質意義，根據就業問題給予症狀緩解的根本原因解決，未來研究可依據此結果，設計相關的介入措施，藉由改善生活品質提升整體臨床照護。

關鍵字

頭頸部癌症 ； 身體功能 ； 症狀嚴重度 ； 就業現況

並列摘要

The major treatment of head and neck cancer (HNC) is surgery, including neck dissection and total laryngectomy. However surgery may result in physical dysfunction that patients have potential barriers to return to work. The purpose of the study is to investigate associations between employment status, sociodemographic and disease related factors, physical function, and symptom severity in HNC patients.
This is a cross-sectional descriptive research by consecutive sampling. The eligible 183 patients after surgical operation were recruited from inpatient and outpatient otolarygology department at a medical center in Taipei. A set of structure questionnaires were used to assess patients’ status including basic information, disease and treatment characteristics, symptoms severity, physical functional, shoulder dysfunction, mouth opening, and physical fitness, including strength, body composition, and flexibility.
The results show: (1) there was significantly associated with age, education level and treatment modality between the employment. (2) the actual measurement of mouth opening, physical fitness（including strength, body composition, and flexibility）and employment status were highly significantly correlated; moreover shoulder dysfunction in the height of items to get is the most impact on employment status. (3) oral dysfunction as speech difficulties were significantly associated with employment.
The clinical care should be focus both in the treatment and rehabilitation to monitor patients exercise adherence to reduce the employment crisis; furthermore, language training will be helpful to employment. The result of this study will contribute to better insight into employment in HNC patients and potential barriers to return to work after treatment. Further physical intervention study will be helpful to improve occupational health services and patients outcome.

並列關鍵字

Head and Neck Cancer ； Physical Function ； Symptom Severity ； Employment

參考文獻

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．安寧療護雜誌，9（2），153 -164。

郭碩宗、徐茂銘（2002）．頸部淋巴廓清術的要點．當代醫學，29（4），14-18。

田沁潔、賴惠玲、許文林、彭逸稘、李茹萍（2007）．護理衛教對頭頸部癌症病人口腔照顧認知、健康信念及自我效能之成效．實證護理，3（3），215 -224

賴鵬安、邱仲峰、趙坤山、翁培豐、葉啓源（2006）．不同強度調控放射線治療計畫系統在頭頸部腫瘤結果之比較．中華放射線技術學雜誌，30（1），27 -40。

王宏銘、廖俊達、范網行、吳樹鏗、詹勝傑、閣紫宸（2009）．頭頸部鱗狀細胞癌治療的新進展．腫瘤護理雜誌，S（9），51-67。