胰臟癌病患術後十二個月內營養狀態、疲憊與生活品質之相關性探討

Relationship among Nutritional Status, Fatigue and Quality of Life in Patients with Pancreatic Cancer Within Twelve Months after Pancreatectomy

許齡方(Ling-Fang Hsu)

指導教授 ： 孫秀卿

國立臺灣大學/醫學院/護理學研究所/碩士(2022年)

https://doi.org/10.6342/NTU202200357

摘要

背景：胰臟腫瘤切除手術是唯一能使胰臟癌治癒的治療方法，過去研究多著重於探討胰臟癌術後營養狀態、疲憊程度及生活品質之變化。然而，術後12個月胰臟癌術後疲憊對於病患之營養狀態與生活品質之改變所扮演的角色其相關機轉仍不甚明瞭，其三者之相關性亟待探討。
目的：瞭解胰臟切除術後十二個月內胰臟癌病患營養狀態、疲憊和生活品質之改變，並探討影響胰臟切除術後胰臟癌病患生活品質之影響因子中，疲憊在營養狀態及生活品質間所扮演的角色。
方法：本文為次級資料分析，採縱貫性、相關性研究設計。原研究採立意取樣，於北部某醫學中心之胰臟外科門診追蹤之胰臟癌術後病患為收案對象，本研究擷取其部分資料，樣本數共為89人。資料收集時間為術前、術後3、6、12個月共4次，以測量身體組成成分、上下肢肌力及迷你營養量表（Mini Nutritional Assessment, MNA）評估受試者之營養狀態。使用疲倦症狀量表（Fatigue Symptom Inventory, FSI）評估其疲憊程度及癌症治療功能性評估一般量表（The Functional Assessment of Cancer Therapy-General, FACT-G）評估其生活品質，並以自擬之基本人口學與疾病治療資料表收集受試者之基本資料。以IBM SPSS Statistics 26.0版進行資料分析，統計方式包含描述性統計、無母數檢定、Spearman等級相關、廣義估計方程式與Sobel中介效果檢定。
結果：胰臟癌病患之營養狀態術前至術後12個月之改變具有顯著差異。其中術前體重（60.45±11.44公斤，p<0.01）及手部平均握力（26.07±9.18公斤重，p=0.02）術前顯著高於術後3、6、12個月；30秒坐站平均次數最低為術前18.55±6.56次，術後6、12個月分別為20.72±8.90次、20.67±7.20次，顯示術前至術後為上升趨勢，但在統計上並無顯著差異；迷你營養量表平均總分術後3個月顯著低於術前、術後6、12個月（23.27±3.34分，p<0.01）。在疲憊方面，術後3個月之疲憊總分（平均21.91±23.88分，p=0.35）、最疲憊的程度（平均3.50±2.88分，p=0.49）、平均的疲憊程度（平均2.21±1.96分，p=0.25）、疲憊干擾（平均1.25±1.95分，p=0.19）、一星期疲憊天數（平均2.8±2.66天，p=0.12）、一天中疲憊時間（平均2.54±2.68，p=0.12）皆高於術前、術後6、12個月之分數，然而在統計上無顯著差異。在生活品質方面，術前生理健全（平均3.23±0.76分，p=0.18）、情緒健全（平均2.59±0.95分，p<0.01）與生活品質總分（平均77.19±14.12分，p=0.42）與術後3、6、12個月相比為最低分，術後3個月至12個月呈現上升趨勢；在社交／家庭健全部分，在術後6個月（平均3.18±0.77分）高於術前（平均3.14±0.78分）、術後3個月（平均3.14±0.74分），然而在統計上並無顯著差異（χ2=3.58、p=0.31）。在功能健全方面，最高分為術前（平均2.89±0.86分）、最低分為術後3個月（平均2.50±0.81分），術後12個月（平均2.84±0.91分）大致恢復至術前水準，但在統計上未有顯著差異（χ2=7.92、p=0.05）。胰臟癌病患術後12個月內手部平均握力及迷你營養量表評估之整體營養狀態與疲憊呈現負相關；體重、手部平均握力及迷你營養量表評估之整體營養狀態與生活品質呈現正相關；疲憊與生活品質呈現負相關。疲憊在手部平均握力與生活品質間存在完全中介效果（t=2.70，p<0.01），在迷你營養量表評估之整體營養狀態與生活品質間存在部分中介效果（t=4.40，p<0.01）。
結論：本研究結果顯示手部平均握力及整體營養狀態與疲憊呈現負相關、疲憊與生活品質呈現負相關，疲憊為手部平均握力、整體營養狀態之中介變項。建議未來在臨床照護及學術研究方面，可以提升手部肌力為介入措施，了解手部肌力於胰臟癌術後病患疲憊之緩解及生活品質之改善。目前國內外未有胰臟癌術後病患營養狀態、疲憊與生活品質之中介模型，本研究結果可提供臨床上照護相關族群之醫護人員參考。

關鍵字

胰臟癌 ； 胰臟切除術 ； 營養狀態 ； 疲憊 ； 生活品質 ； 中介效果

並列摘要

Background: Pancreatic tumor resection is the only curative treatment for pancreatic cancer. In the past, most studies have focused on the changes in nutritional status, fatigue, and quality of life after pancreatic surgery. The role of post-operative fatigue in the nutritional status and quality of life of patients is still unclear, and the correlation between the three needs to be explored urgently.
Purpose: To understand the changes in nutritional status, fatigue, and quality of life of pancreatic cancer patients one year after pancreatectomy within 12 months after surgery, and to explore the factors that affect the quality of life of pancreatic cancer patients after pancreatectomy and the role of fatigue between nutritional status and quality of life.
Methods: This article is a secondary data analysis and adopts a longitudinal and correlational research design. In the original study, intentional sampling was adopted, and patients after pancreatic cancer surgery were tracked in the pancreatic surgery clinic of a medical center in northern Taiwan. The data collection time was before surgery, 3, 6, and 12 months after surgery. Body composition, handgrip strength, 30 seconds sit-to-stand test, and Mini-Nutrition Assessment scale (MNA) were used to evaluate the nutritional status of subjects. Fatigue Symptom Inventory (FSI) was used to assess their degree of fatigue and The Functional Assessment of Cancer Therapy-General (FACT-G) was used to assess their quality of life. The basic information of the subjects was collected with the structured questionnaire. Data analysis was performed with IBM SPSS Statistics version 26.0. The statistical methods included descriptive statistics, Friedman test, Wilcoxon signed-rank test, Spearman's rank correlation, Generalized Estimating Equation, and Sobel's test.
Results: The nutritional status of pancreatic cancer patients varied significantly from preoperatively to 12 months postoperatively. Among them, body weight (60.45±11.44 kg, p<0.01) and handgrip strength (26.07±9.18 kgw, p=0.02) before surgery were significantly higher than that at 3, 6, and 12 months after surgery; the value of 30 seconds sit-to-stand test was 18.55±6.56 times before operation, which is the lowest, 20.72±8.90 times and 20.67±7.20 times at 6 and 12 months after the operation, showing an upward trend from preoperative to postoperative, but no statistically significant difference; the Mini Nutritional Assessment at 3 months postoperatively (23.27±3.34 points, p<0.01) was significantly lower than before surgery, 6 and 12 months after surgery. In terms of fatigue, the total fatigue score (21.91±23.88 points, p=0.35), the most fatigued degree (3.50±2.88 points, p=0.49), the average fatigue degree (2.21±1.96 points, p=0.25), fatigue disturbance (1.25±1.95 points, p=0.19), fatigue days in a week (2.8±2.66 days, p=0.12), fatigue time in a day (2.54±2.68, p=0.12) at 3 months postoperatively were higher than the scores before surgery, 6 and 12 months after surgery, but there was no statistically significant difference. In terms of quality of life, preoperative physical well-being (3.23±0.76 points, p=0.18), emotional well-being (2.59±0.95 points, p<0.01), and total quality of life score (77.19±14.12 points, p=0.42) compared with 3, 6, and 12 months after the operation was the lowest, and showed an upward trend from 3 months to 12 months after the operation. Social/family well-being at 12 months postoperatively (3.10±0.70 points, p=0.31) was the lowest within follow-up, and functional well-being at 3 months postoperatively (2.50±0.81 points, p=0.05) compared with preoperative, 6, and 12 months postoperatively was the lowest. In patients with pancreatic cancer within twelve months after pancreatectomy, handgrip strength and overall nutritional status tested by MNA were negatively correlated with fatigue; bodyweight, handgrip strength, and overall nutritional status tested by MNA were positively correlated with quality of life, and fatigue was negatively correlated with quality of life. There is a complete mediating effect between fatigue handgrip strength (t=2.70，p<0.01) and quality of life, and there was a partial mediating effect between the overall nutritional status and quality of life (t=4.40, p<0.01).
Conclusion: The results of this study show that the handgrip strength and overall nutritional status are negatively correlated with fatigue, and fatigue is negatively correlated with quality of life. Fatigue is a mediating variable between handgrip strength, overall nutritional status, and quality of life. It is suggested that the enhancement of handgrip strength may relieve fatigue and improve the quality of life in patients after pancreatic cancer surgery, and further research is needed. At present, there is no mediation model of nutritional status, fatigue, and quality of life in patients with pancreatic cancer after surgery. The results of this study can provide a reference for medical staff who care for relevant groups in clinical practice.

並列關鍵字

pancreatic cancer ； pancreactectomy ； nutritional status ； fatigue ； quality of life ； mediation effect

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