早期肺癌病人術後一年間害怕癌症復發之軌跡與相關因素探討

多年來肺癌已高居國人癌症死因第一位。醫療科技的進步使存活率的大幅提升，但也促使癌症存活者開始面臨害怕癌症復發問題，同時影響病人生活品質。目前並無早期肺癌病人害怕癌症復發之縱向軌跡與影響因素之研究結果，因此，本研究之目的乃在探索早期肺癌病人術後一年間之：（一）害怕癌症復發整體軌跡及其潛在次型態軌跡；（二）害怕癌症復發之整體病人及次型態病人之重要影響因子。本研究為前瞻性縱貫性研究設計，於台北市某醫學中心胸腔外科門診，連續取樣方式，以結構式問卷評估病人於術後三（T1）、六（T2）、十二個月（T3），共3個時間點之自我陳述資料，再以統計方式(一)潛在類別成長模式:進行害怕癌症復發整體軌跡及其潛在次型態軌跡探索，以及(二)廣義估計方程式:進行害怕癌症復發之整體與潛在次型態之相關因子探討。研究結果首先以害怕癌症復發之臨界程度（cut-off point）為13’來看，整體軌跡呈現先增加後減輕之二次變化；三至六個月（T1-T2）達臨界程度以上之害怕癌症復發（≥13’）；六至十二個月（T2-T3）仍接近臨界程度（13’），而年輕、疲倦及不確定感為長期預測因子。此外，共有三個次型態軌跡於本研究中被發現。分別為低度害怕復發型（29.71 %），呈低而穩定程度之害怕癌症復發，而教育程度、輔助治療、身體功能、疲倦及不確定感為長期預測因子。中度害怕復發型（46.88 %），為先增加後減輕之二次變化型態，高峰期在術後六個月（T2），達臨界程度以上之害怕癌症復發，而疲倦及不確定感為長期預測因子。高度害怕復發型（23.41 %），則呈高度穩定之高程度害怕癌症復發，平均分數超越臨界程度許多，而教育程度、呼吸困難及不確定感為長期預測因子。此外，我們發現與時間相依之重要影響因子包括不確定感，疲勞和呼吸困難在本研究中扮演重要角色。病人有較高的不確定感，疲勞和呼吸困難則其害怕癌症復發程度較高。本研究結論為早期肺癌術後病人常處於臨床顯著程度之害怕癌症復發程度。年齡、教育程度、輔助治療、身體功能、疲倦、呼吸困難及不確定感等為其重要影響因素。結果可提供臨床照護參考藉以發展整體以及個別性之照護計畫與介入時間之參考，以提升癌症照護品質。

關鍵字

肺癌；害怕癌症復發；軌跡

並列摘要

Lung cancer has been the leading cause of cancer death for many years in Taiwan. The advancement of medical technology has greatly improved the survival rate, but it also prompted cancer survivors to face the problem of fear of cancer recurrence（FCR）, while affecting the quality of life of patients. However, there are lack of research on the long-term changes and influencing factors of early lung cancer patients’ fear of cancer recurrence. Therefore, for the early stage lung cancer patients during the first year after surgery, the purpose of this study was to explore: (a) the overall longitudinal trajectory and potential sub- trajectories of fear of cancer recurrence; (b) the factors that predict fear of cancer recurrence in overall patients and subgroups after cancer surgery. A prospective longitudinal design with consecutive sampling was conducted to recruit those diagnosed with early stage lung cancer patients after surgery in a medical center in Northern Taiwan. Three measurements including 3(T1), 6(T2), 12(T3) months after surgery were collected by structured questionnaires to explore the levels of FCR. The statistical analysis were used including: (a) the latent class growth model（LCGM）was adopted to describe the longitudinal trajectory of overall FCR, and to explore the distinct sub-trajectories of FCR; (b) the generalized estimating equations（GEE）was used to identify the factors associated with overall FCR and subgroups. The results reported that a clinically significant levels of the overall FCR trajectory during the study period, which revealed a quadratic change over the study period; that increased over time from T1 to T2, and then decreased over time from T2 to T3. Younger, fatigue and uncertainty were the long-term predictors. A total of three sub-trajectories were found in this study. Low-FCR group（29.71%）, showing stayed low over time; educational level, adjuvant therapy, physical function, fatigue and uncertainty were the long-term predictors. Moderate-FCR group（46.88 %), which was displayed a similar pattern with overall FCR（a quadratic change）. The peak was at 6 months(T2) after surgery, and exceeded clinically significant level(13’)；fatigue and uncertainty were the long-term predictors. High -FCR group（23.41%）, showing stayed high score over time in FCR；education level, dyspnea, and uncertainty were the long-term predictors. In addition, we found time-varying variables including uncertainty, fatigue, and dyspnea were played the vital role in the study. Patients appeared higher uncertainty, fatigue, and dyspnea were represented higher FCR. The conclusion of this study is that patients with early stage lung cancer are often at clinically significant levels of FCR. Age, education, adjuvant therapy, physical function, fatigue, dyspnea and uncertainty are important factors related to FCR. The results can provide time references to provide tailored care plans and interventions for patients, and further to improve the quality of cancer care.

並列關鍵字

lung cancer ； fear of cancer recurrence ； trajectory

參考文獻

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早期肺癌病人術後一年間害怕癌症復發之軌跡與相關因素探討

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