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  • 學位論文

甲狀腺癌病人術後工作衝擊探討

Perceived Impacts on Employment in Operable Thyroid Cancer Patients

指導教授 : 賴裕和

摘要


甲狀腺癌為台灣十大癌症之一,甲狀腺癌五年相對存活率高達98.3%,其中分化型的病人占95%為大宗,近年死亡率下降,發生率卻升高,且發生的年齡大多處於工作的年紀,而且大多數病人會面臨疾病及治療對工作造成的衝擊,然而目前針對這群甲狀腺癌病患工作衝擊之干擾因子的相關研究缺乏。本研究目的為(1)了解甲狀腺癌病人術後返回職場比率(2)了解甲狀腺癌對病人工作衝擊程度(3)探討甲狀腺癌症病人術後疲憊、憂鬱、焦慮、症狀嚴重度(4)探討甲狀腺癌病人術後疲憊、憂鬱、焦慮、症狀嚴重度、重要人口學特質、疾病治療特質與工作衝擊程度的相關性。本研究方法採橫斷式研究設計,收集155個病人於病人手術後三年內在門診進行收案及評估,並以結構式問卷蒐集資料,問卷內容包含返回職場障礙量表(Illness Perceptions Questionnaire)、醫院焦慮憂鬱量表(Hospital Anxiety and Depression Scale)、疲倦症狀評估量表(Fatigue symptom Inventory)、症狀嚴重程度量表(Symptom Severity Scale)和疾病基本資料表,收集之資料以敘述性統計、斯皮爾曼相關係數檢定、無母數統計和複回歸進行分析。本研究結果顯示甲狀腺術後病人有12%病人未返回職場,而正在工作的病人79.9%覺得受到影響,但衝擊程度為輕度,其中五項超過一半以上人會面臨的工作衝擊因素依序為(1)認為癌症及治療不可預測影響工作(70%);(2)癌症及治療導致有情緒的痛苦(62.7%);(3)因癌症及治療有疲倦或感覺精疲力盡(61%);(4)認為癌症及治療導致專注力下降(54.4%);(5)認為癌症及其治療導致有身體症狀(50.7%)。另外工作衝擊程度與性別與教育程度、疲倦程度、疲倦干擾程度、焦慮、憂鬱、症狀嚴重度相關,而工作衝擊程度主要的相關因子為症狀嚴重度(β=0.44, p<0.00)、疲勞程度(β=0.18, p<0.01)、焦慮(β=0.32, p<0.00),R2=0.61。整體而言甲狀腺癌症病人雖然工作衝擊程度較其他癌症別低,但仍有部分病人呈現中高度工作衝擊程度、焦慮、憂鬱和疲倦問題,建議未來門診篩檢針對這些病人,發展進一步的介入措施,讓病人順利維持工作。

關鍵字

甲狀腺癌症 工作衝擊 症狀 焦慮 憂鬱 疲憊

並列摘要


Thyroid cancer is one of the top ten cancer in Taiwan. The 5-year survival of thyroid cancer is >98%. Differentiated thyroid cancer, which includes papillary and follicular histologies, is the most common type of thyroid cancer. It is increasing in incidence and is decreasing in mortality rate. The age of diagnosis of thyroid cancer is during working age. Many patients might face the impacts on employment because of the disease and its treatments. The purposes of this study are (1)recognizing how many thyroid patients return to work after operation. (2)recognizing the impacts on work in thyroid cancer (3) exploring fatigue, depression, anxiety, level of symptoms in thyroid cancer after operation (4)exploring the correlation between the work impacts and fatigue, depression, anxiety, level of symptom, demography, disease information. This study is cross-sectional study. We collected 155 patients who completed thyroidectomy within three years at outpatient clinic in a teaching hospital in Taipei. Patients completed a questionnaire including Illness Perceptions Questionnaire, Hospital Anxiety and Depression Scale, Fatigue symptom Inventory, Symptom Severity Scale and diseases information questionnaire. We analyzed data by Mann-Whitney U test, Kruskal Wallis test, Spearman's rank correlation coefficient, Descriptive Statistics, multiple linear regression. Results shows that 79.9% thyroid cancer patients post operated and employed at time of study‐entry were influenced but the level was light. The top five factors which let over half people might be impacted at work are as follows. (1)Unpredictability of cancer(70%) (2)Emotional distress(62.7%) (3) Fatigue(61%) (4) Lower concentration(54.4%) (5) Physical symptoms(50.7%). The correlation factors of work impacts are gender, fatigue interference, fatigue severity, anxiety, depression, symptoms severity. The main correlation factors is symptoms level (β=0.44, p<0.00)、fatigue severity (β=0.18, p<0.01)、anxiety (β=0.32, p<0.00), R2=0.61. In conclude, work impacts of thyroid patients are lighter than other cancer but some of them are median to moderate level of work impacts, anxiety, depression and fatigue. We suggest that we can develop interventions to help those patients to keep working.

並列關鍵字

Thyroid Cancer Work Impact Symptoms Anxiety Depression Fatigue

參考文獻


王舒儀・(2018)・甲狀腺癌與標靶治療・(32),10-12。 https://doi.org/10.6527/pvm.201806_(32).0004
衛生福利部統計處(2020,6月15日)。108年國人死因統計結果。https://dep.mohw.gov.tw/DOS/cp-4927-54466-113.html
衛生福利部國民健康署(2020a,6月2日)。中華民國 106 年癌症登記報告。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269 pid=12235
衛生福利部國民健康署(2020b,6月2日)。衛生福利部公布癌症發生資料。
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