台灣肝癌患者之症狀群集現象

Symptom Clusters in Taiwanese Hepatoma Patients

鍾孟樺(Meng-Hua Chung)

指導教授 ： 林佳靜

臺北醫學大學/護理學院/護理學研究所/碩士(2005年)

摘要

癌症病患會經歷因腫瘤本身或治療引發的數種常見症狀，這些症狀會導致治療延遲或終止治療，並可能損害功能與復健，另外這些症狀也將導致顯著困擾。西方研究學者認為某些特定症狀彼此之間互相影響並具有相關性(Cleeland et al., 2000)，亦即有症狀群集之現象。癌症為台灣十大死亡原因之首，其中肝癌又佔台灣男性死亡原因之第一位、女性死亡原因之第二位(行政院衛生署，2004)。因此，本研究主要描述台灣肝癌病患的症狀嚴重度及症狀干擾生活之程度，並探討肝癌病患之症狀群集現象。研究設計採用橫斷式描述性相關性研究，研究工具為台灣版安德森症狀量表(MDASI-T)，以方便取樣於北部兩所教學醫院進行收案，共收100位肝癌病患。以描述性統計、皮爾森相關、迴歸分析、群集分析及因素分析進行資料分析。研究結果顯示：症狀嚴重程度以疲勞為最高，症狀干擾日常生活以工作干擾程度為最高。癌症症狀與症狀彼此間具有相關性，僅疼痛症狀與健忘症狀間未具相關性。癌症症狀數目會影響病人的症狀困擾強度。整體肝癌病患症狀總數為7.78。群集分析結果顯示，肝癌患者之症狀呈現兩大症狀群集之現象；症狀群集一之症狀分別為鬱悶、心理難過、疲勞、胃口差、思睡、睡眠紊亂、口乾及疼痛等八個症狀；症狀群集二之症狀分別為噁心、嘔吐、麻木感、呼吸急促及健忘等五個症狀。此與因素分析之三大因素結果一致，三大因素包括因素一「疼痛相關因素」、因素二「腸胃道相關因素」及因素三「知覺感受相關因素」，症狀群集一之症狀與因素一之結果同，而症狀群集二之症狀亦與因素二及因素三之結果相同。 本研究結果顯示肝癌病患不僅經歷單一症狀困擾，許多病患甚至經歷著複雜的症狀群集，因此未來研究可進一步探討及驗證群集症狀發生之時間順序，並施以正確及有效率的醫療處置，以改善肝癌病患之症狀困擾，進而提升其生活品質。 關鍵字：肝癌、症狀困擾、症狀群集

關鍵字

肝癌 ； 症狀困擾 ； 症狀群集

並列摘要

Cancer patients have experienced multiple symptoms simultaneously in cluster due to the treatments received as well as the disease itself. These symptoms have a multidimensional effect on the individual leading to problems with impaired functional abilities and rehabilitation. The Westem scholars believe the inter-relationships among these symptoms are correlated with each other （Cleeland et al., 2000）, namely a phenomenon of symptom clusters. Cancer is the first leading cause of death in Taiwan. Hepatoma is ranked as the first cause of cancer mortality among males as the second cause among females in Taiwan （The Department of Health, 2004）. The purpose of this study was to describe symptom clusters in patients with hepatoma and to explore the phenomena of symptom clusters. This study used demographic form and M. D. Anderson Symptom Inventory-Taiwan Form （MDASI-T）. 100 subjects were recruited by convenience sampling at two teaching hospitals in Taipei. Data were analyzed using descriptive statistics, pearson’s correlation, regression analysis, factor analysis, and cluster analysis. The results showed that fatigue was highest symptom distress and symptom interference work was highest in the last 24 hours. Symptoms have correlated with each other in terms of its intensity, but pain and remembering have not correlated. The numbers of symptom were related to symptom distress intensity. The symptom numbers were 7.78 in overall patients with hepatoma. Results from cluster analysis reveal two clusters. Cluster one presents eight symptoms, distress, sad, fatigue, lack of appetite, drowsy, disturbed sleep, dry mouth, and pain. Cluster two presents five symptoms, nausea, vomiting, numbness or tingling, shortness of breath, and remembering. The result is the same with factor analysis. There are three factors including factor one presents Pain related symptoms, factor two presents GI related symptoms, and factor three presents Sensation related symptoms. Cluster one is in concordance with factor one. Also, cluster two is the same with factor two and three. Hepatoma patients have experienced multiple symptom clusters. Results from this study can provide further research to manage multiple symptoms, most commonly simultaneously happened, in order to decrease symptom clusters and improve the quality of life for cancer patients. Key words : hepatoma, symptom distress, symptom clusters

並列關鍵字

hepatoma ； symptom diatress ； symptom clusters

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