鼻咽癌病患接受放射治療的症狀困擾及情緒狀態之探討

A Study of Symptom Distress and Psychological Status in Nasopharyngeal Carcinoma Patients with Receiving Radiotherapy

鼻咽癌是台灣常見的癌症，其治療方式以放射治療為主。本研究目的為：(1)比較接受不同放射治療狀況之鼻咽癌病患，其症狀困擾、憂鬱、及希望之差異；(2)探討鼻咽癌病患，其不同放射治療狀況之症狀困擾、憂鬱、及希望之相關性。研究採橫斷式相關設計，以方便取樣，針對北部某醫學中心放射腫瘤科門診之鼻咽癌病患，以症狀困擾評估量表、情緒狀態量表之憂鬱次量表及赫氏希望指標，進行結構式問卷訪談，共收得70位個案。研究結果顯示：(1)病患有輕度至中等程度的症狀困擾，其中又以口乾最為困擾病人；(2)病患有輕度至中等程度的憂鬱及希望；(3)不同放射治療狀況的病患其症狀困擾(F=5.23，p<0.01)有顯著差異，困擾程度依序為目前接受放射治療者、診斷一年內已完成放射治療目前未接受放射治療者、診斷一至三年內已完成治療且目前未接受補強之放射治療者；(4)憂鬱與症狀困擾呈正相關；憂鬱與希望呈負相關。本研究結果建議臨床護理人員應於病患接受放射治療之前教導口腔照護的正確方式，並於接受治療期間針對口乾之症狀困擾，給予口腔濕潤之護理衛教，協助症狀困擾之控制以提供更好之支持性照顧，進一步改善其憂鬱程度及提高其希望程度。

Nasopharyngeal carcinoma (NPC) is one of the common cancers in Taiwan and radiotherapy is the major treatment. The purpose of this study was to compare the difference and examine the relationships among symptom distress, depression, and hope in NPC patients with different radiotherapy. A cross-sectional design with seventy subjects was recruited on radiotherapy outpatient department on a medical center in Northern Taiwan. The convenience sampling was used in this study. Structure interview was conducted by using the instruments of Symptom Distress Scale, the Profile of Mood Status (POMS) and Herth Hope Index. The POMS included Depression Subscale. Results of the study showed that: (1) the patients had mild to moderate degree of symptom distress and dry mouth was the most of the distress. (2) the patients had mild to moderate level of depression and hope. (3) there were significant differences (F=5.23, p< .01) on symptom distress in different radiotherapy. The patients were higher symptom distress with radiotherapy perceived than those who were not under the treatment. (4) the depression was positively correlated with distress symptom and then negatively correlated with hope. The results suggested that nurses in clinical settings should correctly teach oral care before radiotherapy, and focus on rinse for dry mouth during radiotherapy. In addition, nurses should educate the patients how to overcome and manage distress symptom during and after radiotherapy. Therefore, there was to decrease the level of depression and then enhance the hope in the patients.