台灣老年癌末病患的症狀

Symptoms in the Elderly with Terminal Cancer-- a Study in Taiwan

老年癌末患者與日俱增，其醫療需求漸受重視。為了解老年癌末患者所承受的症狀及其痛苦程度，本研究之目的在：（1）評估65歲以上老年癌末患者其癌末症狀的盛行率及嚴重程度，（2）比較住院後症狀的控制情形，並藉此探討老年癌末患者照顧之需求。研究對象為1997年9月至1999年4月，所有台大醫院緩和醫療病房滿65歲以上住院癌末病患，共228位。由主要照顧醫師每日評估記載，並經團隊會議定期分析其住院時，住院一週時及死亡前兩天的症狀及其程度變變化。病人平均年齡為73.9±6.3歲，男女各半，超過八成(82.5%)病人一半以上時間臥床(ECOG≧3)，住院後平均存活期為21.3±34.8天。住院時每位病人平均有9.9個症狀，其盛行率依序為：全身倦怠(88.5%)，食慾不振(88.1%)，疼痛(77.9%)，體重減輕(72.0%)，吞嚥困難(61.3%)，不安(57.7%)，呼吸困難(57.0%)。住院一週後，疼痛分數有明顯降低(p<0.05)，而呼吸困難、噁心嘔吐、失眠及口乾之程度平均值也有降低，但未達顯著意義(P>0.05)，而其餘各症狀如全身倦怠、食慾不振、意識不清等之程度則都呈現持續的昇高。死亡前2天的症狀，除了疼痛仍是有意義的減輕之外，呼吸困難、全身倦怠、食慾不振、意識不清、吞嚥困難、不安、口乾、水腫及腹水都明顯的惡化(p<0.05)。結論為，老年癌末患者通常有較多癌末症狀，且因身體原有退化性疾病及身體功能不佳，使得臨床上症狀的評估與處置較為複雜。如何針對老年癌末患者提供良好症狀控制，並發展適當照顧模式，將是老年學醫及緩和醫療界重要之工作。

The suffering of elderly with terminal cancer is gaining increasing attention in the field of health care delivery system. In order to investigate the symptoms which are distressing the elder patients with terminal cancer. This study was conducted to examine the prevalence and severity of symptoms in elder patients with terminal cancer. In addition, to compare the changes of severity after admission. Two hundred and twenty eight terminal cancer patients more than 65 years old, admitted to palliative care unit in National Taiwan University Hospital from September 1997 to April 1999, were enrolled. A structured data collection form was used daily to evaluate symptoms, which were analyzed at the time of admission, 1 week after admission and 48h before death. There were equal number in both gender. Mean age of all patients was 73.9±6.3 years; their mean survival time was 21.3±34.8 days. More than eighty percent (82.5%) of patients, whose ECOG performance was grade 3 or 4. Patients averaged 9.9 symptoms each at the time of admission. The prevalence of some of the symptoms was: weakness (88.5%), anorexia (88.1%), pain (77.9%), weight loss (72.0%); these were predominant symptoms of cancer in most primary sites. After one week in hospice pain was improved (p<0.05); the mean scores of dyspnea, nausea, vomiting, insomnia, dry mouth decreased but didn’t have statistical significance (p>0.05). However, all symptoms except pain tended to worse in the 48h before death. In conclusion, elder patients with terminal cancer were polysymptomatic. The high prevalence of symptoms distressed the elder patients and reduced their quality of life. Management of these symptoms are usually complicated due to the characteristics of elderly such as deteriorating organ function and poor physical performance. Symptom control and care of dying in elderly with terminal cancer will be a challenge in the field of geriatric and palliative medicine.