頭頸癌患者身心社會調適與生活品質之縱貫性研究

The Health-Related Quality of Life and Bio-Psycho-Social Adaptation Effects in Patients with Head and Neck Cancer: A Longitudinal Study

背景：頭頸癌屬於慢性疾病，患者因長期病程，其身心調適與生活品質皆易產生不可預測或持續性的變化。過去研究多採固定時間點測量，未考慮時間的變化及其影響，暸解患者在各階段的心理與生活品質變化，將有助於醫病溝通及發展適切的治療處置。目的：本研究旨在探討頭頸癌患者隨著不同病程階段其身心社會調適的變化情況，以及其調適的初始狀態與後續隨著病程時間階段具調節效果的影響因子。方法：本研究研究對象為頭頸部惡性腫瘤且自願接受施測之患者，分別在診斷後、治療中、治療後三個月及治療後六個月進行四次施測，研究參與者共計109人，收得有效問卷共257份，資料處理方法為描述統計及階層線性模式統計分析。結果：頭頸癌患者的患者心理困擾狀態會隨著時間呈現線性遞減的趨勢；初始狀態影響因素包括年齡、性別、信仰／靈性與工作狀況；而對於心理狀態成長速率具有顯著影響的調節因子，主要是性別、癌症期數與教育程度。其次，生活品質隨著時間無顯著變化，初始狀態影響因素包括年齡與工作狀況；而對於生活品質變化速率具有顯著影響的調節因子為癌症期數、教育程度與婚姻狀況。結論／實務應用：本研究結果顯示患者診斷後有輕微焦慮與憂鬱，療程中生活品質受副作用影響。故建議適時提供心理社會介入及專業諮詢與支持照護並改善副作用，以提升整體生活品質。

Background: Because of the therapies and methods involved in its treatment, head and neck cancer patients often face unpredictable changes in both quality of life (QoL) and psychological status over the long course of their disease. Most studies have used fixed-term measurements that do not consider time variance and its effects. To facilitate medical communication and rehabilitation interventions, we investigated changes in HNC (head and neck cancer) patients' bio-psycho-social status and QoL over time.Purposes: This study examines QoL growth patterns and the bio-psycho-social adaptation effect in HNC patients as well as how various variables affect within-individual and between-individual level factors during the 4 stages of HNC.Methods: A total of 109 HNC patients participated in this study. Two hundred and fifty-seven valid questionnaires were gathered. Questionnaires were given to each patient at 4 times: initial disease diagnosis; during the therapy period; 3 months after therapy; and 6 months after therapy. Descriptive statistics and hierarchical linear models were used in data analysis.Results: The main results revealed that: (1) degree of mood disturbance decreased linearly as illness stage progressed. Age, gender, religion, and job impacted patients' initial status, while gender, cancer stage, and education degree were significant moderators of the rate at which a participant's adaptation effect grew; (2) patient QoL showed no significant difference over time. Age and job were significant impact factors affecting patients' initial status. Cancer stage, educational degree, and marital status had a significant moderating effect on the growth rate of participants' adaptation effect score.Conclusions and Implications for Practice: Our results indicate that participants in this study had a higher level of anxiety and depression than the average population and that their QoL was negatively influenced by the side effects of their therapy. Therefore, study findings recommend that timely psycho-social intervention and side-effect education should be reinforced to enhance patients' quality of life.