不同時期結直腸癌病人症狀困擾、憂鬱與生活品質關係之探討

Symptom Distress, Depression, and Quality of Life in Colorectal Cancer Patients at Different Disease Stages

背景：癌症及其治療計畫常對病人的生活品質產生影響，不同的癌症病程階段所產生之身、心不適症狀及身心調適與生活品質間常有持續性的相關性，而生活品質已被視為癌症治療成效的重要指標。因此醫療人員若能暸解病人在病程階段的生活品質差異，將有助於在不同時期提供更適切的醫療照護。目的：分析治療期與存活期之結直腸癌病人症狀困擾、憂鬱與生活品質之差異以及生活品質重要影響因素之探討。方法：採橫斷性研究設計，以方便取樣選取南部某區域醫院138位結直腸癌病人為研究對象，使用「台灣版安德森症狀困擾量表」、「流行病學研究中心憂鬱症狀量表」、「歐洲癌症治療與研究組織之生活品質問卷」及「基本屬性相關變項」結構式問卷進行資料收集。資料以百分比、平均數、標準差呈現描述性統計資料，並以卡方檢定、獨立樣本t檢定、單因子變異分析及階層複迴歸進行推論性統計。結果：存活期病人整體健康生活品質顯著高於治療期（68.68 vs. 59.54, p＜.05）。階層複迴歸分析顯示，生活品質各構面之影響因子，治療期病人以憂鬱傾向與最多構面有關，其次依序為症狀困擾，症狀干擾生活活動功能、及家庭月收入。存活期病人則以憂鬱傾向與最多構面有關，其次依序為是否復發、症狀干擾生活活動功能及是否接受手術治療。當控制相關顯著變項後，治療期與存活期病人生活品質之解釋變異量在整體健康生活品質分別為38.5%及40.9%。結論／實務應用：本研究結果發現結直腸癌病人生活品質除與基本屬性相關變項有相關外，憂鬱傾向與症狀困擾對治療期的生活品質影響較多，而存活期的病人則以憂鬱傾向與生活品質之構面有相關。臨床照護上針對不同時期的癌症病人皆應給予情緒支持以改善憂鬱傾向，針對治療期的病人則應多給予症狀處置之衛教，協助緩解其症狀困擾、憂鬱，以提高病人在不同時期之生活品質。

Background: Quality of life is increasingly used as a primary outcome measure in studies that are designed to evaluate the effectiveness of treatment in cancer survivors. Purpose: Analyze the symptom distress, depression, and quality of life in colorectal cancer patients and explore the relationship of related variables with changes in QoL (quality of life) during and after treatment. Methods: A cross-sectional study design was used for the present study. Patients (N=138) with colorectal cancer were recruited from a district hospital in southern Taiwan. Data were collected using a self-report questionnaire. Questionnaire scales included the M.D. Anderson Symptom Inventory-Taiwan Form, the Center for Epidemiologic Studies Depression Scale, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 Version 3 in Chinese as well as a demographic and disease-related variables datasheet. Descriptive data were presented using percentage, mean, and standard deviation. Chi-square test, independent t-test, one-way ANOVA, and hierarchical multiple regression were used for inferential statistics. Results: The post-treatment group showed a significantly higher average global health QOL score (68.68 vs. 59.54; p＜.05). Hierarchical regression showed that the impact factor of quality of life has a depressive effect in many dimensions. The second most significant variable was symptom distress. Symptoms interfered with life activity functions and family income and impacted negatively on patient treatment. In survivorship, depressive tendencies was the variable that was most affected, followed by recurrence, symptoms interference, and surgical treatment, respectively. When controlling for the relevant variables, these predictors accounted for 38.5% and 40.9% of the total variance of global health quality of life. Conclusions/Implications for Practice: This study demonstrates that personal characteristics variables, depressive tendencies, and symptom distress all impact on the quality of life of colorectal cancer patients in terms of receiving treatment and survivorship. These findings imply that healthcare professionals must provide appropriate emotional support in order to decrease depression tendency at different stages. Thus, these patients should receive nursing interventions that effectively decrease depression and symptom distress and enhance quality of life at different disease stages.