初次接受化學治療之癌症老年病人之因應行為與症狀困擾相關性之探討

The Relationship Between Coping Behaviors and Symptom Distress in Elderly Patients With Cancer Undergoing Initial Chemotherapy

背景：癌症老年病人於化學治療期間，面臨不適的症狀困擾時，會採取不同的因應行為，進而影響不同的治療反應和結果。目的：探討受化學治療老年病人之因應行為與症狀困擾之相關性。方法　橫斷性相關研究設計、採立意取樣及結構式問卷收集資料。南部某一所醫學中心內外科病房共100位第一次接受化學治療60歲以上癌症老年病人完成問卷。問卷包含：基本資料表、因應行為量表以及症狀困擾量表。結果　本研究對象約有78%發生四種以上症狀困擾，最嚴重的前五名症狀困擾依序為：疲倦、食慾影響、失眠、口乾、排便。最常見症狀困擾前五項依序為：疲倦、口乾、食慾影響、失眠和排便。老年癌病人較常使用「問題取向」因應行為（平均值為3.19分；標準差 = 0.24）。愈常使用「情緒取向」因應行為者，症狀困擾顯著性愈嚴重（r = .44, p ＜ .001）。在慢性病數目、腫瘤診斷分期、癌症治療方式與症狀困擾嚴重度無顯著差異性。結論／實務應用　台灣接受化學治療癌症老年病人之因應行為與症狀困擾嚴重度具有相關性。臨床醫護人員應引導老年病人運用合宜的因應行為，進而協助改善化學治療之症狀困擾。

Background: Elderly cancer patients undergoing initial chemotherapy often suffer discomfort from medicationrelated symptom distress. This discomfort may affect treatment responses and outcomes negatively. Purpose: To examine the relationships between coping behaviors and symptom distress in elderly patients undergoing initial chemotherapy. Methods: This correlational, cross-sectional design study used a purposive sample of 100 patients who were both over 60 years of age and currently undergoing initial chemotherapy. The participants completed a structured questionnaire that was administered at a medical center in southern Taiwan. The questionnaire included a demographics datasheet, Coping Behavior Scale, and Symptom Distress Scale. Data was analyzed using descriptive statistics, Pearson's correlations, Mann-Whitney U, and Kruskal Wallis tests, which were run on SPSS 19.0 software. Results: Three-quarters (78%) of participants reported that they suffered from more than four distress symptoms. The top distress symptoms in terms of severity included: fatigue, poor appetite, insomnia, dry mouth, and altered bowel habits. The top distress symptoms in terms of frequency included: fatigue, dry mouth, poor appetite, insomnia, and altered bowel habits. ＂Problem-focused＂ coping was the most frequent type of coping behavior (mean = 3.19, SD = 0.24) that was used by participants. Furthermore, more frequent use of ＂emotions-focused＂ coping behaviors was associated with a greater risk of experiencing serious distress symptoms (r = .44, p ＜ .001). Number of chronic diseases, cancer stage, and type of cancer treatment had no significant influence of symptom distress. Conclusions / Implications for Practice: Findings confirmed the relationship between coping behavior and symptom distress in elderly Taiwanese cancer patients undergoing initial chemotherapy. The results suggest that healthcare providers may use interventions that target patient coping behavior in order to alleviate the chemotherapy-induced symptoms of distress in elderly cancer patients.