肝癌復發病人的生活品質與影響因素之探討

Exploring the Quality of Life and Its Influencing Factors in Patients with Recurrent Liver Cancer

背景:肝癌在接受治療之後仍可能面臨高復發的情形而影響生活品質，但現有對復發後的病人的生活品質探究較少。目的:本研究的目的為描述肝癌復發病人的生活品質情形，以及探討人口學基本屬性、疾病特質、治療方式、希望、症狀困擾及社會支持對生活品質的影響關係。方法:本研究為描述及相關研究設計，以結構性問卷包含：基本人口屬性及疾病特性、台灣版安德森症狀量表、赫氏希望指數量表、人際支持量表、歐洲癌症研究與治療生活品質問卷收集資料，以逐步迴歸分析影響生活品質的因素。結果:於2012年7月至2014年12月共收集50位肝癌復發病人的資料，雙變項分析結果顯示年齡、有肝硬化病史、癌症分期、希望與症狀困擾與生活品質有關，逐步複迴歸分析結果顯示症狀干擾(b=-0.59, p<0.001)及年齡(b=-0.31, p=0.006)為生理功能面向的影響因子，可解釋生理功能45%的變異量(F=20.79, p<0.001)，症狀干擾(b=-0.28, p=0.04)與癌症分期(第二期) (b=-0.34, p=0.01)可解釋角色功能18%的變異量(F=6.34, p=0.004)，症狀干擾(b=-0.42, p=0.002)解釋情緒功能16%的變異量(F=10.34, p=0.002)，症狀嚴重程度(b=-0.30, p=0.03)解釋認知功能7%的變異量(F=4.77, p=0.03)。結論與實務應用:對於肝癌復發病人仍須有效率的落實症狀評估管理及監控，也需特別注意年齡較年長者以及癌症分期第二期的病人，以提昇病人的生活品質。

Background: Patients with liver cancer could still face disease recurrence and suffer from poor quality of life after treatment. However, limited number of studies investigating the quality of life of recurrent liver cancer patients are available.Purpose: The purpose of this study was to describe the quality of life of liver cancer patients with recurrence and to explore the relationships among basics demographics data, clinical data, treatment modalities, hopes, symptoms distress, social support, and quality of life.Methods: This study was a description and correlation design. Structured questionnaires were used to collect data from July 2012 to December 2014. Stepwise multiple linear regression was used to analyze the influencing factors of quality of life.Result: A total of 50 patients with recurrent liver cancer were included in this study. Bivariate analysis showed that age, history of liver cirrhosis, stage of cancer, hope, and symptom distress was significantly associated with quality of life. The stepwise multiple linear regression analysis showed that symptomatic interference (b=-0.59, p<0.001) and age (b=-0.31, p=0.006) were the influencing factors of''physical function'', which explained the 45% variation of the physical function (F =20.79, p<0.001). Both symptomatic interference (b=-0.28, p=0.04) and stage of cancer (stage II) (b=-0.34, p=0.01) explained 18% variation of the''role function''(F= 6.34, p=0.004). Symptomatic interference (b=-0.42, p=0.002) explained 16% of the variance of the''emotional function''(F=10.34, p=0.002). Symptom severity (b=-0.30, p=0.03) explained the 7% variation of the''cognitive function''(F = 4.77, p = 0.03).Conclusions/ implication: Symptom assessment and management should be considered in clinical practice for patients with recurrent liver cancer. In addition, healthcare professional should also pay special attention to patients who are older and with advanced cancer stage in order to improve patients'quality of life.