靜脈輸液治療對晚期癌症患者家庭照顧者疲憊的影響

The Effects of Intravenous Fluid Therapy on Family Caregivers’Fatigue of Advanced Cancer Patients

背景：晚期頭頸部及消化道癌症病患因為腫瘤位置及疾病進展，影響其進食狀況及身體功能狀態。過去研究發現癌症病患的食慾狀況會導致家庭照顧者疲憊。
目的：探討晚期頭頸部及消化道癌症病患住院使用靜脈輸液對其減低家庭照顧者疲憊的效益。
方法：本研究為縱貫性研究，採立意取樣收案方式，利用結構性問卷調查北部某醫學中心之晚期頭頸部及消化道癌症病患與主要照顧家屬。研究工具包括基本資料問卷、病患的ECOG功能狀態評分表與主觀性整體營養狀況評量表，並以台灣版簡明疲憊量表評估病患入院時及使用輸液7日後的疲憊程度。收案時間為2018年7月到2019年2月。以SPSS 22進行描述性及差異性統計分析。
結果：本研究病患共155人，包括44位依賴管灌飲食及111位由口進食。主要為男性（65.2%），平均年齡60歲，ECOG為0-4分，PGSGA為0-12分。入院使用靜脈輸液主要原因是進食量不足，77.4%是由醫療團隊建議使用。家庭照顧者多為未接受專業照護訓練的病患配偶（49.0%）、年齡60歲（42.6%）、女性（64.5%）。統計分析發現病患使用輸液7日前後，對於家庭照顧者的疲憊程度並無統計上顯著差異，但疲憊干擾與人交往及生活樂趣程度均顯著變差。
結論：對晚期頭頸部及消化道癌症進食狀況不佳病患，住院接受靜脈輸液治療，對改善照顧者疲憊程度並無統計上顯著效益，甚至增加疲憊對生活的負面影響。建議未來研究可以進一步探索影響此類癌症住院接受靜脈輸液治療病患之照顧者疲憊的其他影響因素，以做為臨床介入措施擬定之參考。

Background: The dietary challenges and declining health associated with advanced head and neck cancer and gastrointestinal cancer often impact both the nutritional intake and overall well-being of affected patients. Additionally, the appetite status of cancer patients is known to contribute to fatigue experienced by family caregivers.
Goal: This study assesses the effectiveness of intravenous fluid therapy administered during hospitalization in alleviating fatigue among family caregivers of patients with advanced head, neck, and gastrointestinal cancer, particularly those facing poor dietary intake.
Methods: The study employed purposeful sampling and longitudinal structured questionnaires to investigate patients with advanced head, neck, and gastrointestinal cancers and their primary family caregivers in the Department of Hematology and Oncology at a medical center in northern Taiwan. Research instruments included a demographic questionnaire for both patients and caregivers, the ECOG Performance Status Scale, Patient-Generated Subjective Global Assessment (PG-SGA), and Brief Fatigue Inventory-Taiwan Form (BFT-T) for caregivers. Participants were enrolled from July 2018 to February 2019, completing questionnaires upon admission and after seven days of intravenous fluid therapy. Descriptive and comparative statistical analyses were conducted using SPSS 22.0.
Results: The study included 155 patients, with 44 relying on tube feeding and 111 consuming food orally. Predominantly male (65.2%) and averaging 60 years old, patients exhibited ECOG scores of 0-4 and PGSGA scores of 0-12. Insufficient food intake was the primary reason for hospital admission, with 77.4% recommended intravenous fluids by their medical team. Most family caregivers were spouses
(49.0%), lacked professional nursing training, were aged≥60 years (42.6%), and were predominantly women (64.5%). Statistical analysis revealed no significant difference in family caregivers' overall fatigue levels before and after the patients received seven days of infusion therapy. However, specific aspects of fatigue related to social interactions and life enjoyment were significantly worse.
Conclusion: The findings suggest that hospitalization and intravenous infusion therapy for advanced cancer may not alleviate caregiver fatigue and could even have a negative impact. Future research should explore additional factors influencing caregiver fatigue in hospitalized patients with advanced head and neck cancer and gastrointestinal cancer undergoing intravenous infusion therapy.