頭頸癌患者放射治療後調整生活品質之預期存活

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Title:	頭頸癌患者放射治療後調整生活品質之預期存活 Quality-adjusted life expectancy (QALE) for head and neck cancer patients after radiotherapy
Authors:	廖冠焯;Kuan-Cho Liao
Contributors:	生物統計研究所碩士班
Keywords:	頭頸部癌症;調整生活品質後之預期存活;強度調控放射治療(IMRT);EORTC台灣中文版生活品質問卷;歐洲生活品質五面向量表;Head and Neck cancer;Quality adjusted life expectancy (QALE);intensity modulation radiation therapy(IMRT);EORTC QLQ-C30;EORTC QLQ-HN35;EQ-5D
Date:	2013-07-24
Issue Date:	2013-10-02 11:00:17 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	計量「健康」或「健康損失」是評估醫療照護成本效益之重要基礎。然而，健康的計量已不單是考慮病患存活時間的長短，須同時考量存活期間的生活品質。近年來，關於癌症病患治療成果的探討已由單純之存活分析提升至重視「調整生活品質後之預期存活」(Quality adjusted life expectancy，QALE)。頭頸癌幾十年來一直為台灣重要的健康與社會問題。放射治療為頭頸癌的主要治療方式之一，不同放射治療技術不僅可能影響頭頸癌病人的存活機會，更顯著地影響各項生活品質指標。本研究之目的，探討頭頸癌病患接受根治性放射治療後調整生活品質後之預期存活。本研究整理收集於2000至2007年間於長庚醫院高雄院區放射腫瘤科接受根治性放射治療的頭頸部癌症患者1819人，作為此研究之世代，以計算頭頸部癌症病患之存活函數。本研究利用EORTC台灣中文版生活品質問卷(QLQ-C30、HN35)，與歐洲生活品質五面向量表(Euroqol 5-dimension questionnaire，EQ-5D)對頭頸癌與鼻咽癌病患治療後存活者進行生活品質調查，共計獲得1694筆EORTC問卷資料，與126筆EQ-5D問卷資料，利用以上資料計算生活品質函數，調整生活品質之預期存活則採用Hwang與Wang所發展之方法計算。所有資料以SAS 9.2、SPSS 17.0與iSQoL軟體進行計算分析。頭頸部癌症患者調整生活品質後預期存活，會受到性別、癌症分期、癌症部位、有無手術、有無化學治療、不同治療技術等單一因素影響而不同。而鼻咽癌資料經過配對之後，使用IMRT技術者的調整生活品質後預期存活，的確會比使用非IMRT技術者好，尤其在與癌症治療後相關副作用，如疼痛、吞嚥與口乾等部分有明顯差異。本研究為第一個利用調整生活品質後預期存活，描述比較頭頸部癌症病患接受放射治療後結果。使用調整生活品質後預期存活作為成效評估單位，不但可呈現出存活的狀態，更可進一步描述存活期間可能經歷的生活品質狀態及經歷時間之長短，可提供病患更詳盡的資訊以利其選擇欲採用之治療技術，未來若可獲得不同技術間的花費成本，更可進一步進行成本效性評估。 The quantitative measure of "health" or "health loss" has become a fundamental basis in the assessment of cost-utility in medical care. However, in addition to the length of survival time, the quality of life (QoL) during the survival period has been regarded as a major endpoint in the measurement of health status. Recently, growing reports have not simply used the survival analysis but also performed the so called “quality-adjusted life expectance (QALE) to calculate the treatment outcome for cancer patients. Head and neck cancer (HNC) has been a critical problem of health and social issue in Taiwan for decades. Radiotherapy (RT) is one of the major treatment modalities for patients with HNC. Different RT techniques would impact not only the survival outcome but also the various QoL indices for the surviving patients. In this project, we attempt to calculate QALE for patients with HNC after curative RT. The survival outcome of the cohort of 1819 newly diagnosed HNC patients curatively irradiated at the Department of Radiation Oncology in Kaohsiung Chang Gung Memorial Hospital from Jan. 2000 to Dec. 2007 will be retrospectively collected. A assessment of the QoL outcome measured by the Taiwan Chinese version of the EORTC QLQ-C30, H&N35, and EQ-5D questionnaires will be prospectively performed from the survivors of HNC after curative RT. 1694 EORTC and 126 EQ-5D data be collected to calculate QoL function. We selected the method developied by HWANG and WANG to calculate QALE. All analysis by SAS9.2 , SPSS 17.0 and iSQoL. HNC patient’s QALE affected by gender , cancer stage , cancer site , surgery , Chemotherapy and radiotherapy techniques. After merged NPC patient’s data , patient used IMRT had better QALE than patient used Non-IMRT. Especially in cancer treatment-related side effects, such as pain, swallowing and dry mouth. This study was the first one to use QALE describes the results of HNC patients after radiation therapy. QALE can show survival state , quality of life state , time length of state. And it can provide patient detailed information to selection different treatment technology. If we can get cost between different technologies. Then we can also do cost-effectiveness assessments in the future.
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