肺癌病患生活品質之縱貫面研究—歐洲癌症治療與研究組織生活品質核心問卷、肺癌生活品質問卷之反應性與預測死亡的能力; Longitudinal study of Quality of life in patients with lung cancer in Taiwan: responsiveness and prediction on death of a Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-LC13

中國醫藥大學機構典藏 China Medical University Repository, Taiwan > 公共衛生學院 > 醫務管理學系暨碩士班 > 博碩士論文 > Item 310903500/825

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题名:	肺癌病患生活品質之縱貫面研究—歐洲癌症治療與研究組織生活品質核心問卷、肺癌生活品質問卷之反應性與預測死亡的能力;Longitudinal study of Quality of life in patients with lung cancer in Taiwan: responsiveness and prediction on death of a Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-LC13
作者:	林冠馨;Kuan-Hsin Lin
贡献者:	醫務管理學研究所碩士班
关键词:	肺癌;生活品質;預測死亡;反應性;Lung Cancer;Quality of Life;prediction on death;responsiveness
日期:	2006-06-29
上传时间:	2009-08-12 16:22:31 (UTC+8)
摘要:	歐洲癌症治療與研究組織（European Organization for the Research and Treatment of Cancer core questionnaire，EORTC）所發展癌症生活品質核心問卷（QLQ-C30）與肺癌生活品質問卷（QLQ-LC13）為一廣泛用於測量癌症病患健康相關生活品質之測量工具，當它具有良好的反應性時，才可用以評估臨床照顧病人及進行臨床試驗時隨著時間的照護結果和療效的變化，但中文版癌症生活品質核心問卷、肺癌生活品質核心問卷之反應性則尚未被評估。本研究的研究目的有四，分別為評估核心問卷（QLQ-C30）與肺癌生活品質問卷（QLQ-LC13）預測一年死亡之能力；以核心問卷、肺癌問卷探討肺癌病患一年生活品質之變化及其反應性；以核心問卷、肺癌問卷探討接受手術之肺癌新個案生活品質隨時間的變化及相關因素，與其反應性；以核心問卷、肺癌問卷探討接受化療之肺癌新個案生活品質隨時間的變化及相關因素，與其反應性。在目的一、二的研究起始時間為民國93年9月至94年5月，研究追蹤結束時間為民國94年12月至95年2月；目的三手術前後研究設計之資料搜集時間點為手術前、手術後一個月、三個月及六個月；目的四化療前中後研究設計之資料搜集時間點為化療前、化療二個療程、四個療程、六個療程及化療結束後一個月。此研究對象有三個來源，分別為：追蹤一年之肺癌病患、接受手術之肺癌病患、接受化療之肺癌病患，各有250人、53人及81人。研究結果在預測死亡能力方面，顯示身體功能為顯著的死亡預測因子，身體構面平均分數大於60分者，其死亡危險性相對於小於或等於60分者減少42%。在影響肺癌病患治療後生活品質之相關因素方面，接受手術之肺癌病患其顯著影響因素為手術前肺功能（角色功能、喀血，迴歸係數分別為-0.76及-0.62）與有接受化療（胸痛，迴歸係數為9.57）。接受化療之肺癌病患其顯著影響因素為年齡（腹瀉、財務困難、呼吸困難、咳嗽、末梢神經病變，迴歸係數分別為-0.16、-0.38、0.34、0.37、0.34）；性別（社會功能、喀血、脫髮，迴歸係數分別為-8.78、4.40、-12.21）、身體質量指數（認知功能、疲倦、疼痛、食慾不振、喀血、吞嚥困難，迴歸係數分別為1.27、-2.14、-1.65、-1.79、-1.55、-0.44、-0.88）、臨床分期（身體功能、情緒功能、呼吸困難、財務困難、呼吸困難、吞嚥困難、末梢神經病變，生活品質與功能性構面為正向相關，與其它症狀構面為負相關）及使用cisplatin藥物（便秘，迴歸係數為-14.76）。反應性方面，以反應性統計量來看，追蹤一年肺癌病患、接受手術切除病患及接受化療病患在「核心問卷」中分別以角色功能構面、疼痛構面及噁心嘔吐構面最具有反應性。「肺癌問卷」中，追蹤一年肺癌病患、接受手術切除病患皆以胸痛構面，接受化療病患則以脫髮構面最具有反應性。本研究所使用之中文版「核心問卷」與「肺癌問卷」是一個具有良好反應性之測量工具，且「核心問卷」中的身體功能構面亦具有預測死亡之能力，可廣泛用於肺癌病患生活品質的評估。本研究結果除提供不同治療方式對於肺癌病患生活品質的影響外，亦可使臨床照護人員及家屬了解肺癌病患健康狀態的變化，給予適時的照護及心理支持，藉以提昇病患生活品質及整體醫療照護品質。 The European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire ( EORTC QLQ-C30) and the Lung Cancer Module (QLQ-LC13) are used to measure health-related quality of life（HRQOL）of cancer patients. If the instruments have property of responsiveness, they would be used in clinical to detect changes of quality of life by medical interventions over time. However, responsiveness of Chinese Version of the EORTC QLQ-C30 and QLQ-LC13 have never been assessed. The purposes of this study were to evaluate the ability of Chinese version of EORTC QLQ-C30 and EORTC QLQ-LC13s’ in predicting the one-year mortality in lung cancer patients, to evaluate the changes of patients’ quality of life during one year, to identify the factors of surgical new patient’s and chemotherapeutic patients’ quality of life and to access the responsiveness of the Chinese versions of EORTC QLQ-C30 and EORTC QLQ-LC13. The time points for surgery were at preoperative, a month after operation, three months after operation, and six months after operation. The time points for chemotherapeutic at pre-chemotherapy, cycle 2, cycle 4, cycle 6, and a month after the ending of chemotherapy. There are 3 study samples: 250 lung cancer patients with one-year follow-up, 53 new patients with surgery and 81 new patients with chemotherapy. The scale of physical function was the significant factor to predict one-year mortality in lung cancer patients. Comparing to category of physical function score larger then 60, there is less 42% risk than the category of score less than 60 or equal to 60. Significant factors of quality of life on surgical lung cancer patients were lung functions (β beta coefficients -0.76 and -0.62 for role functioning and hemoptysis, respectively) and chemotherapy (9.57 for chest pain,). Significant factors of HRQOL in chemotherapeutic lung cancer patients were age (β beta coefficients -0.16, -0.38, 0.34, 0.37 and 0.34 for diarrhea, financial impact, dyspnea, cough and Peripheral neuropathy , respectively ), gender (β beta coefficients -8.78, 4.40 and -12.21 for social functioning, hemoptysis and hair loss, respectively), BMI (β beta coefficients 1.27,-2.14, -1.65, -1.79, -1.55, -0.44 and -0.88 for cognitive functioning, fatigue, pain, appetite loss, hemoptysis and dysphagia, respectively), stage (physical functioning, emotional functioning, dyspnea, financial impact, dyspnea, dysphagia, peripheral neuropathy, global QOL and scale of functioning) and use cisplatin (-14.76 for constipation). For QLQ-C30, scales of role functioning, pain and nausea/vomiting had property of responsiveness. For QLQ-LC13, scales of pain in chest had property of responsiveness in group of did one-year follow-up and surgery, and scales of hair loss in chemotherapeutic group. In general, the Chinese versions of EORTC QLQ-C30 and EORTC QLQ-LC13 have good property of responsiveness, and the scale of physical function of the EORTC QLQ-C30 had ability to predict one-year mortality in lung cancer patients, and could be commonly used to assess the quality of life of lung cancer patients. The study demonstrated EORTC QLQ-C30 and QLQ-LC13 can detect the influence of different treatments on quality of life in lung cancer patients. The study also provide the clinicians and the relatives understand the changes of patients’ HRQOL. It also allow the clinician and the patients’ family members to provide the appropriate care and psychological support to promote the quality of life of lung cancer patients and the quality of medical care.
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