早期肺癌擔心癌症復發及相關因素探討

Abstract

擔心癌症復發是癌症病人常見的問題之一，肺癌在癌症疾病中屬相對高致死率及低存活率的疾病，即使是早期肺癌病患接受治療後都可能經歷擔心癌症復發的問題，然而，目前鮮少研究針對早期肺癌病人受治療後之擔心癌症復發的議題進行探討。因此，本研究目的為探討早期肺癌病人擔心癌症復發程度，以及與擔心癌症復發相關的因子。 本研究針對86位20歲以上早期肺癌術後病人，採橫斷式研究設計(Cross-sectional design)，以連續性收案方式，於臺灣北部某教學醫院外科部門診進行收案，透過結構式問卷收集資料。研究工具包含：「擔心癌症復發量表-嚴重度次量表」、「歐洲癌症研究治療組織生活品質量表」、「歐洲癌症研究治療組織生活品質肺癌模組次量表」、「事件衝擊量表修訂版本」及「基本資料」，並以描述性統計、獨立樣本t檢定 (Independent-Samples t test)、皮爾森相關 (Pearson’s correlation)及逐步迴歸分析 (Stepwise linear regression) 等統計方式進行資料分析，藉以探討早期肺癌病人擔心癌症復發之相關因素。 研究結果發現早期肺癌病人約有86.1%會有輕至重度擔心癌症復發的問題存在，與人口學相關之危險因子為教育程度 (t=-2.01)，學歷愈高者，擔心癌症復發程度愈高；疾病嚴重度方面，若呼吸困難 (r=0.37)、疲憊 (r=0.35)、失眠 (r=0.27) 及疼痛 (r=0.23) 症狀愈嚴重，愈易擔心癌症復發；而在疾病衝擊方面，當病人出現侵入想法 (r=0.72)、過度警覺 (r=0.70) 及逃避 (r=0.65) 等衝擊行為程度愈高，愈易擔心癌症復發；依逐步迴歸分析的結果，侵入想法與過度警覺可以預測擔心癌症復發的程度，這兩個變項可以解釋總變異量的56%。 本研究可作為日後早期肺癌病人擔心癌症復發程度之照護參考，對教育程度、症狀嚴重度及事件衝擊程度高者，需注意其擔心復發的狀況，進而協助降低內心對擔憂復發的害怕，提升病人生活品質。

Fear of cancer recurrence (FCR) is one of the common problems in cancer patients. Of various types of cancer, lung cancer is of a relatively high mortality rate and low survival rate. Even for patients who have received early lung cancer treatment might experience FCR. However, limited published studies have focused on FCR in treated early-stage lung cancer survivors. Thus, the purposes of this study are (i) to examine the levels (severity) of FCR and (ii) to examine the factors related to FCR. A cross-sectional design with consecutive sampling was conducted to recruit 86 early-stage lung cancer survivors in the surgical outpatient department of a medical center in Northern Taiwan. Participants were assessed by study nurses and completed self-reported measures assessing (i) Severity Subscale of the Fear of Cancer Recurrence Inventory (FCRI-S), (ii) European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30 (EORTC QLQ-C30), (iii) European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Lung cancer 13 (EORTC QLQ-LC 13), (iv) The Impact of Event Scale-Revised (IES-R), and (v) Background Information Form. Means and standard deviations (SD) were used to describe the levels of FCR. Pearson’s correlation, Independent - Samples t test and stepwise linear regression were used to identify factors related to FCR. Results of the current study indicated that 86.1% of the participants had mild to high levels of FCR. In addition, patients with higher levels of education reported higher levels of FCR than patients with lower levels of education (t=-2.01). Furthermore, participants who had worse symptoms reported experiencing higher levels of FCR, including dyspnea (r=0.37), fatigue (r=0.35), sleep difficulties (r=0.27) and pain (r=0.23). Regarding the impact of events, intrusion (r=0.72), avoidance (r=0.65) and hyperarousal (r=0.70) behaviors were also associated with FCR. The results of stepwise linear regression showed that intrusion and hyperarousal were the major factors to predict the levels of FCR, and these two variables accounted for 56% of the total variance. The results of the current study demonstrated that FCR is a major problem in early-stage lung cancer survivors. Therefore, multidisciplinary primary health care team should pay special attention to patients with moderate to high level of FCR, and provide further assistance to reduce their FCR and improve their quality of life.