頭頸癌患者疼痛困擾與生活功能探討

Abstract

治療引起的疼痛經常困擾頭頸癌患者於存活期，疼痛會影響其生活功能。本研究目的為：(1)探討頭頸癌患者疼痛嚴重度及特質與生活功能，(2)疼痛與生活功能相關性，(3)探討生活功能的預測因子。 本研究以橫斷性研究設計，於臺灣北部某醫學中心耳鼻喉科門診收案，時間自民國103年8月至民國104年5月，以結構式問卷訪談，問卷包括：病患基本資料、簡易疼痛量表、簡易McGill疼痛問卷與世界衛生組織生活功能評估2.0，資料以SPSS統計軟體進行分析，包括描述性統計(次數分配、平均值、標準差及百分比)、皮爾森積差相關 (Pearson’s correlation)、單因子變異數分析 (one-way ANOVA)，及羅吉斯迴歸 (logistic regression)。 本研究共收集119位頭頸癌患者，研究結果發現：(1)半數 (50.5%) 患者在治療結束後仍然受疼痛困擾，且多數為治療所導致，73%患者接受手術治療，手術範圍越大，其疼痛情形越嚴重。(2)治療後疼痛部位多集中於肩頸部，其次為口腔，性質多為「一觸就痛的痛」、「刺痛」及「抽痛」。(3)疼痛強度多介於輕度至中度疼痛，接受治療完成6個月後疼痛干擾明顯下降，但仍有超過半數疼痛患者的疼痛持續時間大於半年。(4)疼痛影響生活功能，尤其以「社會參與」、「活動性」、「與他人相處」以及「認知與溝通」出現最多問題。 臨床照護應關注頭頸癌患者完成治療後疼痛，主動評估疼痛及疼痛引起的生活功能障礙，以減少頭頸癌患者治療後之生活功能障礙。

Head and neck cancer (HNC) patients suffered from treatment-induced pain during survival period. The purpose of this study was to (1) examine the severity and characteristics of pain, and daily function, (2) examine the correlation of pain and daily function, and (3) examine the predictors of daily function in HNC patients. A cross-sectional study was conducted. Participants were recruited from the otolaryngology outpatient department of a medical center in northern Taiwan between August 2014 and May 2015. A set of questionnaires was used to interview, questionnaires including background information from, McGill Pain Questionnaire short-form (MGPQ), Brief Pain Inventory (BPI), and WHO Disability Assessment Schedule 2.0. (WHODAS 2.0). All calculations were made using SPSS for Window. The data analysis was conducted with descriptive statistics (frequency, mean, standard deviation, and percentage), Pearson’s product moment correlation, one-way ANOVA, and logistic regression. A total of 119 HNC patients were recruited in this study. The results showed that (1) half of participants experienced pain at post-treatment, most of the patients was treatment-induced pain. 73% of the patients received surgery, and the larger area of surgery was significantly associated with severe pain, (2) the location of pain focused on shoulder and oral cavity, respectively; the characteristics of pain were tender, sharp, and throbbing, (3) Patients had mild-to-moderate levels of pain, especially significantly interfere with daily function within 6 months, and more than half of patients reported pain lasting more than 6 months, and (4) Patients’ pain impact on daily function, and the top four dimensions according to descending were participation in society, getting around, getting alone with people, and understanding and communication, respectively. Healthcare providers should pay attention for HNC patients’ pain after completing treatment, actively assess the severity and characteristics of pain and interfere with daily function, and reduce the impairment of daily function in HNC patients during post-treatment. The result of this research can provide into clinical HNC survivors’ care, in order to assess disability by pain, and become reference to the study in the future.