2020-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/703007摘要：高達70%病人經歷癌症導致認知障礙(Cancer-Induced Cognitive Impairment, CICI),其影響日常生活、工作狀況、人際關係、情緒、與生活品質。然而，CICI多屬輕度而相較其他症狀較易被忽略且台灣目前缺乏結直腸癌相關認知研究。因此，本研究將以二階段進行三年期計畫:第一階段(第1-2年)為(1)質量性混合式橫斷式設計探討不同時期結直腸癌病人認知功能及其相關因素,及其對生活所造成的困擾與調適。(2)採縱貫式設計瞭解手術與化學治療對於結直腸癌病人認知功能之短、長期影響並確認其高危險因素。橫斷式研究針對40-75歲於5種不同時期(術前、化療3-6個月、完成治療1年內、存活1-2年內、存活2年以上）之結直腸癌患者進行主客觀認知評量。縱貫式研究將追蹤三組個案(A組為手術治療、B組為手術+化學治療組、C組為對照組) 進行42週內6次的追蹤，選取年齡介於40-75歲將開刀之初診斷結直腸癌患者為A、B組；而C組為年齡配對之非癌症門診病人。針對初診斷結直腸癌病人預計接受手術結直腸癌病人以及對照組（非癌症病人）進行。評估工具包括FACT-Cognitive function以及Montreal Cognitive Assessment (MoCA)以及認知功能層面（記憶、執行功能與專注）之評估。橫斷式量性研究中以Logistic regression以及類神經網路之深度學習運算分析認知障礙之高危險因素，預計招募355位；縱貫式研究預計三組共計300 位。質性訪談徵求經歷認知障礙之個案，採半結構式問卷深度訪談及錄音，以瞭解認知障礙對於生活的困擾與個人調適。資料將採內容分析法，預計招募35位。第二階段(第3年)為發展與測試雙重任務走路運動(dual-task walking)介入於改善結直腸癌病人化學治療後改善認知功能(記憶、執行功能、專注)之成效。將針對已完成化學治療9次療程的病人經MoCA 評估小於24分之個案，依其年齡( ≦ 65 VS. > 65歲)分層隨機試驗。實驗組於化療第10-12次間提供3次面對面衛教及12週的雙重任務走路運動的介入措施；控制組為常規照護。資料收集時間點包括化療第10次前(基礎值)以及完成化學治療後第3、6、12個月追蹤認知功能。評估工具同於第一階段；將以廣義線性模式分析二組認知功能差異, 二組預共招募40位個案。<br> Abstract: Up to 70% of cancer patients had reported suffering from cancer-induced cognitive impairment (CICI); however, CICI is general mild and it has been ignored in the clinical settings. Furthermore, there is no study related to CICI in patients with colorectal cancer (CRC) in Taiwan. Therefore, this research program will be conducted in two phases: In the first phase (1st-2nd year), a cross-sectional design with mixed methodology will be used to (1) explore cognitive function under different stages of CRC and its related factors; and (2) understand its disturbance and coping process caused by CICI from patient perspective. A longitudinal design will be used to explore the effect of surgery and chemotherapy on CICI, and to identify high risk population. In cross-sectional study, participants under different cancer trajectory with age ranging 40-75 years will be approached to assess their cognitive function once. In the longitudinal study, three groups (Group A with surgery only, Group B with surgery and chemotherapy, and Group C with age-matched non-cancer outpatients) will be followed. The participants who will receive surgery with age ranging 40-75 years old will be recruited in Group A or B, which are going to receive chemotherapy will be the Group B. Six times within 42 weeks follow-up to assess changes of cognitive function at similar time points for three groups. A set of questionnaire with FACT-Cognitive function, Montreal Cognitive Assessment (MoCA) and a neuropsychological battery test assessing cognitive functioning of memory, executive function and attention will be used to assess cognitive function. Logistic regressions and neural networks deep machine learning to identify the high risk factors with mild cognitive impairment will be used to analyze data. 355 participants will be approached in cross-sectional study and 300 participants will be approached in longitudinal study. Generalized Estimating Equations will be used to examine group differences of cognitive function by changes and Latent Growth Analysis will be used to identify the characteristics of the high risk population. The semi-structured interview guide with digital record will be used to collect patients’ experience of cognitive impairment. Content analysis will be used to analyze the data from 35 participants.In the second phase (3rd year), the aim is to test effect of dual-task walking on improving cognitive function (memory, executive function and attention) in CRC patients. Stratified randomized control trial based on the age (≦65 or > 65) will be used. The participants with newly diagnosed CRC and MoCA < 24 will be recruited. Participants in the experimental group will receive 3 times interventions during 10th to 12th course of chemotherapy and 12 weekly phone-call to assess barriers of dual-task walking. Participants in control group will receive usual care. Outcome of 12-week dual-task walking on improving cognitive function will be assessed at before 10th course of chemotherapy (T0, baseline), at 3 (T1), 6 (T2) and 12 (T3) months after completing chemotherapy by a set of questionnaire as same as first phase. The effect of dual-task walking will be examined by generalized estimating equations. 40 participants will be approached.結直腸癌認知障礙化學治療雙重任務走路Colorectal cancerCognitive impairmentchemotherapydual-task walking