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| 題名: | 肝癌病人初次接受免疫及標靶合併治療之不適症 狀、生活品質、希望感及決策後悔探討
Symptom, Quality of Life, Hope, and Decision Regret in Hepatocellular Carcinoma Patients Receiving Immunotherapy Combined with Targeted Therapy |
| 作者: | 王惠萱
WANG, HUEI-SHIUAN |
| 貢獻者: | 護理學系碩士在職專班
黃采薇 |
| 關鍵詞: | 肝癌;希望感;決策後悔
Hepatocellular Carcinoma;Hope;Decision Regret |
| 日期: | 2024-06-17 |
| 上傳時間: | 2025-01-06 |
| 摘要: | 本研究目的主要在探討肝癌病人接受免疫及標靶合併治療之不適症狀、生活品質、對新療程的希望感、並探討選擇此療程之決策後悔及其相關因素。本研究為前瞻研究設計，收案人數為33位肝癌病人，研究工具為人口學、疾病基本屬性，以及問卷包括：健康生活品質測量問卷 (EuroQol instrumen-5D-5L)中文版、台灣版簡明疲憊量表(Brief Fatigue Inventory-Taiwanese;BFI-T)、埃德蒙?症狀評估量表(Edmonton Symptom Assessment Scale; ESAS)、肝癌病人接受免疫治療相關不良反應問卷調查表、決策後悔量表(Decision Regret Scale,DRS)中文版及赫氏希望指標(Herth Hope Index, HHI)中文版進行資料收集。資料收集日程為病人接受第一次免疫及標靶合併治療療程為T1，每次療程進行問卷填寫，隨訪至第六次療程或中途病人未繼續免疫及標靶合併治療，資料統計分析方法包括:成對樣本t檢定(Paired Sample t-test)、獨立樣本t檢定(Independent t-test)、多元線性迴歸模型（Mutiple Linear Regression Model）、廣義估計方程式（Generalized Estimating Equation）、皮爾森相關係數 (Pearson Correlation Coefficient)、卜瓦松迴歸模型(Poisson Regression Model)及羅吉斯迴歸模型(Logisitc regression Model)，統計分析皆使用SPSS 18.0統計軟體。
本研究共追蹤33位肝癌病人，平均年齡為65.09歲。免疫及標靶合併治療中，其中免疫藥物搭配口服酪胺酸激?抑制劑（Tyrosine kinase inhibitor，TKI）治療有18.2％（n=6人），使用免疫藥物搭配抗血管內皮生長因子（Anti-vascular endothelial growth factor，Anti-VEGF）治療有81.8％（n=27人）。未滿追蹤六次原因中因疾病惡化佔18.1％（n=6人）佔比最多，其中6％（n=2人）為免疫相關不良反應（irAE）而中止療程。結果顯示接受免疫及Anti-VEGF類標靶藥物合併治療，與免疫及TKI類標靶藥物合併治療的病人在症狀表現、疲憊程度以及健康生活品質有明顯不同。對新藥物組合治療的希望程度在接受治療後有顯著下降(p＝.005)，有無過去病史（p＝.024）對於希望感有顯著影響；決策後悔研究中，發現未繼續接受免疫及標靶合併治療的病人有較高的決策後悔（p＝.013）；有無完成六次隨訪（p＝.021）、整體健康感受（p＝.023）及有無過去病史（p＝.024）對於決策後悔有顯著影響。
本研究強調了在肝癌治療過程中，臨床醫護人員需密切關注病人的症狀變化、生活品質以及心理狀況，並及早介入，以減少治療過程中的不良反應和決策後悔，期待肝癌病人在提升存活率的同時，能提供更適切的護理照護並且提升病人的生活品質。
The primary objective of this study is to investigate adverse symptoms, quality of life, hope for new treatments, and decision regret among hepatocellular carcinoma patients undergoing combined immunotherapy and targeted therapy. This prospective study enrolled 33 liver cancer patients. Research instruments included demographic and disease-related attributes, as well as questionnaires such as the Chinese version of the EuroQol-5D-5L, the Brief Fatigue Inventory-Taiwanese (BFI-T), the Edmonton Symptom Assessment Scale (ESAS), a survey on adverse reactions to immunotherapy in hepatocellular carcinoma patients, the Chinese version of the Decision Regret Scale (DRS), and the Chinese version of the Herth Hope Index (HHI). Data collection was scheduled at the initiation of the first combined immunotherapy and targeted therapy (T1) and at each subsequent treatment cycle, following up to the sixth treatment cycle or until the patient discontinued the combined therapy. Statistical analyses included paired sample t-test, independent t-test, multiple linear regression model, generalized estimating equation (GEE), Pearson correlation coefficient, Poisson regression model, and logistic regression model, using SPSS 18.0 for analysis.
This study tracked 33 hepatocellular carcinoma patients with an average age of 65.09 years. In the combination therapy, 18.2% (n=6) of patients received immunotherapy with oral tyrosine kinase inhibitors (TKIs), and 81.8% (n=27) received immunotherapy with anti-vascular endothelial growth factor (Anti-VEGF) therapy. The primary reason for not completing six cycles of follow-up was disease progression (18.1%, n=6), with 6% (n=2) discontinuing due to immune-related adverse events (irAEs). Results indicated significant differences in symptom presentation, fatigue levels, and quality of life between patients receiving combined immunotherapy and Anti-VEGF versus those receiving combined immunotherapy and TKI therapy. There was a significant decrease in hope for new treatment after therapy (p=.005), and past medical history significantly influenced hope (p=.024). Patients who discontinued the combined therapy had significantly higher decision regret (p=.013). Completion of six cycles of follow-up (p=.021), overall health perception (p=.023), and past medical history (p=.024) significantly influenced decision regret.
This study emphasizes the need for clinical healthcare providers to closely monitor changes in symptoms, quality of life, and psychological status of hepatocellular carcinoma patients throughout the treatment process. Early intervention is crucial to reduce adverse reactions and decision regret, aiming to improve survival rates and provide appropriate care to enhance patients' quality of life. |
| 描述: | 碩士
指導教授：黃采薇
口試委員：鄭安理
口試委員：陳錦華
口試委員：黃采薇 |
| 附註: | 論文公開日期：2024-07-23 |
| 資料類型: | thesis |
| 顯示於類別: | [護理學系] 博碩士論文
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