鼻咽癌患者放、化疗期间生存质量及其影响因素研究

福建医科大学硕士学位论文鼻咽癌患者放、化疗期间生存质量及其影响因素研究姓名：林荣金申请学位级别：硕士专业：流行病与卫生统计学指导教师：田俊2011-034[],[]20091020101293EORTCQLQ-C30V3.0MFI-20HADSMCMQECOGEpidata3.1SPSS13.0Spearmanχ2[]12(P0.002)35TT4[]12(T)()3,[]6TheResearchonthequalityoflifeanditsinfluencingfactoramongthepatientswithNasopharyngealCarcinomaduringradiotherapyorchemotherapyAbstract[Objective]Tostudychangesandrelateddeterminantsofqualityoflife(QOL)ofnasopharyngealcarcinoma(NPC)patientsbeforeandafterradiotherapyorchemotherapytoprovideevidencesforimprovingtheirqualityoflife.[Methods]Oursamplewasconsistedof93caseswhohadbeendiagnosedwithnasopharyngealcarcinomaandhadreceiptedthefirstradiotherapyinFujianProvincialTumorHospitalfromOct,2009toDec,2010.Investigationswereconductedbeforeandafterradiotherapyorchemotherapy.Variousmeasuringscaleswereusedintheinvertigation,whichincludedEORTCQLQ-C30(version3.0),MFI-20,HADS,MCMQ,ECOGandself-designedquestionairethatwasaboutbasicinformation,diseasesandtherapyconditionsofpatient.AlldatawereenteredbyEpidata3.1andanalyzedbySPSS13.0.Analysisofvariance(ANOVA)wasusedtoanalyzetheQOL’sdifferencesamongpatientswithdifferentpsychologicalstates.Spearmancorrelationanalysiswasusedtoanalyzetheassociationbetweenfatigueconditions,medicalcopingmodesandthequalityoflifeafterradiotherapyorchemotherapy.Lineartrendtestwasusedtoanalyzetheassociationbetweenanxiety,depression,physicalconditions,andthequalityoflifeafterradiotherapyorchemotherapy.Multiplestepwiseregressionwasusedtoanalyzethefactorsthataffectedthequalityoflifeduringradiotherapyorchemotherapy.[Results]1.Univariateanalysisonqualityoflifeafterradiotherapyorchemotherapy7showedthatthepatientswithmoretiredness,anxiety,depression,copingmodeofsurrender,worsephysicalconditonshadpoorerqualityoflife.2.Qualityoflifeevaluationandfunctionalscalesevaluationafterradiotherapyorchemotherapyappearedlowerthanbefore.Symptomscalesevaluationandsingleitemsevaluationwerehigherthanbefore,withobviouslystatisticdifference(P0.002),whichindicatedthatqualityoflifedecreasedafterradiotherapyorchemotherapy.3.Multivariateanalysisonqualityoflifeafterradiotherapyorchemotherapytreatmentsshowedthatqualityoflifecorrelatedwithnursingstaff,fatigue,anxiety,depression,physicalconditions,medicalcopingmodesandtumorTstage.Basedonstandardizedcoefficients,thepatientswithlessintimaterelationshipwithnursingstaff,worsefatigueconditions,moreanxietyanddepression,worsephysicalconditions,employednegativecopingmodes,diagnosisoflatertumorTstagewouldrelatedtobepoorerquality.4.Multivariateanalysisonqualityoflifebeforeandafterradiotherapyorchemotherapyshowedthatthechangeofqualityoflifecorrelatedwithsex,theplaceofresidence,maritalstatus,nursingstaff,fatigue,anxiety,depression,medicalcopingmodes,radiationmodesandtheperiodofchemotherapy.Basedonstandardizedcoefficients,thefactorswithfemalepatients,ruralresidents,single,lessintimaterelationshipswithnursingstaff,worsefatiguecondition,moreanxiety,anddepression,employingnegativecopingmodes,adoptingthetraditionalradiotherapyandlongerperiodofchemotherapywouldshowpoorerqualityoflife.[Conclusion]1.Qualityoflifeofnasopharyngealcarcinomapatientswithradiotherapyorchemotherapydecreasedobviously.2.Therewereseveralfactorsthatwouldinfluencequalityoflife,themajorityincludedfatigue,phychologicalsituation,medicalcopingmodes,physicalconditions,hospitalcourse(tumorTstage,radiationmodesandtheperiodofchemotherapy)andgeneralcondition(sex,theplaceofresidence,maritalstatusandnursingstaff).83.Moreattentionshouldbepaidontheeducationofnasopharyngealcarcinoma,radiotherapyandchemotherapybeforeradiotherapyorchemotherapy.Patientsshouldbeencouragedtoactivelydotherehabilitationexercisetoimprovetheirmood,toemploypositivecopingmodesandtoimprovetheirnutritionalstatusduringradiotherapyorchemotherapy.Aswellasmoreattentionsshouldbepaidonfemaleandpatientswithlatestages.Moresocialandfamilysupportsarealsorequired.[Keywords]Nasopharyngealcarcinoma;Radiotherapy;Chemotherapy;Qualityoflife;Psychologicalstate;Copingmodes;Physicalcondition2__________________________________________________________________________________________________________________________9QualityofLifeQOLWHO[1][2],,WHO,[3]nasopharyngealcarcinoma,NPC7808[4]WHO80[5]10570%,/590%,/560%[6]1112009.102010.121.11.222.12009102010122.22.2.12.2.2083123.1theEuropeanOrganizationforResearchandTreatmentofCancerQualityofLifeCoreQuestionnaire,EORTCQLQ-C30V3.0,30151/(globalqualityoflife,GOL)5physicalfunction,PFrolefunction,RFcognitivefunction,CFemotionalfunction,EFsocialfunction,SF3fatigue,FApain,PAnausea/vomiting,NV6dyspnoea,DYinsomnia,SLappetiteloss,APconstipation,COdiarrhoea,DIfinancialdifficulties,FI1~281~41-2-3-4-29~301~7170~100510~100[7-10][11]226EORTCQLQ-C303.2theMultidimensionalFatigueInventory-20MFI-20[12]204Likert51=2=3=4=5=25910131416171819134678111215203.313(HospitalAnxietyandDepressionScaleHADS)HADS147246810121471357911136519≥93.4MedicalCopingModesQuestionnaire,MCMQ,32041~48(1491012131819)1251012151619378911141746131820[13]3.5ECOG0~45012343444.14.21410%5%51112140240~49350~59460123121234511