[[alternative]]The Changes Over Time of Health-Related Quality of Life and Its Related Factors in Postoperative Colorectal Cancer Patients

[[abstract]]研究背景：結腸直腸癌佔十大癌症死亡率第三位，目前最有效的治療方式為手術切除病變之部位，術後需面臨症狀困擾，如疲憊、憂鬱、焦慮、失眠等問題，影響病人生活品質，瞭解結腸直腸癌術後病人健康相關生活品質隨時間改變情形及其影響因素將有助於發展適當措施以提升病人之健康相關生活品質。因此本研究主要目的在探討結腸直腸癌病人術後之健康相關生活品質隨時間改變情形及其影響因子。研究方法：研究採長期追蹤之行研究設計，於北部一家醫學中心進行收案，分別於術後一個月、三個月及五個月，三個時間點，以結構性問卷進行資料收集，針對75位結腸直腸癌存活者填答研究問卷。問卷內容包括基本資料表、查爾森共病指數、台灣活動量調查短版問卷、美國飲食研究快篩問卷、匹茲堡睡眠品質量表，疲倦量表、醫院焦慮憂鬱量表、和癌症相關生活品質量表。所得資料以SPSS for Window套裝軟體進行資料統計及分析。首先以平均值、標準差、次數分佈、百分比描述研究變項的集中與離散情形；再以廣義估計方程式(分析與健康相關生活品質隨時間改變情形，之後針對每一個自變項與健康相關生活品質隨時間改變情形的影響進行單變量分析，最後進行多變量分析以確認與健康相關生活品質隨時間改變情形的重要預測因子。研究結果：廣義估計方程式分析結果顯示結腸直腸癌術後病人之健康相關生活品質隨時間變化無顯著差異，平均值於術後一個月、三個月、五個月分別為101.7分（SD=18.5）、98.7分（SD=20.1）、99.7分（SD=18.1）。廣義估計方程式多變量分析結果顯示教育程度、婚姻狀態、職業狀況、經濟狀況、術後輔助治療方式、抽菸習慣、喝酒習慣、纖維攝取量、身體活動量、睡眠品質、疲倦、憂鬱與焦慮為健康相關生活品質隨時間改變情形之重要預測因子。而年齡、共病嚴重程度、和手術方式對健康相關生活品質隨時間改變情形的影響均未達統計上之顯著意義。結論：本研究探討結腸直腸癌術後病人之健康相關生活品質隨時間改變情形及其重要預測因子。研究分析結果發現腸直腸癌術後病人，隨時間維持大量的身體活動量、攝取足夠的纖維量、擁有良好的睡眠品質、疲倦程度低、低憂鬱情形與焦慮程度低有較高的健康相關生活品質。臨床照護上，建議針對此類病人發展適當措施，協助增加身體活動量及纖維攝取量，改善睡眠品質，緩解疲倦程度，減輕憂鬱與焦慮情形，以提升結腸直腸癌術後病人之健康相關生活品質。[[abstract]]Background:Colorectal cancer accounts for the third largest mortality rate among the top ten cancers, At present, the most effective treatment is surgical removal of the lesion. After the operation, you need to face symptoms such as fatigue, depression, anxiety, insomnia, etc. Various problems affect the treatment and prognosis of cancer patients. Understanding the health problems of patients undergoing colorectal cancer surgery and related quality of life changes over time is worthy of attention and attention, and will help clinical care to improve health-related quality of life. The aim of this study is to explore factors influencing changes of quality of life over time in post-operative colorectal cancer patients.Methods:This is a longitudinal observational study. A convenient sample of post-operative colorectal cancer patients were recruited from a medical center in Northern Taiwan. Data were collected by using structured questionnaires at post-operative 1 month, 3 months and 5 months. The questionnaires included basic demographic data, Charlson Comorbidity Index, modified short version of International Physical Activity Questionnaire, Fiber intake, Table Study-Quick Food Scan, Pittsburgh Sleep Quality Index, Functional Assessment of Cancer Therapy: Fatigue, Hospital Anxiety and Depression Scale and Functional Assessment of Cancer Therapy: General. All the data were analyzed using SPSS. First, describe the concentration and dispersion of research variables in terms of mean, standard deviation, frequency distribution, and percentage. The generalized estimating equation was used to analyze the trend of health-related quality of life over time. Biivariate analyses were used to analyze the influence of each independent variable on the change trend of health-related quality of life. Finally, a multivariate analysis was conducted to explore important predictors of health-related quality of life change over time.Result:The results of the generalized estimation equation analysis showed that there was no significant time difference in the health-related quality of life of patients after colorectal cancer surgery. The average value was 101.7 points (SD=18.5) and 98.7 points (SD=20.1), 99.7 points (SD=18.1) in one month, three months, and five months after surgery. The multivariate analysis results of the generalized estimation equation show that education level, marital status, occupational status, economic status, postoperative adjuvant treatment, smoking habits, drinking habits, fiber intake, physical activity, sleep quality, fatigue, depression and anxiety are important predictors of changes in health-related quality of life. However, the effects of age, comorbidity index, and surgical method on the changes in health-related quality of life are not statistically significant.Conclusions:This study explores the health-related quality of life of colorectal cancer patients over time and its important predictors. Research and analysis results show that patients with colorectal cancer surgery maintain a large amount of physical activity over time, intake of sufficient fiber, have good sleep quality, low fatigue, low depression and low anxiety have a higher health-related life quality. In clinical care, it is recommended to develop appropriate measures for such patients to help increase physical activity and fiber intake, improve sleep quality, relieve fatigue, reduce depression and anxiety, and improve the health-related quality of life of patients after colorectal cancer surgery