[[alternative]]The Relationships of Chemotherapy Induced Peripheral Neuropathic Pain, Activities of Daily Lives, Mood, and Quality of Life in Patient with Colorectal Cancers

[[abstract]]本研究旨在探討大腸直腸癌病人因接受化學治療引起之周邊神經性疼痛、日常活動功能、情緒及生活品質的關係。本研究為橫斷式相關性研究設計，方便取樣，以結構式問卷進行資料收集。研究工具包含神經性疼痛症狀量表（Neuropathic Pain Symptom Inventory）、日常活動限制及安全自覺量表（Screening of Activity Limitation and Safety Aweareness Scale，簡稱SALSA scale）、盤氏情緒量表簡版（Profile of Mood States short form, 簡稱POMS SF）、大腸直腸癌病人癌症治療功能性評估量表（Functional Assessment Cancer Therapy-Colorectal instruments version 4，FACT-C version 4）及自擬量表，邀請110位研究對象參與，106位同意並完成資料填寫，有效完成率為96.36%。研究結果顯示，研究對象平均年齡56.92歲（SD＝11.35），男性略多於女性（53.8%：46.2%），教育程度主為高中（職）（29.2%），多數已婚（77.4%）。癌症診斷期別主為第III期（60.4%）及第IV期（34.0%），大部分有一個以上的慢性病史（63.2%），並經根除性手術治療後，接受以oxaliplatin/5-Fu為主要配方之化學藥物治療（95.3%）。研究對象以發生輕微周邊神經性疼痛佔多數（93.4%），其疼痛特性之嚴重程度依次為感覺異常、誘發性疼痛、自發之陣發性疼痛和自發之持續性疼痛，疼痛持續時間以少於1小時佔多數（68.9%），多數無陣發性疼痛（59.4%）；日常活動功能僅少數發生輕度受限情形（11.3%），其受限嚴重程度依次為自我照顧、手的工作、手的靈巧度及足的活動能力。負向情緒程度由嚴重至輕微依次為「活力-好動」、「困惑-迷惑」、「疲勞-懶惰」、「緊張-焦慮」、「沮喪-失意」和「憤怒-敵意」；而生活品質各領域得分依次為生理健康領域、情緒穩定領域、社會家庭健全領域、附加關注事項及功能健全領域。其中，周邊神經性疼痛程度僅次量表「感覺異常」和日常活動功能受限程度之次量表「手的靈巧度」呈輕度正相關（r＝.196, p<.05），整體「周邊神經性疼痛」程度與負向「情緒」程度呈中度正相關（r＝.492, p<.001），以及其次量表「自發之持續性疼痛」與「生活品質」得分呈輕度負相關（r＝-.254, p<.01），「日常活動功能」受限程度與負向「情緒」程度呈中度正相關（r＝.388, p<.01），且與「生活品質」得分呈中度負相關（r＝-.328, p<.01）；而負向「情緒」程度與「生活品質」得分呈高度負相關（r＝-.615, p<.001）。 經階層式迴歸分析（hierarchical multiple regression analysis）發現癌症期別、化學藥物累積劑量、周邊神經性疼痛次量表「自發之持續性疼痛」、日常活動功能及情緒為整體生活品質的預測因子，聯合解釋變異量為45.2%，但加入情緒後，會同時減弱周邊神經性疼痛及日常活動功能的預測力。因此，進一步以OLS多元迴歸分析 (ordinary least square multiple regression analysis)進行中介效應分析，結果發現情緒在自發之持續性疼痛對於生活品質中介效應的解釋變異量為42.51%，而在日常活動功能上對於生活品質中介效應的解釋變異量為43.17%。希冀透過本研究，有助於護理人員更瞭解化學治療引起之周邊神經性疼痛，並重視此症狀對病人日常活動功能、情緒和生活品質所帶來的影響，以協助研發預防及相關照護策略，進而減輕大腸直腸癌病人因化學治療引起的周邊神經性疼痛，降低相關日常活動功能的影響，提升心理健康，並增進生活品質。[[abstract]]The purpose of this study was to investigate the relationships of chemotherarpy induced neuropathic pain, activies of daily lives, mood and quality of life among patients with colorectal cancer in Taiwan. A convenience sample was used in this cross-sectional study. The data was collected by self-administrated questionnaires. The instruments included Neuropathic Pain Symptom Inventory (NPSI)、Screening of Activity Limitation and Safety Aweareness Scale (SALSA scale）、Profile of Mood States short form (POMS SF）and Functional Assessment Cancer Therapy-Colorectal instruments version 4 (FACT-C version 4) as well as self-constructed items. A total of 106 questionnaires were distributed.The results revealed majority of the participants were male (53.8%) and married (77.4%). The average age was 56.92(SD=11.35). The level of education and occupation in most participants were senior high school (29.2%) and housekeeper (20.8%). The stage of cancer in most participants was stage III (60.4%) and IV (34.0%). There was history of chronic disease in the majority of the participants (63.2%) as well as history of post radical resection following by oxaliplatin/ 5-Fu-based chemotherapy (FOLFOX) (95.3%). On the incidence of chemotherapy induced neuropathic pain, majority of the participants is slight (93.4%). The severity of chemotherapy induced neuropathic pain from high to low was paraesthesia, intermittently neuropathic pain, induced neuropathic pain, and spontaneously neuropathic pain, subsequently. On the domain of activities of daily lives, minority of the participants is slight restriction (11.3%). The restrictive severity of activities of daily lives from high to low was self-care, work of hand, dexterity of hands and mobility of feet, subsequently. The score of each domain in mood from high to low was vigor-activity, confusion-bewilder, fatigue-inevtia, tension-anxiety, depression- dejection, and anger-hostility, subsequently. The results indicated that there were a low positive correlation between paraesthesia and dexterity of hands (r＝.196, p<.05), a medium positive correlation between neuropathic pain and mood (r＝.492, p<.001), a medium negative correlation between spontaneously neuropathic pain and quality of life (r＝-.254, p<.01). In additional, a medium positive correlation between activities of daily lives and mood (r＝.388, p<.01), a medium negative correlation between activities of daily lives and quality of life (r＝-.328, p<.01) and a high negative correlation between mood and quality of life were reported (r＝-.615, p<.001). Results from the hierarchical multiple regression analysis detected that stage, accumulative dose of chemotherapy, spontaneously neuropathic pain, and activies of daily lives were determinants in quality of life before mood was included. They can explained 45.2% of the variance on quality of life. Furthermore, the mediating effects of perceived mood on quality of life was analyzed by ordinary least square multiple regression analysis. The result showed 42.51% variance of spontaneously neuropathic pain on quality of life and 43.17% variance of activies of daily lives on quality of life could explained by perceived mood.The result from the current study may provide new insight into status and relationships of chemotherapy induced neuropathic pain, activies of daily lives, mood and quality of life among the patients with colorectal cancer. Strategies which aim to improve the quality of life among patients with colorectal cancer may be developed through the enhancement of nursing evaluation of chemotherapy induced neuropathic pain, activities of daily lives and mood, as well as strengthening management of care guideline