| Summary: | 碩士 === 高雄醫學大學 === 口腔衛生學系碩士在職專班 === 105 === Introduction: Nowadays, many cross-sectional studies on patients with head and neck (H&N) cancer focus on oral health status and their quality of life, but few studies has paid attention to longitudinal studies. Better understanding of the changes of quality of life before and after treatment can help us come up with different intervention strategies for the target group based on different phrases of the study.
Purpose: This study was to demonstrate the change of oral health status, mental health status and quality of life on H&N cancer patients before and after treatment. Furthermore, we would like to analyze whether different H&N cancer staging and different therapeutic methods affect patient’s quality of life. And also, we would like to know if changes of their life quality may affect patient’s overall survival rate.
Materials and Methods: We conducted a prospective longitudinal study. The quality of life of these patients was evaluated by using the general quality of life questionnaire (EORTC-QLQC30) and the quality of life questionnaire (QLQ-H&N35). In this study, H&N cancer patients who received treatment (including curative surgery, chemotherapy or chemotherapy in combination with radiotherapy) in a medical center of southern Taiwan were recruited.The assessment of health-related quality of life (QOL) of the patients as well as oral assessment (maximal mouth opening degree, MMO) was both conducted before treatment and 3-months after treatment. To analyze different aveage value of the demographic features of population and clinical attributes to the quality of life, t-test and ANOVA were adopted.Besides, BSRS-5 and MMO were evaluated to assess the impact on the overall quality of life before and after treatment by conducting Linear Regression Analysis. Furthermore, calculate the surval rate of patients by Kaplan-Meier method and use multivariate analysis in a Cox-regression Hazard mode on the analysis of the survival rate.
Results: The maximal mouth opening degree (MMO) of H&N cancer patients significantly decreased by an average of 0.44 cm after treatment (P<0.001). Changes of BSRS-5 scores(95% CI=-4.49,-2.42) related to the overall healthy living quality showed significant impact on the overall quality of healthy living before and three months after treatment. The increasing score, commonly referred to as one score, means the overall qulity of healthy living decreased to 3.35 and 6.36 before and three months after treatment respectively.Before treatment, oral cancer patients with BSRS-5 score ≧6 had 5.01 times higher mortality rate than those with BSRS-5 score < 6. ((95% CI=1.41-17.71) while three months after treatment, those with BSRS-5 score ≧6 had 22.44 times higher mortality rate than those with BSRS-5 score < 6. (95% CI=7.87-80.44). Therefore, BRSS-5 can be used as an indicator of the 2-year survival prediction in patients with oral cancer. In addition, the dimensions of "Role function", "Financial difficulties" and “social interaction” before treatment and “ Weight Loss” after Treatment in the Quality of Life are identified as important prediction factors of the survival rate of oral cancer patients.
Conclusions: According to our study, BSRS-5 scores of H&N cancer patients were highly related to the overall quality of life and this evaluation should be included in the regular assessment of oral cancer patients before and after treatment. The indicator Quality of life can predict the survival of patients with oral cancer. Before treatment,the following three indictors such as “role function of patients " and "financial difficulties " “and social contact” had significantly associated with the overall survival rate of oral cancer patients. It is advisable to help them with the intervention of social workers. On the other hand, after treatment, the indicator of the dimension of Quality of Life of the the overall survival rate is “Weight Loss” and it is suggested that the nutritionists should provide timely assistance when in needed so that the quality of life can be improved and their suvaival rate can be further enhanced.
Key Word：Quality of Life of Head and Neck Cancer、Survival prediction of Oral Cancer
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