第五章 結果與討論
第四節 建議
一. 未來研究方面
根據本研究的限制，未來研究建議應增加其研究檢力，而方法有二，一為加 樣本數，具體做法包括減低網羅病患過程中被遺漏的對象，或增加收案醫院來源；
二為增加樣本的異質性，多網羅癌症病患中症狀較嚴重、疲倦、虛弱的對象，如 此，研究結果亦較能推論至較嚴重的癌症患者。
有許多研究指出體重下降與存活時間呈反向相關，體重下降愈多，存活時間 愈短，建議未來研究可再加入此一變項預測存活。
「核心問卷」在本研究中顯示有不錯的反應性，建議可加入一般性生活品質 測量工具，以了解一般民眾與肺癌病患之間生活品質的差異性，並探討一般性生 活品質與癌症別生活品質之相關。
二. 臨床照護方面
在「核心問卷」、「肺癌問卷」對於肺癌病患具有良好反應性，可用於臨床照 護的過程中，作為肺癌病患療效評估的工具，藉此可觀察肺癌病患於手術後及化 療療程中健康狀況的變化，可供臨床照護者依病患健康狀況的變化作處置的改變，
以減緩疾病本身及副作用所帶來的不適，改善病患生活品質。
三. 病患家屬方面
由於癌症病患需要更多的情緒舒緩及心理層面的支持，而「核心問卷」、「肺 癌問卷」可反映出病患在治療過程中及治療後的生活品質及症狀的改變，可讓家 屬更了解癌症病患的感受，並給予適當的照顧及心理層面的支持。
參考文獻
1. Aaronson, N.K 英文部份
., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N.J., Filiberti, A., Flechtner, H., Fleishman, S.B., de Haes, J.C., et al. （1993）The European Organization for Research and Treatment of Cancer QLQ-C30: A Quality of Life Instrument for Use in International Clinical Trials in Oncology.
Journal of the National Cancer Institute, 85(5), 365-376.
2. Aaronson, N.K., Ahmedzai, S., Bullinger, M., et al. （1991） The EORTC Core Quality of Life Questionnaire: Interim Results of An International Field Study.
In Effect of Cancer on Quality of Life（Osoba D, ed）, Boston: CRC Press, 185-203.
3. Aaronson, N.K., Cull, A.M., Kaasa, S., Sprangers, M.A.G. （1996） The European Organization for Research and Treatment of Cancer（EORTC）：
Modular Approach to Quality of Life Assessment in Oncology: An Update.（2nd ed.）. Quality of life and Pharmacoeconomics in Clinical Trials, 179-189.
4. Aaronson, N.K., Ahmedzai, S., Bergman, B., et al. （1993） For the EORTC Study Group on Quality of Life. The EORTC QLQ-C30. A Quality of Life Instrument For Use In International Clinical Trials in Oncology. J Natl Cancer Inst, 85(5),365-376.
5. Aaronson, N.K., Cull, A.M., Kaasa, S., Sprangers, M.A.G. （1993） The European Organization for Research and Treatment of Cancer Approach to Quality of Life Assessment: Guidelines for Developing Questionnaire Modules.Qual Life Res, 2,287-295.
6. Aistars, J. (1987) Fatigue in the Cancer Patient: a Conceptual Approach to a Clinical Problem. Oncology Nursing Fortum, 14(6), 25-30.
7. American cancer society. Cancer Statistics 2008 Presentation.
http://www.cancer.org/docroot/home/index.asp.
8. Beaton, D.E., Bombardier, C., Katz, J.N., Wright, J.G., Wells, G. & Boers, M.
(2001) Looking for Important Change/Differences in Studies of Responsiveness.
J Rheumatol, 28, 400-405.
9. Beer, J. （1995）Body Image of Patients With ESRD and Following Renal Transplantation. British Journal of Nursing, 4,591-598.
10. Bergman, B., Aaronson, N.K., Ahmedzai, S., et al. （1994） The EORTC QLQ-LC13: A Modular Supplement to The EORTC Core Quality of Life
Questionnaire (QLQ-C30) for Use in Lung Cancer Clinical Trials. EORTC Study Group on Quality of Life. Eur J Cancer, 30, A635-642.
11. Bjordal, K., Kassa, S. （1992） Psychometric Validation of The EORTC Core Quality of Life Questionnaire, 30-Item Version and A Diagnosis-Specific Module for Head and Neck Cancer Patients. Acta Oncal, 31, 311-321.
12. Bland, J.M., Altman, D.G. （1986） Statistical Methods for Assessing Agreement Between Two Methods of Clinical Measurement. Lancet, 307-310.
13. Bowling, A. （2003） Measuring Disease: A Review of Disease-Specific Quality of Life Measurement Scales（2nd ed.） Open University Press.
14. Cella, D.F. (1994) Quality of Life: Concepts and Definition. Journal of Pain and Symptom Management, 9, 186-192.
15. Cella, D.F., Orofiamma, B., Holland, J.C., Silberfarb, P.M., Tross, S., Feldstein, M., Perry, M., Herbera, M.L., Comics, R. & John, O.E. (1987) The Relationship of Psychological Distress, Extent of Disease, and Performance Status in Patients with Lung Cancer. Cancer, 60(6), 1661-1667.
16. Chie, W.C., Yang, C.H., Hsu, C., Yang, P.C. （2004） Quality of Life of Lung Cancer Patients: Validation of the Taiwan Chinese Version of The EORTC QLQ-C30 and QLQ-LC13. Qual Life Res, 13, 257-262.
17. Coates, A., Porzsolt, F. & Osoba D. (1997) Quality of life in Oncology Practice:
Prognostic Value of EORTC QLQ-C30 Scores in Patients with Advanced Malignancy. European Journal of Cancer, 33(7), 1025-1030.
18. Cohen, J. (1988 ) Statistical Power Analysis for the Behavioral Sciences. 2nd ed.
Hillsdale, NJ: Lawrence Erlbaum Associates.
19. De Boer, J.B., Sprangers, M.A.G., Aaronson, N.K., Lange, J.M.A., van Dam, F.S.A.M. （1994） The Feasibility, Reliability and Validity of The EORTC QLQ-C30 in Assessing the Quality of Life of Patients with Symptomatic HIV Infection or AIDS(CVC IV).Psychol Health, 9, 65-77.
20. Dest, V.M. (2000) Lung Cancer. RN, 63(5), 32-34.
21. Duat, R.L. & Cleeland, C.S. (1982) The Prevalence and Severity of Pain in Cancer. Cancer, 50, 1913-1918.
22. Fayers, P.M., Aaronson, N., Bjordal, K., Sullivan, M. （2001） EORTC Scoring Mannal, （3rd ed.）Brussels, Belgium:Quality of Life Unit, EORTC Data Centre.
23. Fayers, P.M., Bleehen, N.M., Girling, D.J., et al. （1991） Assessment of Quality of Life in Small-Cell Lung Cancer Using a Daily Diary Card Developed by The Medical Research Council Lung Cancer Working Party. Br J Cancer, 64, 299-306.
24. Fayers, P.M., Jones, D.R. （1983） Measuring and Analyzing Quality of Life in Cancer Clinical Trials: A review. Statistics in Medicine, 2, 429-446.
25. Ferlay, J., Bray, F., Pisani, P., Parkin, D.M. & Globocan (2000). Cancer incidence, mortality and prevalence worldwide, version 1.0. Lyons, France: Intermational
Agency for Research on Cancer, 2001(software).
26. Ferrans, C.E. & Powers, M.J. (1985) Quality of Life Index: Development and Psychometric Properties. ANS, 8, 15-24.
27. Ferrell, B.R. (1995) The Impact of Pain on Quality of Life. Nursing Clinics of North America, 30(4), 609-624.
28. Ferrell, B.R., Dow, K.H., Leigh, S., Ly, J. & Gulasekaram, P. (1995) Quality of Life in Long-Term Cancer Survivors. Oncology Nursing Forum, 22(6), 915-922.
29. Fleiss, J.L. （1975） Measuring Agreement Between Two Judges on The Presence or Absence of A Trait. Biometrics, 31, 651-659.
30. Fossa, S. （1994） Quality of Life Assessment in Unselected Oncologic Out-Patients: A Pilot Study. Int J Oncol, 4, 1393-1397.
31. Guyatt, G.H., Berman, L.B., Townsend, M., Pugsley, S.O., Chambers, L.W.
（1987） A Measure of Quality of Life for Clinical Trials in Chronic Lung Disease. Thorax, 42, 773-778.
32. Guyatt, G.H., Norgrasi, S., Halcrow, S., Singer, J., Sullivan, M.J.J., Fallen, E.L.
（1989） Development and Testing of A New Measure of Health Status in Heart Failure. J Gen Inten Med, 4, 101-107.
33. Guyatt, G.H., Walter, S.D. & Norman, G. (1987) Measuring Change over Time:
Assessing the Usefulness of Evaluative Instruments. J Chron Dis, 40, 171-180.
34. Herndon, J.E., Fleishman, S., Kornblith, A.B., Kosty, M., Green, M.R., Holland, J. (1999) Is Quality of Life Predictive of the Survival of Patients with Advanced Nonsmall Cell Lung Carcinoma? Cancer, 85(2), 333-340.
35. Holland, J.C. (1999) Update: NCCN Practice Guidelines for the Management of Psychosocial Distress. Oncology, 13(5A), 113-147
36. Husted, J.A., Cook, R.J., Farewell, V.T., Gladman, D.D. （2000） Methods for Assessing Responsiveness: A Critical Review and Recommendations. J Clin Epidemiol, 53, 459-468.
37. Hutchinson, A., Fowler, P. （1992） Outcome Measures for Primary Health Care:
What Are The Research Priorities? British Journal of General Practice, 42, 227-231.
38. Iwamoto, R. (2000) Lung Cancer. In B. M. Nevidjon & K. W. Sowers(Eds). A Nurse’s Guide to Cancer Care, Philadelphia: Lippincatt, 44-61.
39. Juniper, E.F., Guyatt, G.H., Feeny, D.H., Ferrie, P.J., Griffith, L.E. Townsend, M.
（1995） Measuring Quality of Life in Children with Asthma. J Allergy Clin Immunol, 95, 226.
40. Juniper, E.F., Guyatt, G.H., Willan, A. Griffith, L.E. （1994） Determining a Minimal Important Change in a Disease-Specific Quality of Life Questionnaire.
J Clin Epidemiol, 47, 81-87.
41. Kelsey, J.L., Thompson, W.D., Evans, A.S. （1986） Methods in Occupational Epidemiology. New York: Oxford University Press, 285-308.
42. Kirshner, B., Guyatt, G.H. （1985） A Methodological Framework for Assessing Health Indices. J Chron Dis, 38, 27-36.
43. Kramer J.A., Curran D., Piccart M., J.C.J.M. de Haes, Bruning P., Klijn J., Van Hoorebeeck I. & Paridaens R. (2000) Identification and Interpretation of Clinical and Quality of Life Prognostic Factors for Survival and Response to Treatment in First-line Chemotherapy in Advanced Breast Cancer. European Journal of Cancer, 36, 1498-1506.
44. Larson, P.J., Lindey, A.M., Dodd, M.J., Brecht, M.L. & Packer, A. (1993) Influence of Age on Problems Experienced by Patients with Lung Cancer Undergoing Radiation Therapy. Oncology Nursing Forum, 20(3), 473-480.
45. Liang, M.H., Larson, M.G., Cullen, K.E., Schwartz, J.A. （1985） Comparative Measurement Efficiency and Sensitivity of Five Health Status Instruments for Arthritis Research. Arthritis Rheum, 28, 542-547.
46. Lydick, E., Epstein, R.S. （1993） Interpretation of Quality of Life Changes.
Qual Life Res, 2,221-226.
47. Maltoni M, Pirovano M, Scarpi E, et al (1995) Prediction of Survival of Patients Terminally Ill with Cancer. Cancer, 75:2613-2622.
48. McKenna, S.P. （1993）The Nottingham Health Profile. Paper Presented to the Fifth European Health Services Research Conference, Maastricht.
49. McMillan, S.C. & Mahon, M. (1994) A study of Quality of Life of Hospice Patients on Admission and at Week 3. Cancer Nursing, 17(1), 52-6.
50. Meeberg, G.A.(1993) Quality of Life: A Concept Analysis. J Adv Nurs, 18, 32-38.
51. Mims, S.E. (1984) Helping your Patient Breathe Easier after Chest Surgery. RN, 47(12), 30-31.
52. Montazeri, A., Gillis, C.R., McEwen, J. （1998） Quality of Life in Patients with Lung Cancer :A Review of Literature Form 1970 to 1995. Chest, 113, 467-481.
53. Montazeri, A., Milroy, R., Hole, D., McEwen, J. & Charles R. Gillis (2001) Quality of Life in Lung Cancer Patients as an Important Prognostic Factor. Lung Cancer, 31, 233-240.
54. Mountain, C.F. （1997） Revision in The International Staging System for Staging Lung Cancer. Chest, 111, 1710-1717.
55. Newell, D.J. （1962） Errors in The Interpretation of Errors in Epidemiology.
Am J Public Health, 52, 1925-1928.
56. Niezgoda, H.E., Peter, J.L. （1993） A Validation Study of The Domains of The Core EORTC Quality of Life Questionnaire. Qual Life Res, 2, 319-325.
57. Nunnally, J.C.（1978） Psychometric Theory（ 2nd ed.）New York: McGraw-Hill.
58. Osoba, D., Zee, B., Warr, D., Kaizer, L., Latreille, J. （1994） Psychometric Properties and Responsiveness of The EORTC Quality of Life
Questionnaire(QLQ-C30) in Patients with Breast, Ovarian and Lung Cancer.
Qual Life Res, 3, 353-364.
59. Otto, S.E., Lung cancer, in S.E. Otto (Eds) (2001) Oncology nursing, 4th ed, St.
Louis: Mosby: 380-415.
60. Padilla, G.V. & Frank-Stormborg, M. (1997) Single Instruments for Measuring Quality of Life. In M. Frank-Stormborg, S.J. Olsen, & N.J. Pender (Ed.), Instruments for Clinical Health- Care Research. 2nd ed. 114-134. London: Jones and Bartlett publisher.
61. Ralston SH, Gallagher SJ, Patel U, Campbell J, Boyle IT. (1990)
Cancer-associated Hypercalcemia: Morbidity and Mortality: Clinical Experience in 126 Treated Patients. Ann Intern Med, 112:499-504.
62. Ringdal, G.I., Ringdal, K. （1993） Testing the EORTC Quality of Life
Questionnaire on Cancer Patients with Heterogeneous Diagnoses. Qual Life Res, 3, 129-140.
63. Rosenbaum, P.L., Russell, D.J., Cadman, D.T., Gowland, C., Jarvis, S., Hardy, S.
（1990） Issues in Measuring Change in Motor Function in Children with Cerebral Palsy: A Special Communication. Phys Ther, 17, 18-25.
64. Seale, D.D.& Beaver, B.M. (1992) Pathophysiology of Lung Cancer. Nursing Clinics of North America, 27(3), 603-613.
65. Stevens, S.S. （1946） On the Theory of Scales of Measurement. Science, 103, 667-680.
66. Stratford, P.W., Binkley, J.M., Riddle, D.L. （1996） Health Status Measures:
Strategies and Analytic Methods for Assessing Change Scores. Phys Ther, 76, 1109-1123.
67. Streiner, D.L., Norman, G.R. （1989） Health Measurement Scales－ A Practical Guide to Their Development and Use. New York:Oxford University Press, 79-95, 106-125.
68. Tamburini, M., Brunelli, C., Rosso, S. & ventafridda, V. (1996) Prognostic Value of Quality Scores in Terminal Cancer Patients. Journal of Pain and symptom Management, 11(1), 32-41.
69. Tannock, I.F., Osoba, D. & Stockler, M.R. (1996) Chemotherapy with Mitoxantrone plus Prednisone or Prednisone alone for Symptomatic
hormone-resistant prostate cancer: a Canadian Randomized Trial with Palliative End points. Journal Clin Oncol, 14, 1756-1764.
70. The WHOQOL Group (1995) The World Health Organization Quality of Life
assessment (WHOQOL): Position paper from the World Health Organization.
Social Science and Medicine, 41(10), 1403-1409.
71. Van der Putten, J.J., Hobart, J.C., Freeman, J.A., Thompson, A.J. （1999）
Measuring Change in Disability After Inpatient Rehabilitation: Comparison of The Responsiveness of The Barthel Index and The Functional Independence Measure. J Neurol Neurosurg Psychiatry, 66, 480-484.
72. Wells, N. (1998) Quality of Life in Pain Management. Journal of Pharmaceutical Care in Pain and Symptom Control, 5(4), 51-66.
73. Wells, N., Murphy, B., Wujcik, D. & Johnson R. (2003) Pain-Related Distress and Interference with Daily Life of Ambulatory Patients with Cancer with Pain.
Oncology Nursing Forum, 30(6), 977-986.
74. Winningham M.L., Nail L.M., Burke M.B. et al. (1994) Fatigue and the Cancer Experience: the State of the Knowledge. Oncology Nursing Forum, 21, 23–36.
75. Young-Graham K. & Longman A.J. (1987) Quality of Life and Persons with Melanoma: Preliminary Model Testing. Cancer Nursing, 10(6), 338-346.
76. Zhan, L. (1992) Quality of Life: Conceptual and Measurement Issues. J Adv Nur, 17(7), 795-800.
77. Zhao, H., Kanda, K. （2000） Translation and Validation of The Standard Chinese Version of The EORTC QLQ-C30. Qual Life Res, 9, 129-137.
1. TCOG 肺癌研究委員會（2004）。肺癌臨床指引。國家衛生研究院癌症研究組
4. 王令瑋（1995）。小細胞癌的放射線治療。臨床醫學，35，167-171。
5. 王湘慧、廖華芳（2004）。測量工具之反應性研究回顧。物理治療，29(4)，
10. 李中一（2004）。測量工具的效度與信度。台灣衛誌，23（4），272-281。
11. 李靜雯（2002）。乳癌病患手術後一個月之症狀困擾和情緒狀態之改變及其 相關性。台北醫學院護理學研究所碩士論文。
12. 周繡玲、顧乃平、劉雪娥、白璐（1997）。成人急性白血病病患生活品質及 其相關因素之探討。護理研究，5（2），183-191。
13. 季瑋珠、楊志新、許駿、賴佳君（2002）。癌症病人特定疾病 EORTC 生活品 質量表簡介。台灣醫學，6（2），220-227。
14. 姚開屏(1988)。淺談信度與效度。職能治療學會雜誌，6，51-54。
15. 姚開屏（1996）。從心理計量的觀點看測量工具的發展。職能治療學會雜誌，
14，5-21。
16. 梁繼權（1995）。生活品質評估。醫學繼續教育，5，283-286。
17. 許維中、鍾娜娜、陳宇嘉、詹淑卿、丁禮莉、蔡崇煌、王雪鳳、王博民、林 高德（2004）。早期子宮頸癌病患治療後長期的生活品質之研究。中華放射 線醫學雜誌，29（1），21-29。
18. 許維中、鍾娜娜、陳宇嘉、詹淑卿、丁禮莉、蔡崇煌、王雪鳳、王博民、林 高德（2004）。早期子宮頸癌病患治療後長期的生活品質之研究。中華放射 線醫學雜誌，29（1），21-29。
19. 郭壽雄（1998）。肺癌。當代醫學，25，13-18。
20. 楊志新（1998）。癌症化學治療的原則。當代醫學，25（1），25-29。
21. 鄭素月（2000）。探討乳癌病人的症狀困擾、自我效能、社會支持與生活品 質之關係。台北醫學院護理學研究所碩士論文。
22. 鄭澄寰、何善台、高尚志、葛魯蘋(1991)。癌症疼痛及相關因子之探討。麻 醉學雜誌，29，653-657。
23. 戰愛華（1988）。瞭解癌症病人的心理社會問題。榮總護理，5(3)，294-296。
24. 簡茂發（1978）。信度與效度。楊國樞、文崇一、吳聰賢、李亦園編：社會 及行為科學研究法（上冊）。台北：東華，323-351。
計畫成果自評
本研究為兩年期之計畫，在橫斷面的肺癌病人收集了 227 名病患，追蹤性研 究部分手術病患共追蹤一年之肺癌病患 250 名、手術病患 167 名、化療病患 261 名。研究內容與原計畫完全相符，第一年完成內部一致性、內斂效度、鑑別效度 和因素效度等之量表假設前提之心理測量學特性評估；第二年完成偵測一年生活 品質之變化、手術前後變化與化療前後變化的相關因素與反應性。本研究成果可 應用於臨床上肺癌病人生活品質之測量，亦適合在學術期刊發表。