國立台北護理健康大學護理系碩士論文

國立台北護理健康大學護理系 碩士論文 School of Nursing National Taipei University of Nursing and Health Sciences Master Thesis. 胃癌病患接受胃切除手術後營養狀況及健康相關生活品質 之探討 The analysis of post gastrectomy nutritional status and health-related quality of life in patients with gastric cancer. 王惠美 Hui-Mei Wang. 指導教授：王采芷 博士 Avisor: Tsae-Jyy Wang. 中華民國 104 年 07 月 July, 2015.



誌. 謝. 回首研究所學習歷程中，一路上充滿了挑戰，但收穫滿載，不論是在專業知 識的提昇，對於事物也更有邏輯思考的客觀判斷。首先由衷的感謝王采芷教授， 在撰寫研究論文過程中細心指導，從研究主題的擬定與概念架構的形成，一步步 帶領我進行論文中的每一個步驟，不斷的給予我關懷、指導、嚴謹卻不嚴厲的指 導風格，引導我找到研究樂趣，其精闢的見解、邏輯思考能力更是我學習目標。 感謝梁淑媛老師所給予指導和建議，讓我論文更加充實、完整。另外很感謝黃清 水教授提供許多寶貴的意見，使本研究磨菱去角、更臻完善。 謝謝一般外科所有同仁，在收案期間給予支持與協助，更感謝所有參與此研 究的每一位個案，有你們的配合，我才能完成研究。 再者，感謝親愛的育宜、淑萍、小燕及千淯，若沒有妳們的協助，我想我不 會這樣順利。最後，感謝家人的支持、包容，因為有你們一路上的鼓勵，讓我沒 有後顧之憂。今日的豐收，與您們分享我的喜悅。.

(Functional Assessment Cancer Therapy-Gastric Module version 4) Center for Epidemiologic Studies Depression Scale). (Mini Nutrition Assessment). SPSS 19.0. t. 101. 53. 35.8%. (F= 19.56, p 0.022). i. (52.5%).

ABSTRACT Surgery with either subtotal gastrectomy or total gastrectomy is the primary treatment for gastric cancer. Reduced intake and weight loss are common complications following gastric cancer. Malnutrition can compromise recovery and increase morbidity in patients who underwent gastrectomy for gastric cancer. It is crucial to enhance nutritional status in these patients. A descriptive correlational design was used to describe nutritional status and its related factors in patients after gastrectomy for gastric cancer. A convenient sample of 101 patients who meet the inclusion criteria was recruited for the study. Data were collected with self-reported questionnaires, including questions on demographics, the Functional Assessment Cancer Therapy-Gastric Module version 4, the Concerns in Food Preparation scale, the Scale of Dietary Knowledge, the Center for Epidemiologic Studies Depression Scale, and the Mini Nutrition Assessment. Data were analyzed with SPSS 19.0 software. Descriptive, person correlation coefficient, and linear multivariate regression analyses were used to analyze the study data. Results showed that 52.5% of the study participants were malnourished or at risk. Gastrointestinal symptom distress, working status, and concerns in food preparation were significant predictive factors for nutritional status. The three variables together can explained 35.8% of the variation (F= 19.56, p 0.022) in nutritional status of patients after gastrectomy for gastric cancer. These results indicate that the nutritional status of gastric cancer patients who underwent gastrectomy should be evaluated closely. Special attention should be paid to those who have a higher level of gastrointestinal symptom distress, a greater difficulty in food preparation, and is not currently holding a job. Interventions to improve nutritional status in patients after gastrectomy for gastric cancer may need to include strategies for relieving gastrointestinal symptom distress and decreasing food ii.

preparation difficulties.. Key words: gastric cancer, gastrectomy, nutritional status, gastrointestinal symptom distress, difficulty in food preparation. iii.

目 次 中文摘要……………………………………………………………………… i 英文摘要……………………………………………………………………… ii 目次…………………………………………………………………………… iv 表次…………………………………………………………………………… vii 圖次…………………………………………………………………………… viii 第一章 緒論 第一節. 研究背景與動機……………………………………………. 1. 第二節. 研究目的………………………………………………………. 1. 第三節. 研究假設………………………………………………………. 2. 第二章 文獻探討 第一節. 胃癌流行病學…………………………………………………. 3. 第二節. 胃癌臨床分期及治療…………………………………………. 3. 第三節. 胃癌切除術後營養狀況的變化………………………………. 4. 第四節. 胃切除手術後腸胃困擾情形及其與營養狀況的相關性……. 5. 第五節. 胃癌切除術後飲食及營養指導重點…………………………. 6. 第六節. 胃癌切除術後飲食準備注意事項與準備上可能的困擾……. 6. 第七節. 情緒困擾與營養狀況的相關性………………………………. 7. 第八節. 營養狀況與健康相關生活品質相關性………………………. 8. 第九節. 研究理論架構…………………………………………………. 9. 第三章 研究方法 第一節. 研究設計………………………………………………………. 12. 第二節. 研究對象、選樣與場所………………………………………. 12. 第三節. 研究工具………………………………………………………. 13. 第四節. 資料收集過程…………………………………………………. 16. iv.

第五節. 資料處理分析方法……………………………………………. 16. 第六節. 研究倫理考量…………………………………………………. 17. 第四章 研究結果 第一節. 研究對象之基本屬性與疾病及治療特性……………………. 18. 第二節. 研究對象胃癌飲食知識及飲食指導滿意狀況………………. 21. 第三節. 研究對象飲食準備困擾狀況…………………………………. 22. 第四節. 研究對象腸胃症狀困擾狀況…………………………………. 28. 第五節. 研究對象憂鬱狀況……………………………………………. 29. 第六節. 研究對象之營養狀況…………………………………………. 30. 第七節. 研究對象健康相關生活品質狀況……………………………. 34. 第八節. 研究對象之人口學特性與營養狀況之關係…………………. 36. 第九節. 研究對象之疾病特性與營養狀況之關係……………………. 37. 第十節. 研究對象之年齡、術後時間、飲食準備困擾、胃癌飲食知識 腸胃症狀困擾、憂鬱情形與營養狀況之關係………………. 39. 第十一節 研究對象營養狀況之重要預測因子………………………. 39. 第十二節 研究對象營養狀況與健康相關生活品質之相關性………. 41. 第五章 討論 第一節 研究對象之人口學特性、疾病及治療特性、飲食準備困擾、 胃癌飲食知識、腸胃症狀困擾、憂鬱與營養狀況………. 42. 第二節. 基本屬性、疾病與治療特性與營養狀況之關係……………. 45. 第三節. 人口學特性、飲食準備困擾、胃癌飲食知識、腸胃症狀困擾 憂鬱情形與營養狀況之關係…………………………………. 46. 第四節. 營養狀況之重要預測因子……………………………………. 46. 第五節. 營養狀況與健康相關生活品質之關係………………………. 47. 第六節. 研究限制………………………………………………………. 47. v.

第六章 結論與建議 第一節. 研究結果………………………………………………………. 48. 第二節. 研究建議………………………………………………………. 48. 中文部分…………………………………………………………………. 50. 外文部分…………………………………………………………………. 50. 參考資料. 附錄 研究問卷 附錄一. 個人資料表……………………………………………………. 58. 附錄二. 疾病與治療表…………………………………………………. 59. 附錄三. 胃癌病人癌症治療功能性評估量表…………………………. 60. 附錄四. 胃癌腸胃症狀量表……………………………………………. 61. 附錄五. 飲食準備問卷…………………………………………………. 62. 附錄六. 胃癌飲食知識量表……………………………………………. 64. 附錄七. 流行病學研究中心之憂鬱量表………………………………. 65. 附錄八. 迷你營養評估量表……………………………………………. 66. 附錄九. 量表使用同意書(一)…………………………………………. 68. 附錄十. 量表使用同意書(二)…………………………………………. 70. 附錄十一 量表使用同意書(三)…………………………………………. vi. 71.

表 次 表 4-1 人口學特性………………………………………………………… 19 表 4-2 疾病與治療特性…………………………………………………… 20 表 4-3 胃癌飲食知識得分情形…………………………………………… 21 表 4-4 飲食指導病患滿意度得分情形…………………………………… 22 表 4-5 飲食準備困擾得分情形…………………………………………… 23 表 4-6 病人飲食禁忌分布………………………………………………… 24 表 4-7 病人飲食禁忌理由………………………………………………… 25 表 4-8 病人補充食物……………………………………………………… 26 表 4-9 病人補充飲食理由………………………………………………… 27 表 4-10 腸胃症狀困擾情形………………………………………………… 28 表 4-11 憂鬱症狀得分情形………………………………………………… 29 表 4-12 迷你營養評估得分及分布情形…………………………………… 31 表 4-13 健康相關生活品質………………………………………………… 35 表 4-14 人口學特性與營養狀況之關係…………………………………… 36 表 4-15 疾病特性與營養狀況之關係……………………………………… 38 表 4-16 年齡、術後時間、胃癌飲食知識、飲食準備困擾、腸胃症狀困擾 憂鬱情形與營養狀況之相關性…………………………………… 39 表 4-17 營養狀況之重要預測因子………………………………………… 40 表 4-18 不同營養狀況病人在與健康相關生活品質之差異……………… 41. vii.

圖 次 圖 4-1 營養狀況標準化殘差值的次數分配直方圖……………………… 40 圖 4-2 營養狀況檢定常態性之常態分布圖……………………………… 40. viii.

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(2013). 180 Cronbach's α. Chang(2011) 80%. (. 0.70. Tasi, Hsu, Chan,. 300. 92%. Kappa. 0.68. (2007). Cronbach's α. 0.82. Cronbach's α. 0.71. 88. ) 0.1. (. ). BW-120H. 0.1 (. ) (. ) 0.5. ( (. 2007. ). ). 90 (gastrocnemius) 0.5. (Lin, Hwang, Liu, & Lin, 2012). (Functional Assessment Cancer Therapy-Gastric Module version 4. FACT-Ga version 4)(Cella, Yost, Lai,&. Zagari, 2003 Eremenco, Cashy, & Webster, 2003). 27 7. ( ). /. (. 7. (. 6. (. 7. 1. (. ). ( 19. (0. ). ). ). 0-4. 2. 3 15. 5 4. Likert-type ).

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2014. 3. 2015. 2. 217. 146. 42. 3. 101. 66.5. (SD=13.99). 53 40. (52.5%). 48. (39.6%). (26.8%). 92 81. 48. 89. (33.7%). (91.1%). 9. (47.5%) 95. (47.5%). 34. (80.2%). (94.1%). 25. (9.0%). 20. (19.8%). 43. (42.6%). 6. (5.9%). 74. (73.3%). 27. 4-1. 19. (18.8%) 40. 4. 8. (39.6%). 31. (7.9%). (AJCC). (30.7%). 26. (4%). 81. 20. (19.8%). 24. (23.8%) 6. 51 27. (60.4%) 41. (50.5%) (26.7%). 36. (35.6%). (40.6%). 35. (24.8%). 69 (31.7). 24. (80.2%). (5.9%) 61. 32. (25.7%) 0. 3 21. 6. (20.8%). 4-2. 18. 36. 4 (34.7%). (4%) 25. (68.3%) (35.6%). 21.

4-1 (N=101). [. /. (. ]. ). 66.45. 13.99. 53 48. 52.5 47.5. 8 32 9 25 27. 7.9 31.7 8.9 24.8 26.8. 92 9. 91.1 8.9. 81 20. 80.2 19.8. 10 48 43. 9.9 47.5 42.6. 95 6. 94.1 5.9. 19. 25-89.

4-2 (N=101). Adenocarcinoma GIST Singent-cell carcinoma (AJCC ) 0 Ⅰ Ⅱ Ⅲ. 74 8 19. 73.3 7.9 18.8. 4 31 26 40. 4.0 30.7 25.7 39.6. Subtotal gastrectomy + B-II anastomosis Subtotal gastrectomy + B-I anastomosis Total gastrectomy. 65 16 20. 64.4 15.8 19.8. 6 95. 5.9 94.1. 50 51. 49.5 50.5. 61 36 4. 60.4 35.6 4.0. 25 35 41. 24.8 34.7 40.6. 32 69 10.94. 31.7 68.3 7.62. (. )[. /. ]. 20.

Kim. (2013). 10. 1. 0. 10 (SD=1.08). 7.09 5. 10 100 97. (99.0%). (96.0%) 94. 93 90. (93.1%). (92.1%). (89.1%). 12-24 30-60 (. 4-3) 5. Likert. 0~5. 0~20. 16.47(SD=3.29). 5. 20(. 4-4). 4-3 (N=101) (%) 7.09 1.. 47 (46.5). 2.. 97 (96.0). 3. 4. 5.. 100 (99.0) 86 (85.1) 94 (93.1). 6.. 60 (59.4). 30-60. 7. 8.. 90 (89.1) 43 (42.6). 9. 10.. 78 (77.2) 93 (92.1) 21. 1.08. 5-10.

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(n=66, 65.3%). (n=51, 50.5%). (n=12, 11.9%)(. 4-9). 1. 2.. 22.28 1.58 2.18. 8.13 0.96 1.20. 13-45 1-5 1-5. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.. 2.08 1.80 2.20 2.18 1.19 1.34 1.43 1.63 1.13 1.92 1.64. 1.18 1.01 1.13 1.18 0.48 0.77 0.93 0.98 0.39 1.21 1.05. 1-5 1-5 1-5 1-5 1-5 1-5 1-5 1-5 1-5 1-5 1-5. 4-5 (N=101). 23.

4-6 (N=101). (. (. 53 48. 52.5 47.5. 57 40 38 35 33 30 30 25 21 21 19 19 17 13 13 13 11 11 10 10 9 9 7 7 7 5 4 4 4 2 2 1 8. 56.4 39.6 37.6 34.7 32.7 29.7 29.7 24.8 20.8 20.8 18.8 18.8 16.8 12.9 12.9 12.9 10.9 10.9 9.9 9.9 8.9 8.9 6.9 6.9 6.9 4.9 4 4 4 2 2 1 7.9. ). ). 24. 1 2 3 4 5.

4-7 (N=101) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.. (. 35 28 26 20 11 8 5 2 0 17. ). ─ ─. 25. 34.7 27.7 25.7 19.8 10.9 7.9 5.0 2.0 0 16.8.

4-8 (N=101). 66 (65.3) 64 (63.4) 43 (42.6) 37 (36.6) 19 (18.8) 16 (15.8) 9 (8.9) 6 (5.9) 3 (3.0) 2 (2.0). 35 (34.7) 37 (36.6) 58 (57.4) 64 (63.4) 82 (81.2) 85 (84.2) 92 (91.1) 95 (94.1) 98 (97.0) 99 (98.0). 53 (52.5) 51 (50.5) 32 (31.7) 31 (30.7) 16 (15.8) 11 (10.9) 7 (6.9) 5 (5.0) 3 (3.0) 2 (2.0). 11 (10.9) 12 (11.9) 11 (10.9) 6 (5.9) 3 (3.0) 4 (4.0) 1 (1.0) 1 (1.0) 0 0. 2 (2.0) 1 (1.0) 0 0 0 1 (1.0) 1 (1.0) 0 0 0. 14 (13.9) 8 (7.9) 5 (5.0) 3 (3.0). 87 (86.1) 93 (92.1) 96 (95.0) 98 (97.0). 8 (7.9) 6 (5.9) 5 (5.0) 3 (3.0). 1 (1.0) 2 (2.0) 0 0. 5 (5.0) 0 0 0. 58 (57.4) 37 (36.6) 28 (27.7) 13 (12.9) 13 (12.9) 11 (10.9) 8 (7.9) 7 (6.9) 6 (5.9) 5 (5.0) 4 (4.0) 2 (2.0) 2 (2.0) 1 (1.0) 0 0. 43 (42.6) 64 (63.4) 73 (72.3) 88 (87.1) 88 (87.1) 90 (89.1) 93 (92.1) 94 (93.1) 95 (94.1) 96 (95.0) 97 (96.0) 99 (98.0) 99 (98.0) 100 (99.0) 101 (100) 101 (100). 27 (26.7) 14 (13.9) 19 (18.8) 8 (7.9) 5 (5.0) 5 (5.0) 5 (5.0) 5 (5.0) 4 (4.0) 4 (4.0) 4 (4.0) 2 (2.0) 0 1 (1.0) 0 0. 8 (7.9) 4 (4.0) 7 (6.9) 3 (3.0) 4 (4.0) 2 (2.0) 1 (1.0) 1 (1.0) 2 (2.0) 1 (1.0) 0 0 1 (1.0) 0 0 0. 23 (22.8) 19 (18.8) 2 (2.0) 2 (2.0) 4 (4.0) 4 (4.0) 2 (2.0) 1 (1.0) 0 0 0 0 1 (1.0) 0 0 0. 26.

4-9 (N=101). 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.. 66 (65.3) 51 (50.5) 12 (11.9) 10 (9.9) 9 (8.9) 8 (7.9) 7 (6.9) 7 (6.9) 5 (5.0) 3 (3.0) 3 (3.0) 9 (8.9). 27. 65.3 50.5 11.9 9.9 8.9 7.9 6.9 6.9 5.0 3.0 3.0 8.9.

FACT-Ga(Cella, Yost, Lai,& Zagari, 2003. Eremenco, Cashy, &. Webster, 2003) 0~76 17.66(SD=11.73) 2.06. 3-57. (SD=1.15). 1.65(SD=1.09). 1.51. (SD=1.35)(. 4-10). 4-10 (N=101). 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. *. 17.66 0.40 0.66 0.72 2.06 0.94 1.01 0.88 0.28 0.92 1.65 0.68 1.51 1.05 0.89 1.31 0.49 0.93 0.63 0.57. *. *. (. ). 28. 11.73 0.86 1.81 1.04 1.15 1.06 1.09 1.12 0.74 1.07 1.09 0.95 1.35 1.13 1.02 1.34 0.84 1.11 1.06 0.98. 3-57 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-4.

20 0~60. 12.57. (SD=4.76). 0~29 ( 19. 4-11). 16. 18.8%. 4-11 (N=101). 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. *. 12.57 0.29 0.43 0.42 1.62 0.34 0.35 0.75 1.53 0.27 0.32 0.67 1.70 0.26 0.16 0.06 1.61 0.10 0.22 0.04 0.42. *. *. *. *. 29. 4.76 0.61 0.73 0.78 1.45 0.74 0.70 0.85 1.02 0.63 0.63 0.91 0.89 0.61 0.42 0.28 0.93 0.30 0.48 0.24 0.64. 0-29 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3 0-3.

22.81 48. (SD=3.99). (47.5%). (43.6%). 8.5. 24. 44. 17~23.5. 9. (8.9%). 21.38 (SD=3.33) 32. (31.7%). 19~21 21. (20.8%). (27.7%). 21~23 28. 31.7(SD=3.69). 53 20. (65.3%). 30. 20. (27.7%). (19.8%). (52.5%) 45. 23. 21. 28. 31. 66. 22 35. (34.7%). 31. (n = 86; 85.1%). 9. (8.9%). (5.9%). 6. (n = 85; 84.2%) 59. 77. 31.9. (MAC) 18. 21~21.9. 17. 14.4. ( n= 64; 63.4%) 22.6(SD=2.71). 28.5. (76.2%). 3~5. 60. (58.4%). (59.4%). (n=100, 99%). 88 (55.4%). (87.1%) 96. (95%). (98%). 56 99 (n=84, 83.2%). (n=99, 98%) 30.

61 46 48. (60.4%). (45.5%). (47.5%). 44. (43.6%). 4- 12 4-12 (N=101). 22.81. 3.99. 19 19~20.9 21~22.9 ≧23 3 > ~. ( ) 21 21~21.9 ≧ 22 ( ) 31 ≧ 31. 31. 8.5-28.5 9 44 48. 8.9 43.6 47.5. 20 32 21 28. 19.8 31.7 20.8 27.7. 11 22 64 4. 10.9 21.8 63.4 4.0. 20 28 53. 19.8 27.7 52.5. 35 66. 34.7 65.3.

4-12 ( ). 3~5 5. 32. 6 9 86. 5.9 8.9 85.1. 2 14 85. 2.0 13.9 84.2. 5 59 37. 5.0 58.4 36.6. 24 77. 23.8 76.2. 18 60 23. 17.8 59.4 22.8. 1 3 97. 1.0 3.0 96.0.

4-12 ( ). 33. 13 88. 12.9 87.1. 56 45. 55.4 44.6. 5 96. 5.0 95. 1 1. 1.0 1.0. 99. 98.0. 17 84. 16.8 83.2. 2 99. 2.0 98.0. 7 33 61. 6.9 32.7 60.4. 28 19 46 8. 27.7 18.8 45.5 7.9.

FACT-Ga(Cella, Yost, Lai,& Zagari, 2003. Eremenco, Cashy, &. Webster, 2003) 27. /. 0-108 66.24. (SD=13.04). 19.73(SD=8.57) 2.93 2.91. 3.36 3.29. 1.40. 3.25 0. (SD=0.97). 23. (SD=1.32). (SD=1.19). 28. 3.11. (SD=0.95) (SD=1.39) (. 29 (. (SD=1.11). 2.6. 2. 0. (SD=1.59). (SD=0.96). 8.17(SD=6.04). 19.3(SD=6.66). 28. 2.86 19.5(SD=5.77). ). 93. (SD=1.54). (SD=1.41). /. 2.72. 1. 25. 2.76 4-13). 34. (SD=1.10).

4-13 (N=101). 1. 2. 3. 4. 5. 6. 7.. * * * * * * * /. 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 5. 6.. (. ). * * * * *. 1. 2. 3. 4. 5. 6. 7. *. 35. 66.24 19.73 2.68 2.91 2.86 2.85 2.70 2.67 2.93 19.46 2.96 3.25 3.07 3.36 3.17 3.29 0.67 8.17 1.40 2.60 0.95 1.04 0.77 1.40 19.29 2.62 2.72 2.76 3.11 2.69 2.70 2.71. 13.04 8.57 1.47 1.41 1.59 1.38 1.27 1.24 1.54 5.77 1.10 0.97 1.08 0.96 1.13 1.11 1.21 6.04 1.19 1.32 1.63 1.66 1.49 1.74 6.66 1.46 1.39 1.10 0.95 1.08 1.29 1.05. 25-93 1-28 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-29 0-4 0-4 0-4 0-4 0-4 0-4 0-4 0-23 0-4 0-4 0-4 0-4 0-4 0-4 0-28 0-4 0-4 0-4 0-4 0-4 0-4 0-4.

T (one way ANOVA) (t=1.99, p=0.049). (t=-4.07, p. ) (. 4-14). 4-14 (N=101). n. Mean (SD). 53 48   . (. ). (. ). t/F 1.99. p 0.049. 2.12. 0.125. 1.13. 0.282. 23.55 (4.23) 22.00 (3.58). 40 34 27. 22.48 (3.63) 22.15 (4.66) 24.13 (3.38). 92 9. 22.95 (4.04) 21.56 (3.42) -4.07 0.001. 78 23   . 22.16 (4.12) 25.02 (2.53). 10 48 43. 1.07. 0.347. -2.13. 0.068. 21.40 (3.96) 22.62(4.22) 23.35 (3.72). 95 6. 22.69(4.06) 24.75 (2.14). 36.

T. (one. way ANOVA) (F=5.39, p=0.006) 0 (F=3.68, p=0.029). (. Post Hoc Scheffe. 4-15). 37. Post Hoc Scheffe.

4-15. (N=101) n. Mean (SD). Adenocarcinoma 74 GIST 8 Other 19. 23.04 (4.09) 22.63 (2.43) 22.00 (4.16). 0~  . 24.51 (2.87) 21.65 (5.34) 22.08 (3.42). 35 26 40. Subtotal+BSubtotal+BTotal. 65 16 20. 23.16 (3.93) 23.94 (2.77) 20.78 (4.48). 6 95. ). 0.597. 5.39 (   ). 0.006. 3.68 (   ). 0.029. 0.96. 0.370. -1.19. 0.235. 0.85. 0.430. 0.52. 0.599. 1.37. 0.259. 22.78 (2.98) 22.75 (4.40). 61 36 4. (. 0.52. 22.34 (3.86) 23.29 (4.09). 32 69.   . p. 23.75 (2.34) 22.75(4.07). 51 50.   . t/F(post Hoc). 22.75 (3.81) 23.11 (3.71) 21.00 (8.63). 25 35 41. 22.72 (3.73) 23.66 (3.42) 22.15 (3.99). 38.

(r=-0.540, p (r=-0.426, p. (r=-0.280, p. ). (. 1.00 .003 -.198* .097. -.133 -.046 .084 0.05, **p 0.01. 1.00 .019 .020 .157 .017 -.002. (. *p. ). ). 4-16). 4-16). *. 1.00 -.127 .143* .173 .426**. 1.00 -.108 -.150 .040. 1.00 .527** 1.00 -.540** -.280**. (Stepwise) 35.8%. (F=19.56, p 0.022)( 28.4%. 4.4% 3.0% (. 4-1). (. (VIF 10) 39. 4-2). 4-17). 1.00.

4 -17 ( Model 1. 2. 3.. ). β. t. p. -.43 .19 -.21. -4.28 2.36 -2.34. <0.001 0.020 0.022. 4-1. 4-2 40. Adjust R² 0.358. F 19.56. VIF 1.210 1.054 1.242.

(Pearson's correlation) (r=0.122, p =0.222) (F = 0.87, p=0.423)(. 4-18). 4-18. n. Mean (SD). 9 44 48. 62.11 (10.29) 65.41 (13.02) 67.77(13.51). 41. F 0.87. p 0.423.

102. (. 2014). 68.8 48. 47.5%. (91.1%). 95. (94.1%). Lee (2012) 78. 77.2%. Javier, Loarte. Pilco(2008). 42.9%. 66.5 40. (33.7%) 48. 52.5%. 66.5 92. Shin. 53. 27. 43. (42.6%). 74. (39.6%). (39.6%) 31. 34. (26.8%). (47.5%). 40. (39.6%). (73.3%) AJCC (AJCC). (30.7%). 26. (25.7%) 0. 40 4. (4%). 81 (80.2%). (2006). 1974. 1154. 86.7% (. 2012) 42. 2000.

66 6. (65.3%). Ⅱ Ⅲ. (5.9%). Jin. 51 (2013). (50.5%) 360. 34.7% (Unsal et al… 2006). 61. (60.4%). 68 (67.3%). 0-10. 0~20. 16.47 Churm, Andrew, Holden, Hildreth, & Hawkins. (2009). 29% (. ). 13~65 22.28. (SD=8.13). 43.

(2007). FACT-Ga. 101. 3-57. Olsson. 17.66. (SD=11.73). (2002). Takiguchi. 12.57. Bao 16. (2013). 6. 5. (2013) 81.2%. 16 18.8%. 16. 21.38(SD=3.33) (31.7%). 64 22.81. 9. (8.9%). (SD=3.99). (MNA 17. (>24 ). 19~21 (63.4%) ). Javier 22.03. 50.0%. 21.4%. (18.5≦BMI 44. MNA 48. (2008). 23.9). 32. (47.5%).

(24.0≦BMI. 26.9). 81. (80.2%). FACT-G. 66.24. (SD=13.04). 19.73. /. 19.46 19.29. 8.17. Zhou. (2012) (. / (24.3. (21.5 ). ). (19.3. (20.1. Rausi. 85.2 ). ). (2013). Atter (2012) Colavelli. (2010) 8. 22. (7.9%). (21.8%) (t=-4.07, p. 0.001). Kuwahara et al. (2010). 0 Deans. Ⅰ. Ⅱ. Ⅲ. (2009). Abdiev 45. ).

(2011). (Nakamura et al, 2009). (r=-0.426, p. 0.001). (2007) (r=-0.540, p. 0.001). Ryu. (2010) (r=-0.280, p=0.005) (. 2011) Tian. 28.4%. (2009). 32.8% 35.8%. (Colavelli et al., 2010). 46.

Uthman. (2013). (p>0.05) Tian. (2008). Barrios. (2014). 65 (55.4%) 9. (8.9%). 44. Cronbach's. 47. 0.73. (43.6%). 56.

22.81 43.6%. 8.9%. 47.5%. 20.8% 66.24. 52.5%. (60.4%). (Malnutrition Universal Screening Tool, MUST). 48.

「. i-pad. 30-60. 49.

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FUNCTIONAL ASSESSMENT OF CHRONIC ILLNESS THERAPY (FACIT) LICENSING AGREEMENT October 7, 2013 The Functional Assessment of Chronic Illness Therapy system of Quality of Life questionnaires and all related subscales, translations, and adaptations (“FACIT System”) are owned and copyrighted by David Cella, Ph.D. The ownership and copyright of the FACIT System - resides strictly with Dr. Cella. Dr. Cella has granted FACIT.org (Licensor) the right to license usage of the FACIT System to other parties. Licensor represents and warrants that it has the right to grant the License contemplated by this agreement. Licensor provides to Cathay General Hospital the licensing agreement outlined below. This letter serves notice that Cathay General Hospital (“COMPANY”) is granted license to use the Traditional Chinese version of the FACT-Ga in one study. This current license extends to (COMPANY) subject to the following terms: 1) (COMPANY) agrees to provide Licensor with copies of any publications which come about as the result of collecting data with any FACIT questionnaire. 2) Due to the ongoing nature of cross-cultural linguistic research, Licensor reserves the right to make adaptations or revisions to wording in the FACIT, and/or related translations as necessary. If such changes occur, (COMPANY) will have the option of using either previous or updated versions according to its own research objectives. 3) (COMPANY) and associated vendors may not change the wording or phrasing of any FACIT document without previous permission from Licensor. If any changes are made to the wording or phrasing of any FACIT item without permission, the document cannot be considered the FACIT, and subsequent analyses and/or comparisons to other FACIT data will not be considered appropriate. Permission to use the name “FACIT” will not be granted for any unauthorized translations of the FACIT items. Any analyses or publications of unauthorized changes or translated versions may not use the FACIT name. Any unauthorized translation will be considered a violation of copyright protection. 4) In all publications and on every page of the FACIT used in data collection, Licensor requires the copyright information be listed precisely as it is listed on the questionnaire itself. 5) This license is not extended to electronic data capture vendors of (COMPANY). Electronic versions of the FACIT questionnaires are considered derivative works and are not covered under this license. Permission for use of an electronic 68.

version of the FACIT must be covered under separate agreement between the electronic data capture vendor and FACIT.org 6) This license is only extended for use on the internet on servers internal to (COMPANY). This FACIT license may not be used with online data capture unless specifically agreed to by Licensor in writing. Such agreement will only be provided in cases where access is password protected. 7) Licensor reserves the right to withdraw this license if (COMPANY) engages in scientific or copyright misuse of the FACIT system of questionnaires. 8) There are no fees associated with this license.. 二 上午 寄件者. 收件者. . 69.

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