鼻咽癌病患放射治療中斷的原因及分析

　　　　　目的:隨著醫療科技的進步,許多鼻咽癌癌症患者經治療後存活下來。然而過去數 十年的醫療研究，重點放在診斷及療效上;對鼻咽癌病患未完成全程治療的原因及其生活品質 則很少被研究、探討。本文藉由了解鼻咽癌病人中斷治療的因素，試圖解決或改善無法全程 治療的原因,協助病人增加治癒的機會。 材料與方法:林口長庚醫院放射腫瘤科自1979至1994年共16年內，259位鼻咽癌患者 未完成全程放射線治療，進行原因調查及分析。資料來源乃根據病歷記載、電話會談連繫及 信件通訊追蹤為依據。 結果:259位中斷治療之鼻咽癌病患有115位(44.4%)個案無法忍受治療後引起的副作用 及害怕治療合併症。52位(20.l%)因病情嚴重、虛弱、自覺治療無效且對是否患病仍存疑。 採用偏方療法有48位(18.5%)。17位(6.6%)病患有社會與經濟問題。因路途遙遠及交通不便， 故轉院治療有13位(5%)。有7位(2.7%)個案乃因其它科醫師認為不適合繼續放射治療，改用 手術或化學治療。而因家庭因素反對任何正統治療，以求神拜佛、吃香灰仙丹者共7位 (2.7%)。 結論:放射治療的副作用及合併症，是病患無法完成全程治療的最大因素，佔44.4%;醫 療人員應加強對放射治療引起之副作用的照顧及事先對病人的教育。部份病患對另類療法抱 持極大希望，需探討另類療法對於癌病上之功效。故臨床醫療小組需加強癌患社會、經濟、 心理、教育等的支援及建設，俾使病患排除困難，鼓勵病患接受全程治療並完成之。
　　　　　Purpose: The survival of nasopharyngeal cancer (NPC) patient improved after the advance in the diagnostic technology and in megavoltage facility of radiotherapy. Radiotherapy has become the standard local treatment for NPC, and failure in completion of the treatment will almost lose the chance for cure. There are few articles to explore and analyze the reasons why NPC patients interrupted or even refused the radiotherapy treatment. The aim of this study is to investigate the problem. Material and Methods: There are 2,860 NPC cases registered in Radiation Oncology Department of Chang Gung Memorial Hospital from 1979 to 1994. Two hundred and fifty-nine patients did not complete their treatment after registration. The survey from hospital records, telephone or mail contacts were used to analyze the reasons why these patients escaped from the treatment of local irradiation. Results: One hundred and fifteen (44.4%) in these 259 patients cannot tolerate the acute reactions of the treatment or fear for the thought of the expected long-term sequels. Fifty-two patients (20.1%) had poor general condition, or psychologically ignored the disease. Forty-eight patients tried alternative treatments instead of the radiotherapy and seventeen suffered from economic problem. The last 14 patients either lacked the support from family or converted to have chemotherapy only by the referring physician. Conclusion: Adverse effect of radiation therapy in NPC is one of the important reasons to causing the cessation of the treatment. Alternative treatments are another motivation causing interruption of local treatment. Fail to have faith on the curable by radiotherapy and fear for the complications remained the main causes of interruption. It is important to encourage and help the NPC patients and their family to go through the local treatment.