目的：比較台灣癌症患者有無使用輔助及替代醫學（CAM）的生活品質（QOL）差異及預測因子。

患者和研究方法：於台灣南部一醫學中心的核子醫學部門，使用三種問卷（歐洲癌症治療與研究組織生活品質核心問卷、簡明疲憊量表、匹茲堡睡眠品質指數量表），對確診為癌症的病患進行面談。統計方式以卡方檢定作為類別變項之分析，連續變項則以t檢定來進行統計分析，並且建立線性迴歸模型來預測生活品質指數。

結果：共有216例癌症患者完成面談。使用輔助及替代醫學的病患佔69.4％（150人）。CAM使用者當中，有91.6％使用傳統中醫治療及膳食補充劑（維生素，礦物質，草本萃取物，葡萄糖胺，菇類製劑，魚油及排毒治療。接近半數的病患罹患乳癌（49.5％）且多數的病患未向臨床醫護人員告知其使用CAM的狀況（74.7％）。52.7%的病患在一確診時即開始使用CAM，同時26.7%的病患則增加其原先使用的次數。在使用者及非使用者間，整體的生活品質並無顯著差異。但女性、乳癌/肝癌患者、年紀較輕、低教育水準、接受化學治療、增加使用CAM頻率、無使用維生素、使用傳統中醫治療、接受臨床醫護建議使用CAM者，可預期其生活品質較差。同時，有無使用CAM、使用CAM總數、使用頻率、罹病時間長短、礦物質/藻類/排毒治療，發現與生活品質並無顯著相關。

結論：在台灣的癌症患者有非常高的輔助及替代醫學使用率，但卻很少告知醫護人員。許多因素對低生活品質具有顯著相關性。臨床醫師應重視癌症患者的生活品質，並且提供正確的輔助及替代醫學知識，以提早察覺並努力解決病患未被滿足的需求。

PURPOSE: To compare the characteristics of cancer patients in Taiwan who use complementary and alternative medicine (CAM) to cancer patients who do not use CAM and determine the predictors of quality of life (QoL) among cancer patients who use CAM.

PATIENTS AND METHODS: Face-to-face interviews were conducted with and 3 questionnaires (the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire, the Brief Fatigue Inventory, and the Pittsburgh Sleep Quality Index) were administered to 216 cancer patients being treated at the Nuclear Medicine Department in southern Taiwan. Chi-square testing for categorical variables and t-testing for continuous variables were conducted to determine the correlation between sociodemographic and clinical data and CAM use. Analysis of variance was performed to conduct within-group comparison of QoL scales and CAM use. Linear regression models were established to predict QoL score.

RESULTS: A total of 216 cancer patients were interviewed. The prevalence of CAM use was found to be 69.4% (150 of 216 subjects). Among the CAM users, 91.6% had used traditional Chinese medicine (TCM), dietary supplementation (vitamin, herbal, mineral, glucosamine, mushroom, and/or fish oil supplementation), or detoxification therapy. A greater percentage (49.5%) of CAM users had breast cancer than any other type of cancer, and a very large percentage (74.7%) did not inform their primary caregiver of their CAM use, whereas 52.7% used CAM after initiation of diagnosis and 26.7% increased the original frequency of their CAM use during the course of their treatment. Overall QoL was not found to be significantly different between CAM users and nonusers. Predictors of poor QoL were female gender, breast or liver cancer patient, younger age, lower education, chemotherapy, increased frequency of CAM use, non-vitamin/TCM use, and having received CAM information from primary caregiver. The factors of CAM use, number of CAM modalities used, frequency of CAM use, duration of cancer diagnosis, mineral/algae supplementation, and detoxification therapy were not found to be significant in this population.

CONCLUSION: Cancer patients in Taiwan have a high rate of CAM use but a low rate of disclosure of CAM use to their primary caregivers. Multiple factors appear to have a significant correlation with poor QoL. Clinical physicians should emphasize the QoL of cancer survivors, providing more accurate CAM information and endeavoring to address their unmet needs.

論文審定書 I
ACKNOWLEDGEMENTS II
誌謝 III
ABSTRACT IV
中文摘要 VII
TABLE OF CONTENTS IX
LISTS OF TABLES XI
CHAPTER 1 1
INTRODUCTION 1
Purpose of the Study 2
CHAPTER 2 4
LITERATURE REVIEW 4
Definition of Cancer 4
Definition of Conventional Medicine and CAM 5
Conventional medicine 5
Complementary medicine 6
Alternative medicine 6
Classification of CAM Modalities 7
Dietary Supplementation 7
Physical Therapy and Manual Healing Modalities 8
Biologic and Pharmacologic Modalities 8
Mind-Body and Spirit-Healing Modalities 8
Prevalence of Cancer 9
Prevalence of CAM Use 10
Prevalence of CAM Use in the United States 10
Prevalence of CAM Use in Europe 12
Prevalence of CAM Use in Asia 13
Prevalence of CAM Use in Taiwan 14
Quality of Life of Cancer Patients 16
Cancer-related Fatigue 17
Depression 18
Sleep Disorders 19
CHAPTER 3 21
THEORETICAL FRAMEWORK 21
Outcomes of CAM Use by Cancer Patients 21
Conceptual Framework 23
Hypotheses 24
CHAPTER 4 25
METHODOLOGY 25
Study Design 25
Data Collection 26
Measures and Survey Questionnaires 27
The European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 27
The Brief Fatigue Inventory 29
The Pittsburgh Sleep Quality Index 29
Statistical Analysis 30
CHAPTER 5 31
RESULTS 31
CHAPTER 6 51
DISCUSSION AND CONCLUSION 51
Discussion 51
Predictors of Quality of Life 54
CONCLUSION 60
LIMITATIONS 61
REFERENCES 62
APPENDIX I 85
APPENDIX II 86
APPENDIX III 88
APPENDIX IV 89


Lists of Tables
Table 1. Raw score definition of EORTC QLQ-C30 28
Table 2. Sociodemographic profiles of study participants 32
Table 3. Cancer types between CAM users and non-users 33
Table 4. Types of conventional treatment between CAM user and non-users 33
Table 5. Types of complementary and alternative therapies 34
Table 6. Demographic profiles of CAM users 35
Table 7. Comparison of EORTC Quality of Life (QLQ–C30), Brief Fatigue Inventory (BFI) and Pittsburgh Sleep Quality Index (PSQI) between CAM users and non-users 36
Table 8-1. Comparison of quality of life scales between sex and age 38
Table 8-2. Comparison of quality of life scales between education level 39
Table 8-3. Comparison of quality of life scales between cancer types 40
Table 8-4. Comparison of quality of life scales between disease duration 41
Table 8-5. Comparison of quality of life scales between conventional treatment types 42
Table 8-6. Comparison of quality of life scales with numbers of conventional treatments and frequency change of CAM use 43
Table 8-7. Comparison of quality of life scales with types of CAM 44
Table 8-8. Comparison of quality of life scales with numbers of CAM and frequency of use 46
Table 8-9. Comparison of quality of life scales with information source of CAM and disclosure to caregivers 47
Table 8-10. Comparison of quality of life scales with expenditure 48
Table 9. The indicators fo quality of life 49

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