頭頸癌個案接受放射線治療之吞嚥生活品質和照顧者生活品質與照顧負擔之相關性探討

本研究旨在探討接受放射線治療之頭頸癌個案在與治療相關的三個時間點之吞嚥生活品質、個案照顧者之生活品質與照顧負擔的變化及兩者之關聯性，並探討基本人口學屬性之預測影響。研究共納入31組接受放射線治療之頭頸癌個案及其主要照顧者，有效樣本數為62人。研究工具包括中文版吞嚥生活品質量表( Swallowing Quality of Life questionnaire, SWAL-QOL Taiwan version )、世界衛生組織生活品質量表( World Health Organization Quality of Life Assessment-BREF, WHOQOL-BREF )及中文版Zarit照顧負擔量表( Chinese version of the Zarit Caregiver Burden Interview, CZBI )，並於三個時間點施測：T1( 接受放射線治療前 )、T2( 放射線治療第2–3週期間 )及T3( 放射線治療完成後兩週內 )。研究結果顯示，個案之吞嚥生活品質於三個時間點平均得分為185.61（T1）、144.29（T2）、124.84（T3），呈顯著下降（p < .001），顯示放射線治療對生活品質造成明顯影響。在人口學變項中，多元迴歸分析發現「腫瘤位置」具顯著正向預測力（β = .483, p = .005）。在照顧者生活品質部份，三個時間點之平均得分為89.55（T1）、88.45（T2）及87.10（T3），雖然隨著三個時間點呈下降趨勢，但未達顯著差異（p = .266）。其中「是否與個案同住」與「月收入」為其顯著預測因子（p < .05）。在照顧者負擔部分，三個時間點之平均得分為25.58（T1）、28.68（T2）、28.00（T3），呈顯著上升（p = .024），其中T2和T1之間具有顯著差別（p = .006），顯示治療中期為負擔高峰期；惟多元迴歸結果顯示人口變項對照顧負擔未具穩定預測力。最後，照顧者生活品質與其照顧負擔在三個時間點均呈顯著負相關，顯示隨負擔感上升，其生活品質亦同步下降。研究結果整體發現，頭頸癌個案在放射線治療歷程中面臨顯著的吞嚥生活品質下降，而其主要照顧者亦處於生活品質下降與照顧負擔增加的雙重挑戰。實務上建議，語言治療師應於頭頸癌個案接受放射線治療前即介入吞嚥功能評估與訓練，並提供個別化吞嚥衛教以減緩功能惡化。對照顧者亦應重視其心理與生活需求，特別針對與個案同住且經濟條件不佳者提供資源與支持，提升整體照護品質與雙方生活福祉。

This study was conducted at a medical center in central Taiwan and included 31 dyads of head and neck cancer patients receiving radiotherapy and their primary caregivers, totaling 62 participants. The aim was to investigate changes in swallowing-related quality of life ( Swallowing Quality of Life Questionnaire, SWAL-QOL, Taiwan version ) in patients, caregiver quality of life ( World Health Organization Quality of Life-BREF, WHOQOL-BREF ), and caregiver burden ( Chinese version of the Zarit Caregiver Burden Interview, CZBI ) across treatment phases, and to examine associations between these variables, including demographic predictors.Data were collected at three time points: T1( before treatment ), T2 ( weeks 2–3 during radiotherapy ), and T3 ( within two weeks after treatment ). Patients' swallowing quality of life declined significantly ( T1: 185.61; T2: 144.29; T3: 124.84; p < .001 ), with tumor site identified as a significant predictor ( β = .483, p = .005 ). Caregiver quality of life showed a mild decreasing trend ( T1: 89.55; T2: 88.45; T3: 87.10; p = .266 ), and was significantly predicted by co-residence and income level ( p < .05 ). Caregiver burden peaked during mid-treatment ( T2: 28.68 ), significantly higher than pre-treatment ( T1: 25.58; p = .006 ), though demographic variables did not consistently predict burden. A consistent negative correlation was observed between caregiver quality of life and burden across all time points ( T1: r = –.364、T2: r = –.444、T3: r = –.565；p < .05 ).These findings underscore the importance of early dysphagia assessment and individualized intervention by speech-language pathologists for head and neck cancer patients. Supporting caregivers especially those living with patients and experiencing financial strain, can help improve overall care outcomes and mutual quality of life.