中心館藏網址 http://tulips.ntu.edu.tw/record=b2173953*cht

[ 摘要 ]
研究目的：頭頸部癌症近十年來的發生率快速竄升，加上病患多到了晚期才治療，造成之死亡、醜型、與失能，常令臨床醫師感到力不從心，然而學界並無有效的方法可降低其發生率。本研究的目的，首先要釐清頭頸部癌症在東台灣的嚴重性，並由分析病人的疾病行為，希提出較合實際的衛教及防治方法。 方法：本研究分兩部份：一、由健康統計方面的資料查證，分析東台灣頭頸部癌症的發生率與全台灣是否相同。二、以花蓮慈濟醫院耳鼻喉科病房中晚期的頭頸部癌症病人（鼻咽癌除外）為對象，針對影響疾病行為之相關因素，包括社會人口特性、病因認知、醫療體系利用、對菸酒檳榔態度、家庭與社會支持、健康決控模式等，以參加觀察與深入訪談等方式，進行資料收集。共計訪問33位病人，其中阿美族16位，漢族17位。 研究結果：一、東台灣的頭頸部癌症發生率較台灣地區高，佔全癌症的比率也較高。不同族群好發的癌症部位有差別，漢族得口腔癌較多，阿美族以下咽癌較多，其他原住民則是鼻咽癌較多。二、不同族群的疾病行為有差異，阿美族對於西醫的信賴度高，雖不一定認同西醫的病因解釋，得到癌症後仍採西醫治療為主。阿美族傳統合作和諧的社會文化特質，充分表現在對疾病積極樂觀、能坦然面對生死，與親友之輪流照顧、能接納病人上。漢族暨認同西醫的病因解釋，也採西醫治療，然對個人生命的堅持與傳統觀念，於治療過程中較易產生衝突與挫折。兩族群的相同點如下，約一半的受訪者有被醫療延遲，得病後將近一半的人仍無法戒除菸酒檳榔，且兩族群病人普遍認為休息才是預防癌症再發的不二法門。 研究建議：一、應深入探討東台灣頭頸部癌症發生率較高的原因，並解釋為何不同族群好發的癌症不同。二、針對不同族群病人強調的重點應不同，對阿美族應教育癌症初期的症狀不一定以疼痛表現，以期早期發現早期治療；對漢族應協助其照顧系統，並加強面對死亡時之心理建設。三、菸酒檳榔危害的觀念應從小灌輸，由點而線而面，並強調體質的差別。

[ 英文摘要 ]
Facing the rapid escalation of head and neck cancer incidence, the medical authorities still cannot find an efficient way to persuade people to quit smoking, drinking, and betel nut chewing. Why there is a big gap between ordinary people and the medical professionals? From the sociocultural point of view, the aim of this study is to decipher the thinking of advanced head and neck cancer patients, and to work out better ways to prevent the disease in the future. The study encompasses two parts: first to analyze the incidence and severity of head and neck cancers in Eastern Taiwan from the health statistics, then to study the illness behaviors of advanced head and neck cancer patients by participant observation and in-depth interview. The patient samples were gathered from the inpatients of otorhinolaryngology department of Tzu Chi General Hospital. Among 33 interviewees, 16 were Amis and 17 were Han Chinese. The results showed that the incidence of head and neck cancers was higher in Eastern Taiwan than the national average. The aboriginal patients have higher incidence of pharyngeal cancers instead of oral cancer although they were habitual betel nut chewers. Patients of different ethnic groups behaved differently when coping with head and neck cancers. Most of the Amis patients were fatalistic, gentle, happy, and cooperative. They had good kin and social supports. They can accept hospice care at the terminal stage. Han Chinese patients acted not the same as Amis, they struggled throughout the disease course. They were aggressive, mastering, anxious and not willing to surrender. When entering the final stage of cancer, they still asked for survival and prayed for miracle. This study suggested that the medical system in Eastern Taiwan should notice the severity of head and neck cancers and keep higher index of suspicion. It is inappropriate to treat patients from different ethnic groups the same way. For Amis patients, education about health knowledge would be very important to alert people at the early stage of cancer. For Han Chinese, improvement of supporting system and propagation of hospice care would be helpful. By the way, the campaign of no smoking, drinking, and betel nut chewing should be proposed from patients’ prospect of view.