乳癌術後婦女於化療期間身體活動量與睡眠品質及相關因素之探討

Physical Activity and Sleep Quality in Post Operative Breast Cancer Patients Receiving Chemotherapy

楊素月(Su-Yueh Yang)

指導教授 ： 蔡仁貞

臺北醫學大學/護理學院/護理學研究所/碩士(2008年)

摘要

台灣地區從1999年至今，乳癌一直是女性癌症疾病排行榜發生率第二位、死亡率第四位，面對如此高發生率的女性癌症病患時，更應積極投注關懷與提供適切的照護活動。因此，本研究目的在瞭解乳癌術後婦女接受化療時期，其身體活動量與睡眠品質型態分布，以及探討兩者間的相關性。以縱貫式研究設計方法，以七日身體活動回憶量表、中文版匹茲堡睡眠品質量表及七日睡眠日誌表做為測量工具，採立意取樣選取乳癌術後婦女（疾病分期stage I~III）正接受化學藥物輔助治療階段為收案對象，於某治療階段完成化療當次前、後各七日，收集個案身體活動量與睡眠品質回憶量表等資料。將所得資料採以SPSS 13.0套裝軟體進行統計分析，如百分比、平均值、標準差、無母數魏可遜配對分析、曼-惠特尼U考驗及斯皮爾曼相關因素分析等統計方法，進行資料分析。
研究結果發現：（1）乳癌婦女在接受化療後，其總活動量及不同強度身體活動量均呈現明顯降低（p= .02）。（2）乳癌婦女在化療前以中度身體活動量居多，但化療後反為以輕度身體活動量為多。（3）乳癌婦女接受化療期間，所能接受的日常活動強度及類別，在中度活動有快慢走、手臂爬牆及拉繩、整理園藝、拖地板等；輕度活動則以處理家事，如煮飯、洗碗、洗衣、掃地及散步等。（4）乳癌婦女在人口學特性中BMI值偏高者，其身體活動量是偏低的。（5）乳癌婦女在睡眠品質自我評價，化療前、後未有顯著差異；但仍有69.2% 個案自我評價有睡眠障礙之困擾，其中以睡眠潛伏期、主觀睡眠品質及睡眠困擾等睡眠品質指標項目，評價結果得分較高。（6）乳癌婦女在化療前、後身體活動量與睡眠品質自我評價，未呈現顯著相關；但在平均相對總活動量、相對輕度及相對中度身體活動量等，分別與每日睡眠總時數呈負相關之結果。
本研究結果顯示乳癌婦女於接受化療時期，所呈現的身體總活動量和不同強度身體活動量，在化療前、後是具有顯著的變化及差異，且絕多數個案均以中度及輕度活動為主；而個案身體總活動量卻與睡眠品質未有顯著相關。此研究結果可提供醫護人員在照顧此群乳癌婦女時，可做為臨床建立個案從事規律性活動衛教指導之依據，以及未來進行介入性運動研究方向之參考。

關鍵字

乳癌婦女 ； 化學治療 ； 身體活動量 ； 睡眠品質

並列摘要

Since 1999, breast cancer has been listed as top two most frequently diagnosed cancer and the top four cause of death among women with cancer in Taiwan. In light of such a high incidence rate, sear ching appropriate medical care to the patients with breast cancer is of importance.
Therefore, the aim of this study was to examine the relationship between the level of physical activity and sleep quality in post-operative breast cancer patients receiving chemotherapy. This study adopted a longitudinal design. The Seven-Day Physical Activity Recall Summary Sheet, the Pittsburgh Sleep Quality Index (Chinese version), and the Seven-Day Daily Sleeping Log were used to collect data. Participants were post-operative breast cancer women who underwent chemotherapy (cancer classified stage I-III). Variables were measured ror a 7-day period before the course of chemotherapy and for a 7-day period after the completion of chemotherapy. The data were analyzed by using SPSS 13.0 including percentage, mean, standard deviation, Wilcoxon Pair-Matched test, Mann-Whitney U test, and Spearman rank-order correlation.
Results of the study showed that both the total amount of physical activity and the level of intensity of the post-operative breast cancer women after chemotherapy significantly decreased (p= .02). The majority of activities adopted by the women with breast cancer prior to the chemotherapy was moderate. In contrast, the style shifted to mild activities after the completion of chemotherapy. During the course of chemotherapy, the type and intensity of the acceptable daily activities adopted by the breast cancer patients included moderate activities (i.e., brisk walking, wall climbing, rope pulling, gardening, and mopping floor) and mild activities (i.e., cooking, washing dishes, laundry, sweeping floor, and walking). The breast cancer patients with a high BMI exhibited a reduction of the level of physical activity. No significant correlation was found between the level of physical activity and sleep quality in these patients prior to and after the chemotherapy. However, of those, 69.2% of the patients demonstrated suffering sleep difficulty, particularly in aspects of sleeping latency, impaired sleep quality and sleep disturbance based on the Self-Evaluation of Sleep Quality. However, the level of physical activity negatively correlated with total hours of sleep.
Results of this study suggests that an appropriate treatment plan can be assigned in order to compensate the physical and sleep differences prior to and after the chemotherapy, to well control body weight, as well as to keep BMI level and further more to improve the health condition and quality of life for this group of patients.

並列關鍵字

breast cancer ； chemotherapy ； physical activities ； sleep quality

參考文獻

王貴霞、劉哲銘、呂志得（2005）•乳癌病患的困擾及擔憂問題 ∙北市醫學雜誌，2（9），71-77。

朱嘉華、方進隆（1998）•國小運動習慣對睡眠品質影響之研究•中華民國體育學會學報，26，217-224。

朱嘉華、方進隆（1989）•運動與睡眠品質之探討•中華體育，11（2），98-108。

朱嘉華、賴政全（2000）•體適能與睡眠品質之關係探討•大專體育，61，162-167。

李芸湘、蔡芸芳、賴裕和、高瑞和(2002)•肺癌病患在化學治療期間疲憊程度及其相關因素∙台灣醫學，6（6），797-804。