乳癌病患接受化學治療期間疲憊及睡眠品質之研究

The Fatigue and Quality of Sleep in Patients with Breast Cancer During Chemotherapy

黃采薇(Tsai-Wei Huang) ； 謝孟蓁(Meng-Chen Hsieh) ； 賴俊宏(June-Hung Lai) ； 賴秋絨(Choung-Rong Lay)

《弘光學報》 49期 (2006/11) Pp. 111-123

摘要

疲憊及睡眠問題是癌症病患常見的症狀困擾之一，但目前國內對於睡眠品質之概念仍屬發展階段，本研究目的(1)、探討乳癌病患在接受化學治療期間疲憊及睡眠品質之現況；(2)、了解乳癌病患在接受化學治療期間之疲憊與睡眠品質的關係；(3)、探討影響乳癌病患在接受化學治療期間疲憊及睡眠品質的相關因素。本研究採取描述相關性的研究設計，以立意取樣方式於中部某醫學中心進行資料收集，共收案98人；研究工具包括匹茲堡睡眠品質量表、症狀嚴重度量表及醫院焦慮憂鬱量表及簡明疲憊量表，資料分析以描述性統計、獨立 t 檢定、單因子變異數分析(one way ANOVA)與事後檢定(Scheffe's post hoc )、皮爾森積差相關分析及迴歸分析等方法進行統計分析。研究結果顯示：(1)有50%的乳癌病患在持續接受化學治療期間感受到疲憊感覺，疲憊程度介於輕度至中等程度之間；在化學治療期間，乳癌病患的症狀困擾部分，疲憊為最困擾的項目，其次分別為失眠、食慾影響、外觀改變及麻木感（2）睡眠品質的平均得分為6.13，有52%的病人睡眠品質大於5，顯示睡眠品質較差，在睡眠潛伏期差的層面得分最高，顯示乳癌病人在化學治療期間較不易入睡。（3）疲憊與睡眠品質間之相關性介於0.155-0.324；症狀困擾與睡眠品質及疲憊之相關性介於0.522-0.541間；焦慮與睡眠品質及疲憊之相關性介於0.269-0.329間；憂鬱與睡眠品質及疲憊之相關性介於0.264-0.409間。基本屬性部分，身體活動功能量表〈KPS〉為80分（身體有一些症狀且自我照顧需費力）者其睡眠品質明顯較90分（能繼續一般活動且有輕微症狀者）的病人差。（4）檢測睡眠品質的預測因子，發現症狀困擾、憂鬱及目前疲憊程度均達到顯著差異，可解釋整體睡眠品質之總變異量的36.4%。其中症狀困擾度對整體睡眠品質有最大的解釋力。本研究結果支持病人的症狀嚴重度、憂鬱及目前疲憊程度均會影響睡眠品質，可作為臨床瞭解乳癌病患之睡眠型態參考，且依據研究結果建議應有系統地評估及利用有效的護理措施，降低患者的症狀困擾度程度並給予情緒上的支持，以減低病人的生理及情緒困擾，提昇睡眠品質。

關鍵字

化學治療 ； 睡眠品質 ； 疲憊

並列摘要

Fatigue and insomnia causes severe distress in patients with breast cancer during chemotherapy. There is no related research of sleep in patients with breast cancer during chemotherapy in Taiwan. The aim of our study was to investigate and realize the characters, relationship and related factors about fatigue and quality of sleep in breast cancer patients during chemotherapy. A descriptive method was used in this study. The subjects included 98 women breast cancer receiving adjuvant chemotherapy in chemotherapy room of the medical center. The data were collected using Brief Fatigue Index (BFI), PQSI, Hospital Anxiety and Depression Scale (HADS), and Symptom Distress Scale (SDS). Results of the study showed that during active chemotherapy, (1) 50% patients had fatigue feeling. In symptom distress scales, fatigue and insomnia are the most distress symptom. (2) The PSQI average score was 6.13, and 52% subjects in bad sleep quality (PSQI＞5). The most serious problem is the increasing sleep latency. (3) The relationship between fatigue and quality of sleep is 0.155~0.324. The relationship between symptom distress and quality of sleep, fatigue is 0.522~0.541. The relationship between anxiety and quality of sleep, fatigue is 0.269~0.329. The more worse quality of sleep in patients with 80 score of KPS than that with 90 score of KPS. (4) Multiple regression analysis was performed to identify significant predictors of sleep quality in breast cancer. The predictors included symptoms distress, depression, and fatigue. Which could explain 36.4% of SD in whole quality of sleep. The results of this study show the symptom distress, depression, and fatigue was very important predictors of sleep quality, in order to offer appropriate prevention and management, and improve the quality of breast cancer patient. The findings of this study suggest that an awareness of the importance of understanding sleep and its related factors in breast cancer patients receiving chemotherapy is necessary to enable future testing of research-based interventions and increase the quality of breast cancer care.

並列關鍵字

chemotherapy ； sleep quality ； fatigue

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