肺癌病人化學治療三個月前後身體活動、疲憊與身體功能量改變之探討

The Pre-post Changes of Physical Activity, Fatigue, and Physical Functional Capacity over Three Months in Lung Cancer Patients with Chemotherapy

張碧華(Pi-Hua Chang)

指導教授 ： 賴裕和

國立臺灣大學/醫學院/護理學研究所/博士(2020年)

https://doi.org/10.6342/NTU202003671

摘要

目的
本研究目的為探討轉移性非小細胞肺癌病人，接受化學治療前與治療三個月時之：(1)身體活動量、疲憊(平均疲憊及疲憊干擾)與身體功能量(6分鐘走路距離及ECOG-PS身體功能狀態)的改變；(2)身體活動量、疲憊和身體功能量改變的相關因素；(3)身體活動量、疲憊和身體功能量改變的相關分析。
方法
本研究為二個時間點的描述性相關研究，於台灣中部某醫學中心之胸腔內科病房收案，以連續取樣方式針對住院之晚期肺癌接受住院化學治療病人收案二次，包括住院接受化學治療前及化學治療3個月後，評估病人人口學特質、疾病與過去治療特質、身體活動自我效能、身體活動障礙、身體活動量(Godin休閒時間運動問卷)、平均疲憊程度與干擾(簡明疲憊量表)、身體功能量(ECOG-PS身體功能評估與6分鐘走路距離)。因過去之治療亦會影響病人目前身體狀況，因此，本研究依據受試者過去癌症治療狀況分為4組：初診斷無任何治療過、過去僅接受化療、過去接受多重治療及化療及過去接受多重治療但無化療。以描述性統計、無母數分析及廣義廻歸方程模式(GEE)分析資料。
結果
本研究納入124位非小細胞肺癌病人，共102位病人完成兩次測量，完成率為82.3%。住院化療到三個月再測其改變，整體病人身體活動量未顯著改變(Z= -1.39, p= .164)，平均疲憊程度變差(Z= -2.01, p= .045)，六分鐘走路距離下降，趨近於顯著(P=0.09)。從5個GEE模式中，確認身體活動自我效能信念是改善身體活動量、疲憊干擾程度、6分鐘走路距離及ECOG-PS身體功能狀態改變的重要因素，而影響身體活動的轉移部位數目則是平均疲憊程度、疲憊干擾程度、6分鐘走路距離及ECOG-PS身體功能狀態變差的相關因素。再者，3個月的後測結果也呈現身體活動量與疲憊呈現顯著的中度負相關，疲憊與身體功能量改變呈現顯著的高度負相關，顯示出身體活動量、疲憊程度及身體功能量的改變均有顯著相關。
結論
化學治療是轉移性非小細胞肺癌病人常見的治療，尤其是過去已接受過多種治療組合的狀況，對身體活動、疲憊及身體功能量造成顯著的改變。然而，身體活動自我效能是協助病人在化學治療期間執行身體活動，改善疲憊及身體功能量的重要因素。因此，本研究建議健康照護人員考量身體活動介入措施時，可併用病人自我效能信念策略，協助病人能掌握體能及接受治療。

關鍵字

肺癌 ； 化學治療 ； 自我效能 ； 身體活動 ； 疲憊 ； 身體功能量

並列摘要

Purposes
The purposes of the study were to (1) examine the changes of physical activity level, fatigue intensity and interferences and functional capacity (through ECOG-PS and 6-minute walking distance/6MWD); (2) explore factors related to the above variables through; and (3) examine the relationships among the above between physical activity level, fatigue intensity, and physical functional capacity in advanced lung cancer patients before and 3-month after chemotherapy.
Method
A 2-timepoint observed study was conducted at a chest inpatient ward of a medical center in Central Taiwan. Eligible subjects were advanced non-small cell lung cancer who would receive chemotherapy. Data were collected before chemotherapy and three months later. Patients were assessed of their demographics, disease and treatments related characteristics, self-efficacy (on taking physical activity), barriers of taking physical activity, level of physical activity (by Godin Leisure-Time Exercise Questionnaire), Fatigue intensity and fatigue interference (by Brief Fatigue Inventory), function capacity (by ECOG-PS and 6MWD). Based on patients’ previous treatment conditions, patients were categorized into four subgroups. They were patients with (1) newly diagnosed without previous any treatment group, (2) chemotherapy only group, (3) multimodality treatments with chemotherapy group, and (4) multimodality treatments without chemotherapy group. The descriptive statistics, Non-parametric analysis, and General Estimated Equation (GEE) were applied to analyze the data.
Results
A total of 124 eligible patients were approached, and 102 patients completed the two-time assessment with an 82.3% completion rate. Patients’ physical activity did not change before and after chemotherapy (Z= -1.39, p= .164). However, after chemotherapy, generally, patients reported more fatigue (Z= -2.01, p= .045) and worse functional capacity in ECOG-PS scores and 6-minute walking distance (approaching to significant, P=0.09). We conducted five GEE models to identify the factors related to the changes of physical activity, average fatigue, fatigue interference, 6MWD, and ECOG-PS. Self-efficacy on taking physical activity was related to physical activity level, fatigue interference, 6MWD, and ECOG-PS. The number of metastatic sites related to patients’ physical activity (which impaired patients’ physical activity) was associated with fatigue intensity, fatigue interference, 6MWD, and ECOG-PS. Furthermore, a moderately negative correlation between physical activity level and fatigue, and a highly negative correlation between fatigue and 6MWD/ECOG-PS were found in the second assessment, indicating that physical activity, fatigue intensity, 6MWD, and ECOG-PS were significantly correlated.
Conclusions
Chemotherapy, which is one of the conventional treatments for patients with advanced non-small-cell lung cancer, especially those with multimodality treatments, would strongly affect physical activity, fatigue, and functional capacity. However, self-efficacy on taking physical activity is one of the crucial factors that can help patients to improve physical activity, fatigue, and functional capacity. Therefore, it is suggested that health care providers should consider physical activity interventions combined with self-efficacy strategies to help patients to maintain better functional capacity for chemotherapy.

並列關鍵字

Lung cancer ； Chemotherapy ； Self-efficacy ； Physical activity ； Fatigue ； Physical functional capacity

參考文獻

參考文獻

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