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

張碧華

doi:10.6342/NTU202003671

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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 , Ph.D　　Advisor：賴裕和　　

繁體中文 DOI： 10.6342/NTU202003671

肺癌；化學治療；自我效能；身體活動；疲憊；身體功能量； Lung cancer ； Chemotherapy ； Self-efficacy ； Physical activity ； Fatigue ； Physical functional capacity

Abstract │ Reference (189)

Abstract 〈TOP〉

Parallel Abstract 〈TOP〉

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.

Reference ( 189 ) 〈TOP〉

參考文獻
李明憲, 彭台珠, 黃森芳. (2004). 社區婦女休閒時間身體活動測量問卷信效度評價. 衛生教育學報, 22, 177-192.
周繡玲, 朱基銘, 唐婉如. (2008). 肺癌病人化學治療期間疲憊型態－縱貫性研究. 腫瘤護理雜誌, 8(2), 33-43.
黃怡菁, 唐婉如, 史麗珠, 余志騰. (2005). 肺癌病患化療期間之疲憊軌跡. 腫瘤護理雜誌, 5(2), 15-27.
Al-Majid, S., McCarthy, D. O. (2001). Cancer-induced fatigue and skeletal muscle wasting: The role of exercise. Biological Research for Nursing, 2(3), 186-197. doi:10.1177/109980040100200304

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