監控式運動介入對大腸直腸癌病患在化療期間的影響

Abstract

大腸直腸癌位居台灣十大癌症發生率的第一名及癌症死亡率的第三名。大部分大腸直腸癌患者的首次療程為手術治療(80.2%) 和化學治療(53.8%)。雖然手術技術與化學治療的進步使得治癒率提高，但是癌症本身與癌症治療的後遺症卻會影響病患的身體功能進而造成失能。過去的研究顯示運動對於癌症病人是一種安全、可行、有效的治療方式，並且可以協助減緩癌症與癌症治療的副作用，但是目前尚無研究探討運動對於正在接受化療的大腸直腸癌患者之療效。本研究的目的為探討監控式運動介入對於正在接受化療之大腸直腸癌患者的體能、疲倦、情緒、睡眠品質與生活品質的影響。 本研究從台大醫院外科招收第二期或第三期，年齡大於或等於18歲，美國東岸癌症臨床研究合作組織活動能力分數0-2、接受輔助性化療的大腸直腸癌病患。願意參與的受試者分配到監控式運動組或居家運動組。監控式運動組接受為期12週的有氧合併阻力運動計畫，控制組則接受居家運動計畫。兩組受試者皆在介入前後接受成果評量，包括基本資料、六分鐘行走測試、肌力測試、生活品質問卷、疲倦問卷、情緒問卷、睡眠品質問卷及身體活動量表。所有分析皆使用SPSS 13.0作為統計分析之工具，以獨立t檢定(independent t-test)/獨立樣本U檢定(Mann-Whitney U test)檢定初評時各變項在兩組間是否有差異。以2x2重複量數雙因子變異數/Friedman test分析方式比較監控式運動組與居家運動組的評量成果在介入前後的差異。 本研究共招收45位年齡介於32到76歲的大腸直腸癌病患。結果顯示監控式運動組與居家運動組的各變項在初評時及介入後無顯著組間差異。兩組的握力、六分鐘行走距離、及生活品質問卷中的身體功能在介入後有顯著的組內差異(p<0.05)；監控式運動組在介入後之身體活動量(χ2 (1) = 7.200, p=0.007)、疲倦干擾(χ2 (1) = 4.263, p=0.039)、及生活品質的角色功能(χ2 (1) = 7.143, p=0.008)、社交功能(χ2 (1) = 10.286, p=0.001)、疲倦(χ2 (1) = 9.308, p=0.002)、疼痛(χ2 (1) = 9.308, p=0.002)等皆有統計上顯著的進步。本研究顯示監控式運動比居家運動更能改善正在接受化療之大腸直腸癌患者的體能、身體活動量、疲倦、及生活品質。建議後續研究應以大型隨機控制試驗設計驗證本研究結果。

Colorectal cancer (CRC) is the third leading cause of cancer mortality in Taiwan. Majority of CRC patients received surgery (80.2%) and chemotherapy (53.8%) as their primary treatment. Although improved surgical techniques and chemotherapeutics result in higher cure rates, cancer and its treatment sequelae are associated with significant morbidity that may impair function and cause disability. Exercise has been introduced as a safe, feasible, and promising therapy to help alleviate many of the common side effects from cancer and its treatments. However, to date, no study on the benefits of an exercise program for CRC patients during chemotherapy period was identified. The purpose of this study was to investigate the effects of supervised exercise intervention on physical fitness, fatigue, emotional distress, sleep quality, and quality of life (QoL) in patients with CRC undergoing chemotherapy. Patients with CRC (stage II to III) aged 18 years or older were recruited after operation from Department of Surgery of National Taiwan University Hospital if they had an Eastern Cooperative Oncology Group (ECOG) Performance Status of 0–2 and were admitted for adjuvant chemotherapy. Subjects who consented to participate in this study were allocated to either a supervised exercise group that received a 12-week combined aerobic and resistance exercise program or a control group that received home-based exercise after baseline assessment. The participants were assessed at baseline and post-intervention. Assessments included cardiorespiratory fitness (6-minute walk test), muscle strength (hand-held dynamometer), QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, EORTC QLQ-C30), emotional distress (Hospital Anxiety and Depression Scale), physical activity (Index of Physical Activity Questionnaire-Short Form), fatigue (Fatigue Symptom Inventory), and sleep quality (Medical Outcomes Study Sleep Scale). All analyses were performed using the SPSS version 13.0. The baseline data of the two groups were compared using independent t-test/ Mann-Whitney U test. A 2x2 two way repeated measures analysis of variance (ANOVA)/Friedman test was used to compare between supervised exercise and home-based exercise group in changes in the outcome variables between baseline and the 12-week assessments. In total, 45 patients with CRC aged 32-76 years were recruited. No significant difference was found between both groups at baseline and post-intervention. A time main effect was found for hand-grip strength and physical functioning subscale of EORTC QLQ-C30. The Friedman test showed statistically significant differences between pre- and post-intervention values within both groups in cardiorespiratory fitness. Moreover, significant differences in physical activity level (χ2 (1) = 7.200, p=0.007), fatigue interference (χ2 (1) = 4.263, p=0.039), and four subscales of EORTC QLQ-C30, role functioning (χ2 (1) = 7.143, p=0.008), social functioning (χ2 (1) = 10.286, p=0.001), fatigue (χ2 (1) = 9.308, p=0.002), and pain (χ2 (1) = 9.308, p=0.002) over time were seen in supervised exercise group. The results of this study with a limited number of subjects indicate that, for patients with CRC who were receiving adjuvant chemotherapy, supervised exercise program may improve physical fitness, physical activity, fatigue, and QoL more than home-based exercise. Larger randomized controlled trials are needed to confirm these findings.