成人急性白血病患者接受化學治療期間的疲倦及體能改變及其相關因素之探討

Abstract

癌症相關疲倦(Cancer-Related Fatigue)是多數白血病患者在治療期間常見的症狀之一，運動是最有效的非藥物治療方法，但臨床上住院患者的接受度卻不高，長時間活動量減少可能導致疲倦程度增加及體能退化，然而目前並無針對白血病患者住院接受化學治療期間疲倦及體能改變的相關研究，故此研究之目的為：(1) 探討白血病患者在住院接受化學治療前、後之症狀嚴重度、焦慮及憂鬱程度；(2)探討白血病患者在住院接受化學治療前、後疲倦各層面(疲倦強度、對日常生活之干擾、身體層面、情感層面、認知層面)和體能的改變及相關因素；(3) 探討白血病患者疲倦與體能的相關性。 本研究自2011年12月28日至2012年10月10日於台北市某醫學中心血液腫瘤病房進行收案，採縱貫式資料收集，以預計住院一周以上的化學治療患者為收案對象，於患者入院48小時內(T0)及出院前48小時內(T1)進行收案，藉由結構式問卷收集資料，包括基本資料表、疲倦症狀量表、癌症疲倦量表、症狀嚴重度量表、醫院焦慮與憂鬱量表；而體能測試的項目包含6分鐘走路測試、慣用手握力測量、30秒坐站測試。資料分析使用描述性統計分析各變項之現況，以相關性統計分析疲倦、體能之間的相關性，並藉由廣義推估方程式分析患者在住院期間疲倦和體能改變的重要因子。本研究共完成30位個案，研究結果顯示：(1) 疾病治療過程中，最常見的症狀為：食慾減低、疲倦、失眠、疼痛、口乾、麻木感，且治療前後之嚴重程度有顯著差異，研究參與者之焦慮及憂鬱程度並無顯著之改變；(2) 在接受化學治療前後，研究參與者在身體、認知、情感層面的疲倦無顯著的差異，在平均疲倦強度及疲倦對於日常生活干擾程度有顯著的上升，影響疲倦的重要因子包括年齡、憂鬱程度及治療前後時間；(3) 在體能方面僅「身體質量指數」有顯著下降，其他各項體能均無顯著差異，影響體能的重要因子包括性別、疾病診斷、本次住院天數、血色素值及憂鬱程度；(4) 研究參與者在接受化學治療後，最嚴重的疲倦強度、平均疲倦強度、以及疲倦對於日常生活的干擾程度較高者，其六分鐘走路距離、慣用手握力及30秒坐站次數之測試結果較差。 疲倦是急性白血病患者疾病治療期間常見的症狀之一，接受化學治療後平均疲倦程度較高者，其體能較差，雖然本研究族群出院前之體能與其入院時無顯著差異，但仍較一般健康民眾差，因此，臨床照護者應教導患者透過運動改善其疲倦程度，並維持其後續治療期間的體能。

Cancer-Related Fatigue (CRF) is one of the common distressed symptoms that leukemia patients experienced during the period of chemotherapy. Enhancing activity is the most effective non-pharmacologic treatment for decreasing the level of fatigue but inpatients refuse to take exercise in clinical settings in Taiwan. Decreased physical activity may increase the intensity of fatigue and degenerate the physical fitness; however, there is no study to explore the change of fatigue and physical fitness for leukemia patient during hospitalization. Therefore, the purposes of this study were to (1) explore the severity of symptom of leukemia patients experienced before and after chemotherapy in hospital, (2) investigate the change of the fatigue and physical fitness, and their related factors, and (3) the correlation between fatigue and physical fitness. A longitudinal designed study was conducted to recruit the leukemia patients in a medical center in Taipei. Eligible patients were those were going to receive chemotherapy and in hospital at least one week. Data were collected at the first 48 hours after hospitalization (T0) and the 48 hours before the patient discharged (T1) from 28 December in 2011 to 10 October in 2012. A set of structured questionnaire was used to collect data including the background information form, the Fatigue Symptom Inventory (FSI), the Cancer Fatigue Scale (CFS), the Symptom Severity Scale (SSS), and the Hospital Anxiety and Depression Scale (HADS). Patients were received physical fitness test including the 6-Minute Walking Test (6MWT), grip strength of dominant hand, and 30-second chair stand test (30-sec CST). The descriptive statistics was used to analyze the symptom severity, fatigue, and physical fitness, and the inferential statistics was used to analyze the correlation of fatigue, and physical fitness. Besides, generalized estimating equations (GEE) were used to analysis the average of population change of fatigue and physical fitness. A total of 30 patients completed the survey. The results showed that (1) loss of appetite, fatigue, insomnia, pain, dry mouth, and numbness were the most of symptom during the period of treatment with the symptom severity changed significantly, but the level of anxiety and depression remained stable; (2) There were no significant change in physical, cognition, and affective of fatigue, but the average severity and interference by fatigue increased after chemotherapy. The important factors affecting fatigue including age, depression, and time effect; (3) Only BMI decreased after chemotherapy, the distance of 6MWT, the grip strength of dominant hand, and the times of 30-sec CST were no significant change. The important factors affecting physical fitness included gender, diagnoses, hospitalization days, hemoglobin, and depression; (4) The more the level of fatigue and interference, the worse the results of 6MWT, grip strength of dominant hand, and 30-sec CST. Fatigue was one of the main symptoms during the period of treatment of patients with acute leukemia. The great the level of average fatigue, the worse the physical fitness. Although there were no significant different prior and post chemotherapy, the physical fitness of this group still worse than health people. Therefore, health provider should encourage the patients to exercise to decrease the level of fatigue, and maintain the physical fitness in following treatment.