宫颈癌同步放化疗患者治疗后癌因性疲乏症状体验的质性研究

目的深入了解行同步放化疗的宫颈癌患者治疗后癌因性疲乏(cancer-related fatigue,CRF)的真实体验,以期为医护人员有针对性地实施干预提供依据,为宫颈癌同步放化疗患者CRF症状的管理与控制提供研究基础。方法 2016年1-6月,采用现象学研究方法,通过目的抽样对12名行同步放化疗的宫颈癌患者进行半结构式访谈,运用Colaizzi 7步分析法对资料进行分析。结果归纳出7个主题,即CRF在同步放化疗的宫颈癌患者中普遍存在且多维度、CRF有相关的伴随症状、CRF影响患者的心理状态、CRF影响患者的睡眠、患者存在对疲劳症状理解的误区、患者需要社会支持、患者有向医护人员寻求缓解疲乏症状的诉求。结论 CRF症状是主观且多维度的,医护人员应在宫颈癌患者同步放化疗的多个阶段进行疲乏及疲乏相关症状的评估与干预,以缓解患者的疲乏症状,提升其应对疾病的能力。     

Tumorbedingte Fatigue und ihre psychosozialen Belastungen

Cancer-related fatigue (CRF) is a highly prevalent and the most distressing symptom during and after treatment for cancer. It is characterized by feelings of physical and mental tiredness, weakness, and lack of energy and is not influenced by rest or sleep. Approximately 40% of patients suffer from CRF at diagnosis and nearly all patients experience fatigue during the course of cancer therapy. The impact of CRF on daily living and patient quality of life (QoL) is substantial. It profoundly affects patient quality of life and limits personal, social and occupational roles. The fatigue is also associated with significant levels of distress and it imposes a financial burden by limiting the ability to work. The underlying causes of CRF are poorly understood as are the relationship between fatigue and psychosocial distress, depression or anxiety. This paper seeks to give an overview of cancer-related fatigue and its psychosocial burden.     

Cancer-related fatigue and its psychosocial burden

Cancer-related fatigue (CRF) is a highly prevalent and the most distressing symptom during and after treatment for cancer. It is characterized by feelings of physical and mental tiredness, weakness, and lack of energy and is not influenced by rest or sleep. Approximately 40% of patients suffer from CRF at diagnosis and nearly all patients experience fatigue during the course of cancer therapy. The impact of CRF on daily living and patient quality of life (QoL) is substantial. It profoundly affects patient quality of life and limits personal, social and occupational roles. The fatigue is also associated with significant levels of distress and it imposes a financial burden by limiting the ability to work. The underlying causes of CRF are poorly understood as are the relationship between fatigue and psychosocial distress, depression or anxiety. This paper seeks to give an overview of cancer-related fatigue and its psychosocial burden.     

Nonpharmacologic supportive strategies to promote quality of life in patients experiencing cancer-related fatigue: a systematic review

Cancer-related fatigue (CRF) is a distressing symptom that affects the quality of life (QOL) of patients with breast cancer and their families. The effectiveness of pharmacologic therapies alone has not been sufficient in the management of CRF; therefore, a combination of pharmacologic and nonpharmacologic approaches is justified. The purpose of this article is to critically review the literature related to nonpharmacologic supportive strategies in enhancing QOL among patients with breast cancer experiencing CRF. The results show that exercises (e.g., home-based exercise, supervised exercise), education and counseling, sleep therapy, and complementary therapy are feasible as effective nonpharmacologic supportive interventions to improve QOL in patients with breast cancer suffering from CRF. Therefore, nurses may consider these nonpharmacologic supportive strategies as adjunctive interventions to pharmacologic interventions in enhancing QOL for patients with breast cancer experiencing CRF. However, because previous studies had some methodologic limitations, such as small sample size, lack of objective measures, or predominantly Caucasian sample, future research to further explore nonpharmacologic interventions in this area is warranted.     

Development and implementation of a clinical survey for cancer-related fatigue assessment

In recent years, fatigue has been recognized as a prevalent and often debilitating symptom for patients with cancer. Despite the increased recognition of cancer-related fatigue (CRF), it often is not assessed adequately in the clinical setting. This article reports the results of a feasibility test to evaluate the utility and relevance of the Quick Fatigue Assessment Survey (QFAS), a brief fatigue assessment technique for determining the onset, intensity, and duration of fatigue and for identifying known factors that contribute to the experience and severity of fatigue. Patients from four outpatient oncology clinics, with a variety of cancer diagnoses, participated in the test of the QFAS. The overwhelming majority (96%) of patients who completed the QFAS reported experiencing CRF. The nurses who administered the survey subsequently evaluated its utility in clinical practice. Ninety-six percent of the nurses found the QFAS helpful in providing a quick assessment of patient fatigue. The majority (92%) also believed that the QFAS helped identify contributing factors associated with CRF, and 74% responded that the QFAS assisted them in planning for interventions to minimize CRF. A fatigue assessment technique that is relevant and useful in the clinical setting may be a helpful first step in addressing the problem of CRF.     

肺癌术后化疗患者的癌因性疲乏及影响因素研究

目的描述肺癌术后化疗患者的癌因性疲乏水平,探讨其影响因素,旨在为制定有效的疲乏干预措施提供理论依据。方法采用描述性相关性研究设计,方便抽样的方法,采用Piper疲乏修正量表、抑郁自评量表、匹兹堡睡眠质量指数量表对广州市2家三级甲等医院的100例肺癌患者的癌因性疲乏水平、抑郁水平、睡眠质量进行调查。结果87％肺癌术后化疗患者存在癌因性疲乏,呈中等水平;83％患者存在抑郁情绪,且抑郁程度越高,患者的CRF水平越高。患者术前疲乏总分为（4．72±0．88）分,术后为（5．44±1．26）分,组间比较差异具有统计学意义（t=11．98,P〈0．01）。患者睡眠质量PSQI评分总分为（11．00±3．85）分,患者的睡眠质量较差,且影响其CRF的水平,肺癌患者的CRF总分与睡眠质量的得分呈正相关（r=0．234,P〈0．05）。结论肺癌术后化疗患者普遍存在癌因性疲乏,医护人员应关注肺癌患者的情绪和睡眠质量,尽可能创造条件减轻患者的疲乏。     

卵巢癌患者癌因性疲乏体验的质性研究

目的了解卵巢癌患者癌因性疲乏(cancer related fatigue,CRF)的感受及体验,为患者提供更加个性化的支持照护提供依据。方法采用现象学研究方法对在某三甲医院妇科病房住院的16例卵巢癌患者进行深度访谈,并采用Giorgy资料分析方法进行分析、提炼主题。结果卵巢癌患者CRF形成原因主要为化疗药物的影响、经济因素、精神压力、家庭支持和照顾、环境因素;卵巢癌患者CRF临床表现为不同程度的躯体疲乏、多种精神疲乏及由此产生多种疲乏后果。结论癌因性疲乏是卵巢癌患者普遍存在主观的、多维度的痛苦体验,临床上未引起重视。医护人员应对癌因性疲乏进行有效地干预,为卵巢癌患者提供个性化的支持照护。     

Why am I so tired all the time? Understanding cancer-related fatigue

DEFINITION: Cancer-related fatigue (CRF) is a "persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning" (National Comprehensive Cancer Network [NCCN] & American Cancer Society [ACS], 2005). Unlike other fatigue, CRF is not relieved by sleep or rest.     

癌因性疲乏对姑息治疗肺癌患者生活质量的影响

目的:探讨癌因性疲乏对姑息治疗肺癌患者生活质量的影响。方法:选取我院行姑息治疗的86例肺癌患者作为研究对象,采用癌症生活质量问卷-C30(QLQ-C30)、Piper疲乏量表(PFS)进行调查,分析患者生活质量与癌因性疲乏的相关性。结果:肺癌患者PFS得分为(5.43±1.27)分,整体生活质量得分为(57.22±11.25)分。随着患者疲乏程度的增加,患者生活质量得分越低(P0.05)。Peason相关系数分析显示癌因性疲乏与整体生活质量、功能总分、躯体功能、角色功能、情感功能、认知功能、社会功能呈负相关(P0.05),与症状评分、疲劳、呕吐、疼痛呈正相关(P0.05),与其余6个单项测量项目呈正相关(P0.05)。结论:肺癌患者的癌因性疲乏处于中度疲乏水平,生活质量处于较差水平,癌因性疲乏程度越高,患者的生活质量越低,应采取多角度干预措施减轻癌因性疲乏。     

肺癌化疗患者癌因性疲乏及其对生活质量的影响分析

目的 了解肺癌化疗患者癌因性疲乏的发生率和严重程度,分析肺癌化疗患者癌囚性疲乏与生活质量的相关性.方法 采用横断面调查研究方法,应用Piper疲乏量表和简明健康测量量表(SF-36)对72例肺癌化疗患者进行问卷调查.结果 肺癌化疗患者疲乏的发生率为76.4%,整体疲乏和行为/严重性、情感、感觉等维度的中重度疲乏发生率分别为68.1%、63.9%、76.4%、65.3%,认知/情绪维度的轻中度疲乏发生率为41.7%,疲乏得分排序为情感维度＞行为俨重性维度＞感觉维度＞认知/情绪维度.肺癌化疗患者的癌因性疲乏与生活质量在多个维度上呈显著负相关.结论 肺癌化疗患者癌因性疲乏的发生率较高、程度较重,疲乏与生活质量两者相互影响,应采取减轻疲乏的干预措施,以提高肺癌化疗患者的生活质量.     

"四维规范性"护理干预老年乳腺癌患者癌因性疲乏的效果及相关机制

目的 观察"四维规范性"护理干预82例老年乳腺癌患者癌因性疲乏(CRF)的效果,并探讨相关机制.方法 选取2010年1月~2015年2间存在CRF的乳腺癌患者82例为研究对象,随机分为研究组42例和对照组40例.对照组采用常规的护理方式,研究组在进行常规护理的同时采用"四维规范性"护理干预方式.比较两组患者的CRF评分、血红蛋白(Hb)、最大摄氧量(VO2 max)、自我效能(GSES评分)、社会支持(SSRS评分)、生活质量(QOL评分)是否改善,从而评价"四维规范性"护理的效果.结果 ①癌因性疲乏:与干预前相比,研究组干预后的CRF相关得分均出现显著改变(均P<0.05),而对照组干预后的CRF相关得分均无明显变化(均P>0.05);研究组干预后的CRF相关得分均明显高于对照组(均P<0.05);②Hb和VO2max:与干预前相比,两组干预后的Hb均明显下降(均P<0.05),研究组的VO2 max明显升高(P<0.05);而两组干预后的Hb比较,差异无统计学意义(P>0.05),但研究组干预后的VO2max明显高于对照组(P<0.05);③自我、社会、生活评价:与干预前比较,两组干预后的GSES、QOL均明显升高(均P<0.05),研究组干预后的SSRS明显升高;与对照组相比,研究组干预后的GSES、SSRS、QOL明显高于对照组(P<0.05).结论 "四维规范性"护理干预对老年乳腺癌患者的CRF效果较好,能够显著减轻或消除CRF,提高最大摄氧量、自我效能、社会支持,改善患者的生活质量,优于常规的护理方式,可在临床上用于乳腺癌患者的CRF护理.     

系统护理干预对乳腺癌癌因性疲乏患者的影响

目的探讨乳腺癌癌因性疲乏患者的系统护理干预方法及其效果。方法将70例乳腺癌癌因性疲乏患者随机分为观察组35例、对照组35例。对照组接受常规护理,观察组在接受常规护理的基础上行系统的癌因性疲乏护理干预,即日记干预、食疗干预、运动干预和心理干预。比较两组的癌因性疲乏状况和整体生活质量。结果干预前,两组患者Piper疲乏量表(RPFS)得分和整体生活质量的差异均无统计学意义(P>0.05)。干预后,观察组RPFS得分低于对照组,差异有统计学意义(P<0.05);与干预前比较,观察组RPFS得分无显著变化(P>0.05),而对照组RPFS得分较干预前明显升高(P<0.01);观察组整体生活质量显著优于对照组,差异有统计学意义(P<0.05)。结论系统护理干预方法优于传统护理方法,可消除或缓解乳腺癌患者癌因性疲乏程度,提高患者的生存质量。     

A qualitative analysis of cancer-related fatigue in ambulatory oncology

The purpose of this study was to describe patients' perceptions of the causes, relief, related symptoms, meaning, and suffering secondary to cancer-related fatigue (CRF). In total, 252 patients with breast, lung, colon, and prostate cancers were enrolled in a quasiexperimental study to test the effects of a clinical intervention on reducing barriers to symptom management in ambulatory care. Analysis of data reported in this article was derived from the Piper Fatigue Scale-Revised. Using qualitative research methods and content analysis, written statements related to the impact of CRF were coded using the following themes: patients' perceptions of CRF, causes, relief, related symptoms, meaning, and suffering. Comments were categorized and reviewed for content. Overall, CRF had a significant impact on physical, psychological, social, and spiritual well-being. CRF limited the ability of participants to function, socialize, and participate in enjoyable activities. Emotional issues as a result of CRF were common. The negative impact of CRF on patients' overall well-being alters the meaning and suffering related to the cancer experience. The assessment of personal meaning and suffering related to CRF is an important component of the multidimensional assessment of CRF and will enable nurses to better understand the suffering related to CRF.     

Outcomes of a Cancer-Related Fatigue Clinic in a Comprehensive Cancer Center

Cancer-related fatigue (CRF) is a significant issue for cancer patients and frequently precipitates increased stress and anxiety for patients and caregivers alike. CRF may present well after the initial phase of cancer diagnosis and treatment, regardless of whether the cancer is in remission, widely metastatic, or somewhere in between. Determining whether the etiology of fatigue is potentially reversible and whether it is an effect of treatment or another unrelated cause is often perplexing. Because of the significant impact of CRF on patients at our institution, we organized a CRF clinic and began evaluating patients for fatigue in 1998. Our goal has been to initiate a more focused and, at the same time, more comprehensive effort in educating, evaluating, and treating CRF. The purpose of this report was to present a retrospective review of patients treated in our CRF clinic between 1998 and 2005, to examine the outcomes of our patients, and to briefly describe some of the challenges encountered in treating these patients. This information may help reassess and improve approaches in addressing CRF and subsequently improve fatigue in these patients.     

基于自我效能理论的护理干预对食管癌根治术后患者的影响

目的 探讨基于自我效能理论的护理干预对食管癌根治术后患者营养状况以及癌因性疲乏的影响。 方法 采用便利抽样法,选取南昌市某三级甲等医院2017年1月—2020年12月收治的119例食管癌根治术后患者作为研究对象,按照随机数字表法将其分为试验组（n=59）与对照组（n=60）。试验组采取基于自我效能理论的护理干预,对照组接受术后常规护理干预,比较两组在出院时（T₀）、出院后1个月（T₁）、出院后3个月（T₂）、出院后6个月（T₃）以及出院后1年（T₄）的自我效能感、营养状况、癌因性疲乏情况。 结果 重复测量方差分析结果显示,干预后不同时间点试验组健康行为自我效能感量表得分均高于对照组,营养风险筛查表2002得分均低于对照组,差异有统计学意义（P<0.05）;在T₄时,试验组癌因性疲乏量表得分为（33.90±6.30）分,显著低于对照组的（44.93±7.66）分,差异具有统计学意义（P<0.001）。 结论 基于自我效能理论的护理干预可显著增加食管癌根治术后患者的自我效能感、改善其营养状况、缓解癌因性疲乏。     

Heavy to carry: a survey of parents' and healthcare professionals' perceptions of cancer-related fatigue in children and young people

Cancer-related fatigue is a prevalent, but often under-recognized, symptom with the potential to impact the lives of both the child and the family. There is little known about the biological and the behavioral dimensions of fatigue, and not about the patterns of this symptom. The aim of this study was to investigate cancer-related fatigue from the perspective of parents of children and young people with cancer and from the perspective of healthcare professionals (HCPs) and to examine its impact on quality of life. A cross-sectional, questionnaire-based survey was undertaken with parents of patients attending 4 of the 22 United Kingdom Childhood Cancer Study Group centers; HCPs from 20 of these centers were also surveyed. Response rates were 42% for parents and caregivers (95/224) and 35% for HCPs (235/679). Results showed that fatigue was prevalent. Fifty-six percent of HCPs thought "most" or "all" patients experienced moderate fatigue; 57% of parents said that the patient experienced fatigue at least once a week. Data demonstrate that fatigue was perceived to be a significant problem by parents and HCPs. Healthcare professionals indicated that the mean percentage of patients who experience fatigue, to whom they recommended a treatment, was 29%. Rest and relaxation were recommended by the majority (59%; 138). The overall impression is that both HCPs and parents acknowledge that children and young people are likely to experience fatigue. Recognition of the significance of this symptom is a crucial first step in improving future management and offering strategies that can help both child and family.