穴位措施對同步化放療頭頸癌病人疲憊與心率變異的改善成效

Effects of an Acupoint Intervention on Improving Fatigue and Heart Rate Variability in Head and Neck Cancer Patients Receiving Concurrent Chemoradiotherapy

10.6224/JN.201906_66(3).07

周雅惠(Ya-Hui CHOU)；王玉真(Yu-Jen WANG)；葉美玲(Mei-Ling YEH)；林倩伃(Chien-Yu LIN)

穴位措施 ； 頭頸癌 ； 同步化放療 ； 疲憊 ； 心率變異 ； acupoint intervention ； head and neck cancer ； concurrent chemoradiotherapy ； fatigue ； heart rate variability

護理雜誌

66卷3期（2019 / 06 / 01）

46 - 58

繁體中文

背景：疲憊是頭頸癌病人於同步化放療期間最盛行的症狀，然而，穴位措施對頭頸癌病人之疲憊及心率變異效益仍未明確。目的：評值穴位措施對接受同步化放療的頭頸癌病人之疲憊及心率變異改善成效。方法：本隨機控制試驗研究採重複性測量，並以塊狀排列隨機分派病人至不同組別。穴位組與控制組的所有參與者均接受常規照護，穴位組再多接受六週體穴電刺激及耳穴貼壓。資料使用簡明疲憊量表及心率變異儀器收集，於前測、第1、2、3及6週進行測量。結果：廣義估計方程式分析的結果，呈現疲憊程度在介入措施第6週的組別與時間交互作用具有顯著差異（p＝.036），而正常心搏間期標準差、低頻功率、高頻功率及低頻／高頻功率比等心率變異參數均無組別與時間交互作用的顯著差異（p＞.05）。結論／實務應用：本研究支持穴位措施之可近性與可行性。此六週的體穴電刺激及耳穴貼壓措施，可用以改善接受化放療的頭頸癌病人的疲憊狀態，且未發現不良反應。

Background: Fatigue is the most common symptom in head and neck cancer patients who receive concurrent chemoradiotherapy (CCRT). However, evidence of the effects of acupoint interventions on fatigue and heart rate variability in these patients is unclear. Purpose: To evaluate the effect of an acupoint intervention on fatigue and heart rate variability in head and neck cancer patients receiving CCRT. Methods: This randomized controlled trail applied repeated measures, and used permuted block randomization to randomly assign the participants into the acupoint and control groups. Participants in both groups received usual care. In addition, participants in the acupoint group received transcutaneous electrical acupoint stimulation and auricular acupressure for a period of six weeks. Data were collected using the brief fatigue inventory and a heart rate variability device at baseline and during the 1^(st), 2^(nd), 3^(rd), and 6^(th) weeks of the study. Results: The generalized estimating equation analysis found a significant group-by-time interaction for fatigue on the 6^(th) week of acupoint stimulation (p = .036). No significant differences in group-by-time interaction were found for the standard deviation of normal to normal intervals (SDNN), low frequency (LF), high frequency (HF), or LF/HF ratio (p ＞ .05). Conclusions/Implications for Practice: This study supports the accessibility and feasibility of the acupoint intervention. No adverse effects were observed. The six-week transcutaneous electrical acupoint stimulation and auricular acupressure may be used to improve fatigue in head and neck cancer patients currently receiving CCRT.

1. American Society of Clinical Oncology. (2017). Head and neck cancer: Statistics. Retrieved from https://www.cancer.net/cancer-types/head-and-neck-cancer/statistics
2. Arab, C.,Dias, D. P.,Barbosa, R. T.,Carvalho, T. D.,Valenti, V. E.,Crocetta, T. B.,Ferreira, C.(2016).Heart rate variability measure in breast cancer patients and survivors: A systematic review.Psychoneuroendocrinology,68,57-68.
3. Bower, J. E.,Bak, K.,Berger, A.,Breitbart, W.,Escalante, C. P.,Ganz, P. A.,American Society of Clinical Oncology(2014).Screening, assessment, and management of fatigue in adult survivors of cancer: An American Society of Clinical Oncology clinical practice guideline adaptation.Journal of Clinical Oncology,32(17),1840-1850.
4. Coumbe, B. G. T.,Groarke, J. D.(2018).Cardiovascular autonomic dysfunction in patients with cancer.Current Cardiology Reports,20(8),69.
5. Cowan, M. J.(1995).Measurement of heart rate variability.Western Journal of Nursing Research,17(1),32-48.
6. Crosswell, A. D.,Lockwood, K. G.,Ganz, P. A.,Bower, J. E.(2014).Low heart rate variability and cancer-related fatigue in breast cancer survivors.Psychoneuroendocrinology,45,58-66.
7. Fagundes, C. P.,Murray, D. M.,Hwang, B. S.,Gouin, J. P.,Thayer, J. F.,Sollers, J. J., III.,Kiecolt-Glaser, J. K.(2011).Sympathetic and parasympathetic activity in cancer-related fatigue: More evidence for a physiological substrate in cancer survivors.Psychoneuroendocrinology,36(8),1137-1147.
8. Fan, K. H.,Chen, Y. C.,Lin, C. Y.,Kang, C. J.,Lee, L. Y.,Huang, S. F.,Chang, J. T. C.(2017).Postoperative radiotherapy with or without concurrent chemotherapy for oral squamous cell carcinoma in patients with three or more minor risk factors: A propensity score matching analysis.Radiation Oncology,12(1),184.
9. Global Burden of Disease Cancer Collaboration,Fitzmaurice, C.,Akinyemiju, T. F.,Al Lami, F. H.,Alam, T.,AlizadehNavaei, R.,Naghavi, M.(2018).Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: A systematic analysis for the global burden of disease study.JAMA Oncology,4(11),1553-1568.
10. Hadadian, F.,Sohrabi, N.,Farokhpayam, M.,Farokhpayam, H.,Towhidi, F.,Fayazi, S.,Abdi, A.(2016).The effects of transcutaneous electrical acupoint stimulation (TEAS) on fatigue in haemodialysis patients.Journal of Clinical and Diagnostic Research,10(9),YC01-YC04.
11. Hou, L.,Zhou, C.,Wu, Y.,Yu, Y.,Hu, Y.(2017).Transcutaneous electrical acupoint stimulation (TEAS) relieved cancer-related fatigue in non-small cell lung cancer (NSCLC) patients after chemotherapy.Journal of Thoracic Disease,9(7),1959-1966.
12. Hsu, W. L.,Yu, K. J.,Chiang, C. J.,Chen, T. C.,Wang, C. P.(2017).Head and neck cancer incidence trends in Taiwan, 1980-2014.International Journal of Head and Neck Science,1(3),180-189.
13. Jou, A.,Hess, J.(2017).Epidemiology and molecular biology of head and neck cancer.Oncology Research and Treatment,40(6),328-332.
14. Kirshbaum, M.(2010).Cancer-related fatigue: A review of nursing interventions.British Journal of Community Nursing,15(5),214-219.
15. Kuo, T. B.,Lin, T.,Yang, C. C.,Li, C. L.,Chen, C. F.,Chou, P.(1999).Effect of aging on gender differences in neural control of heart rate.American Journal of Physiology -Heart and Circulatory Physiology,277(6),H2233-H2239.
16. Kuo, Y. T.,Chang, T. T.,Muo, C. H.,Wu, M. Y.,Sun, M. F.,Yeh, C. C.,Yen, H. R.(2018).Use of complementary traditional Chinese medicines by adult cancer patients in Taiwan: A nationwide population-based study.Integrative Cancer Therapies,17(2),531-541.
17. Lee, P. L.,Tam, K. W.,Yeh, M. L.,Wu, W. W.(2016).Acupoint stimulation, massage therapy and expressive writing for breast cancer: A systematic review and meta-analysis of randomized controlled trials.Complementary Therapies in Medicine,27,87-101.
18. Li, Y. M.,Liu, H. P.,Feng, S. L.,Gong, D. F.(2006).The therapeutic effects of electrical acupuncture and auricular-plaster in 32 cases of chronic fatigue syndrome.Journal of Traditional Chinese Medicine,26(3),163-164.
19. Li, Z.,Wang, C.,Mak, A. F.,Chow, D. H.(2005).Effects of acupuncture on heart rate variability in normal subjects under fatigue and non-fatigue state.European Journal of Applied Physiology,94(5-6),633-640.
20. Ling, W. M.,Lui, L. Y.,So, W. K.,Chan, K.(2014).Effects of acupuncture and acupressure on cancer-related fatigue: A systematic review.Oncology Nursing Forum,41(6),581-592.
21. Mason, H.,DeRubeis, M. B.,Burke, N.,Shannon, M.,Karsies, D.,Wolf, G.,Worden, F.(2016).Symptom management during and after treatment with concurrent chemoradiotherapy for oropharyngeal cancer: A review of the literature and areas for future research.World Journal of Clinical Oncology,7(2),220-226.
22. Matovina, C.,Birkeland, A. C.,Zick, S.,Shuman, A. G.(2017).Integrative medicine in head and neck cancer.Otolaryngology–Head and Neck Surgery,156(2),228-237.
23. Mayer, D.(2010).Essential evidence-based medicine.New York, NY:Cambridge University Press.
24. Mendoza, T. R.,Wang, X. S.,Cleeland, C. S.,Morrissey, M.,Johnson, B. A.,Wendt, J. K.,Huber, S. L.(1999).The rapid assessment of fatigue severity in cancer patients: Use of the brief fatigue inventory.Cancer,85(5),1186-1196.
25. Molassiotis, A.,Bardy, J.,Finnegan-John, J.,Mackereth, P.,Ryder, W. D.,Filshie, J.,Richardson, A.(2013).A randomized, controlled trial of acupuncture self-needling as maintenance therapy for cancer-related fatigue after therapist-delivered acupuncture.Annals of Oncology,24(6),1645-1652.
26. Morgan, P. D.,Tyler, I.,Fogel, J.,Barnett, K.(2014).African American women share ‘real talk’ stories about fatigue related to breast cancer treatment.The ABNF Journal,25(4),116-122.
27. Niska, J. R.,Halyard, M. Y.,Tan, A. D.,Atherton, P. J.,Patel, S. H.,Sloan, J. A.(2017).Electronic patient-reported outcomes and toxicities during radiotherapy for head-and-neck cancer.Quality of Life Research,26(7),1721-1731.
28. Reidunsdatter, R. J.,Rannestad, T.,Frengen, J.,Frykholm, G.,Lundgren, S.(2011).Early effects of contemporary breast radiation on health-related quality of life – Predictors of radiotherapy-related fatigue.Acta Oncologica,50(8),1175-1182.
29. Rosenthal, D. I.,Mendoza, T. R.,Fuller, C. D.,Hutcheson, K. A.,Wang, X. S.,Hanna, E. Y.,Gunn, G. B.(2014).Patterns of symptom burden during radiotherapy or concurrent chemoradiotherapy for head and neck cancer: A prospective analysis using the University of Texas MD Anderson Cancer Center Symptom Inventory-Head and neck module.Cancer,120(13),1975-1984.
30. Shu, Q.,Wang, H.,Litscher, D.,Wu, S.,Chen, L.,Gaischek, I.,Liang, F.(2016).Acupuncture and moxibustion have different effects on fatigue by regulating the autonomic nervous system: A pilot controlled clinical trial.Scientific Reports,6,37846.
31. So, R. C. H.,Ng, J. K. F.,Ng, G. Y. F.(2007).Effect of transcutaneous electrical acupoint stimulation on fatigue recovery of the quadriceps.European Journal of Applied Physiology,100(6),693-700.
32. Spratt, D. E.,Sakae, M.,Riaz, N.,Lok, B. H.,Essandoh, S.,Hsu, M.,Lee, N. Y.(2012).Time course and predictors for cancer-related fatigue in a series of oropharyngeal cancer patients treated with chemoradiation therapy.The Oncologist,17(4),569-576.
33. Task Force of the European Society of Cardiology,North American Society of Pacing and Electrophysiology(1996).Heart rate variability: Standards of measurement, physiological interpretation, and clinical use.European Heart Journal,17(3),354-381.
34. Tshering Vogel, D. W.,Thoeny, H. C.(2016).Cross-sectional imaging in cancers of the head and neck: How we review and report.Cancer Imaging,16(1),20.
35. Yeh, C. H.,Chien, L. C.,Lin, W. C.,Bovbjerg, D. H.,van Londen, G. J.(2016).Pilot randomized controlled trial of auricular point acupressure to manage symptom clusters of pain, fatigue, and disturbed sleep in breast cancer patients.Cancer Nursing,39(5),402-410.
36. Zhang, Y.,Lin, L.,Li, H.,Hu, Y.,Tian, L.(2018).Effects of acupuncture on cancer-related fatigue: A meta-analysis.Supportive Care in Cancer,26(2),415-425.
37. Zhou, W.,Wan, Y. H.,Chen, Q.,Qiu, Y. R.,Luo, X. M.(2018).Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: A randomized controlled trial.Journal of Pain and Symptom Management,55(3),737-744.
38. 李金霞, J. X.,謝晶軍, J. G.,潘中強, Z. Q.,郭小青, X. Q.,李燁, Y.,傅瑞陽, R. Y.(2017)。經皮穴位電刺激治療慢性疲勞綜合徵：隨機對照研究。中國針灸，37(12)，1276-1279。
39. 周幸來, H. L.,周舉, C.(2008).望耳診病與耳穴治療圖解.台北市=Taipei City, Taiwan, ROC:大展=Dah Jaan.
40. 國民健康署, Taiwan, ROC.(2018).105年癌症登記年報.
41. 葉柏巖, B. Y.,劉耕豪, G. H.,許逸群, Y. C.,卓韋佳, W. J.,陳玉昇, Y. S.(2012)。電針刺足三里上巨虛穴位組對氣血傾移的效應。中醫藥雜誌，23(2)，235-244。
42. 葉美玲, M. L.,陳興夏, H. H.,林宜信, I. H.(2004).現代實用經絡俞穴療護.台北市=Taipei City, Taiwan, ROC:華杏=Farseeing.
43. 葉美玲, M. L.,陳興夏, H. H.,林宜信, I. H.(2004).中醫經絡與俞穴.台北市=Taipei City, Taiwan, ROC:華杏=Farseeing.
44. 趙久惠, C. H.,陳秋媛, C. Y.,葉明憲, M. H.(2012)。中醫藥治療癌因性疲憊的研究進展。台灣中醫臨床醫學雜誌，18(3)，8-18。
45. 鍾傑, C.,鍾維慈, W. T.(2002).耳針治療黃金律.台北市=Taipei City, Taiwan, ROC:正光書局=Cheng Kuang Book.

1. Hui-Ling WANG,Hsuan-Man HUNG,Hsiao-Ching CHIANG(2021).The Impact of Gender on the Effectiveness of an Auricular Acupressure Intervention Administered to Community-Dwelling Poor Sleepers: A Cluster Randomized Controlled Trial.The Journal of Nursing Research,29(3),1-11.