探討運動方案改善晚期肺癌病人癌因性疲憊及症狀困擾之成效

Effect of an Exercise Program on Cancer-Related Fatigue and Symptom Disturbance Alleviation in Patients with Advanced Lung Cancer

10.6142/VGHN.201906_36(2).0008

黃秀霖(Hsiu-Lin Huang)；郭鳳霞(Foung-Shia Kou)；樊君儀(Chun-I Fan)；廖淑貞(Shu-Chen Liao)；洪世欣(Shih-Hsin Hung)

肺癌 ； 運動方案 ； 癌因性疲憊 ； 症狀困擾 ； lung cancer ； exercise ； cancer related fatigue ； symptoms disturbance

榮總護理

36卷2期（2019 / 06 / 01）

178 - 190

繁體中文

癌因性疲憊（Cancer-related fatigue，以下簡稱CRF） 存在於癌症的各階段病程，是最常見的症狀困擾，實證研究證實運動可有效改善CRF，唯晚期肺癌病人深受疾病所苦，需審慎設計適合的運動計畫以助益病人，故引發動機欲研擬本土化之實證應用研究以探討成效。本研究採隨機對照研究，期探討運動介入對晚期肺癌病人CRF、症狀困擾及活動耐力的改善成效，於北部某醫學中心收案54名肺癌治療中病人，研究期間因病情進展或死亡而流失17名（33.3%），實驗組（19名）接受專為晚期肺癌病人設計之運動方案，對照組（18名）維持原居家活動型態，持續追蹤八週。藉由運動日誌觀察活動情形及運動堅持度，以台灣版簡明疲憊量表（BFI-Taiwan Form）、安德森症狀量表（MDASI-Taiwan Form） 及六分鐘走路距離進行評估。研究資料以描述性及推論性統計分析，結果發現兩組前測僅年齡達顯著差異（p ＜ .05），以廣義估計方程式（Generalized Estimating Equation, GEE）統計檢定後，實驗組介入八週運動之後，疲憊、疲憊對生活干擾、症狀困擾、與六分鐘走路距離等均較對照組有改善，但未達顯著差異，僅症狀困擾對生活的妨礙程度較對照組有顯著下降（p ＜ .05），且實驗組介入前後之六分鐘走路距離已達最小臨床重要差異（Minimal Clinical Importance Difference, MCID），顯示運動方案可有效降低晚期肺癌病人的症狀困擾對生活妨礙程度，並增進活動耐力，可提供照護團隊臨床應用參考。

Cancer-related fatigue (CRF), a common symptom, has a substantial adverse effect on cancer patients' quality of life. Exercise is the most effective nonpharmacological intervention for managing CRF. Patients with advanced lung cancer experience CRF; this warrants carefully design of a suitable exercise program to aid these patients. This randomized controlled study determined whether an exercise program can alleviate CRF and symptom disturbance in patients with advanced lung cancer. In total, 54 patients were enrolled in this study; 17 patients were lost to follow-up due to disease progression. All enrolled patients were randomly assigned to the experimental and control groups. All 19 patients in the experimental group underwent a specially designed exercise program, and all 18 patients in the control group were asked to perform regular home activity patterns. All patients were followed for 8 weeks. The following tools of evaluation were used: Taiwanese version of the Brief Fatigue Inventory Form, Taiwanese version of the Anderson Symptom Inventory Form, and a 6-minute walk distance before and after the intervention. The results of this study revealed that the exercise program significantly alleviated symptoms that shorten patients' life expectancy clinically and increased activity endurance to the minimal clinically importance difference in patients with advanced lung cancer. The results can be used as a reference by medical teams for the clinical application of appropriate exercise programs.

1. 邱惠英、林佑樺、王金洲、陳婉宜、張晃智、林孟志(2016)。肺癌化學治療後病人照護需求與相關因素之探討。護理雜誌，63(3)，62-72。
   連結：
2. Bade, B. C.,Thomas, D. D.,Scott, J. B.,Silvestri, G. A.(2015).Increasing physical activity and exercise in lung cancer: Reviewing safety, benefits, and application.Journal of Thoracic Oncology,10(6),861-871.
3. Borg, G.,Sjöberg, H.(1981).The variation of hand steadiness with physical stress.Journal of Motor Behavior,13(2),110-116.
4. Bower, J. E.(2014).Cancer-related fatigue-mechanisms, risk factors, and treatments.Nature Reviews Clinical Oncology,11(10),597.
5. Campos, M.,Hassan, B.,Riechelmann, R.,Del Giglio, A.(2011).Cancer-related fatigue: A practical review.Annals of Oncology,22(6),1273-1279.
6. Chen, H. M.,Tsai, C. M.,Wu, Y. C.,Lin, K. C.,Lin, C. C.(2015).Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer.British Journal of Cancer,112(3),438-445.
7. Cheville, A. L.,Kollasch, J.,Vandenberg, J.,Shen, T.,Grothey, A.,Gamble, G.,Basford, J. R.(2013).A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: A randomized controlled trial.Journal of Pain and Symptom Management,45(5),811-821.
8. Cleeland, C. S.,Mendoza, T. R.,Wang, X. S.,Chou, C.,Harle, M. T.,Morrissey, M.,Engstrom, M. C.(2000).Assessing symptom distress in cancer patients: The MD Anderson Symptom Inventory.Cancer,89(7),1634-1646.
9. Coats, V.,Maltais, F.,Tremblay, L.,Saey, D.(2014).Exercise-Based Rehabilitation for People with Lung Cancer.Journal of Pulmonary & Respiratory Medicine,4(3)
10. Dhillon, H.,Bell, M.,van der Ploeg, H.,Turner, J.,Kabourakis, M.,Spencer, L.,Clarke, S.(2017).Impact of physical activity on fatigue and quality of life in people with advanced lung cancer: A randomized controlled trial.Annals of Oncology,28(8),1889-1897.
11. Enright, P. L.,Sherrill, D. L.(1998).Reference equations for the six-minute walk in healthy adults.American Journal of Respiratory and Critical Care Medicine,158(5),1384-1387.
12. Granger, C. L.,Holland, A. E.,Gordon, I. R.,Denehy, L.(2015).Minimal important difference of the 6-minute walk distance in lung cancer.Chronic Respiratory Disease,12(2),146-154.
13. Hsieh, R. K.,Shun, S. C.,Rau, K. M.,Chiou, T. J.,Sung, Y. C.,Yeh, S. P.(2015).Occurrence, severity, and impact of cancer-related fatigue in Taiwanese patients with cancer: A national survey.Journal of Clinical Oncology,33(29_suppl),77.
14. Jones, L. W.,Eves, N. D.,Peterson, B. L.,Garst, J.,Crawford, J.,West, M. J.,Douglas, P. S.(2008).Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients: A pilot study.Cancer,113(12),3430-3439.
15. Kirshbaum, M.(2010).Cancer-related fatigue: A review of nursing interventions.British Journal of Community Nursing,15(5),214-219.
16. Kuchinski, A. M.,Reading, M.,Lash, A. A.(2009).Treatment-related fatigue and exercise in patients with cancer: A systematic review.Medsurg Nursing,18(3),174-180.
17. Kuehr, L.,Wiskemann, J.,Abel, U.,Ulrich, C. M.,Hummler, S.,Thomas, M.(2014).Exercise in patients with non-small cell lung cancer.Medicine and Science in Sports and Exercise,46(4),656-663.
18. Laboratories, A. C. o. P. S. f. C. P. F.(2002).ATS statement: Guidelines for the six-minute walk test.American Journal Respiratory Critical Care Medicine,166,111-117.
19. Lin, C. C.,Chang, A. P.,Chen, M. L.,Cleeland, C. S.,Mendoza, T. R.,Wang, X. S.(2006).Validation of the Taiwanese version of the Brief Fatigue Inventory.Journal of Pain and Symptom Management,32(1),52-59.
20. Lin, C. C.,Chang, A. P.,Cleeland, C. S.,Mendoza, T. R.,Wang, X. S.(2007).Taiwanese version of the M. D. Anderson symptom inventory: Symptom assessment in cancer patients.Journal of Pain and Symptom Management,33(2),180-188.
21. 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.
22. Minton, O.,Stone, P.(2009).A systematic review of th escales used for the measurement of cancer-related fatigue (CRF).Annals of Oncology,20(1),17-25.
23. Mustian, K. M.,Sprod, L. K.,Palesh, O. G.,Peppone, L. J.,Janelsins, M. C.,Mohile, S. G.,Carroll, J.(2009).Exercise for the management of side effects and quality of life among cancer survivors.Current Sports Medicine Reports,8(6),325-330.
24. National Comprehensive Cancer Network (2018). NCCN clinical practice guidelines in oncology: Cancer-related fatigue. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf
25. Quist, M.,Rorth, M.,Langer, S.,Jones, L. W.,Laursen, J. H.,Pappot, H.,Adamsen, L.(2012).Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: A pilot study.Lung Cancer,75(2),203-208.
26. Rhudy, L.,Dose, A. M.,Basford, J.,Griffin, J. M.,Cheville, A. L.(2015).Caregivers' attitudes toward promoting exercise among patients with late-stage lung cancer.The Journal of Community and Supportive Oncology,13(11),392-398.
27. Schwartz, A. L.(2009).Fatigue in long-term cancer survivors.Oncology,23(8 Suppl),33-24.
28. Spence, R. R.,Heesch, K. C.,Brown, W. J.(2010).Exercise and cancer rehabilitation: A systematic review.Cancer Treatment Reviews,36(2),185-194.
29. Temel, J. S.,Greer, J. A.,Goldberg, S.,Vogel, P. D.,Sullivan, M.,Pirl, W. F.,Smith, M. R.(2009).A structured exercise program for patients with advanced nonsmall cell lung cancer.Journal of Thoracic Oncology,4(5),595-601.
30. Velthuis, M.J.,Agasi-Idenburg, S.C.,Aufdemkampe, G.,Wittink, H. M.(2010).The effect of physical exercise on cancer-related fatigue during cancer treatment: A meta-analysis of randomized controlled trials.Clinical Oncology,22(3),208-221.
31. Weis, J.(2011).Cancer-related fatigue: Prevalence, assessment and treatment strategies.Expert Review of Pharmacoeconomics & Outcomes Research,11(4),441-446.
32. Wise, R. A.,Brown, C. D.(2005).Minimal clinically important differences in the sixminute walk test and the incremental shuttle walking test.COPD: Journal of Chronic Obstructive Pulmonary Disease,2(1),125-129.
33. 台灣癌症安寧緩和醫學會(2019)。癌因性疲憊症之臨床治療指引。
34. 周繡玲、王冠今、姚鍾太(2010)。癌症相關疲憊與發炎前細胞激素之關係。腫瘤護理雜誌，10(1)，25-37。
35. 黃鈺萍、廖維華、錢桂玉、陳建銘(2016)。系統性回顧：高強度間歇訓練對於癌症患者之效益探討。台灣復健醫學雜誌，44(2)，55-69。
36. 趙基安、許名雅、陳虹汶、蘇文浩、黃麗卿、鄒孟婷(2011)。癌因性疲憊相關之病理生理機轉。安寧療護雜誌，16(3)，348-360。
37. 衛生福利部(2018，7 月23 日) ．106 年死因統計結果．取自https://dep.mohw.gov.tw/DOS/cp-3960-41756-113.Html

1. 鄭雅君,葉惠玲,李珍妮,池雅頻(2023)。印尼籍白血病患者來臺接受異體造血幹細胞移植之護理經驗。志為護理-慈濟護理雜誌，22(5)，103-112。