癌症有關失眠困擾照護之新概況

A new profile of nursing care for cancer-related insomnia distress

黃秀月(Yueh-Huang Hsiu)；謝素英(Suh-Ing Hsieh)

癌症 ； 失眠 ； 3P失眠模式 ； 臨床處置 ； 認知行為治療 ； Cancer ； insomnia ； 3P insomnia model ； clinical intervention ； cognitive-behavior treatment

台灣健康照顧研究學刊

17期（2016 / 12 / 01）

111 - 126

繁體中文

失眠是癌症患者很常見的症狀困擾之一，以往卻少受到醫護人員的重視，在多種類型癌症的病患失眠的盛行率大約是30-50%，比一般人的失眠高出20%。研究顯示在診斷癌症一年後仍有失眠困擾的人約有36.9-58.7%，可見癌症患者的失眠容易轉變成慢性失眠。而失眠不僅會影響醫療成本的支出、再住院率、照顧者的壓力負擔、及疾病病程的進展，也會使得患者的生活品質下降。反之，當癌症患者得到充足的睡眠時，其壓力減少，皮質醇的濃度下降，而免疫系統則會重新活化，有助於減緩疾病的進展，提高生活品質。故本文透過文獻回顧來說明癌症有關失眠困擾的定義與分類、生理病理機轉、導因、護理評估、臨床處置及相關研究，期望藉由本篇以喚起護理人員注重此議題，並加以評估及處理此困擾，進而提升癌症患者的生活品質。

Insomnia is a very common symptom distress in cancer patients, but it was rarely paid great attention by the medical and nursing staff previously. The prevalence of insomnia is around 30-50% in diverse types of cancer patients and is 20% higher than the general people. Studies show that 36.9-58.7% of cancer patients still have insomnia one year after cancer diagnosis. Thus, insomnia of cancer patients can become chronic insomnia. However, insomnia not only affect the payment of medical cost, re-admission rate, caregivers' stress burden, and disease process progression, but also decrease the quality of life in cancer patients. Conversely, while cancer patients obtain efficient sleep, their stress and cortisol levels decrease. Thus, their immune system will reactive that can slow down disease progression and enhance quality of life. However, this article describes the definition and classification, pathophysiological mechanisms, etiology, nursing assessment, clinical intervention, and related studies. Hopefully, this article can cause nursing staffs to pay attention to this issue and assess and manage this distress for promoting quality of life in cancer patients.

1. 林維君, W. C.(2010)。癌症患者失眠的認知行為治療：系統性的文獻回顧。中華心理學刊，52(2)，173-188。
   連結：
2. Berger, A. M.,Kuhn, B. R.,Farr, L. A.,Lynch, J. C.,Agrawal, S.,Chamberlain, J.,Susanna, G. V.(2009).Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue.Psycho-Oncology,18(3),634-646.
3. Buysse, D. J.,Reynolds, C. F.,Monk, T. H.,Berman,S. R.,Kupfer, D. J.(1989).The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research.Psychiatry Research,28(2),193-213.
4. Deak, M. C.,Winkelman, J. W.(2012).Insomnia.Neurol Clin,30,1045-1066.
5. Demiralp, M.,Oflaz, F.,Komurcu,S.(2010).Effects of relaxation training on sleep quality and fatigue in patients with breast cancer undergoing adjuvant chemotherapy.Journal of Clinical Nursing,19(7-8),1073-1083.
6. Dirksen, S. R.,Epstein, D. R.,Hoyt, M. A.(2009).Insomnia, depression, and distress among outpatient with prostate cancer.Science Dirct,22,154-158.
7. Gooneratne, N. S.,Dean, G. E.,Roger, A. E.,Nkwuo, J. E.,Coyne, J. C.,Kaiser, L. R.(2007).Sleep and quality of life in long-term lung cancer survivors.Lung Cancer,58,403-410.
8. Graci, G.(2005).Pathogenesis and management of cancer-related insomnia.The Journal of Supportive Oncology,3(5),349-359.
9. Kwekkeboom, K. L.,Abbott-Anderson, K. A.,Wanta, B.(2010).Feasibility of a patient-controlled cognitive-behavioral intervention for pain, fatigue, and sleep disturbance in cancer.Oncology Nursing Forum,37(3),E151-E159.
10. Lichstenin, K, L.,Stone, K. C.,Donaldson, J.,Nau, S. D.,Soeffing, J. P.,Murray, D.,Aguillard, R. N.(2006).Actigraphy validation with insomnia.Sleep,29(2),232-239.
11. Matthews, E. M.,Berger, A. M.,Schmiege, S. J.,Cook, P. F.,McCarthy, M. S.,Moore, C. M.,Aloia, M. S.(2014).Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: A randomized, controlled trial.Oncology Nursing Forum,41(3),241-253.
12. Morin, C. M.(1993).Insomnia: Psychological assessment and management.New York, NY:Guilford.
13. Morin, C. M.,Benca, R.(2012).Chronic insomnia.Lancet,379,1129-1141.
14. Reeve, K.,Bailes, B.(2010).Insomnia in adults: Etiology and management.The Journal for Nurse Practitioners,6(1),53-60.
15. Roscoe, J. A.,Garland, S. N.,Heckler, C. E.,Perlis, M. L.,Peoples, A. R.,Shayne, M.,Morrow, G. R.(2015).Randomized placebo-controlled trial of cognitive behavioral therapy and armodafinil for insomnia after cancer treatment.Journal of Clinical Oncology,33(2),165-171.
16. Spielman, A. J.,Caruso, L. S.,Glovinsky, P. B.(1987).A behavioral perspective on insomnia treatment.Psychiatr Clin North Am,10(4),541-553.
17. Wennberg, A. M.,Canham, S. L.,Smith, M. T.,Spira, A. P.(2013).Optimizing sleep in older adults: Treating insomnia.Maturitas,76,247-252.
18. 朱哲生, Z. S.,陸悌, T.(2011)。失眠之最新概況。臺灣醫界，54(6)，8-14。
19. 周繡玲, H. L.,廖珍娟, J. J.,姚鐘太, C. T.(2007)。癌症病人的失眠困擾。腫瘤護理雜誌，7(2)，25-35。
20. 洪智倫, Z. L.(2009)。探討“漸進式肌肉放鬆”技術對舒緩學前教育工作者的工作壓力之成效。長庚科技學刊，10，1-16。
21. 張金堅, K. J.(2013)。女性癌病人最常見的身心煎熬─疲憊、失眠與疼痛。臺灣醫界，56(6)，38-42。
22. 曾令儀, L. Y.,李引玉, Y. Y.(1999)。放鬆治療在護理上的應用。護理雜誌，46(5)，68-74。
23. 蔡佳芬(2011)‧睡不著怎麼辦？談癌症病患的失眠問題(下)‧取自http://hospital.kingnet.com.tw/essay/essay.html?pid=29632 [Tsai, C. F. (2011). What can do about insomnia? Talking about cancer patients’ insomnia problem. Retrieved from http://hospital.kingnet. com.tw/essay/essay.html?pid=29632 ]

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