感知控制、自我管理对乳腺癌化疗患者癌因性疲乏的影响

Effect of perception control and self-management on cancer-related fatigue in breast cancer patients with chemotherapy

目的了解乳腺癌化疗患者感知控制、自我管理与癌因性疲乏(CRF)的现状,探讨感知控制、自我管理对CRF的影响。方法采用横断面调查法抽取山东省肿瘤防治研究院246例乳腺癌化疗患者进行问卷调查。采用癌症经验与效能量表评估患者的感知控制水平,癌症患者自我管理测评量表评估患者的自我管理水平,Piper疲乏量表评估患者的CRF情况。比较不同人口学资料患者的CRF评分情况,分析感知控制、自我管理行为对患者CRF的影响。结果不同文化程度(F=3.392,P=0.019)、医疗费用来源(F=4.368,P=0.005)、疾病分期(F=4.376,P=0.005)、化疗周期(F=3.865,P=0.010)、病程(F=3.094,P=0.028)的患者CRF评分差异均具有统计学意义。乳腺癌化疗患者感知控制的癌症经验(F=7.248,P=0.001)、控制效能(F=96.595,P<0.001)、癌症患者自我管理(F=65.009,P<0.001)、CRF(F=130.973,P<0.001)各维度差异均具有统计学意义。感知控制中的癌症经验与CRF呈正相关(r=0.467;P<0.001);控制效能、癌症患者的自我管理与CRF呈负相关(r=-0.505,P<0.001;r=-0.564,P<0.001)。多元线性回归显示,医疗费用来源(以商业保险为参照组)、化疗周期(化疗周期≥6周期为参照组)、癌症经验、控制效能与自我管理进入回归模型,对CRF解释率为55.5%,且存在显著的线性关系(F=17.100,P<0.001)。结论医护人员应重点关注自费及处于2~5化疗周期患者的CRF;癌症经验与CRF呈正相关,控制效能、自我管理行为与CRF呈负相关。

Objective To understand the status quo of perception control,self-management and cancer-related fatigue(CRF)in breast cancer patients receiving chemotherapy,and to investigate the impacts of perception control and self-management on CRF.Methods In this study,246 breast cancer patients undergoing chemotherapy from Shandong Cancer Hospital and Institute were investigated by means of cross-sectional survey.Cancer experience and efficiency scale was used to evaluate the patients′perception control;cancer patients′self-management scale was used to assess their self-management;and Piper Fatigue Scale was used to evaluate their CRF.Finally,the scores of CRF among the patients with different demographic data were compared,and the effects of perception control and self-management behavior on CRF were analyzed.Results In univariate analysis,there were statistically significant differences of CRF scores resulting from different educational backgrounds(F=3.392,P=0.019),sources of medical cost(F=4.368,P=0.005),disease stages(F=4.376,P=0.005),chemotherapy periods(F=3.865,P=0.010)and courses of disease(F=3.094,P=0.028).The differences in each dimension of perceived control cancer experience(F=7.248,P=0.001),control efficacy(F=96.595,P<0.001),self-management level of cancer patients(F=65.009,P<0.001)and CRF(F=130.973,P<0.001)were statistically significant.Cancer experience in perception control was positively correlated with CRF(r=0.467,P<0.001);control effectiveness and self-management of cancer patients were negatively correlated with CRF(r=-0.505,P<0.001;r=-0.564,P<0.001).Multiple linear regression showed that source of medical expenses(setting commercial insurance as the reference group),chemotherapy cycle(setting chemotherapy cycle≥6 cycles as the reference group),cancer experience,control effectiveness,and self-management were entered in regression models,which could explain 55.5%of the total variation in CRF scores,and there was a significant linear relationship(F=17.100,P<0.001).Conclusion Medical staff should focus on CRF in patients at their own expense and in the 2-5 chemotherapy cycles.Cancer experience is positively correlated with CRF.Control effectiveness and self-management behavior are negatively correlated with CRF.