Wielgus Kimberly K, Berger Ann M, Hertzog Melody
University of Nebraska Medical Center, Omaha, Nebraska, USA.
Oncol Nurs Forum. 2009 Jan;36(1):38-48. doi: 10.1188/09.ONF.38-48.
PURPOSES/OBJECTIVES: To identify the predictors of fatigue 30 days after completing adjuvant chemotherapy for breast cancer and whether differences are observed between a behavioral sleep intervention and a healthy-eating attention control group in predicting fatigue.
Descriptive, exploratory, secondary analysis of a randomized clinical trial.
Outpatient oncology patients in a midwestern U. S. city.
96 women, ages 29-83 years, 72% married, 95% white, diagnosed with stage I-IIIA breast cancer, receiving adjuvant anthracycline and taxane chemotherapy.
Participants were randomized to a behavioral sleep intervention group or an attention control group. Participants completed data collection prior to and during the peak and rebound days of the initial chemotherapy treatment cycle and after the last treatment.
Fatigue, circadian rhythms of activity, objective and subjective sleep-wake, and objective and subjective activity-rest.
Predictors of fatigue were less total sleep time prior to treatment, higher fatigue prior to treatment and at the peak, and less energy upon awakening on rebound days. In the control group, predictors of higher fatigue were higher fatigue prior to treatment, higher body mass index, higher number of positive lymph nodes, and less daytime dysfunction. For the intervention group, lower peak activity at the peak of initial treatment differentially predicted fatigue.
Results suggest the sleep intervention group participants who maintained activity balanced with sleep at the peak of the initial treatment benefited most from the intervention.
Nurses should screen for fatigue prior to initial chemotherapy treatment and at regular intervals, further assess for poor sleep in patients who report fatigue of 4 or higher (on a 0-10 scale), and use evidence-based guidelines to select appropriate interventions.
确定乳腺癌辅助化疗结束30天后疲劳的预测因素，以及在预测疲劳方面行为睡眠干预组和健康饮食注意力控制组之间是否存在差异。
对一项随机临床试验进行描述性、探索性二次分析。
美国中西部城市的门诊肿瘤患者。
96名年龄在29 - 83岁之间的女性，72%已婚，95%为白人，被诊断为I - IIIA期乳腺癌，接受蒽环类和紫杉烷类辅助化疗。
参与者被随机分配到行为睡眠干预组或注意力控制组。参与者在初始化疗治疗周期的高峰期和反弹期之前、期间以及最后一次治疗后完成数据收集。
疲劳、活动的昼夜节律、客观和主观的睡眠 - 觉醒情况以及客观和主观的活动 - 休息情况。
疲劳的预测因素包括治疗前总睡眠时间较短、治疗前及高峰期疲劳程度较高以及反弹日醒来时精力较少。在对照组中，较高疲劳的预测因素包括治疗前疲劳程度较高、体重指数较高、阳性淋巴结数量较多以及白天功能障碍较少。对于干预组，初始治疗高峰期较低的峰值活动对疲劳有不同的预测作用。
结果表明，在初始治疗高峰期保持活动与睡眠平衡的睡眠干预组参与者从干预中受益最大。
护士应在初始化疗治疗前及定期筛查疲劳，对报告疲劳程度为4或更高（0 - 10分制）的患者进一步评估睡眠不佳情况，并使用循证指南选择合适的干预措施。
