Fox Chase Cancer Center, Philadelphia, Pennsylvania 19012, USA.
J Pain Symptom Manage. 2010 Aug;40(2):200-16. doi: 10.1016/j.jpainsymman.2009.12.020. Epub 2010 Jun 18.
Multiple complex symptoms from cancer treatment can interfere with functioning.
To evaluate the efficacy of an "energy and sleep enhancement" (EASE) intervention to relieve fatigue and sleep disturbance and improve health-related functional status.
Individuals receiving chemotherapy (CTX) were randomized to the EASE (n=153) or a control intervention (n=139). The EASE intervention included information and behavioral skills taught by an oncology nurse in three telephone sessions. The primary outcomes of fatigue, sleep disturbance, and functional status were measured before CTX, Day 4 after first treatment (baseline), and 43-46 or 57-60 days later (follow-up), depending on the CTX cycle length.
The sample was primarily female (82%) and non-Hispanic white (89%), with mean age of 53.9 years. Fatigue and patient-reported sleep disturbance were elevated in both groups at baseline and follow-up. Actigraphy revealed that the total sleep time was almost eight hours, and sleep percent was greater than 85% for both groups at both time points (normal range). Physical functioning was diminished and at the same level as a sample with serious illness. Mental functioning was in normal range. A repeated-measures analysis of variance revealed no statistically significant group-by-time effects for fatigue, sleep disturbance, or functional status. Unemployed individuals showed greater benefit from the EASE intervention, reporting less pain and symptom interference.
Potential explanations include high variability and/or floor effect for fatigue, incorrect timing of measures, insufficient amount or dose of the intervention, and confounding effects of gender. Future research should consider screening for symptom severity and tailoring interventions.
癌症治疗带来的多种复杂症状可能会影响功能。
评估一种“能量和睡眠增强”（EASE）干预措施缓解疲劳和睡眠障碍、改善健康相关功能状态的效果。
接受化疗（CTX）的个体被随机分配到 EASE（n=153）或对照组（n=139）。EASE 干预包括由肿瘤护士通过三次电话会议提供信息和行为技能。疲劳、睡眠障碍和功能状态的主要结局指标在 CTX 前、首次治疗后第 4 天（基线）和 43-46 天或 57-60 天（随访）进行测量，具体取决于 CTX 周期长度。
样本主要为女性（82%）和非西班牙裔白人（89%），平均年龄为 53.9 岁。基线和随访时两组的疲劳和患者报告的睡眠障碍均升高。活动记录仪显示总睡眠时间接近 8 小时，两组在两个时间点的睡眠百分比均大于 85%（正常范围）。身体功能下降，与患有严重疾病的样本水平相当。精神功能处于正常范围。重复测量方差分析显示，疲劳、睡眠障碍或功能状态在组间无统计学显著差异。未就业者从 EASE 干预中获益更多，报告的疼痛和症状干扰较少。
可能的解释包括疲劳的变异性和/或地板效应、测量时间不正确、干预措施的数量或剂量不足以及性别混杂效应。未来的研究应考虑对症状严重程度进行筛查并调整干预措施。
