School of Nursing, University of California, San Francisco, California.
Dana Farber Cancer Institute, Boston, Massachusetts.
Semin Oncol Nurs. 2024 Oct;40(5):151718. doi: 10.1016/j.soncn.2024.151718. Epub 2024 Aug 20.
Evidence suggests that lower levels of morning energy are associated with higher levels of stress and lower levels of resilience in patients receiving chemotherapy. Study purposes were to identify subgroups of patients with distinct morning energy profiles; evaluate for differences among the profiles in demographic and clinical characteristics, as well as measures of stress, resilience, and coping.
A total of 1,343 outpatients receiving chemotherapy completed a demographic questionnaire and measures of global, cancer-related, and cumulative life stress, and resilience at study enrollment. Morning energy was assessed using the Lee Fatigue Scale at six time points over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct morning energy profiles. Differences among the subgroups were evaluated using parametric and nonparametric tests.
Three morning energy profiles were identified (i.e., High (17.3%), Low (60.3%), Very Low (22.4%)). Compared to High class, the other two morning energy classes were less likely to be employed; had a lower functional status and a higher comorbidity burden; and were more likely to self-report depression and back pain. For all three types of stress, significant differences were found among the three classes with scores that demonstrated a dose response effect (i.e., High < Low < Very Low; as decrements in morning energy increased, stress scores increased). Compared to High class, Very Low class reported higher rates of physical and sexual abuse. The resilience scores exhibited a dose response effect as well (i.e., High > Low > Very Low). Patients with the two worst energy profiles reported a higher use of disengagement coping strategies.
Findings highlight the complex relationships among decrements in morning energy, various types of stress, resilience, and coping in patients undergoing chemotherapy.
Clinicians need to assess for stress and adverse childhood experiences to develop individualized management plans to increase patients' energy levels.
有证据表明，接受化疗的患者早晨精力水平较低与压力水平较高和适应能力较低有关。本研究旨在确定具有不同晨能特征的患者亚组；评估这些特征在人口统计学和临床特征以及压力、适应能力和应对措施方面的差异。
共有 1343 名接受化疗的门诊患者在研究入组时完成了人口统计学问卷和全球、癌症相关和累积生活压力以及适应能力的测量。使用 Lee 疲劳量表在两个化疗周期的六个时间点评估晨能。使用潜在剖面分析确定具有不同晨能特征的患者亚组。使用参数和非参数检验评估亚组之间的差异。
确定了三种晨能特征（即高（17.3%）、低（60.3%）、极低（22.4%））。与高能量组相比，其他两个晨能组更不可能就业；功能状态较低，合并症负担较高；更有可能自我报告抑郁和背痛。对于所有三种类型的压力，三个类别的分数都存在显著差异，表现出剂量反应效应（即高<低<极低；随着晨能下降，压力分数增加）。与高能量组相比，极低能量组报告了更高的身体和性虐待率。适应能力得分也表现出剂量反应效应（即高>低>极低）。两个最差能量特征的患者报告了更高的回避应对策略的使用。
研究结果突出了接受化疗的患者晨能下降、各种类型的压力、适应能力和应对策略之间的复杂关系。
临床医生需要评估压力和不良的童年经历，以制定个体化的管理计划，提高患者的能量水平。
