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

doi:10.3760/cma.j.issn.1673-422X.2020.01.003

Abstract

Abstract:

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.

Key words: Breast neoplasms, Fatigue, Analysis of influence factor, Perception control

Li Ranran, Yang Fuguo, Fan Min, Huang Wei, Yuan Fang. Effect of perception control and self-management on cancer-related fatigue in breast cancer patients with chemotherapy[J]. Journal of International Oncology, 2020, 47(1): 18-23.

Figures/Tables 4

项目	例(%)		评分( $x ?$ ±s)		t/F值		P值
年龄(岁)
18~30	23(9.3)		5.22±0.76
31~40	71(28.9)		5.13±0.71
41~50	80(32.5)		5.11±0.76		0.250		0.910
51~60	60(24.4)		5.20±0.65
>60	12(4.9)		5.08±0.82
民族
汉族	231(93.9)		5.15±0.72		0.216		0.829
其他	15(6.1)		5.11±0.64
婚姻状况
未婚	17(6.9)		5.18±0.70
已婚	186(75.6)		5.18±0.72		0.940		0.392
离异或丧偶	43(17.5)		5.01±0.70
文化程度
小学	20(8.1)		5.40±0.62^a
初中	78(31.7)		5.23±0.72^a		3.392		0.019
高中/中专	96(39.0)		4.98±0.67
大学及以上	52(21.1)		5.25±0.78^a
居住地区
城市	145(58.9)		5.08±0.70		1.890		0.060
农村	101(41.1)		5.25±0.74
职业
工人	29(11.8)		5.05±0.56
农民	54(22.0)		5.19±0.80
公务员	11(4.5)		5.47±0.90		1.792		0.115
职工	80(32.5)		5.19±0.72
自由择业者	54(22.0)		5.16±0.67
退休	18(7.3)		4.75±0.66
医疗费用来源
自费	8(3.3)		5.81±0.54^b
职工医保	76(30.9)		5.17±0.63^bc		4.368		0.005
居民医保	113(45.9)		5.20±0.78^bc
商业保险(含同时载有居民/职工医保)	49(19.9)		4.86±0.65
家庭月收入(元)
≤1 000	3(1.2)		5.51±0.37
1 001~3 000	63(25.6)		5.07±0.70		1.904		0.130
3 001~6 000	111(45.1)		5.08±0.73
>6 000	69(28.0)		5.30±0.71
病理类型
浸润性导管癌	225(91.5)		5.13±0.73		-0.604		0.546
非浸润性导管癌	21(8.5)		5.24±0.61
项目		例(%)		评分( $x ?$ ±s)		t/F值	P值
疾病分期
Ⅰ期		10(4.1)		4.82±0.65^d
Ⅱ期		57(23.2)		5.92±0.71^de		4.376	0.005
Ⅲ期		106(43.1)		5.17±0.70
Ⅳ期		73(29.7)		5.33±0.72
化疗方案
AC-T(H)或TAC(H)		136(55.3)		5.11±0.75
TC(H)		24(9.8)		5.33±0.60		0.810	0.490
TX或NP		74(30.1)		5.13±0.71
其他		12(4.9)		5.30±0.63
化疗周期
1周期		24(9.8)		4.93±0.60^fg
2~3周期		38(15.4)		5.41±0.73		3.865	0.010
4~5周期		76(30.9)		5.29±0.65
≥6周期		108(43.9)		5.00±0.74^fg
病程
≤1年		98(39.8)		5.09±0.78^h
>1年且≤3年		36(14.6)		4.95±0.61^h		3.094	0.028
>3年且≤5年		52(21.1)		5.38±0.63
>5年		60(24.4)		5.16±0.70

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项目	各维度评分	各条目评分	F值	P值
癌症经验	59.85±7.10	3.74±0.44
个人经验	15.30±2.43	3.83±0.61^a
社会经验	23.18±3.16	3.86±0.53^a	7.248	0.001
情绪经验	22.03±3.72	3.67±0.62
控制效能	47.25±4.79	3.63±0.37
个人效能	16.70±2.72	3.34±0.54^bc
集体效能	18.57±2.22	3.71±0.44^c	96.595	<0.001
医护效能	12.00±1.73	4.00±0.58^b
自我管理	152.26±6.67	3.46±0.15
日常生活管理	35.63±3.76	3.24±0.34^defg
症状管理	25.45±2.93	3.64±0.42^egh
情绪管理	29.29±3.90	3.25±0.43^efg	65.009	<0.001
与医护人员沟通	15.53±2.42	3.88±0.61^eg
信息管理	11.07±1.98	3.69±0.66^g
自我管理效能感	35.29±4.24	3.53±0.42
CRF	5.14±0.72	5.14±0.72
行为/严重维度	6.00±0.79	6.00±0.79^ijk
情感维度	4.62±1.14	4.62±1.14^jk	130.973	<0.001
感知维度	5.42±0.87	5.42±0.87^k
认知维度	4.55±0.96	4.55±0.96

项目	B值	SE值	β值	t值	P值
(常量)	11.748	1.006	-	11.676	<0.001
文化程度(小学)	0.164	0.130	0.063	1.259	0.209
文化程度(初中)	-0.034	0.091	-0.022	-0.372	0.710
文化程度(高中/中专)	-0.113	0.087	-0.077	-1.297	0.196
居住地(城市)	-0.013	0.066	-0.009	-0.194	0.846
医疗费用来源(自费)	0.595	0.194	0.147	3.069	0.002
医疗费用来源(职工医保)	0.063	0.096	0.040	0.655	0.513
医疗费用来源(居民医保)	0.087	0.094	0.061	0.933	0.352
疾病分期(Ⅱ期)	-0.055	0.182	-0.032	-0.301	0.764
疾病分期(Ⅲ期)	0.039	0.170	0.027	0.231	0.818
疾病分期(Ⅳ期)	0.042	0.173	0.027	0.243	0.809
化疗周期(1周期)	0.190	0.114	0.079	1.667	0.097
化疗周期(2~3周期)	0.232	0.096	0.117	2.423	0.016
化疗周期(4~5周期)	0.241	0.073	0.157	3.323	0.001
病程(>1年且≤3年)	-0.160	0.097	-0.079	-1.647	0.101
病程(>3年且≤5年)	0.033	0.093	0.019	0.357	0.722
病程(>5年)	-0.089	0.089	-0.054	-1.005	0.316
癌症经验	0.026	0.005	0.254	5.318	<0.001
控制效能	-0.045	0.007	-0.300	-6.203	<0.001
自我管理	-0.039	0.005	-0.366	-7.450	<0.001