| Summary: | 碩士 === 長庚大學 === 護理學研究所 === 93 === About 72%-99% of the lung cancer patients feel fatigued and unwell during the course of chemotherapy. If healthcare providers fail to realize the change of patients’ long-term fatigue and the related influencing factors, they will not be able to provide individualied care. Researchers in the past usually discussed the topic of fatigue in a corss-sectional approach, and failed to get an in-depth understanding of changes in patients’ fatigue at different points of time during the chemotherapy. A few longitudinal studies did subtly reveal the fluctuation of fatigue during the chemotherapy. However, since those studies did not trace the changes of fatigue for the entire period of chemotherapy, this study looks to understand the comprehensive change in fatigue of lung cancer patients and the related influencing factors during the course of chemotherapy by ments of a long longitudinal research.
Subjects of the study are lung cancer patients sampled from the Department of Pulmonary Medicine of a medical center in north Taiwan by convenience sampling. A total of 9 patients fulfilling the sampling criteria were selected. The whole research was conducted in two parts: (1) Collect data about patients’ fatigue feeling everday using the Visual Analog Scale to understand the fluctuation of fatigue in the monoring and evening during the entire period of chemotherapy, as well as the difference before and after the chemotherapy. (2) Collect data about patients’ fatigue status and about related influencing factors at every hospitalization of patients before the chemotherapy was administered. Apart from descriptive and inferential statistics, Generalized Estimation Equations (GEE) were also used to supplement analysis considering the nature of the data being collected repeatedly from the same cases.
Results of the research showed that fatigue had fluctuant changes during the entire course of chemoyherapy. Most patients had a fatigue feeling the day after the chemotherapy episode or after they returned home. As the therapy progressed, fatigue tended to be heightened transiently after each episode of chemotherapy, which gradually receded to the minimum before the next episode. Besides, fatigue was higher in evening than in the morning, and fatigue after the chemotherapy episode was significantly more severe than before the episode. Considering the course of chemotherapy, it is found that patients’ fatigue feeling increased gradually from the first episode to the third episode, marginally declined at the fourth episode, and rose again at the fifth episode.
Patients fatigue during the course of chemical therapy was related to depression, pain and sleeping condition. Interferential symptoms like vomiting, fever, dyspnea often happened after the chemotherapy, and their relation to fatigue was also significant. On the other hand, these interferential symptoms were also significantly related to depression, pain and sleeping condition. It was also shown that symptoms usually appeared together, and were related with each other, which represented the concept of symptom clustering. This explained why the influencing factors of patients’ fatigue were multiple during the entire course of chemotherapy. And the transient rise of fatigue after a chemotherapy episode was the cause of fatigue fluctuation. Therefore, using cross- sectional or intermittent longitudinal approach alone to explore the question of fatigue is not sufficient.
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