臺灣博碩士論文加值系統

本研究探討乳癌婦女化療開始二年內的體重、身體質量指數(body mass index, BMI)與身體組成之變化以及治療一年及二年後體重、體脂肪的改變，並分析其影響因子，特別是檢視運動與飲食因子的預測力。本研究利用一原調查乳癌術後症狀的縱貫性研究，分析其中的147位個案在化療開始2年內共12個時間點下所測量的體重與各身體組成資料。統計方法包含階層線性模式(Hierarchical Linear Modeling; HLM)與邏輯式迴歸(Logistic Regression)。
研究結果發現：(一)化療後2年內的體重與BMI在前8.5-9個月呈幅度較大的上升、之後小幅下降、最後2個月呈微升，最高點的體重比化療前增加2.5 kg (4.4%)，體脂肪率呈持續上升，身體總水量率則呈持續下降；(二)化療開始後第1及第2年有6至7成婦女的體重/體脂肪增加，第1及第2年體脂肪顯著增加的比例均比體重顯著增加的比例高；(三)同時影響體重、體脂肪率變化的因子包括規律運動習慣改變型態、化療前BMI與化療藥物種類；(四)同時影響第1年體重、體脂肪顯著增加的因子為化療前BMI；(五)運動類因子能預測化療後體重、體脂肪率的變化，飲食類因子則否。
由上述結果建議醫護人員除了監測乳癌病人化療後的體重問題外，更需注意體脂肪率是否有持續增加的傾向。另針對化療後BW/ BF增加的高危險群，可給予較嚴密的監測，以及適時提供相關的衛教指導與介入措施。

The purposes of this study was to investigate (1) the change trajectory of weight (BW), body mass index (BMI), and body compositions in breast cancer women within the period of 2 years after adjuvant chemotherapy, (2) the change of BW and body fat (BF) at the first and the second year after chemotherapy; and (3) the risk factors, especially the exercise and nutrition-related factors, in predicting the overall change pattern of BW and body fat percentage (BF%) and whether significant increase of BW and BF occurred at the 1st and 2nd year. The study sample came from a larger longitudinal study that examined symptoms after surgery in newly diagnosed breast cancer women. Data were analyzed using Hierarchical Linear Modeling (HLM), and logistic regression.
Data from 147 patients showed that: (1) For the trend of BW/BMI, the lowest measures were occurred at 1.5 months before chemotherapy; then it gradually increased to the highest at 8.5 - 9 months after the first chemotherapy and thereafter had a small decrease. During the last 2 months, it showed a slight re-ascending. The highest weight gain was 2.5 kg (4.4%). The trend of BF% change showed a constant increase over time while percentage of total body water showed a constant decrease. (2) Over 60% of breast cancer women gained weight or BF at the 1st and 2nd year after chemotherapy. The proportions of significant increase at 1st and 2nd year were both higher in BF than in BW. (3) The change patterns of BW and BF% were associated with the change of exercise habit, BMI prior to chemotherapy, and chemotherapy regimen. (4) BMI prior to chemotherapy was associated with the significant increase of BW and BF at the first year. (5) The exercise-related factors had a predicting effect on the change pattern of BW and BF% whereas the nutrition-related factors did not.
In addition to monitoring weight gain after adjuvant chemotherapy in women of breast cancer, health care professionals should also pay special attention in the increase of BF%. Strict surveillance and proper interventions should be provided to the high risk groups identified in this study.

目錄 頁次
指導教授推薦書
口試委員審定書
授權書 iii
中文摘要 iv
英文摘要 v
誌謝 vii
目錄 viii
圖表目錄 xi
第壹章 緒論 1
第一節 研究動機 4
第二節 研究目的 7
第三節 研究問題 7
第四節名詞解釋 8
第貳章 文獻查證 9
第一節 體脂肪/身體組成測量方法 10
第二節 接受輔助性化療之乳癌婦女的體重與身體組成改變 15
第三節 化學治療造成體重或體脂肪增加的可能機轉 17
第四節 影響體重或體脂肪改變的因子 20
第五節 總結 25
第叁章 研究方法 28
第一節 概念架構 29
第二節 研究設計 31
第三節 研究對象與場所 32
第四節 樣本數估算 33
第五節 研究工具 35
第六節 資料收集過程 42
第七節 資料處理與統計分析 44
第八節 研究對象保護權益 45
第九節 前驅調查 46
第肆章 研究結果與分析 48
第一節 個案基本資料與其它體重相關資料之特性 49
第二節 乳癌婦女化療後二年內之體重、BMI與身體組成的變化歷程 57
第三節 乳癌婦女化療後第一及第二年體重、體脂肪重的改變狀況以及
體重變化的主觀感受 72
第四節 影響化療後二年內體重、體脂肪率變化的相關因子 77
第五節 影響化療後第1與第2年BW/BF顯著增加的相關因子 93
第伍章 討論 100
第一節 乳癌婦女化療後二年內之體重、BMI與身體組成的變化歷程 100
第二節 乳癌婦女化療後第一、二年體重、體脂肪重的改變程度 104
第三節 乳癌婦女化療後體重變化的主觀感受 105
第四節 影響化療後二年內體重/體脂肪率變化以及第ㄧ與第二年BW/BF
顯著增加的相關因子 107
第陸章 結論與建議 116
第一節 結論 116
第二節 護理的應用 117
第三節 研究限制與建議 118
參考資料 121
附件 135
附件一：史氏情境-特質焦慮量表 135
附件二：憂鬱狀態評估表 137
附件三：疲憊狀態評估表 138
附件四：經期狀態評估表 139
附件五：噁心/嘔吐程度評估表 140
附件六：身體活動評估表 141
附件七：飲食習慣評估 143
附件八：其它個人、疾病與治療資料表 149
附件九：loge(BW)變化的參數估計與轉換後的體重變化曲線 152
附件十：單因子HLM分析結果 153

圖表目錄
圖1-1 臺灣女性乳癌發生人數與死亡人數之長期趨勢，1995-2005年 2
圖1-2 臺灣女性乳癌年齡別發生人數，2005年 3
圖2-1 研究理論架構 27
圖3-1 研究概念架構 30
圖3-2 各電極貼片、電極接頭與電極線擺放位置 36
圖4-1 整體的體重變化 70
圖4-2 整體的BMI變化 70
圖4-3 整體的體脂肪重變化 70
圖4-4 整體的體脂肪百分比變化 70
圖4-5 整體的去體脂肪重變化 71
圖4-6 整體的去體脂肪百分比變化 71
圖4-7 整體的身體總水量變化 71
圖4-8 整體的身體總水量百分比變化 71
圖4-9 整體的細胞外水量變化 71
圖4-10 整體的細胞內水量變化 71
圖4-11 化療後第1與第2年的體重/體脂肪重增加率人數比例分佈 74
圖4-12 規律運動習慣改變型態與BW關係圖-多因子分析 87
圖4-13 經期狀態改變型態與BW關係圖-多因子分析 87
圖4-14 化療前BMI與BW關係圖-多因子分析 88
圖4-15 化療藥物種類與BW關係圖-多因子分析 88
圖4-16 抗荷爾蒙治療與BW關係圖-多因子分析 88
圖4-17 規律運動習慣改變型態與BF%關係圖-多因子分析 92
圖4-18 化療前BMI與BF%關係圖-多因子分析 92
圖4-19 化療藥物種類與BF%關係圖-多因子分析 92

表3-1 研究資料收集時間表 43
表3-2 各資料收集時間點相對應之化療時程 43
表4-1 乳癌化療婦女人口學特性 52
表4-2 化療前體重、BMI與身體組成 52
表4-3 習慣性脂肪攝取 53
表4-4 運動習慣 54
表4-5 乳癌化療婦女疾病、治療特性 55
表4-6 乳癌化療婦女心理狀態 56
表4-7 體重、BMI及身體組成的時間變化模型比較 59
表4-8 BW變化(含補入值)的參數估計結果 67
表4-9 BW變化(不含補入值)的參數估計結果 67
表4-10 BMI變化的參數估計結果 67
表4-11 BF變化的參數估計結果 67
表4-12 BF%變化的參數估計結果 68
表4-13 FFM變化的參數估計結果 68
表4-14 TBW變化的參數估計結果 68
表4-15 TBW%變化的參數估計結果 68
表4-16 ECW變化的參數估計結果 69
表4-17 ICW變化的參數估計結果 69
表4-18 化療後第1與第2年體重、體脂肪重的增加量與增加程度之分佈 74
表4-19 化療前後體重改變主觀感受及與客觀數值之相關 75
表4-20 各因子特性 77
表4-21 與BW及BF%變化有顯著相關的因子-單因子分析 82
表4-22 BW變化的隨機係數模型與多因子模型之參數估計 86
表4-23 BF%變化的隨機係數模型與多因子模型之參數估計 91
表4-24 各因子與第1年BW/BF是否顯著增加的相關性-單因子分析 95
表4-25 各因子與第2年BW/BF是否顯著增加的相關性-單因子分析 97
表4-26 與BW/BF%變化或與第1年及第2年BW/BF顯著增加相關之
因子統整總表 99

1. National Department of Health. History of cancer registration in Taiwan. Retrieved Nov. 12, 2007, from http://crs.cph.ntu.edu.tw/crs_c/annual.html, 2003.
2. TTY oncology team. Global breast cancer tendency. Retrieved Nov. 12, 2007, from http://www.totcare.com.tw/can_masto/globe_02.htm, 2005.
3. Taiwan Cancer Registry. Breast cancer survival rates in Taiwan. Retrieved May. 20, 2010, from http://tcr.cph.ntu.edu.tw/uploadimages/Sur_Breast.pdf, 2008.
4. Demark-Wahnefried W, Winer EP, Rimer BK. Why women gain weight with adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology 1993;11(7):1418-1429.
5. McInnes JA, Knobf MT. Weight gain and quality of life in women treated with adjuvant chemotherapy for early-stage breast cancer. Oncology Nursing Forum 2001;28(4):675-684.
6. Lauver D, Connolly-Nelson K, Vang P. Health-related goals in female cancer survivors after treatment. Cancer Nursing 2007;30(1):9-15.
7. Sitzia J, Huggins L. Side effects of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy for breast cancer. Cancer Practice 1998;6(1):13-21.
8. Bozzetti F, Mariani L. Defining and classifying cancer cachexia: a proposal by the SCRINIO Working Group. Journal of Parenteral and Enteral Nutrition 2009;33(4):361-367.
9. Aslani A, Smith RC, Allen BJ, Pavlakis N, Levi JA. Changes in body composition during breast cancer chemotherapy with the CMF-regimen. Breast Cancer Research and Treatment 1999;57(3):285-290.
10. Camoriano JK, Loprinzi CL, Ingle JN, Therneau TM, Krook JE, Veeder MH. Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. Journal of Clinical Oncology 1990;8(8):1327-1334.
11. Campbell KL, Lane K, Martin AD, Gelmon KA, McKenzie DC. Resting energy expenditure and body mass changes in women during adjuvant chemotherapy for breast cancer. Cancer Nursing 2007;30(2):95-100.
12. Cheney CL, Mahloch J, Freeny P. Computerized tomography assessment of women with weight changes associated with adjuvant treatment for breast cancer. American Journal of Clinical Nutrition 1997;66(1):141-146.
13. Costa LJ, Varella PC, del Giglio A. Weight changes during chemotherapy for breast cancer. Sao Paulo Medical Journal 2002;120(4):113-117.
14. DeGeorge D, Gray JJ, Fetting JH, Rolls BJ. Weight gain in patients with breast cancer receiving adjuvant treatment as a function of restraint, disinhibition, and hunger. Oncology Nursing Forum 1990;17(3 Suppl):23-28; discussion 28-30.
15. Del Rio G, Zironi S, Valeriani L, Menozzi R, Bondi M, Bertolini M, et al. Weight gain in women with breast cancer treated with adjuvant cyclophosphomide, methotrexate and 5-fluorouracil. Analysis of resting energy expenditure and body composition. Breast Cancer Research and Treatment 2002;73(3):267-273.
16. Demark-Wahnefried W, Hars V, Conaway MR, Havlin K, Rimer BK, McElveen G, et al. Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. American Journal of Clinical Nutrition 1997;65(5):1495-1501.
17. Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, et al. Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. Journal of Clinical Oncology 2001;19(9):2381-2389.
18. Freedman RJ, Aziz N, Albanes D, Hartman T, Danforth D, Hill S, et al. Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. Journal of Clinical Endocrinology Metabolism 2004;89(5):2248-2253.
19. Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J, Sidlofsky S, et al. Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. Journal of Clinical Oncology 1999;17(1):120-129.
20. Goodwin PJ, Ennis M, Pritchard KI, Trudeau M, Hood N. Risk of menopause during the first year after breast cancer diagnosis. Journal of Clinical Oncology 1999;17(8):2365-2370.
21. Harvie MN, Campbell IT, Baildam A, Howell A. Energy balance in early breast cancer patients receiving adjuvant chemotherapy. Breast Cancer Research and Treatment 2004;83(3):201-210.
22. Heasman KZ, Sutherland HJ, Campbell JA, Elhakim T, Boyd NF. Weight gain during adjuvant chemotherapy for breast cancer. Breast Cancer Research and Treatment 1985;5(2):195-200.
23. Hoskin PJ, Ashley S, Yarnold JR. Weight gain after primary surgery for breast cancer--effect of tamoxifen. Breast Cancer Research and Treatment 1992;22(2):129-132.
24. Huntington MO. Weight gain in patients receiving adjuvant chemotherapy for carcinoma of the breast. Cancer 1985;56(3):472-474.
25. Hupperets PS, Wils J, Volovics L, Schouten L, Fickers M, Bron H, et al. Adjuvant chemohormonal therapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) with or without medroxyprogesterone acetate for node-positive breast cancer patients. Annals of Oncology 1993;4(4):295-301.
26. Ingram C, Brown JK. Patterns of weight and body composition change in premenopausal women with early stage breast cancer: has weight gain been overestimated? Cancer Nursing 2004;27(6):483-490.
27. Irwin ML, McTiernan A, Baumgartner RN, Baumgartner KB, Bernstein L, Gilliland FD, et al. Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. Journal of Clinical Oncology 2005;23(4):774-782.
28. Knobf MK, Mullen JC, Xistris D, Moritz DA. Weight gain in women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum 1983;10(2):28-33.
29. Kumar N, Allen KA, Riccardi D, Bercu BB, Cantor A, Minton S, et al. Fatigue, weight gain, lethargy and amenorrhea in breast cancer patients on chemotherapy: is subclinical hypothyroidism the culprit? Breast Cancer Research and Treatment 2004;83(2):149-159.
30. Kumar NB, Allen K, Cantor A, Cox CE, Greenberg H, Shah S, et al. Weight gain associated with adjuvant tamoxifen therapy in stage I and II breast cancer: fact or artifact? Breast Cancer Research and Treatment 1997;44(2):135-143.
31. Kutynec CL, McCargar L, Barr SI, Hislop TG. Energy balance in women with breast cancer during adjuvant treatment. Journal of American Dietetic Association 1999;99(10):1222-1227.
32. Lankester KJ, Phillips JE, Lawton PA. Weight gain during adjuvant and neoadjuvant chemotherapy for breast cancer: an audit of 100 women receiving FEC or CMF chemotherapy. Clinical Oncology 2002;14(1):64-67.
33. Levine EG, Raczynski JM, Carpenter JT. Weight gain with breast cancer adjuvant treatment. Cancer 1991;67(7):1954-1959.
34. Makari-Judson G, Judson CH, Mertens WC. Longitudinal patterns of weight gain after breast cancer diagnosis: observations beyond the first year. Breast Journal 2007;13(3):258-265.
35. Marttunen MB, Andersson S, Hietanen P, Karonen SL, Koistinen HA, Koivisto VA, et al. Antiestrogenic tamoxifen and toremifene increase serum leptin levels in postmenopausal breast cancer patients. Maturitas 2000;35(2):175-179.
36. Heideman WH, Russell NS, Gundy C, Rookus MA, Voskuil DW. The frequency, magnitude and timing of post-diagnosis body weight gain in Dutch breast cancer survivors. European Journal of Cancer 2009;45(1):119-126.
37. Tredan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, et al. Body weight change in women receiving adjuvant chemotherapy for breast cancer: A French prospective study. Clinical Nutrition 2010;29(2):187-191.
38. Kopelman PG. Obesity as a medical problem. Nature 2000;404(6778):635-643.
39. Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 2001;92(6):1368-1377.
40. Carmichael AR, Bates T. Obesity and breast cancer: a review of the literature. Breast 2004;13(2):85-92.
41. Ingram D, Nottage E, Ng S, Sparrow L, Roberts A, Willcox D. Obesity and breast disease. The role of the female sex hormones. Cancer 1989;64(5):1049-1053.
42. Porter GA, Inglis KM, Wood LA, Veugelers PJ. Effect of obesity on presentation of breast cancer. Annals of Surgical Oncology 2006;13(3):327-332.
43. Yu H, Rohan T. Role of the insulin-like growth factor family in cancer development and progression. Journal of the National Cancer Institute 2000;92(18):1472-1489.
44. Carmichael AR. Obesity as a risk factor for development and poor prognosis of breast cancer. BJOG: an international journal of obstetrics and gynaecology 2006;113(10):1160-1166.
45. Griggs JJ, Sorbero ME, Lyman GH. Undertreatment of obese women receiving breast cancer chemotherapy. Archives of Internal Medicine 2005;165(11):1267-1273.
46. Rose DP, Gilhooly EM, Nixon DW. Adverse effects of obesity on breast cancer prognosis, and the biological actions of leptin (review). International Journal of Oncology 2002;21(6):1285-1292.
47. Sen A, Jen KL, Djuric Z. Baseline leptin levels predict change in leptin levels during weight loss in obese breast cancer survivors. Breast Journal 2007;13(2):180-186.
48. Caan BJ, Emond JA, Natarajan L, Castillo A, Gunderson EP, Habel L, et al. Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer. Breast Cancer Research and Treatment 2006;99(1):47-57.
49. Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. Journal of Clinical Oncology 2002;20(4):1128-1143.
50. Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. Journal of Clinical Oncology 2005;23(7):1370-1378.
51. Petrelli JM, Calle EE, Rodriguez C, Thun MJ. Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes and Control 2002;13(4):325-332.
52. Rock CL, Demark-Wahnefried W. Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. Journal of Clinical Oncology 2002;20(15):3302-3316.
53. Ryu SY, Kim CB, Nam CM, Park JK, Kim KS, Park J, et al. Is body mass index the prognostic factor in breast cancer?: a meta-analysis. Journal of Korean Medical Science 2001;16(5):610-614.
54. Senie RT, Rosen PP, Rhodes P, Lesser ML, Kinne DW. Obesity at diagnosis of breast carcinoma influences duration of disease-free survival. Annals of Internal Medicine 1992;116(1):26-32.
55. Tao MH, Shu XO, Ruan ZX, Gao YT, Zheng W. Association of overweight with breast cancer survival. American Journal of Epidemiology 2006;163(2):101-107.
56. Kirshbaum MN. A review of the benefits of whole body exercise during and after treatment for breast cancer. Journal of Clinical Nursing 2007;16(1):104-121.
57. Schwartz AL. Exercise and weight gain in breast cancer patients receiving chemotherapy. Cancer Practice 2000;8(5):231-237.
58. WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363(9403):157-163.
59. Sandowski SA. What is the ideal body weight? Family Practice 2000;17(4):348-351.
60. WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia: Melbourne, 2000.
61. Department of Health. Executive Yuan. R.O.C. (Taiwan). The definition of obesity in adult. Retrieved Oct. 16, 2007, from http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=25&;now_fod_list_no=3942&;level_no=2&;doc_no=32.
62. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 1991;59(1):12-19.
63. Rock CL, Thomson C, Caan BJ, Flatt SW, Newman V, Ritenbaugh C, et al. Reduction in fat intake is not associated with weight loss in most women after breast cancer diagnosis: evidence from a randomized controlled trial. Cancer 2001;91(1):25-34.
64. Saquib N, Flatt SW, Natarajan L, Thomson CA, Bardwell WA, Caan B, et al. Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women's healthy eating and living (WHEL) study. Breast Cancer Research and Treatment 2007;105(2):177-186.
65. Han HS, Lee KW, Kim JH, Kim SW, Kim IA, Oh DY, et al. Weight changes after adjuvant treatment in Korean women with early breast cancer. Breast Cancer Research and Treatment 2009;114(1):147-153.

66. Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML. Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States). Cancer Causes Control 2005;16(5):545-556.
67. Rock CL, Flatt SW, Newman V, Caan BJ, Haan MN, Stefanick ML, et al. Factors associated with weight gain in women after diagnosis of breast cancer. Women's Healthy Eating and Living Study Group. Journal of the American Dietetic Association 1999;99(10):1212-1221.
68. Herman DR, Ganz PA, Petersen L, Greendale GA. Obesity and cardiovascular risk factors in younger breast cancer survivors: The Cancer and Menopause Study (CAMS). Breast Cancer Research and Treatment 2005;93(1):13-23.
69. Amani R. Comparison between bioelectrical impedance analysis and body mass index methods in determination of obesity prevalence in Ahvazi women. European Journal of Clinical Nutrition 2007;61(4):478-482.
70. Tsai YM. The suitability of evaluating obesity by BMI for the air force academy students, Taiwan, R. O. C. Journal of Physical Education in Higher Education 2002;4(1):175-184.
71. Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J, et al. Accuracy of body mass index in diagnosing obesity in the adult general population. International Journal of Obesity 2008;32(6):959-966.
72. Loi S, Milne RL, Friedlander ML, McCredie MR, Giles GG, Hopper JL, et al. Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiology Biomarkers Prevention 2005;14(7):1686-1691.
73. Chinese Taipei Association for the Study of Obesity (CTASO). Ideal body fat percentage. Retrieved Oct. 16, 2007, from http://www.ctaso.org.tw/dietmethod_a3.html.
74. McNeill G, Fowler PA, Maughan RJ, McGaw BA, Fuller MF, Gvozdanovic D, et al. Body fat in lean and overweight women estimated by six methods. British Journal of Nutrition 1991;65(2):95-103.
75. Yang CH, Lin JC. Effects of different underwater weight selection methods on body composition measurement. Physical Education Journal 1995;20:339-350.
76. National Health Research Institutes (NHRI) Forum. Physical activity and body composition. Taipei, Taiwan: National Health Research Institutes (NHRI), 2001.
77. Dempster P, Aitkens S. A new air displacement method for the determination of human body composition. Medicine and Science Sports Exercise 1995;27(12):1692-1697.
78. The department of nutrition and food sciences. Methods of body composition analysis tutorials: Retrieved Dec. 13, 2007, from http://nutrition.uvm.edu/bodycomp/.
79. Lukaski HC, Bolonchuk WW, Hall CB, Siders WA. Validation of tetrapolar bioelectrical impedance method to assess human body composition. Journal of Applied Physiology 1986;60(4):1327-1332.
80. Thomson R, Brinkworth GD, Buckley JD, Noakes M, Clifton PM. Good agreement between bioelectrical impedance and dual-energy X-ray absorptiometry for estimating changes in body composition during weight loss in overweight young women. Clinical Nutrition 2007;26(6):771-777.
81. Going S, Nichols J, Loftin M, Stewart D, Lohman T, Tuuri G, et al. Validation of bioelectrical impedance analysis (BIA) for estimation of body composition in Black, White and Hispanic adolescent girls. International Journal of Body Composition Research 2006;4(4):161-167.
82. Tamburini E, Vaccari G, Tosi S, Trilli A. Near-infrared spectroscopy: a tool for monitoring submerged fermentation processes using an immersion optical-fiber probe. Applied Spectroscopy 2003;57(2):132-138.
83. Bray GA. What is the ideal body weight? Journal of Nutritional Biochemistry 1998;9:489-492.
84. Van Loan MD. Estimates of fat-free mass (FFM) by densitometry, dual energy X-ray absorptiometry (DXA), and bioimpedance spectroscopy (BIS) in caucasian and Chinese-American women. Applied Radiation and Isotopes 1998;49(5-6):751-752.
85. Demark-Wahnefried W, Rimer BK, Winer EP. Weight gain in women diagnosed with breast cancer. Journal of the American Dietetic Association 1997;97(5):519-526, 529.
86. Basaran G, Turhal NS, Cabuk D, Yurt N, Yurtseven G, Gumus M, et al. Weight gain after adjuvant chemotherapy in patients with early breast cancer in Istanbul Turkey. Medical Oncology 2010;in press.
87. Demark-Wahnefried W, Kenyon AJ, Eberle P, Skye A, Kraus WE. Preventing sarcopenic obesity among breast cancer patients who receive adjuvant chemotherapy: results of a feasibility study. Clinical Exercise Physiology 2002;4(1):44-49.
88. Harvie MN, Howell A, Thatcher N, Baildam A, Campbell I. Energy balance in patients with advanced NSCLC, metastatic melanoma and metastatic breast cancer receiving chemotherapy--a longitudinal study. British Journal of Cancer 2005;92(4):673-680.
89. Tas F, Duranyildiz D, Argon A, Oguz H, Camlica H, Yasasever V, et al. Serum levels of leptin and proinflammatory cytokines in advanced-stage non-small cell lung cancer. Medical Oncology 2005;22(4):353-358.
90. Koyama H, Wada T, Nishizawa Y, Iwanaga T, Aoki Y. Cyclophosphamide-induced ovarian failure and its therapeutic significance in patients with breast cancer. Cancer 1977;39(4):1403-1409.
91. Minton SE, Munster PN. Chemotherapy-induced amenorrhea and fertility in women undergoing adjuvant treatment for breast cancer. Cancer Control 2002;9(6):466-472.
92. Asarian L, Geary N. Modulation of appetite by gonadal steroid hormones. Philosophical Transactions of the Royal Society of London. Series B, Biological sciences 2006;361(1471):1251-1263.
93. Spiegelman BM, Flier JS. Adipogenesis and obesity: rounding out the big picture. Cell 1996;87(3):377-389.
94. Segal R, Evans W, Johnson D, Smith J, Colletta S, Gayton J, et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. Journal of Clinical Oncology 2001;19(3):657-665.
95. Kennedy ET, Bowman SA, Powell R. Dietary-fat intake in the US population. Journal of the American College of Nutrition 1999;18(3):207-212.
96. Satia-Abouta J, Patterson RE, Schiller RN, Kristal AR. Energy from fat is associated with obesity in U.S. men: results from the Prostate Cancer Prevention Trial. Prevenive Medicine 2002;34(5):493-501.
97. Donnelly JE, Sullivan DK, Smith BK, Jacobsen DJ, Washburn RA, Johnson SL, et al. Alteration of dietary fat intake to prevent weight gain: Jayhawk Observed Eating Trial. Obesity (Silver Spring) 2008;16(1):107-112.
98. Donahoo W, Wyatt HR, Kriehn J, Stuht J, Dong F, Hosokawa P, et al. Dietary fat increases energy intake across the range of typical consumption in the United States. Obesity (Silver Spring) 2008;16(1):64-69.
99. Schlundt DG, Hill JO, Pope-Cordle J, Arnold D, Virts KL, Katahn M. Randomized evaluation of a low fat ad libitum carbohydrate diet for weight reduction. International Journal of Obesity and Related Metabolic Disorders 1993;17(11):623-629.
100. de Waard F, Ramlau R, Mulders Y, de Vries T, van Waveren S. A feasibility study on weight reduction in obese postmenopausal breast cancer patients. European Journal of Cancer Prevention 1993;2(3):233-238.
101. Jen KL, Djuric Z, DiLaura NM, Buison A, Redd JN, Maranci V, et al. Improvement of metabolism among obese breast cancer survivors in differing weight loss regimens. Obesity Research 2004;12(2):306-312.
102. Loprinzi CL, Athmann LM, Kardinal CG, O'Fallon JR, See JA, Bruce BK, et al. Randomized trial of dietician counseling to try to prevent weight gain associated with breast cancer adjuvant chemotherapy. Oncology 1996;53(3):228-232.
103. Shaw C, Mortimer P, Judd PA. A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer 2007;110(8):1868-1874.
104. Chlebowski RT, Blackburn GL, Thomson CA, Nixon DW, Shapiro A, Hoy MK, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. Journal of the National Cancer Institute 2006;98(24):1767-1776.
105. Thomson CA, Rock CL, Giuliano AR, Newton TR, Cui H, Reid PM, et al. Longitudinal changes in body weight and body composition among women previously treated for breast cancer consuming a high-vegetable, fruit and fiber, low-fat diet. European Journal of Nutrition 2005;44(1):18-25.
106. Wein FS. Hierarchical linear modeling: theory, method and application. Taipei: Yeh Yeh Book Gallery, 2006.
107. Adewale AJ, Hayduk L, Estabrooks CA, Cummings GG, Midodzi WK, Derksen L. Understanding hierarchical linear models: applications in nursing research. Nursing Research 2007;56(4 Suppl):S40-46.
108. Krueger C, Tian L. A comparison of the general linear mixed model and repeated measures ANOVA using a dataset with multiple missing data points. Biological Research for Nursing 2004;6(2):151-157.
109. Wein FS. The decision of sample size. Hierarchical linear modeling: theory, method and application. Taipei: Yeh Yeh Book Gallery, 2006:(8) 22-36.
110. Yang CC, Liu HY, Yang CC. Sample size requirements of using latent growth models in longitudinal study. Journal of Education and Psychology 2004;27(3):603-626.
111. Spielberger CD, Gorsuch RL, Lushene PR, R. VP, G. JA. Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto: Consulting Psychologists Press, Inc., 1983.
112. Kabacoff RI, Segal DL, Hersen M, Van Hasselt VB. Psychometric properties and diagnostic utility of the Beck Anxiety Inventory and the State-Trait Anxiety Inventory with older adult psychiatric outpatients. Journal of Anxiety Disorders 1997;11(1):33-47.
113. Stanley MA, Novy DM, Bourland SL, Beck JG, Averill PM. Assessing older adults with generalized anxiety: a replication and extension. Behaviour Research and Therapy 2001;39(2):221-235.
114. Addolorato G, Ancona C, Capristo E, Graziosetto R, Di Rienzo L, Maurizi M, et al. State and trait anxiety in women affected by allergic and vasomotor rhinitis. Journal of Psychosomatic Research 1999;46(3):283-289.
115. Knight RG, Waal-Manning HJ, Spears GF. Some norms and reliability data for the State--Trait Anxiety Inventory and the Zung Self-Rating Depression scale. British Journal of Clinical Psychology 1983;22 (Pt 4):245-249.
116. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1977;1(3):385-401.
117. Wenzel LB, Fairclough DL, Brady MJ, Cella D, Garrett KM, Kluhsman BC, et al. Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer 1999;86(9):1768-1774.
118. Hann D, Winter K, Jacobsen P. Measurement of depressive symptoms in cancer patients: evaluation of the Center for Epidemiological Studies Depression Scale (CES-D). Journal of Psychosomatic Research 1999;46(5):437-443.
119. Lee LH. The effects of music therapy on the depressive elderly adults [Unpublished master thesis]. Tzu Chi University, 2003.
120. Lu SY. The relationship among life event stress, perimenopause attitude, climacteric symptoms, self-concept, and depression in women during perimenopause [Unpublished master thesis]. National Cheng Kung University, 2003.
121. Lee KA, Hicks G, Nino-Murcia G. Validity and reliability of a scale to assess fatigue. Psychiatry Research 1991;36(3):291-298.
122. Meek PM, Nail LM, Barsevick A, Schwartz AL, Stephen S, Whitmer K, et al. Psychometric testing of fatigue instruments for use with cancer patients. Nursing Research 2000;49(4):181-190.
123. Miaskowski C, Lee KA. Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: a pilot study. Journal of Pain Symptom Management 1999;17(5):320-332.
124. Bines J, Oleske DM, Cobleigh MA. Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology 1996;14(5):1718-1729.
125. National Cancer Institute. Common terminology criteria for adverse events v3.0 (CTCAE). Retrieved Feb. 06, 2009, from http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf, 2006.
126. Booth CM, Clemons M, Dranitsaris G, Joy A, Young S, Callaghan W, et al. Chemotherapy-induced nausea and vomiting in breast cancer patients: a prospective observational study. Journal of Supportive Oncology 2007;5(8):374-380.
127. American College of Sports Medicine. Physical activity assessment. ACSM's resource manual for guidelines for exercise testing and prescription. Philadelphia: Lippincott Williams &; Wilkins, 2005:136-145.
128. Kristal AR, Shattuck AL, Henry HJ. Patterns of dietary behavior associated with selecting diets low in fat: reliability and validity of a behavioral approach to dietary assessment. Journal of the American Diet Association 1990;90(2):214-220.
129. Shannon J, Kristal AR, Curry SJ, Beresford SA. Application of a behavioral approach to measuring dietary change: the fat- and fiber-related diet behavior questionnaire. Cancer Epidemiology Biomarkers Prevention 1997;6(5):355-361.
130. Irwin ML, Alvarez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, et al. Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity (Silver Spring) 2009;17(8):1534-1541.
131. Rooney M, Wald A. Interventions for the management of weight and body composition changes in women with breast cancer. Clinical Journal of Oncology Nursing 2007;11(1):41-52.
132. Westcott WL. Why is it so hard to lose weight? Retrieved April. 02, 2010, from http://www.kandiymca.org/images/Wayne/Why_Hard_To_Lose_Wt%20-%20Weight%203.pdf.
133. Brodhead P. Safe and effective weight losss strategies. Retrieved April. 02, 2010, from http://www.brighterdayfoods.com/PDFDocs/t/T7S8VUWV40EC8N2C2B3N4EDH381P5PRE.PDF, 2004.
134. Aslani A, Smith RC, Allen BJ, Levi JA. Changes in body composition during adjuvant chemotherapy for breast cancer. Applied Radiation and Isotopes 1998;49(5-6):637-638.
135. Courneya KS, Friedenreich CM. Physical exercise and quality of life following cancer diagnosis: a literature review. Annals of Behavioral Medicine 1999;21(2):171-179.
136. Hacker E. Exercise and quality of life: strengthening the connections. Clinical Journal of Oncology Nursing 2009;13(1):31-39.
137. Smigel K. Weight gain in breast cancer patients: a problem? Journal of the National Cancer Institute 1990;82(5):348-350.
138. Lin YC, Yen LL, Chen SY, Kao MD, Tzeng MS, Huang PC, et al. Prevalence of overweight and obesity and its associated factors: findings from National Nutrition and Health Survey in Taiwan, 1993-1996. Preventive Medicine 2003;37(3):233-241.
139. Beisecker A, Cook MR, Ashworth J, Hayes J, Brecheisen M, Helmig L, et al. Side effects of adjuvant chemotherapy: perceptions of node-negative breast cancer patients. Psychooncology 1997;6(2):85-93.
140. Borde F, Chapelle-Marcillac I, Fumoleau P, Hery M, Bonneterre J, Kerbrat P, et al. Role of chemo-induced amenorrhea in premenopausal, nodepositive, operable breast cancer patients: 9-year follow-up results of French Adjuvant Study Group (FASG) data base. Breast Cancer Research and Treatment 2003;82(Sup.1):S30.
141. Parulekar WR, Day AG, Ottaway JA, Shepherd LE, Trudeau ME, Bramwell V, et al. Incidence and prognostic impact of amenorrhea during adjuvant therapy in high-risk premenopausal breast cancer: analysis of a National Cancer Institute of Canada Clinical Trials Group Study--NCIC CTG MA.5. Journal of Clinical Oncology 2005;23(25):6002-6008.
142. Martin M, Villar A, Sole-Calvo A, Gonzalez R, Massuti B, Lizon J, et al. Doxorubicin in combination with fluorouracil and cyclophosphamide (i.v. FAC regimen, day 1, 21) versus methotrexate in combination with fluorouracil and cyclophosphamide (i.v. CMF regimen, day 1, 21) as adjuvant chemotherapy for operable breast cancer: a study by the GEICAM group. Annals of Oncology 2003;14(6):833-842.
143. Francini G, Petrioli R, Montagnani A, Cadirni A, Campagna S, Francini E, et al. Exemestane after tamoxifen as adjuvant hormonal therapy in postmenopausal women with breast cancer: effects on body composition and lipids. British Journal of Cancer 2006;95(2):153-158.