(3.238.96.184) 您好!臺灣時間:2021/05/08 03:16
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:蔡宜娟
研究生(外文):Yi-Chuan Tsai
論文名稱:癌末病患疲倦感與細胞激素相關因素之探討
論文名稱(外文):Fatigue and Cytokines in Terminal Cancer Patients
指導教授:吳麗珍吳麗珍引用關係
學位類別:碩士
校院名稱:長榮大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:79
中文關鍵詞:疲倦細胞激素癌症末期症狀群疲倦困擾
外文關鍵詞:fatiguecytokinesterminal cancersymptom clusterfatigue distress
相關次數:
  • 被引用被引用:2
  • 點閱點閱:194
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:1
台灣從1982年起,惡性腫瘤已連續二十五年蟬聯死因首位。幾乎所有的癌症病患都有過某種程度的疲倦,而高達90%的癌症末期病患正在經歷疲倦感。因此,疲倦是癌症最常見的症狀困擾之一,也嚴重的衝擊到病患的生活品質。有研究指出,癌症病患的細胞激素濃度有上升的現象,也發現疲倦與腫瘤進展的細胞激素有關。本前瞻性縱貫研究目的為測量癌末病患之疲倦感與細胞激素濃度間之相關性。以台灣南部某地區教學醫院安寧病房之住院癌末病患為對象。納入收案的條件為年滿20歲,經確立診斷為癌症末期病患,意識清楚、可由語言溝通,並簽署同意書者。病患入院三天內收案為第一天,有42人參與此研究,以問卷與血液收集每週一次,第八天有21人及第十五天有12人。血液檢體測量WBC, Hb, platelet, CRP, BUN, creatinine, GOT, GPT, albumin, pre-albumin與細胞激素(TNF-α, IL-10)的濃度。而細胞激素濃度的測定以ELISA(enzyme-link immunosorbent assay)技術來操作。疲倦程度問卷包含三部分,量測病患主觀的感受,分別為疲倦視覺量表(FVAS)、症狀困擾量表(SDS)及病歷資料。統計分析採用皮爾森相關係數(Pearson’s product moment correlation coefficient)與重複測量(ANOVA-Repeated measurements)方式進行。結果顯示,疲倦之嚴重程度隨住院時間有增加的趨勢,而疲倦困擾程度接近中度困擾,但在三階段住院期間的變化均相同。疲倦嚴重程度與症狀困擾(r = 0.38,p<0.05)及身體活動功能分數(r = 0.33,p<0.05)皆有正相關;症狀困擾總分(F = 4.29,p<0.05)與失眠(F = 5.79,p<0.05)與便秘(F = 3.45,p<0.05)在住院期間困擾皆有改善;疲倦與噁心嘔吐(r = 0.35,p<0.05)、食慾差(r = 0.32,p<0.05)、失眠(r = 0.48,p<0.01)、便秘(r = 0.48,p<0.01)、專注力差(r = 0.54,p<0.01)均有正相關。疲倦嚴重程度與所有血液檢驗值均無相關,疲倦困擾程度與Hb(r = 0.45,p<0.05)、WBC(r = 0.63,p<0.05)有正相關。細胞激素(TNF-α,IL-10)與疲倦嚴重程度無關;但TNF-α及IL-10在第一天(r = 0.68,p<0.001)與第八天 (r=0.64,p<0.001)都互相有高度相關;而控制症狀群困擾分數與Hb兩因子後,疲倦嚴重程度與TNF-α(r = 0.45,p<0.01)有相關,但與IL-10(r = 0.28,p = 0.12)無相關。由本研究發現,疲倦在癌末病患住院過程中,是最常見的症狀,但仍無良好的指標來測量疲倦。細胞激素與疲倦程度無顯著相關性。而症狀困擾及身體功能分數與疲倦程度有正相關。瞭解疲倦之生理現象將有助於我們發展護理措施與診斷的參考。
Since 1982, malignant tumors have been the leading cause of death in Taiwan. Almost all patients of cancer complain of various degrees of fatigue and more than 90% suffer from fatigue in the terminal stage. Studies have shown that fatigue is related to cytokines in tumor progression, and elevated levels of several cytokines have been found in cancer patients. The purpose of this longitudinal study is to examine the correlation between fatigue and plasma cytokine levels in terminal cancer patients. The investigator recruited 42 patients from a palliative care unit at a local hospital in southern Taiwan. Terminal cancer patients that were 20 years-old and older were included in this study, and those who could not communicate were excluded. Blood samples were collected on day 1 (after being admitted), day 8, and day 15. Fatigue severity questionnaires were administered as well. The blood samples were measured for WBC, Hb, platelet, CRP, BUN, creatinine, GOT, GPT, albumin, pre-albumin, and cytokines (TNF-α, interleukin-10). The cytokine levels in the blood were measured by using enzyme-link immunosorbent assay (ELISA). Two inventories were used in this study to investigate subjective fatigue syndrome: the Fatigue Visual Analogue Scale and Symptom Distress Scale. Pearson’s product moment correlation coefficient and ANOVA repeated measurements were used for data analysis.
This study showed that subjects did suffer from moderate degrees of fatigue and their suffering slightly increased during the data collecting period. However, the changes were not significant. Fatigue severity was correlated to symptom distress (rd1=0.38, p<0.05) and activity performance status (rd1=0.33, p<0.05). Fatigue is related to other symptoms such as nausea (r=0.35, p<0.05), poor appetite (r=0.32, p<0.05), insomnia (r=0.48, p<0.01), constipation (r=0.48, p<0.01), and concentration difficulty (r=0.54, p<0.01). The symptom control during hospitalization was noted, including total symptom distress (F=4.289, p<0.05), insomnia (F=5.79, p<0.05), and constipation (F=3.45, p<0.05). Fatigue severity was not related to all of the serum lab parameters. The fatigue distress levels were associated with Hb (r=0.45, p<0.05) and WBC (r=0.63, p<0.05). With regard to cytokines, TNF-α and IL-10 are highly correlated for both day 1 (rd1=0.68, p<0.001) and day 8 (rd8=0.64, p<0.001);no relationship was found between fatigue severity and cytokines(TNF-α, IL-10). However when controlling SDS total score and Hb, fatigue severity was correlated to TNF-α (rd1=0.45, p<0.01).
The research results showed that fatigue is one of the most common symptoms that terminal cancer patients have and their fatigue continues during hospitalization although other symptoms have been reduced. Since TNF-α and IL-10 were not correlated to severity of fatigue, the patients’s subjective feeling is the most important indicator of fatigue. Thus, the health care providers should listen to patients’ complaints carefully in order to find interventions to assist patients in reducing their suffering from fatigue.
目 錄

中文摘要……………………………………………………… Ⅰ-Ⅱ
英文摘要……………………………………………………… Ⅲ-V
致 謝……………………………………………………… Ⅵ-Ⅷ
目 錄……………………………………………………… Ⅸ-Ⅹ
圖表目錄……………………………………………………… ⅩⅠ


壹、緒論……………………………………………………… 1
第一節 研究背景…………………………………………… 1
第二節 研究目的…………………………………………… 3
第三節 名詞定義…………………………………………… 4
貳、文獻探討………………………………………………… 5
第一節 惡性腫瘤的成因及治療…………………………… 5
第二節 癌末病患的症狀控制……………………………… 6
第三節 疲倦的定義及測量方法…………………………… 8
第四節 實驗室生理指標與疲倦相關性研究……………… 12
第五節 疲倦與細胞激素相關性研究……………………… 13
第六節 研究架構…………………………………………… 17
參、研究方法………………………………………………… 18
第一節 研究設計…………………………………………… 18
第二節 研究場所與對象…………………………………… 18
第三節 資料收集過程……………………………………… 18
第四節 研究工具與材料…………………………………… 19
第五節 資料分析方法……………………………………… 26
第六節 研究對象權益的保護……………………………… 27
肆、研究結果………………………………………………… 28
第一節 研究對象基本資料………………………………… 28
第二節 各研究變項之敘述性統計分析與變化…………… 32
第三節 疲倦程度、細胞激素與其他研究變項之相關性… 44
伍、討論及建議……………………………………………… 49
第一節 討論………………………………………………… 49
第二節 研究限制…………………………………………… 56
第三節 結論………………………………………………… 58
第四節 建議………………………………………………… 59
參考資料……………………………………………………… 61
中文部份……………………………………………………… 61
英文部分……………………………………………………… 62

圖 表 目 錄
圖一 研究概念架構圖…………………………………… 17
圖二 症狀困擾變化圖…………………………………… 37
圖三 血液生理指標變化圖……………………………… 40-42
圖四 細胞激素變化圖…………………………………… 43
表一 研究對象之基本資料……………………………… 30-31
表二 研究對象住院期間之疲倦程度變化分析………… 34
表三 住院期間其他困擾症狀之敘述性統計與分析…… 36
表四 患者住院期間血液檢驗值之敘述性統計與分析… 39
表五 患者住院期間疲倦有關變項與細胞激素之相關性 45
表六 疲倦困擾與其它困擾症狀之相關性……………… 46
表七 疲倦嚴重程度或困擾程度與血液檢驗值之相關性 47
表八 細胞激素濃度與症狀困擾程度之相關性………… 48
附錄一 個人基本屬性表與疾病特性……………………… 73
附錄二 疲倦視覺量表Fatigue Visual Analogue Scale (FVAS) … 74
附錄三 症狀困擾量表Symptom Distress Scale (SDS)… 75
附錄四 同意臨床試驗證明………………………………… 76
附錄五 病人參與研究同意書……………………………… 77
附錄六 「症狀困擾量表」使用同意書…………………… 78
自 述 ……………………………………………………… ⅩⅡ
參考資料
一、中文部分
王令瑋(2004)•簡介癌症病人生活品質測量•臨床醫學,54,165-168。
行政院衛生署(2006)•衛生統計資訊網•摘自2007年6月18日,網址:
http://www.doh.gov.tw/statistic/index.htm
李芸湘、蔡芸芳、賴裕和、高瑞和(2002)•肺癌病患在化學治療期間疲憊程度及其相關因素•台灣醫學,6 (6),797-804。
李英芬、蔡麗雲、劉景萍(2005)•癌末病人之疲倦及其相關因素•安寧療護雜誌,10 (3),258-271。
李莉華(1996)•臨終病人的美足護理•安寧療護雜誌,2,9-14。
卓宜靜、蔡秀鸞(2004)•穴位指壓合併按摩對末期腎疾病患者的疲憊感和憂鬱之成效•護理研究,12 (1),51-59。
高宇(2004)•分子生物學,第20章,台北:鼎茂。
高以信、劉鎮嘉、鄭宇翔、江瑞坤、王美華、陳世琦、賴育民(2007)•癌末病患短期存活的預測因子•台灣醫學,11(2),153-161。
張議文(2001)•癌症相關的疲勞•台灣醫學,5 (6),714-718。
許禮安(1998)•心蓮心語-安寧療護與生死學,台北:慈濟文化。
郭集慶(2000)•癌症初期患者接受安寧時之症狀與醫療問題研究,未發表論文,安寧療護基金會。
黃怡菁、唐婉如、史麗珠、余志騰(2005)•肺癌病患化療期間之疲憊軌跡•腫瘤護理雜誌,5 (2),15-27。
黃彩薇、賴裕和、鄭安理、史麗珠、張正雄、向肇英(2001)•背部按摩對化學治療期間疲憊及焦慮之成效•台灣醫學,5 (4),369-377。
楊克平、尹祚芊(1998)•癌末病患健康相關生活品質內含之確認•護理研究,7 (2),129-143。
楊慧琪(2003)•癌症臨終照護之指引,第六章,台北:合記。
劉淑華(2001)•疲憊之概念分析•護理雜誌,48 (4),73-77。
賴裕和(1998)•化學治療病人之症狀困擾及居家護理需求•護理研究,6 (4),279-289。
蔡兆勳、邱泰源、鄭逸如、胡文郁、陳慶餘(2002)•癌末病人的疲倦控制•安寧療護雜誌,7 (1),33-43。
蕭雅莉、賴裕和、邱仲峰、蔡若婷、葉啟源、鍾道生、高仲瑜、林美良(2003)•肝癌患者接受立體定位放射線治療期間疲倦及血液數值變化之探討•放射治療與腫瘤學,10 (4),197-208。
謝文欽(2004)•細胞與分子免疫學,第11章,台北:合記。
梁實秋(1990)•遠東英漢大辭典,台北:遠東。
二、英文部分
Aggarwal, B.B., & Shishodia, S.(2006). Molecular targets of dietary agents for prevention and therapy of cancer. Biochemical Pharmacology, 7, 1397-1421.
Agriles, J.M., Garcia-Martinez, C., Llovera, M., & Lopez-Soriano, F.J.(1992). The role of cytokines in muscle wasting: its relation with cancer cachexia. Medicine Research Reviews, 12, 637-652.
Ahlberg, K., Ekman, T., Johansson, F.G., & Mock, V.(2003). Assessment and management of cancer-related fatigue in adults. The Lancet, 362, 640-650.
Barsevick, A.M., Dudley, W.N., & Beck, S.L.(2006). Cancer-related fatigue, depression symptoms, and functional status. Nursing Research, 55(5), 366-372.
Beach, P., Siebeneck, B., Buderer, N.F., & Ferner, T.(2001). Relationship between fatigue and nutritional status in patients receiving radiation therapy to treat lung cancer. Oncology Nursing Forum ,28(6),1027-1030.
Beck, F.K., & Rosenthal, T.C. (2002). Prealbumin: a marker for nutritional evaluation. American Family Physician, 65(8), 1575-1578.
Bender, C.M., Ergun,F.S., Rosenzweig, M.Q., Cohen, S.M.,& Sereika, A.M.(2005). Symptom clusters in breast cancer across 3 phases of the disease. Cancer Nursing,28(3),219-225.
Borthwick, D., Knowles, G.., McNamara, S., Odea, R., & Stroner, P. (2003). Assessing fatigue and self-care strategies in patients receiving radiotherapy for non-small cell lung cancer. European Journal of Oncology Nursing,7(4),231-241.
Bower, J.E., Ganz, P.A., Aziz, M., & Fahey, J.L.(2002). Fatigue and proinflammatory cytokine activity in breast cancer survivors. Psychosomatic medicine,64 ,604-611.
Bower, J.E., Ganz, P.A., Aziz, M., Olmstead, R., Irwin, M.R., & Cole, S.W.(2006). Inflammatory responses to psychological stress in fatigues breast cancer survivors: relationship to glucocorticoids. Brain, Behavior, and Immunity, 21(3), 251-258.
Bower, J.E., Ganz, P.A., Aziz, N., Fahey, J.L., & Cole, S.W.(2003).T-cell Homeostasis in breast cancer survivors with persistent fatigue. Journal of the National Cancer Institute, 95(15), 1165-1168.
Dimeo, F., Schmittel, A., Fietz, T., Schwartz, S., Kohler, P., Boning, D., & Thiel, E. (2004). Physical performance, depression, immune status and fatigue in patients with hematological malignancies after treatment. Annals of Oncology, 15, 1237-1242.
Dinarello, C.A.(2000).Impact of basic research on tomorrow’s medicine: Proinflammatory cytokines. Chest, 118, 503-508.
Dodd, M.J., Miaskowski, C., & Paul, S.M.(2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum,28(3) ,465-470.
Donovan, H.S., & Ward, S.(2005).Representation of fatigue in women receiving chemotherapy for gynecologic cancers. Oncology Nursing Forum,32(1),113-116.
Dunlop, R.J., & Campbell, C.W.(2000).Cytokines and advanced Cancer. Journal of Pain and Symptom Management, 20(3),214-232.
Engvall, E., & Perlman, P.(1971). Enzyme-linked immunosorbent assay (ELISA).Quantitative assay of immunoglobulin G.Immunochemistry, 8(9), 871-874.
Foubert, J.(2006). Cancer-related anemia and fatigue: assessment and treatment. Nursing Standard,20(36),50-57.
Franklin, D.J., & Packel, L.(2006). Cancer-related fatigue. Archives of Physical Medicine and Rehabilition, 87(1), S91-S93.
Geinitz, H., Zimmermann, F.B., Stoll, P., Thamm, R., Kaffenberger, W., Ansorg, K., et al.(2001).Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer. International Journal of Radiation Oncology Biology Physical, 51(3), 691-698.
Grant, M., Padilla, G.V., & Greimel, E.R.(1996). Survivorship and quality of life issues. In R.McCorkle, M. Grant, M. Frank-Stromborg, & S.B. Baird(Eds.), Cancer nursing: A comprehensive textbook (2nd ed., pp.1312-1321). Philadelphia: W.B. Saunders Co.
Hann, D.M., Denniston, M.M., & Baker, F.(2000). Measurement of fatigue in cancer patients: Further validation of Fatigue Symptom Inventory. Quality of Life Research, 9(1), 847-854.
Hjermstad, M.J., Oldervoll, L., Fossa, S.D., Holte, H., Jacobsen, A.B. & Loge, J.H.(2006). Quality of life in long-term Hodgkin’s disease survivors with chronic fatigue. European Journal of Cancer, 42(3),327-333.
Ho, S.Y., Guo, H.R., Chen, H.W., Peng, C.J.(2003). Nutritional predictors of survival in terminal ill cancer patients. Journal of Formosa Medicine Association, 102(8),544-550.
Jacobsen, P.B., Garland, L.L., Jone, M.B., Donovan, K.A., Thors, C.L., Winter, E., & Grendys, E.(2004).Relationship of hemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy. Journal of Pain and Symptom Management, 28(1),7-18.
Jacobsen, P.B., Hann D.M., Azzarello, L.M. Horton, J., Balducci, L., & Lyman , G.H.(1999)Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. Journal of Pain and Symptom Management, 18(4),233-242.
Kapella, M.C., Larson, J.L., Patel, M.K., Covey, M.K., & Berry, J.K. (2006). Subjective fatigue, influencing variables, and consequences in chronic obstructive pulmonary Disease. Nursing Research, 55(1), 10-17.
Kim, H.J., McGuire, D.B., Tulman, L., Barsevick, A.M. (2005). Symptom clusters. Cancer Nursing, 28(4), 270-282.
Klinkenberg, M., Willems, D.L., Wal, G., & Deeg, D.J.H.(2004). Symptom burden in the last week of life. Journal of Pain and Symptom Management, 27(1),5-13.
Knobel, H., Loge, J.H., Nordey, T., Kolstad, A.L., Espevik, T., Kvaley, S., & Kaasa, S.(2000). High level of fatigue in lymphoma patients treated with high dose therapy. Journal of Pain and Symptom Management, 19(6),446-456.
Knobf, M.T., & Sun, Y.(2005). A longitudinal study of symptoms and self-care activities in women treated with primary radiotherapy for breast cancer. Cancer Nursing,28(3), 210-218.
Kuo, H.H., Chiu, M.J., Liao, W.C., & Hwang, S.L.(2006). Quality of sleep and related factors during chemotherapy in patients with stageI/II breast cancer. Journal of Formosa Medicine Association, 105(1),64-69.
Lindqvist, O., Widmark, A., Rasmussen, B.H. (2004). Meanings of the phenomenon of fatigue as narrated by 4 patients with cancer in palliative care. Cancer Nursing,27 (3),237-243.
Macarthur, M., Sharp, L., Hold, G.L., Little, J., & El-Omar, E.M.(2005). The role of Cytokine gene polymorphisms in colorectal cancer and their interaction with aspirin use in the northeast of Scotland. Cancer Epidemiology,Biomarkers & Prevention, 14(7), 1613-1618.
Mantovani, G.., Madeddu, C., Maccio, A., & Serpe, R.(2004). Cancer–related anorexia/cachexia syndrome and oxidative stress: An innovative approach beyond current treatment. Cancer Epidemiology,Biomarkers & Prevention,13 (10),1651-1659.
Martignoni, M.E., Kunze, P., & Friess, H.,(2003). Cancer cachexia. Molecular Cancer ,2(1),36-38.
Mazur, B., Mertas, A., Jakimczyk, D.S., Anski,T.Z., & Moszant, A.J.(2004).Concentration of IL-2, IL-6, IL-8, IL-10, and TNF-alpha in children with acute lymphoblastic leukemia after cessation of chemotherapy. Hematological Oncology, 22, 27-34.
McCorkle, R., & Young, K.(1978).Development of a symptom distress scale. Cancer Nursing, 1, 373-378.
Meyers, C. A., Albitar, M., & Estey, E.(2005). Cognitive impairment, Fatigue, and cytokine levels in patients with acute myelogenous leukermia or myelodysplastic syndrome. Cancer, 104(4),788-793.
Molassiotis, A., & Chan, C.W.H.(2004).Fatigue patterns in Chinese patients receiving radioherapy. Europen Journal of Oncology Nursing, 8, 334-340.
Opal, S.M., & DePalo, V.A. (2000).Impact of basic research on tomorrow’s medicine: Anti-inflammatory cytokines. Chest, 117, 1162-1172.
Park, P., McMullen, M.R., Huang, H., Thakur, V., & Nagy, L.E.(2007).Short-term treatment of RAW264.7 macrophages with adiponectin increases TNF-α expression via ERK1/2 activation and EGR-1 expression: Role of TNF-α in adiponextin-stimulated IL-10 production. The Journal of Biological Chemistry, [article in press]
Porock, D., & Juenger, J.A.(2004). Just go with the flow: a qualitative study of fatigue in biotherapy. European Journal of Cancer Car, 13, 356-361.
Prue,G.,Rankin,J.,Allen,J.,Gracey,J.,& Cramp,F.(2006). Cancer-related fatigue: A critical appraisal.European Journal of Cancer, 42(7), 846-863.
Pusztai, L., Mendozab,T.R., Reubenc, J.M., Martinez, M.M., Willey, J.S., Lara, J., Syed, A., Fritsche, H.A., Bruera, E., Booser, D., Valero, V., Arun, B., Ibrahim, N., Rivera, E., Royce, M., Cleeland, C.S., & Hortobagyi, G.N.(2004). Changes in plasma levels of inflammatory cytokines in response to paclitaxel chemotherapy. Cytokine, 25, 94-102.
Quattrin, R., Zanini, A., Buchini, S., Turello, D., Annunziata, M.A., Vidotti, C., Colombatti, A., & Brusaferro, S.(2006).Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: methology and outcomes. Joneral of Nursing Managmant ,14(2),96-105.
Ream, E., & Richardson, A.(1999).From therapy to practice: Designing interventions to reduce fatigue in patient with cancer. Oncology Nursing Forum,26 (8),1295-1303.
Rhodus, N.L., Cheng, B., Myers, S., Bowles, W., Ho, V., & Ondrey, F.(2006). Proinflammatory cytokine levels in saliva before and after treatment of (erosive) oral lichen planus with dexamethasone. Oral Disease, 12(2), 112-116.
Rhodus, N.L., Cheng, B., Myers, S., Bowles, W., Ho, V., & Ondrey, F.(2005).A comparison of the pro-inflammatory, NF-kB-dependent cytokines: TNF-alpha, IL-6, and IL-8 in different oral fluids from oral lichen planus patients. Clinical Immunology, 114, 278-283.
Rutkowski, P., Kaminska, J., Kowakska, M., Ruka, W., & Steffen, J.(2003). Cytokine and cytokine receptor serum levels in adult bone sarcoma patients: correlation with local tumor extent and prognosis. Journal of Surgical Oncology, 84,151-159.
Shafqat, A., Einhorn, L.H., Hanna, N., Sledge, G.W., Hanna, A., Juliar, B.E., Monahan, P., & Bhatia, S.(2005). Screening studies for fatigue and laboratory correlates in cancer patients undergoing treatment. Annals of Oncology, 16, 1545-1550.
Shen, J., Barbera, J., & Shapiro, C.M.(2006). Distinguishing sleepiness and fatigue: focus on definition and measurement. Sleep Medicine Reviews, 10, 63-76.
Shih,Y.T., Wang, X.S., Cantor, S.B.,& Cleeland, C.S.(2006).The association between symptom burdens and utility in Chinese cancer patients. Quality of Life Research, 15(8),1427-1438.
Shun, S.C., Beck, S.L., Pett, M.A., & Berry, P.H.(2006).Psychometric testing of three Chinese Fatigue Instruments in Taiwan. Journal of Pain and Symptom Management, 32(2),155-167.
Stone, P., Richardson, A., Ream, E., Smith, A.G., Kerr, D.J., & Kearney, N.(2000). Cancer-related fatigue: Inevitable, unimportant and untreatable? Result of a muti-centre patient survey. Annals of Oncology, 11, 971-975.
Stone, P.C., Abdul-Wahab, A., Gibson, J.S., Wright, R.J., & Andrews, P.L.(2005).Fatigue in cancer patients is not related to changes in oxyhaemoglobin dissociation. Support Care Cancer, 13, 854-858.
Wu, H.S., & McSweeney, M.(2007). Cancer-related fatigue:”It’s so much more than just being tired”. European Journal of Oncology Nursing, 11(2),117-125.
Wu, H.S., & McSweeney, M.(2004). Assessing fatigue in persons with cancer. Cancer, 101,1685-1695.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
1. 王令瑋(2004)•簡介癌症病人生活品質測量•臨床醫學,54,165-168。
2. 王令瑋(2004)•簡介癌症病人生活品質測量•臨床醫學,54,165-168。
3. 李英芬、蔡麗雲、劉景萍(2005)•癌末病人之疲倦及其相關因素•安寧療護雜誌,10 (3),258-271。
4. 李英芬、蔡麗雲、劉景萍(2005)•癌末病人之疲倦及其相關因素•安寧療護雜誌,10 (3),258-271。
5. 李莉華(1996)•臨終病人的美足護理•安寧療護雜誌,2,9-14。
6. 李莉華(1996)•臨終病人的美足護理•安寧療護雜誌,2,9-14。
7. 黃怡菁、唐婉如、史麗珠、余志騰(2005)•肺癌病患化療期間之疲憊軌跡•腫瘤護理雜誌,5 (2),15-27。
8. 黃怡菁、唐婉如、史麗珠、余志騰(2005)•肺癌病患化療期間之疲憊軌跡•腫瘤護理雜誌,5 (2),15-27。
9. 楊克平、尹祚芊(1998)•癌末病患健康相關生活品質內含之確認•護理研究,7 (2),129-143。
10. 楊克平、尹祚芊(1998)•癌末病患健康相關生活品質內含之確認•護理研究,7 (2),129-143。
11. 蔡兆勳、邱泰源、鄭逸如、胡文郁、陳慶餘(2002)•癌末病人的疲倦控制•安寧療護雜誌,7 (1),33-43。
12. 蔡兆勳、邱泰源、鄭逸如、胡文郁、陳慶餘(2002)•癌末病人的疲倦控制•安寧療護雜誌,7 (1),33-43。
13. 蕭雅莉、賴裕和、邱仲峰、蔡若婷、葉啟源、鍾道生、高仲瑜、林美良(2003)•肝癌患者接受立體定位放射線治療期間疲倦及血液數值變化之探討•放射治療與腫瘤學,10 (4),197-208。
14. 蕭雅莉、賴裕和、邱仲峰、蔡若婷、葉啟源、鍾道生、高仲瑜、林美良(2003)•肝癌患者接受立體定位放射線治療期間疲倦及血液數值變化之探討•放射治療與腫瘤學,10 (4),197-208。
 
系統版面圖檔 系統版面圖檔