臺灣博碩士論文加值系統

背景：癌症相關疲倦對於罹患大腸直腸癌且接受癌症治療的病患來說，是一個常見而且複雜的癌症相關症狀。然而，在癌症族群中，疲倦與肌力的相關性研究甚少；因此欲透過一系列研究探討疲倦與肌力之相關性改變及在運動介入後，疲倦及肌力隨著時間改變的影響。
目的：研究一 - (1) 探討不同年齡族群的人口學及臨床特質對於疲倦與肌力 (手握力、髖屈肌、膝伸肌及30秒坐站) 相關性之影響；(2) 檢驗探討不同年齡族群的手握力、髖屈肌、膝伸肌及30秒坐站對於疲倦之截切點。研究二 - (1) 探討在中等強度運動之介入措施下，實驗組及控制組之病患其疲倦及不同肌力測量結果隨著時間改變之差異；(2) 探討實驗組之次分組- 遵從性高及遵從性差兩組之疲倦及不同肌力測量結果隨著時間改變之差異。
方法：研究一 – 為橫斷性研究之次級資料分析。以Spearman’s correlations 檢驗疲倦以及個肌力之相關性，以Receiver operating characteristic analysis檢驗各肌力對於疲倦之截切點。研究二 – 為隨機臨床試驗研究之次級資料分析。以Generalized linear mixed models and mixed-effects models來分析介入組及控制組在疲倦及肌力隨著時間之改變是否有差異。
結果：研究一： 265位大腸直腸癌存活個案中，人口學方面，正在養育小於18歲的孩子與有工作此兩項目，年齡小於60歲及年齡大於60歲兩組達顯著差異。年齡小於60歲之組別有較嚴重程度之疲倦程度、較高的疲倦干擾程度、疲倦之持續時間也較長，尤其是下午時段。研究二 – 與控制組比較，介入組之髖屈肌之肌力隨著時間變弱且達顯著差異，其餘之肌力測量皆無顯著差異。
結論：在研究一，大腸直腸癌患者之疲倦及肌力在不同年齡層有不同的影響結果，小於60歲的組別中疲倦及手握力及髖曲肌肌力之相關性達顯著差異，而大於60歲之組別則顯示疲倦及肌力未有顯著差異。其可能與個案之家庭結構及工作狀態有關。未來研究需要將患者之職業及育兒狀態納入考量。研究二，在運動介入下，介入及控制組之疲倦及肌力隨著時間之改變無顯著差異。在運動遵從性好及遵從性差的組別中，其疲倦及肌力隨著時間之改變亦顯示無顯著差異。由於介入組運動的遵從性差，導致研究結果皆無達顯著差異。在運動影響居家運動之遵從性之因素，在未來研究設計上需進一步考量個案本身對於原本的運動行為、運動的重要性、安全性之認知及動機等因素並簡化運動相關紀錄之方式。

Background: Cancer-related fatigue (CRF) is one of the most common symptom complexes impacting survivors of colorectal cancer following cancer treatments, and preliminary studies suggest that physical exercise intervention can improve fatigue and quality of life in patients with cancer. However, there is little known about the relationship between CRF and muscle strength and whether fatigue levels and muscle strength change over time.
Objectives: Study I: (1) To explore the age-related effects on the relationship between different muscle strength measurements [handgrip strength (HGS), hip-flexor strength (HFS), keen-extensor strength (KES) and 30-second sit-and-stand (STS) tests and CRF; (2) To examine the cut-off points of average fatigue/perceived interference and muscle strength measurements in a young group and an old group by using receiver operating characteristic analysis. Study II: (1) To investigate the muscle strength and fatigue change patterns and compare its change trajectories in intervention and control groups; (2) To further examine the difference in fatigue and muscle strength in the subgroups who have good adherence and poor adherence to the exercise intervention.
Methods: Study I: A cross-sectional study design with secondary analysis was conducted. The correlation between the Fatigue Symptom Inventory (FSI), HGS, HFS, KES, and 30-s STS tests were examined in young (age ≤ 60) and old (age > 60) groups. Study II- A two-group randomized design research study was conducted with a home-based exercise program for patients with colorectal cancer with secondary analysis. Generalized linear mixed models and mixed-effects models were used to account for individual-level variability over time in each outcome measure (average fatigue, perceived interference, HGS, HFS, KES, 30-s STS tests, and 6-minute walk test).
Results: Study I: 265 colorectal cancer survivors were selected for further analysis [young (age ≤ 60) and old (age > 60) groups]. More young group participants had childcare (p < 0.001) and job (p < 0.001) responsibilities. The young group had greater average intensity (p = 0.033), longer duration (p = 0.019) and greater perceived interference from fatigue (p = 0.024), particularly in the afternoon (p = 0.048). In the young group, average fatigue had a significant association with HGS (p = 0.036) and HFS (p = 0.032); significant association between fatigue duration and HGS (p = 0.034)/HFS (p = 0.039); perceived interference showed a significant negative association with HGS (p = 0.019) and HFS (p = 0.015). Study II-144 participants were selected for random assignment as control (n=72) and intervention groups (n=72). The intervention group showed a significantly reduced HFS at T1 with no difference at T2 compared with the control group. There were no significant differences in average fatigue, perceived interference, HGS, KES, 30-s STS and 6MWT across time points. Furthermore, good adherence and poor adherence groups within the intervention group showed no significant change difference in average fatigue, perceived interference, HGS, KES, 30-s STS tests and 6MWT.
Conclusion: In Study I, the young group had a higher percentage of childcare and work responsibilities, greater fatigue intensity, duration and interference (especially in the afternoon) than the old group. Significant negative correlations between CRF and HGS/HFS tests were found in the young group. In Study II, the HFS test revealed decreased strength during the first 3 months in the intervention group and no significant difference in the rest of the outcome measurements. Further study should consider the factors affecting home-based exercise intervention adherence.

ACKNOWLEDGEMENTS I
中文摘要 II
ABSTRACT IV
LIST OF FIGURES XI
LIST OF TABLES XII
1. CHAPTER ONE INTRODUCTION 1
1.1. BACKGROUND AND IMPORTANCE 1
1.2. OBJECTIVES OF THE STUDY 4
2. CHPTER TWO OVERALL LITERATURE REVIEW 5
2.1. INTRODUCTION 5
2.2. BRIEF OVERVIEW OF COLORECTAL CANCER TREATMENT AND SYMPTOMS 5
2.3. CANCER-RELATED FATIGUE 8
2.4. ASSESSMENT OF CANCER-RELATED FATIGUE 14
2.5. RELATIONSHIP BETWEEN MUSCLE STRENGTH MEASUREMENTS AND CANCER-RELATED FATIGUE 16
2.6. EFFECTS OF EXERCISE INTERVENTION ON CANCER-RELATED FATIGUE 17
3. CHAPTER THREE STUDY I — AGE-RELATED EFFECTS ON THE RELATIONSHIP BETWEEN CANCER-RELATED FATIGUE AND MUSCLE STRENGTH IN COLORECTAL CANCER SURVIVORS 22
3.1. INTRODUCTION 22
3.2. RESEARCH QUESTIONS 24
3.3. RESEARCH FRAMEWORK 25
3.4. METHODS 25
3.4.1. Sample and Settings 25
3.4.2. Data Collection 26
3.4.3. Measurements 27
3.5. DATA ANALYSIS 30
3.6. RESULTS 32
3.6.1. Age differences in demographic and clinical disease characteristics 32
3.6.2. FSI- the average fatigue/perceived interference/daily fatigue pattern and its age differences 34
3.6.3. Muscle strength and its age differences 36
3.6.4. Correlation between the CRF and muscle strength in different age subgroups 37
3.6.5. Receiver operating characteristic (ROC) analysis 38
3.7. DISCUSSION 41
3.8. CONCLUSION 46
4. CHAPTER FOUR STUDY II — THE CHANGE OF CANCER-RELATED FATIGUE AND MUSCLE STRENGTH OVER A HOME-BASED EXERCISE PROGRAM IN PATIENTS WITH COLORECTAL CANCER 47
4.1. INTRODUCTION 47
4.2. RESEARCH QUESTIONS 49
4.3. RESEARCH FRAMEWORK 50
4.4. METHODS 51
4.4.1. Sampling and Settings 52
4.4.2. Intervention 53
4.4.3. Measurements 54
4.5. DATA ANALYSIS 56
4.6. RESULTS 58
4.6.1. Participant recruitment 58
4.6.2. Participant characteristics 60
4.6.3. Exercise programme adherence in intervention group 62
4.6.4. The changes of CRF, muscle strength and physical function in the intervention and control groups over time 65
4.6.5. The changes of CRF, muscle strength and physical function in subgroups over time 70
4.7. DISCUSSION 73
4.8. CONCLUSION 77
5. CHAPTER FIVE OVERALL DISCUSSION AND CONCLUSION 78
REFERENCES 80

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