| Objective:The aim of this study was to describe the status and factors influencing cancer-related fatigue(CRF) in ovarian cancer patients undergoing primary treatment with adjuvant chemotherapy and to explore the effect of in-home cognitive behavioral therapy(IH-CBT) on CRF, sleep, anxiety and depression in ovarian cancer patients receiving adjuvant chemotherapy. Methods:This study was a clinical randomized controlled trial during November 2014 to November 2015, 72 ovarian cancer patients with CRF(Piper fatigue scale total score >0) who were hospitalized in gynaecology department of the first hospital of jilin university and voluntary to participate in this study were Selected to be samples, then the samples were randomly divided into intervention group and control group, 36 participants in each group. The control group received regular care, in addition to given regular care, intervention group received IH-CBT from the first chemotherapy until the end of the sixth chemotherapy. All participants were measured by the revised Piper fatigue scale-Chinese version(RPFS), Pittsburgh Sleep Quality Index(PSQI), Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS), Outcome measures were completed at baseline(T1), 4 times before chemotherapy(T2) and 6 times chemotherapy(T3) to analysis the factors influencing fatigue and the effect of this intervention. Results:1. The baseline results showed that the level of two groups of patients overall fatigue and four dimensions of fatigue(behavioral/ emotional/ awareness/ recognition), all belong to moderate, scores of the behavior fatigue(intervention group 5.02±1.27, control group 4.90±1.27) and cognitive fatigue(intervention group 4.66±1.35, control group 4.61±1.37) were relatively high. 64.18% of the patients reflected the most serious fatigue of one day is in the morning.2. Influential factors analysis: Single factor measure analysis of variance showed that the total score of CRF between the tumor metastasis and outdoor activities in ovarian cancer chemotherapy patients was significant difference(P(27)0.05). Pearson correlation analysis results showed that the RPFS total score and its four dimensions scores and anxiety, depression, sleep quality scores was significantly positively related. Multiple linear regression analysis showed that the sleep quality and family relationship affect the degree of patients CRF, the worse sleep quality, the higher level of patients CRF. Approximately 28.36% patients experienced mild-to-moderate anxiety; 22.39% patients suffered from mild-to-moderate depression.3. Data analysis after intervention:(1) The effect of IH-CBT on CRF: Repeated measures analysis of variance results showed that: main intervention effect on the overall fatigue, behavior fatigue, and cognitive fatigue was statistically significant(P(27)0.05) between intervention group and control group. The main time effect on overall fatigue and four dimensions fatigue was statistically significant in both groups(P(27)0.05); the interaction effect between intervention factor and time factor on the cognitive fatigue and behavior fatigue was significant. Compared the fatigue scores before and after intervention between intervention group and control group showed that: after intervention overall fatigue, behavior fatigue, perception fatigue and cognitive fatigue scores of intervention group in two time points(T2, T3) were lower than the control group, and scores in intervention group were lower than the previous one time point, the differences between the two groups have statistical significance(P(27)0.05), there was no statistically significant difference between two group emotional fatigue after intervention.(2) The effect of IH-CBT on anxiety and depression: Compared the level of anxiety score before and after intervention between two groups showed that: there was no statistically significant difference after intervention in two time points(T2, T3). Repeated measures analysis of variance results showed that: the main time effect and main intervention effect were statistically significant(P(27)0.05) on depression scores and there exist interaction between the interference factor and time factor. The mean depression scores in intervention group were lower in two time points(T2, T3) than that of the previous point and the difference was significant(P(27)0.05). In control group, depression scores in T2 time points higher than T1 and T3.(3) The effect of IH-CBT on sleep: Compared the level of PSQI score before and after intervention between two groups showed that: the difference in sleep time, sleep disorder, daytime dysfunction dimensions and the total scores of PSQI was statistically significant(P(27)0.05) in T2(before 4th chemotherapy) and T3(6th chemotherapy) time points. Repeated measures analysis of variance results showed that: the main intervention effect on sleep time, sleep disorder, daytime dysfunction dimensions and overall PSQI scores was significant(P(27)0.05); The main time effect had statistical significance on all dimensions(P(27)0.05);The interaction effect between intervention factor and time factor was exists on Sleep disorders dimension. Conclusion:(1) Moderate CRF is common among ovarian cancer patients receiving adjuvant chemotherapy. The main factors that could affect CRF are anxiety, depression, sleep quality and family relationship. CRF is significantly positively related with anxiety and depression, and present negative correlation with family relationship.(2) IH-CBT can effectively reduce the level of fatigue in ovarian cancer patients undergoing chemotherapy. The level of cognitive fatigue, behavior fatigue and overall fatigue are significantly reduced after the intervention.(3) IH-CBT could significantly improve the quality of sleep and reduce the level of depression in ovarian cancer patients with chemotherapy. |
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