| Objective1.Through a cross-sectional survey,analyze the severity of cancer-related fatigue(CRF)in patients with gastric cancer during chemotherapy and discuss its important influencing factors.2.Through a randomized controlled study,the effectiveness of graded walking exercise on CRF during chemotherapy of gastric cancer patients was clearly defined.Explore the optimal number of exercise steps for patients with gastric cancer at different stages of chemotherapy.3.Clarify the impact of CRF changes on patients’ sleep,self-management effectiveness and quality of life.Method1.Cross-sectional survey: From October to November 2018,219 cases were diagnosed as a general grade questionnaire and cancer-related fatigue questionnaire(The Revised Piper Fatigue Scale,RPFS)in a third-grade Class A cancer hospital in Fujian.Patients with gastric cancer are investigated.SPSS20.0 was used for statistical analysis,where count data was described by frequency and percentage,and measurement data was described by mean ± standard deviation;the mean comparison between two groups was by independent sample t test,and the mean comparison between multiple groups was by analysis of variance;Chi-square test was used to compare the sample rate,and P <0.05 was considered statistically significant.2.Randomized controlled experiment: According to the inclusion and exclusion criteria,124 gastric cancer patients from a third-grade class A cancer hospital in Fujian from November 2018 to June 2019 were selected as the research objects,and were divided into the primary group(5,000～ 7,499 steps/day),intermediate group(7,500-9,999 steps/day),advanced group(≥10,000 steps/day)and control group,31 cases in each group,of which the control group adopts routine nursing intervention,the primary group,intermediate group He and the senior group performed stepped walking exercise intervention on the basis of routine care.The number of daily steps of the research subject needs to meet the group requirements.The four groups were used at the time of admission to the first chemotherapy(before intervention),at the admission of the third chemotherapy,at the admission of the fifth chemotherapy,and at the admission of the seventh chemotherapy,respectively,using the Cancer-related Fatigue Scale(RPFS)and the Pittsburgh Sleep Index Scale(Pittsburgh Sleep Quality Index,PSQI),Health Promotion Strategy Scale(Strategies Used by People to Promote Health,SUPPH),Functional Assessment of Cancer Therapy-Generic Scale(FACT-G),and hemoglobin Indicators to evaluate CRF,sleep status,self-management efficacy and quality of life of gastric cancer patients during chemotherapy.The general linear model and generalized estimation equation(GEE)in repeated measurement analysis were used to analyze the RPFS score and hemoglobin index decline,so as to clarify the effectiveness of graded walking exercise on CRF,and determine the optimal number of exercise steps for patients at different stages of chemotherapy.A generalized mixed linear model was used to explore the impact of CRF changes on patients’ sleep,self-management efficacy,and quality of life.Results1.Cross-sectional surveyCancer-induced fatigue during gastric cancer patients was divided into(3.70±1.57)points,52.5% of patients had moderate fatigue,of which the behavioral dimension score was the highest(4.06±2.09),followed by the sensory dimension(3.74±1.60))Points and cognitive dimension(3.61±1.63)points,the emotional dimension score is the lowest(3.29±1.94)points.Multiple linear regression analysis showed that daily exercise status,smoking history,number of chemotherapy and total protein levels were important factors influencing patients’ CRF.The P values were0.006,0.001,0.000,and 0.000,respectively,and the difference was statistically significant(P<0.05).2.Randomized controlled experiment(1)Equilibrium comparison: There was no statistically significant difference in the general demographic data,disease-related data and scores of the scales of the four groups of subjects at the first chemotherapy admission(before intervention)(all P>0.05),and they were comparable.(2)Cancer-induced fatigue:the point-in-time effect can significantly affect the change of CRF(F=34.430,P<0.001),indicating that CRF will change significantly with the stage of chemotherapy;different groups can significantly affect the change of CRF level(F=27.028,P<0.001),there is a significant interaction effect between time point and group(F=5.159,P<0.001),indicating that the trend of CRF degree with time point will be different for different groups.Simple effect analysis shows:(1)Control group: The RPFS score changed significantly from the first chemotherapy admission to the third chemotherapy admission(P<0.001),but from the third chemotherapy admission to the fifth chemotherapy admission,the fifth chemotherapy There was no significant change from admission to the 7th chemotherapy admission(P=1.000,P=0.140);(2)Primary group: RPFS scores range from the first admission to the third admission,the third admission to the fifth admission,the fifth admission to the seventh admission,No significant change(P=0.524,P=1.000,P=0.435);(3)Intermediate group: RPFS score from the first chemotherapy admission to the third chemotherapy admission,the third chemotherapy admission to the fifth chemotherapy admission,the fifth chemotherapy admission to the seventh chemotherapy admission,the same There was no significant change(P=0.862,P=0.576,P=0.682);(4)Advanced group: RPFS score showed a significant change from the first admission to the third chemotherapy(P=0.002),but there was no significant change from the third admission to the fifth chemotherapy(P=0.234,P=0.667).(5)Upon admission to the first chemotherapy(before intervention): Compare d with the control group,the RPFS scores of the primary group,intermediate group and advanced group were not significantly different(P=0.205,P=0.922,P=0.126).Compared with the intermediate group,the junior group and the adv anced group,and the intermediate group and the advanced group,there was no statistically significant difference in the RPFS score of the patients(P=0.82,P=1.000,P=0.681);(6)Upon admission to the third chemotherapy: compared with the control group,the RPFS scores of the primary group,intermediate group and advanced group were significantly different(P<0.05),the primary group and the intermediate group were compared,the primary group and the advanced group were compared For comparison,there was no significant difference in RPFS score between the intermediate group and the advanced group(P=0.993,P=0.454,P=0.856);(7)Upon admission to the 5th chemotherapy: Compared with the control group,the RPFS scores of the primary group,intermediate group and advanced group were significantly different(P<0.05).Compared with the intermediate group,the RPFS scores were not statistically significant(P= 0.997),comparing the junior group with the advanced group,the intermediate group with the advanced group,the difference in RPFS score was statistically significant(P<0.05);(8)Upon admission to the 7th chemotherapy: Compared with the control group,the RPFS scores of the primary group,intermediate group and advanced group were significantly different(P<0.05),and the RPFS scores of the primary group and intermediate group were not statistically different(P= 0.922),compared with the junior group and the advanced group,the intermediate group and the advanced group,the difference in RPFS score was statistically significant(P<0.001).(3)Hemoglobin:The decline rate of hemoglobin index in the advanced group was significantly lower than that in the control group,B=-1.204,P=0.018,and the decline rate was only30% of that in the control group.There was no significant difference in hemoglobin index between the primary group and the intermediate group compared with the advanced group,P =0.281,P=0.093,indicating that the primary group and the control group,the intermediate group and the control group had significant differences in the hemoglobin decline rate,and the intermediate group and the primary group had no significant difference in hemoglobin decline rate.The incidence of hemoglobin decline at the 7th chemotherapy admission was significantly higher than that at the 1st chemotherapy admission,B=0.552,P=0.002.There was no significant difference in the incidence of the decline between the 3rd chemotherapy admission and the 7th chemotherapy admission,P =0.088,there was no significant difference in the incidence of the decrease between the admission of the fifth chemotherapy and the admission of the seventh chemotherapy,P=0.315,which means that the admission of the third chemotherapy and the admission of the fifth chemotherapy were the same as the admission of the first chemotherapy.Compared with the time,the incidence of hemoglobin decline was also significantly different,and there was no significant difference in the incidence of hemoglobin decline between the third chemotherapy admission and the fifth chemotherapy admission.(4)Sleep quality:The CRF degree of the four groups of patients significantly affected the PSQI score(β=1.023,β=0.561,β=0.294,β=0.379,P<0.05),and the CRF of patients in each stage of chemotherapy before and after the intervention was severe.The degree can positively influence the PSQI score(β=0.728,β=0.904,β=0.978,β=0.863,P<0.001).Compared with the experimental group(primary group,intermediate group and advanced group),the influence of CRF severity on sleep quality was significantly different between the control group and the experimental group.The difference in the ability to affect was 0.481,P<0.001.Compared with the admission to the first chemotherapy(before the intervention)and the admission to the seventh chemotherapy(after the intervention),the impact of the severity of CRF on sleep quality was significantly different between the patients,and the difference in the ability to affect was 0.135,P<0.001.(5)Self-management effectiveness:The severity of CRF in all four groups significantly negatively affected the SUPPH score(β=-12.750,β=-7.642,β=-4.167,β=-9.036,P<0.001),and each stage of chemotherapy before and after intervention The severity of CRF in all patients can significantly negatively affect the SUPPH score(β=-9.118,β=-8.753,β=-13.211,β=-11.347,P<0.001).Compared with the experimental group(primary group,intermediate group and advanced group),the control group had a significant difference in the impact of CRF severity on self-management efficiency.The difference in impact ability was-5.133,P<0.001.Compared with the admission to the first chemotherapy(before the intervention)and the admission to the seventh chemotherapy(after the intervention),the effect of the severity of CRF on the self-management efficiency of the patients was significantly different.The difference of the influence ability was 2.229,P<0.001.(6)Quality of life:For the control group,the severity of patients’ CRF significantly negatively affected the FACT-G score(β=-2.528,P<0.001).For the primary group,intermediate group,and advanced group,the severity of the patient’s CRF could not significantly affect the quality of life score(P>0.05),for each stage of chemotherapy before and after the intervention,the severity of CRF can negatively affect the FACT-G score(β=-1.407,β=-1.145,β=-2.670,β)=-1.737,P<0.05),indicating that the control group and each stage of chemotherapy,the more obvious the symptoms of CRF,the worse the quality of life of the patients,but this change is not obvious in the primary group,intermediate group and advanced group.Compared with the experimental group(primary group,intermediate group and advanced group),the control group had a significant difference in the impact of CRF severity on quality of life.The difference in the ability to affect was-2.86,P<0.001.Compared with the admission to the first chemotherapy(before the intervention)and the admission to the seventh chemotherapy(after the intervention),the impact of the CRF severity on the quality of life of the patients was significantly different.The difference in the ability to affect was 0.33,P<0.001,indicating Different groups and chemotherapy stages can significantly adjust the relationship between patients’ CRF and quality of life.Conclusion1.Cross-sectional surveyPatients with gastric cancer generally have moderate cancer-induced fatigue during chemotherapy.CRF has the greatest impact on patients’ behavior,followed by sensory and cognitive dimensions,and the least impact on emotional dimensions.To this end,improving the adverse symptoms of CRF in patients with gastric cancer during chemotherapy is an important issue that needs to be resolved at this stage.Smoking history,malnutrition,frequency of chemotherapy,and daily movement of patients are important factors affecting CRF during gastric cancer patients.Clinical medical staff can further reduce gastric cancer by helping patients quit smoking,strengthening nutrition management,and encouraging patients to perform daily exercise.Patient’s CRF during chemotherapy.2.Randomized controlled experiment(1)Graded walking exercise can effectively control the severity of CRF during chemotherapy in patients with gastric cancer.(2)The number of exercise steps the patient adapts to at different stages of chemotherapy(1)The first to third chemotherapy: the best exercise step for patients to relieve CRF is≥5,000 steps/day;(2)4th to 5th chemotherapy: the best exercise steps for patients to relieve CRF are 5,000 to 9,999 steps/day;(3)6th to 7th chemotherapy: the best exercise steps for patients to relieve CRF are 5,000 to 9,999 steps/day.(3)Changes in the severity of CRF have a significant impact on sleep quality,self-management effectiveness,and quality of life.The severity of CRF will vary depending on the exercise group and the stage of chemotherapy.It shows that graded walking exercise can effectively control the degree of CRF,and can also effectively improve the sleep quality of patients,and improve the self-management efficiency and quality of life. |
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