2013-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/648206摘要：疲倦是癌症病患最常面臨的症狀困擾，雖然目前已證實運動可以減輕疲倦且可以降低癌症復發及死亡率特別是結直腸癌病患，但是癌症存活者維持規律運動的比例偏低。再者，疲倦之測量仍僅有主觀之問卷測量，缺乏客觀之測量指標(例如肌力或生理指標)。因此，此四年期計畫之研究目的：(1) 探討存活期結直腸癌病患運動行為的現況、阻礙運動之原因以及影響執行運動行為之重要因素。(2) 探討存活期結直腸癌病患疲倦、肌力及能量代謝體之相關性，並探討肌力及能量代謝體成為癌症相關疲倦之生理指標的可能性。(3) 發展個別化疲倦處理及運動衛教手冊，並測試於可開刀之結直腸癌病患於改善疲倦之成效，以發展適合結直腸癌病患術後之居家運動臨床建議指引。第一階段(第1年) 採縱貫式研究設計，針對門診之結直腸癌存活者進行二次問卷訪談(間隔3個月)，以瞭解結直腸癌病患之運動行為及態度現況、阻礙運動原因及影響運動因素以提供衛教介入措施之參考。問卷使用自擬之基本屬性及計畫性運動行為量表、國際身體活動問卷、癌症疲倦量表、症狀困擾量表、及醫院焦慮與憂鬱量表評估病患之運動行為、身體活動量、疲倦、症狀困擾、焦慮及憂鬱。使用描述性統計、student t test, Pearson’s 相關性分析、及廣義線性推估模式(generalized estimating equations; GEE)，以瞭解運動行為及其阻礙、身體活動量、疲倦、情緒等之相關性，並分析影響執行運動行為之重要預測因子。預估第一階段完成二次訪談個案，共計100位。第二階段(第2年) 採橫斷式研究設計，針對接受治療結束三個月以上之結直腸癌病患存活者進行問卷訪談、6分鐘走路測試、手部握力及下肢肌力之測量與血液及尿液檢體，以瞭解結直腸癌病患之疲倦、上下肢肌力與能量料代謝體之相關性。問卷使用自擬之基本屬性、國際身體活動問卷、社會再調適評估量表、癌症疲倦量表、症狀困擾量表、及醫院焦慮與憂鬱量表評估病患之身體活動量、生活壓力、疲倦、症狀困擾、焦慮及憂鬱。使用描述性統計、student t test, Pearson’s 相關性分析及GEE，以瞭解疲倦、肌力及能量代謝體之相關性，並分析疲倦之重要預測因子。預估此階段完成70位。第三階段(第3-4年) 採分層臨床隨機試驗，於台北市某一醫學中心大腸直腸外科病房，選取結直腸癌早期術後預計出院個案為研究對象，依據過去運動習慣分層後，隨機分配至對照組或實驗組。對照組接受常規照護，而實驗組則於出院前給予個別化疲倦處理衛教以及12週之中等強度運動計畫。將以疲倦、上下肢力以及能量代謝體做為介入措施後之監測指標以及測試三者隨時間改變過程之相關性。測量時間共計三次，分別於出院前(介入前)、進入研究第13、25週進行問卷、體能測量以及血液尿液之檢測以瞭解執行12週個別化中等強度運動之立即效果及維持三個月之效果。資料將以描述性統計、獨立t檢定、以及GEE進行分析，以瞭解運動之成效以及疲倦、肢力以及能量代謝體的改變關係。此階段實驗組與對照組各 57人，考量流失率20%，預計此階段共需徵求136位病患。預期結果: 預期本研究結果可瞭解結直腸癌病患之運動行為以及疲倦、肌力、能量代謝體之相關性以及測試發展疲倦的生理監測指標之可能性，同時發展適合台灣結直腸癌存活者術後早期之疲倦處理及運動建議指引，並作為未來臨床照護之參考。<br> Abstract: Fatigue is one of the most distressed symptoms for cancer patients. Evidences have shown that exercise could decrease the level of fatigue and increased physical activity after cancer diagnosis reduces the risk of cancer recurrence and mortality, especially for colon cancer patients. However, most cancer survivors did not maintain regular exercise. In addition, only subjective measure of fatigue is available without any objective measurement indicator (i.e., muscle strength or biomarkers) for fatigue. Therefore, the aims of this four-year study are to (1) explore exercise behavior, exercise barriers, and identify the significant factors for exercise behavior in colorectal cancer survivors, (2) explore the relationships among fatigue, muscle strength, and metabolomics and further examine the possible biomarkers from muscle strength and metabolomics for fatigue, and (3) develop a clinical guidelines of home-based fatigue management and exercise program and test its effect on decreasing fatigue for patients with colorectal cancer after surgery in Taiwan. In the first phase (the first year), a longitudinal design will be used to recruit colorectal cancer survivors for interviewing twice within 3 months to explore their exercise behavior, attitude and exercise barrier and significant factors affecting exercise behavior. A set of structured questionnaire will be used to assess patients’ exercise behavior, fatigue, symptom distress, anxiety and depression. Data will be analyzed by descriptive, Pearson’s Correlation, student t test and generalized estimating equations to examine the significant factors for exercise behavior. At least 100 subjects will be interviewed in the first phase. In the second phase (the 2nd year), a cross-sectional correlation design will be used to recruit colorectal cancer survivors completed treatment at least 3 months in clinics to explore the relationships among fatigue, muscle strength and metabolomics using a set of structured questionnaire interviewing, 6-minute walking testing, muscular strength, and blood and urine sample. Data will be analyzed by descriptive, Pearson’s Correlation, student t test and generalized estimating equations to examine the relationship among fatigue, muscle strength, and metabolomics and further explore the significant factors for fatigue. At least 70 subjects will be interviewed in this phase.In the third phase (the 3rd-4th year), stratified randomization control trial will be used to recruit eligible subjects from inpatients on a medical center in Taipei. The eligible subjects will be patients with early stage colorectal cancer after surgery and will be discharged. They will be stratified by past exercise behavior and randomized into a control or experimental group. The patients in the control group will maintain their daily activity and those in the experimental group will receive twice individual education program before discharge and 12-week moderate intensity exercise program. Fatigue, muscle strength and metabolomics will be outcome indicators and three time points of data collection will be on the day before discharge, and the 13, 25 weeks entering into the study to explore the immediate and short term of three months effect of the intervention program. Data will be analyzed by descriptive, student t test and generalized estimating equations to examine the effect of intervention program on fatigue, muscle strength, and energy metabolism. Totally, 136 subjects will be approached in terms of including a 20% dropout rate in this phase.We expect this study to explore the exercise behavior and relationship among fatigue, muscle strength, and metabolomics in patients with colorectal cancer and develop the clinical exercise education program guideline for patients with early stage colorectal cancer survivor. The results may provide information for clinicians to tailor interventions in clinical settings.結直腸癌疲倦肌力代謝體Colorectal CancerFatigueMuscle strengthMetabolomics