Trajectories of Symptom Distress, Symptom-Management Self-Efficacy and Quality of Life among New Diagnosed of Breast Cancer Patients with Chemotherapy
| Autor: | WEI, CHING-WEN, 魏倩雯 |
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| Rok vydání: | 2019 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 107 Breast cancer is the most commonly diagnosed cancer among women worldwide, and chemotherapy is the standard treatment of breast cancer. Chemotherapy and its side effects bring variety of life interference and symptom distress to breast cancer survivors, and then survivors reported that they suffered high level of symptom distress. Inadequate management-related capacity cognition for the symptoms affect quality of life badly in the aspect of physical, psychological, social and environmental. The purpose of this study was to investigate the change of symptom distress, symptom-management self-efficacy, and quality of life, and the trajectory of peri-chemotherapy breast cancer survivor. This longitudinal study, using convenience sampling, recruited ninety-three patients and data was collected at 4 points of time, before received the first chemotherapy (T1), the first week after received the first chemotherapy (T2), the first week after received the third chemotherapy (T3) and the first week when chemotherapy completed (T4). Four questionnaires, that is, demographic and clinical characteristics, M. D. Anderson symptom inventory-Taiwan form, symptom management self-efficacy scale and EORTC QLQ-BR23 were used to collect data between December 1, 2017 and January 31, 2019. All data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, repeated measure ANOVA, general linear regression, generalized estimating equation, and group-based trajectory modeling under SPSS (Version 20.0). The study results revealed that the participants had mild symptom distress and symptom interference during the chemotherapy period, and the most severe symptom were sleep disturbance and fatigue, whereas the mildest symptom were shortness of breath and pain. Mood and daily activity were affected by symptom interference mostly. The severity of symptom distress and symptom interference declined over time. Symptom-management self-efficacy was moderate and increased over time. Functional QOL improved over time, however, sexual behavior presented the poorest results in functional QOL during chemotherapy. The highest severity of symptomatic QOL was showed at the first week after received the first chemotherapy (T1) and then declined over time. The side effects and symptom of breast and upper arm showed the worst result after and before chemotherapy, respectively, while hair loss only appeared after the first chemotherapy. Symptom distress was negatively associated with symptom-management self-efficacy and functional QOL, and it was positively associated with symptomatic QOL. Education, smoking, drinking, symptom distress, symptom interference, and symptom-management self-efficacy were the predictors of functional QOL, and ER receptor status, whether completed the chemotherapy as schedule, symptom distress, and symptom interference were the predictors of symptomatic QOL. Symptom-management self-efficacy has mediating effects either in symptom distress or symptom interference on functional QOL, especially in the groups of who were mild symptom distress, and mild/moderate symptom interference. The analysis of trajectory contained five dimesons. First, symptom distress were grouped into 4 models, and age, marital status and stage of breast cancer were the factors. The highest symptom distress showed at the period before chemotherapy or middle of chemotherapy on the group who aged between 50 to 60 within married, whereas the highest symptom distress showed after chemotherapy when participants who were older than 60 without married. Second, symptom interference weregrouped into 3 models, and family income, ER receptor status and axillary dissection were the factors. The highest symptom interference presented after the first chemotherapy on the group having better family income and receiving total axillary dissection, whereas the highest symptom interference displayed in the middle of chemotherapy on the samples who had low family income and received dissection of sentinel lymph node. Third, symptom-management self-efficacy were grouped into 3 models. Age, education, religion, menstruation and whether completed the chemotherapy as schedule were the factors, and age was the significant variable toward trajectory analysis. The poorest self-efficacy demonstrated before the first chemotherapy on the sample aged around 50, moreover, the poorest self-efficacy appeared after the first chemotherapy on the group were older than 60. In regard of functional QOL, there were 3 models with the factors of employment before cancer diagnosed. The group having job had poor functional QOL before the first chemotherapy, furthermore, the group of unemployment present poor functional QOL after the first chemotherapy. Finally, symptomatic QOL were grouped into 3 models with the factors of ER receptor status and surgery type of breast which also the significant variable toward trajectory analysis. The lowest symptomatic QOL occurred after the first chemotherapy on the group receiving total mastectomy, as well as the lowest symptomatic QOL showed in the middle of chemotherapy on the group receiving partial mastectomy. Breast cancer survivors and family not only suffer symptom distress but also need to enhance symptom-management self-efficacy in order to maintain quality of life since the diagnosis of cancer, thus they demand the physical and psychological support from medical team. Data generated from this study provide a beginning for future studies. Recommendations for future research include increasing measurement of time point and period that correlate significant variables and reveal trend during the whole period of cancer treatment. The implications for clinical practice is to understand the factors affecting the results of trajectory, and then to develop individualized care providing proper intervention in the right time to the certain group. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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