A trajectory study of sleep and related symptoms in breast cancer patients based on ecological momentary assessment

doi:10.3761/j.issn.0254-1769.2019.10.003

Abstract

Abstract: Objective To construct the Symptom Assessment Platform based on ecological momentary assessment and explore the trajectory and correlation of sleep and symptoms in breast cancer patients during chemotherapy by the platform.Methods We developed the Symptom Assessment Platform based on ecological momentary assessment and analyzed the correlation between sleep and fatigue,anxiety,depression,nausea,vomiting,pain in 60 breast cancer patients by self-monitoring and experience-sampling method.Results Sleep quality,sleep efficiency,number of wake-ups and fatigue,anxiety,depression,nausea,vomiting and pain in breast cancer patients aggravated sharply on the 2nd day,peaked on the 2nd to 4th day,then gradually improved. There were different degrees of correlation between sleep quality,number of wake-ups and symptoms. Number of wake-ups were significantly related to fatigue on day 1 and day 7 during chemotherapy（r=0.613,P<0.01;r=0.780,P<0.01）. Sleep quality（r=-0.439,P<0.05） and sleep efficiency（r=-0.471,P<0.05） were lowly related to anxiety and depression on day 2 during chemotherapy.Conclusion The symptoms of breast cancer patients showed trends which begin with clinical deterioration and turn to be relieved during chemotherapy,and there were different degrees of correlation at different times. The assessment of symptoms based on ecological momentary assessment might be a better way for cancer care.

Key words: Breast Neoplasms, Sleep, SYMPTOMS & SIGNS;, Ecological Momentary Assessment, Nursing Assessment

摘要： 目的构建基于生态瞬时评估法的症状评估平台,并以该平台为依托,探究乳腺癌患者化疗期间睡眠状况与相关症状的变化轨迹及关联度。方法开发基于生态瞬时评估法的症状评估平台,以该平台为研究工具,采用自我监控法和便利取样法对60例乳腺癌患者化疗后1周的睡眠状况,以及疲乏、焦虑抑郁、恶心呕吐、疼痛症状进行持续监测,分析睡眠与症状变化趋势及相关性。结果乳腺癌患者化疗后1周内,睡眠状况与疲乏、焦虑抑郁、恶心呕吐、疼痛症状在第2天急剧加重,在第2~4天达到高峰,随后逐渐缓解;睡眠状况与症状、症状与症状之间均存在不同程度的关联,其中醒来次数与疲乏在化疗第1天和第7天（r=0.613,P<0.01;r=0.780,P<0.01）呈显著相关,睡眠质量（r=-0.439,P<0.05）和睡眠效率（r=-0.471,P<0.05）与化疗第2天的焦虑抑郁呈低度相关。结论乳腺癌患者化疗期间睡眠与相关症状均呈现先恶化后缓解的趋势,并且在不同时间存在不同程度的关联,也说明基于生态瞬时评估法的症状评估平台能够在一定程度上实现症状的精准化评估。

关键词: 乳腺肿瘤, 睡眠, 症状和体征, 生态瞬时评估法, 护理评估

SHANG Zimo, WU Jing, ZHOU Jie. A trajectory study of sleep and related symptoms in breast cancer patients based on ecological momentary assessment[J]. Chinese Journal of Nursing, 2019, 54(10): 1456-1462.

尚子妺, 吴静, 周洁. 乳腺癌患者睡眠及相关症状的轨迹研究[J]. 中华护理杂志, 2019, 54(10): 1456-1462.

Figures/Tables 10

References 27

[1]	李贺, 郑荣寿, 张思维 , 等. 2014年中国女性乳腺癌发病与死亡分析[J]. 中华肿瘤杂志, 2018,40(3):166-171.
[2]	Partridge AH, Rumble RB, Carey LA , et al. Chemotherapy and targeted therapy for women with human epidermal growth factor receptor 2-negative(or unknown) advanced breast cancer:American society of clinical oncology clinical practice guideline[J]. J Clin Oncol, 2014,32(29):3307-3329.
[3]	中国女医师协会临床肿瘤学专业委员会. 中国进展期乳腺癌共识指南(CABC 2015)[J]. 癌症进展, 2015(3):223-245.
[4]	Palesh OG, Collie K, Batiuchok D , et al. A longitudinal study of depression,pain,and stress as predictors of sleep disturbance among women with meta-static breast cancer[J]. Biol Psychol, 2007,75(1):37-44.
[5]	Mao HJ, Bao T, Shen XY , et al. Prevalence and risk factors for fatigue among breast cancer survivors on aromatase inhibitors[J]. Eur J Cancer, 2018,101:47-54.
[6]	Pedraza-Flechas AM, Lope V, Moreo P , et al. Sleep patterns,sleep disorders and mammographic density in Spanish women:the DDM-Spain/Var-DDM study[J]. Maturitas, 2017,99:105-108.
[7]	Jung D, Lee KM, Kim WH , et al. Longitudinal association of poor sleep quality with chemotherapy-induced nausea and vomiting in patients with breast cancer[J]. Psychosom Med, 2016,78(8):959-965.
[8]	Liu LQ, Rissling M, Natarajan L , et al. The longitudinal relationship between fatigue and sleep in breast cancer patients undergoing chemotherapy[J]. Sleep, 2012,35(2):237-245.
[9]	Berger AM, Wielgus K, Hertzog M , et al. Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy[J]. Support Care Cancer, 2010,18(1):105-114.
[10]	Fontes F, Gonçalves M, Pereira S , et al. Neuropathic pain after breast cancer treatment and its impact on sleep quality one year after cancer diagnosis[J]. Breast, 2017,33:125-131.
[11]	Stone AA, Shiffman S . Ecological momentary assessment(ema) in behavioral medicine[J]. Ann Behav Med, 1994,16(3):199-202.
[12]	吴静, 吴彩琴, 董璐 , 等. 生态瞬时评估法的研究策略及在护理领域的应用现状[J]. 解放军护理杂志, 2017,34(9):59-62.
[13]	Ho SY, Rohan KJ, Parent J , et al. A longitudinal study of depression,fatigue,and sleep disturbances as a symptom cluster in women with breast cancer[J]. J Pain Symptom Manage, 2015,49(4):707-715.
[14]	Miller CB, Kyle SD, Marshall NS , et al. Ecological momentary assessment of daytime symptoms during sleep restriction therapy for insomnia[J]. J Sleep Res, 2013,22(3):266-272.
[15]	艾中平, 周建荣 . 乳腺癌化疗相关症状随疗程的变化趋势[J]. 中国老年学杂志, 2013,33(10):2346-2348.
[16]	Zou LY, Yang L, He XL , et al. Effects of aerobic exercise on cancer-related fatigue in breast cancer patients receiving chemotherapy:a meta-analysis[J]. Tumour Biol, 2014,35(6):5659-5667.
[17]	时璇, 林细吟, 刘可 , 等. 乳腺癌术后化疗患者睡眠质量及相关因素分析[J]. 护理学报, 2012,19(6):67-70.
[18]	朱素文, 许勤, 蒋明 , 等. 乳腺癌化疗患者睡眠质量的调查分析[J]. 护理管理杂志, 2011,11(3):184-185.
[19]	Ancoli-Israel S, Liu LQ, Rissling M , et al. Sleep,fatigue,depression,and circadian activity rhythms in women with breast cancer before and after treatment:a 1-year longitudinal study[J]. Support Care Cancer, 2014,22(9):2535-2545.
[20]	Beck SL, Berger AM, Barsevick AM , et al. Sleep quality after initial chemotherapy for breast cancer[J]. Support Care Cancer, 2010,18(6):679-689.
[21]	Berger AM, Higginbotham P . Correlates of fatigue during and following adjuvant breast cancer chemotherapy:a pilot study[J]. Oncol Nurs Forum, 2000,27(9):1443-1448.
[22]	钟代曲, 程晓东, 沈盈盈 , 等. 脑卒中患者网络化管理系统的设计及应用效果研究[J]. 中华护理杂志, 2018,53(7):783-788.
[23]	赵正清, 钱进军, 莫永珍 , 等. 移动居家护理平台对妊娠糖尿病患者血糖与生活质量的影响[J]. 护士进修杂志, 2018,33(6):490-492,496.
[24]	吴玲, 羊丽芳, 李菊云 , 等. 永久性肠造口居家护理平台的设计及在江苏省的应用[J]. 中华护理杂志, 2017,52(10):1192-1194.
[25]	金艾香, 陈肖敏, 章小飞 , 等. 乳腺癌患者术后康复训练虚拟现实系统的设计及应用[J]. 中华护理杂志, 2018,53(2):168-172.
[26]	贾静, 徐晶晶, 仇晓溪 . 医院-社区-家庭失禁护理平台在压力性尿失禁患者管理中的应用研究[J]. 中华护理杂志, 2018,53(5):533-536.
[27]	Burke LE, Shiffman S, Music E , et al. Ecological momentary assessment in behavioral research:addressing technological and human participant challenges[J]. J Med Internet Res, 2017,19(3):e77.

项目	例数	百分比（%）	项目	例数	百分比（%）
文化程度			癌症分期（期）
初中及以下	20	33.3	Ⅰ~Ⅱ	42	70.0
高中/中专	23	38.3	Ⅲ~Ⅳ	18	30.0
大专/本科	17	28.4	手术方式
婚姻状况			无	10	16.7
未婚	3	5.0	保乳术	9	15.0
已婚	53	88.3	根治术/改良根治术	14	23.3
离异/丧偶	4	6.7	单纯乳房切除术	27	45.0
职业			化疗方案
在职	21	35.1	EC-T/P^1）、TC/AC-T^2）	52	86.6
退休	27	45.0	DP/GP/PC^3）	8	13.4
个体	5	8.3	转移部位
其他	7	11.6	无	36	60.0
家庭人均收入（元）			淋巴转移	22	36.7
<3 000	8	13.4	其他	2	3.3
3 000~	27	45.0	合并症
>5 000	25	41.7	无	49	81.7
居住地			有	11	18.3
省城	42	70.0
地级市	5	8.3
城镇/农村	13	21.7

项目	例数	百分比（%）	项目	例数	百分比（%）
文化程度			癌症分期（期）
初中及以下	20	33.3	Ⅰ~Ⅱ	42	70.0
高中/中专	23	38.3	Ⅲ~Ⅳ	18	30.0
大专/本科	17	28.4	手术方式
婚姻状况			无	10	16.7
未婚	3	5.0	保乳术	9	15.0
已婚	53	88.3	根治术/改良根治术	14	23.3
离异/丧偶	4	6.7	单纯乳房切除术	27	45.0
职业			化疗方案
在职	21	35.1	EC-T/P^1）、TC/AC-T^2）	52	86.6
退休	27	45.0	DP/GP/PC^3）	8	13.4
个体	5	8.3	转移部位
其他	7	11.6	无	36	60.0
家庭人均收入（元）			淋巴转移	22	36.7
<3 000	8	13.4	其他	2	3.3
3 000~	27	45.0	合并症
>5 000	25	41.7	无	49	81.7
居住地			有	11	18.3
省城	42	70.0
地级市	5	8.3
城镇/农村	13	21.7

项目	焦虑抑郁			疼痛			恶心呕吐			疲乏
项目	回归系数	OR值	P值	回归系数	OR值	P值	回归系数	OR值	P值	回归系数	OR值	P值
睡眠效率	-0.024	0.977	0.173	-0.012	0.988	0.117	0.001	1.001	0.903	0.006	1.006	0.321
睡眠质量	-0.323	0.724	0.031	-0.040	0.961	0.760	-0.098	0.906	0.374	0.004	1.004	0.973
醒来次数	-0.009	0.991	0.951	-0.261	0.770	0.018	-0.420	0.657	0.025	0.327	1.387	0.008
焦虑抑郁	-	-	-	0.179	1.196	0.361	0.372	1.450	0.001	0.186	1.205	0.068
疼痛	0.983	2.672	0.001	-	-	-	-0.158	0.854	0.318	-0.108	0.897	0.515
恶心呕吐	0.045	1.046	0.801	-0.066	1.160	0.513	-	-	-	0.373	1.452	<0.001
疲乏	0.321	1.379	0.016	-0.389	0.678	0.010	0.542	1.720	<0.001	-	-	-

项目	焦虑抑郁			疼痛			恶心呕吐			疲乏
项目	回归系数	OR值	P值	回归系数	OR值	P值	回归系数	OR值	P值	回归系数	OR值	P值
睡眠效率	-0.024	0.977	0.173	-0.012	0.988	0.117	0.001	1.001	0.903	0.006	1.006	0.321
睡眠质量	-0.323	0.724	0.031	-0.040	0.961	0.760	-0.098	0.906	0.374	0.004	1.004	0.973
醒来次数	-0.009	0.991	0.951	-0.261	0.770	0.018	-0.420	0.657	0.025	0.327	1.387	0.008
焦虑抑郁	-	-	-	0.179	1.196	0.361	0.372	1.450	0.001	0.186	1.205	0.068
疼痛	0.983	2.672	0.001	-	-	-	-0.158	0.854	0.318	-0.108	0.897	0.515
恶心呕吐	0.045	1.046	0.801	-0.066	1.160	0.513	-	-	-	0.373	1.452	<0.001
疲乏	0.321	1.379	0.016	-0.389	0.678	0.010	0.542	1.720	<0.001	-	-	-

化疗时间	变量	回归系数	标准误	标准回归系数	t值	P值
第1天	疼痛	-0.055	0.356	-0.022	-0.154	0.878
	疲乏	-0.173	0.243	-0.122	-0.711	0.480
	焦虑抑郁	0.018	0.352	0.009	0.052	0.958
	恶心呕吐	-0.463	0.535	-0.120	-0.865	0.391
第2天	疼痛	-0.259	0.265	-0.125	-0.976	0.333
	疲乏	-0.005	0.217	-0.004	-0.021	0.983
	焦虑抑郁	-0.812	0.330	-0.439	-2.462	0.017
	恶心呕吐	0.255	0.326	0.130	0.782	0.438
第3天	疼痛	0.062	0.224	0.031	0.276	0.784
	疲乏	-0.162	0.143	-0.190	-1.130	0.263
	焦虑抑郁	-0.490	0.207	-0.370	-2.365	0.022
	恶心呕吐	-0.152	0.197	-0.115	-0.771	0.444
第4天	疼痛	-0.109	0.180	-0.086	-0.605	0.548
	疲乏	0.044	0.150	0.053	0.292	0.771
	焦虑抑郁	-0.315	0.244	-0.230	-1.287	0.204
	恶心呕吐	-0.251	0.183	-0.222	-1.376	0.175
第5天	疼痛	-0.077	0.235	-0.059	-0.330	0.743
	疲乏	0.043	0.172	0.055	0.253	0.801
	焦虑抑郁	-0.265	0.251	-0.216	-1.058	0.295
	恶心呕吐	-0.152	0.202	-0.134	-0.750	0.456
第6天	疼痛	0.181	0.309	0.104	0.583	0.562
	疲乏	-0.178	0.203	-0.191	-0.874	0.386
	焦虑抑郁	0.056	0.330	0.032	0.171	0.865
	恶心呕吐	-0.041	0.266	-0.026	-0.154	0.878
第7天	疼痛	0.212	0.362	0.116	0.587	0.560
	疲乏	0.077	0.246	0.072	0.311	0.757
	焦虑抑郁	-0.325	0.421	-0.160	-0.770	0.445
	恶心呕吐	0.130	0.351	0.066	0.372	0.712