Kobe University Repository : Kernel タイトル Title 著者 Author(s) 掲載誌 巻号 ページ Citation 刊行日 Issue date 資源タイプ Resource Type 版区分 Resource Version 権利 Rights DOI JaLCDOI URL 外来がん化学療法を受ける患者の倦怠感の要因と生活行動に関する研究 : 決定木 (decision tree) による解析 (Decision Tree Analysis of Fatigue and Daily Activity in Outpatients Receiving Cancer Chemotherapy) 福田, 敦子 / 宇佐美, 眞 / 坂本, 憲広 / 田淵, 寛人 / 竹本, 菜保子 / 佐野, 彩香 / 南, 博信 神戸大学大学院保健学研究科紀要,28:21-40 2012 Departmental Bulletin Paper / 紀要論文 publisher http://www.lib.kobe-u.ac.jp/handle_kernel/81004825 PDF issue: 2019-03-09
decision tree 1 1 2 1 3 3 2 46 : Diagnosis Procedure CombinationDPC 19 1) 2) 3,4) 6099 5) 5686 6) 7-9) 10) 11) 12) quality of lifeqol 1 2 3
QOL 1980 13) Stage 14,15) 16) 17) 18) 19,20) 21) Performance StatusPS 22,23) 4,7,9,21-23) 24,25) 26 QOL 1 Piper's Integrated Fatigue Model 27) ADL Wessely et al s model 28) Winningham's psychoviological entropy model 29)
-- Piper's Integrated Fatigue Model 27) Winningham's psychobiological entropy model 28) Wessely general model 29) 1. 1. 21,30,31) 2. 32) 1. A 2. 2010 3 1 3 31 3. Performance Status(PS) 1) Piper Fatigue ScalePFS PFS Piper BF 13) 33,34) 4 / 22 010 10 013mild46moderate 710severe
2) Hospital Anxiety and Depression ScaleHADS HADS 35,36) 4 7 7 14 0 3 07 810 11 3) Pittsburgh Sleep Quality Index 37) PSQI-J 38) PSQI-J 1 7 7 0 3 0 21 PSQI-J 39) cut off point 5.5 PSQI-J 5.5 5.5 4) Activities of Daily Living ADLInstrumental Activity of Daily Living IADL 10 10 9,11) 4. 1) PFSHADSPSQI-J 2 2 Spearman 5% 2) AlbHb 24,25) 3) McNemar McNemar 5% 2 pruning 4 r 40) SPSS12.0J
-- 5. 1. 1 46 27 19 61.4±11.0 63.3±10.9 58.8±11.5 12 9 8 22 13 9 41 PS 010 1 14 214 36 42 9 3 34 40.5±108.0 0 669 37 29 1.
2. 1) PFS Piper Fatigue ScalePFS3.30±2.15 3.46±2.25 2.63±1.65 2PFS t 2.3 20.5, p=0.035 2. PFSPSQIHADS mild 60%moderate 30severe 8 2 2 PFS mildmoderate PFS 2) PSQI-J PSQI-J5.61±3.18 5.5 5.38±3.12 6.58±3.43 62.2% 2 2 3) HADS HADS 4.33±2.87 4.46±2.87 3 1 2 2 4) r=0.43, p<0.01r=0.50, p<0.01 r=0.36, p<0.05r=0.39, p<0.01 r=0.71, p<0.01
-- 3. 2 19 66.7%18/27 76.2%16/21 86.7%13/15 503/6 2. 4. 3-1
70.6% 26.5%61.8% 38.2%79.4% 32.4%41.2% 19.4%47.1% 20.6% p<0.05 3-1 84.2% 26.3%89.5% 52.6%94.7% 26.3%57.9% 15.8%p<0.05 73.3% 26.7%73.3% 26.7%p<0.05 68.4% 26.3%57.9% 26.3%84.2% 36.8% p<0.05 3-2 3-1. 3-2. 5 1) 3-a 84.216/19 53.38/15 14 3 58.37/12 66.74/6
-- 83.35/6 3-a. a 3 3-b 29.68/27 7 66.5 45.55/11 2 66.5 81.313/16 3-b. a 3
p<0.05 p<0.05 4 4. 2) 4-a 89.517/19 14 73.311/15 63.5 87.57/8 4-a. a 3
-- 4-b 7 48.813/27 76.910/13 71.410/14 60.5 5 4-b. a 3 p<0.05 4 3) -a 94.718/19 60.0 9/15 87.57/8 5-a. a 3
5-b 43.0 2 43 75.024/32 43 50.04/8 3 80.04/5 43 12 33.34/12 5-b. a 3 p<0.05 4) Alb 6 Alb Alb3.5Alb< 3.5Alb 3.5 g/dl 6 Alb 3.5 g/dl 50.014/28 Alb 3.5 g/dl 63.212/19 50.5 75.03/4 50.5 73.311/15 56.5 36.4% 4/11 Alb 3.5 g/dl 77.87/9 61.0 6
-- 6. a 3 p<0.05 p<0.05 p<0.05p<0.05 p<0.05p<0.05 4 5) 7-a 59.5 59.5 64.39/14 59.5 82.414/17 59.5 753/4 59.5 808/10 7-b 68.5 68.5 90.120/22 68.5 45 19 68.5 41.75/12 68.5 76.5 76.5 505/10 p<0.05 p<0.05 p<0.05p<0.05 p<0.05 4
7-a. a 3, Alb, Hb 3 7-b. a 3 41) PS
-- 1. 23) 21) 2,3) 42) 2. 43) 44) (multi track) 45) 21,46 9)
Alb 3.5 g/dl Alb 47,48) 49) Alb 21 PS 2 PS3 1 PS t F 22,23 3.
-- Alb 3.5g/dl 1 261233-1239 2011. 2 Prue G, Rankin J, Allen J, et al. Cancer-related fatigue: A critical appraisal. Eur J Cancer 42:846-63, 2006. 3 Tavio M, Milian I, Tirelli U. Cancer-related Fatigue (review). Int J Oncol 21: 1093-1099, 2002. 4 5429-9332008 5 Irvine DM, Vincent L, Bubela N, et al. A critical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nurs 14:188-99, 1991. 6 Love RR, Leventhal H, Easterling DV, et al. Side effects and emotional distress during chemotherapy. Cancer 63:604-612, 1989. 7 19 41-572003 8 Meyerowitz BE, Watkins IK, Sparks FC. Quality of life for breast cancer patients receiving adjuvant chemotherapy. Am J Nurs 83:232-235, 1983. 9 2553-612004 10 11277-2852001 11: 17186-1892012 12Nynke de Jong, Arnold D.M. Kester, Harry C. Schouten, et al. Course of fatigue between two cycles of adjuvant chemotherapy in breast cancer patients. Cancer Nurs 29:467-477, 2006. 13Piper BF, Dibble SL, Dodd MJ, et al. The revised piper fatigue scale; psychometric evaluation in women with breast cancer. Oncol Nurs Forum 25:677-684, 1998. 14Matthews CE, Wilcox S, Hanby CL, et al. Evaluation of a 12-week home-based walking intervention for breast cancer survivors. Support Care Cancer 15:203-211, 2007. 15Daley AJ, Crank H, Saxton JM, et al. Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol 25:1713-1721, 2007.
16Berger AM, Farr LA, Kuhn BR, et al. Values of sleep/wake, activity/rest, circadian rhythms, and fatigue prior to adjuvant breast cancer chemotherapy. J Pain Symptom Manage 33:398-409, 2007. 17Cancer Fatigue Scale 9-31 H9 47-591997 18 356-360 2004 19 31 141-1432001 20 35 21-232004 21 2072-79 2006 22 2417-222003 23 Kitakanto Medical Society 5863-692008 24J.R.AI C4.51995 25 pp.96-1272001 26 11180-1882010 27Piper BF, Lindsey AM. Lindsey, Dodd MJ. Fatigue mechanisms in cancer patients. developing nursing theory. Oncol Nurs Forum 14:17-21, 1987. 28Wessely, S., Hotopf, M. and Sharpe, M. Chronic Fatigue and its Syndromes, 1st ed. Oxford, England: Oxford University Press, 1998. 29Winningham, M.L., Nail,L.M., Burke,M.B.,et al Fatigue and the cancer experience: The state of the knowledge. Oncol Nurs Forum 21:23-36, 1994. 30 2963-702008 31Agnes Glaus, Rosemary crow and cean Hammond. A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. Support Care Cancer 4:82-96, 1996. 32 49-562004 33Piper 1550-511999 34 1348-59 1999 35Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychat Scand 67: 361-370, 1983. 36Zigmond AS, Snaith RP,. Hospital anxiety and depression scalehad. 4371-3721993 37Buysse DJ, Reynolds III CF, Monk TH, et al. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28: 193 213. 1989.
-- 38 13755 7631998 39Yuriko Doi, Masumi Minowa, Makoto Uchiyama, et al. Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects. Psychiatry Res 97: 165-172, 2000. 40http://www.r-project.org/ 41. MBE, ME 11113-17 2011 42Berger AM, Lockhart K, Agrawal S. Variability of patterns of fatigue and quality of life over time based on different breast cancer adjuvant chemotherapy regimens. Oncol Nurs Forum 36:563-570, 2009. 43A.H. 1987 44 2006 45. A 31-182004 46Barsevick AM, Dudley W, Beck S. A randomized clinical traial of energy conservation for patients with cancer-related fatigue. Cancer 100:1302-1310, 2004. 47 64215-2192011 48Morley, J. E., Glick, Z., Rubenstein, L. Z. Nutritional assessment. Geriatric Nutrition-A Comprehensive Review. Raven press, Newyork, 81-82, 1995. 49. Topic 26 26:917-934, 2011
Decision Tree Analysis of Fatigue and Daily Activity in Outpatients Receiving Cancer Chemotherapy Atsuko Fukuda 1, Makoto Usami 1, Norihiro Sakamoto 2, Hiroto Tabuchi 1, Naoko Takemoto 3, Ayaka Sano 3, Hironobu Minami 2 Abstract The purpose of this study is to clarify the factors consisting of the fatigue in outpatients receiving cancer chemotherapy and to provide the suitable information for nursing support for these patients. Decision tree analysis was performed to explore the relationship among the fatigue in cancer patients receiving chemotherapy, patients demographic and laboratory data, and daily activities. The relationship was compared in between when patients were fatigued and were fine. As a result, the factors related to the fatigue were female, symptoms other than fatigue and previous chemotherapy treatment. Daily activities differed when patients have fatigue or not. When they had fatigue, patients reduced or minimized cleaning, washing, shopping, and social and physical activity in order to conserve the energy to live. Daily activities essential for living such as eating, bathing, and sleeping were done as usual with fatigue. It was suggested that nursing support for outpatients receiving cancer chemotherapy requires to help their daily activities and basic needs and to give enough information following results indicated in this study. Furthermore, decision tree analysis could be an effective tool for studies involving categorizing and predicting in the research for nursing. Key Words: Cancer chemotherapy, Outpatient, Fatigue, Daily activity, Decision tree analysis 1 Kobe University Graduate School of Health Sciences 2 Kobe University Graduate School of Medicine 3 Kobe University Hospital