The Relationship Among Coping Style, Sleep Disturbances, Cancer-related Fatigue And Quality Of Life In The Gynecological Cancer Patients

Objectives:(1) To investigate the coping style, sleep disturbances, cancer-related fatigue and quality of life in patients who were hospitalized with gynecological cancer.(2) To explore the relationship among coping style, sleep disturbances, cancer-related fatigue and quality of life in the gynecological cancer patients; and to built a structural equation model among these factors, thus giving evidence for improving quality of life in gynecological cancer patients.Methods:608gynecological cancer patients from the Hunan Provincial Tumor Hospital, the Third Xiangya Hospital, the Second Xiangya Hospital and the Xiangya Hospital of Central South University between May and November2012were enrolled in our survey. The questionnaires contained demographic information sheet, Medical Coping Modes Questionnaire (MCMQ), Pittsburgh Sleep Quality Index (PSQI), Cancer Fatigue Scale (CFS), Functional Assessment of Cancer Therapy Generic scale(FACT-G). All data were analyzed by statistical analysis software package of SPSS (version13.0) and AMOS (Analysis of Moment Structures). Statistical methods included descriptive analysis, correlation analysis, one-way ANOVA, multiple linear regression and structural equation modeling analysis and so on.Results1676subjects were recruited into this study, and608(89.9%) subjects completed the questionnaires.2The score of quality of life in gynecological cancer patients, the total quality of life score was (70.17±13.39), physical dimension score was (19.53±5.46), family-social dimension score was (18.85±3.53), emotional dimension score was (17.00±4.76), functional dimension score was (14.78±5.92).3One-way ANOVA showed there were significant differences in quality of life scores among patients with different education levels, marriage status, places of residence, type of medical payment, stage of tumor, confidence of prognosis, satisfaction of treatment effect. Multiple linear regression showed marriage status, places of residence, stage of tumor, satisfaction of treatment effect entered the regression equation of quality of life in the gynecological cancer patients.4Pearson correlation analysis showed(1) Avoidance scores had positive correlation with2dimensions (family-social dimension and functional dimension) of quality of life (r=0.161; r=0.181, P values all<0.01), had negative correlation with physical dimension of quality of life(r=-0.099, P<0.05). Resignation scores had negative correlation with3dimensions (family-social dimension excluded) of quality of life (r=-0.477, r=-0.542; r=-0.332, P values all<0.01). Sleep disturbances scores had negative correlation with3dimensions (family-social dimension excluded) of quality of life (r=-0.497; r=-0.322; r=-0.358, P values all<0.01). Fatigue scores had negative correlation with3dimensions (family-social dimension excluded) of quality of life (r=-0.626; r=-0.503; r=-0.422, P values all<0.01).(2) Confrontation scores had positive correlation with avoidance scores and fatigue scores (r=0.195, P<0.01; r=0.081, P<0.05). Resignation scores had positive correlation with sleep disturbances scores and fatigue scores(r=0.277, r=0.516, P values all<0.01). Sleep disturbances scores had positive correlation with fatigue scores (r=0.452, F<0.01)5SEM showed that confrontation had direct positive effect on cancer-related fatigue ((β=0.067, P<0.05). Resignation had direct positive effect on sleep disturbances ((β=0.277, P<0.01) and cancer-related fatigue (β=0.425, P<0.01), and direct negative effect on quality of life (β=-0.364, P<0.01). Sleep disturbances had direct positive effect on cancer-related fatigue (β=0.332, P<0.011), and direct negative effect on quality of life (β=-0.286, P<0.01). Cancer-related fatigue had direct negative effect on quality of life (β=-0.497, P<0.01). Confrontation had indirect effect on quality of life via cancer-related fatigue; Resignation had indirect effect on quality of life via cancer-related fatigue and sleep disturbances. Conclusion1Education levels, marriage status, places of residence, type of medical payment, stage of tumor, confidence of prognosis, satisfaction of treatment effect are influencing factors for quality of life in gynecological cancer patients.2Avoidance scores had positive correlation with quality of life, resignation scores had negative correlation with quality of life. Sleep disturbances and cancer-related fatigue had negative correlation with quality of life.3Sleep disturbances and cancer-related fatigue had direct negative effect on quality of life. Coping styles had direct and/or indirect effect on quality of life in gynecological cancer patients, sleep disturbances and cancer-related fatigue, as mediated variables, can mediate the relationship between coping style and quality of life.