| Objective:To understand the occurrence status of cancer-related fatigue in patients with laryngeal cancer after operation and to explore its influence on the quality of life of patients.To evaluate the effect of self-management intervention on patients with cancer-related fatigue after laryngeal cancer operation and its prospect in clinic.Methods:1.This study is divided into two parts.The first part is a cross-sectional study.A convenient sampling method is used.From May 2016 to October 2016,71 patients who met the criteria of inclusion and exclusion of ENT&HN Surgery Department in two Grade 3A hospitals in a certain province were selected as the study objects.The questionnaire was made up of general information questionnaire,cancer fatigue scale(CFS)and the Chinese version of FACT-H&N scale.According to the results of the investigation,the status of cancer induced fatigue in patients with laryngectomy and the relationship between them and the quality of life were analyzed.The second part is a kind of quasi-experiental study,using a convenient sampling method.The patients who were hospitalized in the department of otolaryngology and head and neck surgery at a Grade3A hospital in a province from November 2016 to October 2017 were selected as study subjects who were diagnosed with laryngeal cancer and received surgical treatment(total laryngectomy or partial laryngectomy).There were 64 effective participants who eventually met the inclusion and exclusion criteria and completed the entire study process,According to the time of admission,33 patients who came to hospital from November 2016 to April 2017 as control group and 31 patients from May to October2017 as intervention group.The control group received admission education,health assessment,perioperative nursing,discharge education and follow-up routine nursing.On the basis of routine nursing measures,the intervention group was given a self-management intervention program with fatigue self-management assistant manual as its intervention content 3 months after operation:the principle of self management strategy,the basic procedure of self management as the step,the combination of group learning and personality guidance.The basic process of group learning is to identify problems,formulate goals,find methods and make plans.The purpose of group learning is to develop patients'awareness of self-management and preliminary understanding of the fatigue Self-Management Assistance Manual.The basic procedure of personality guidance is to carry out the plan,to check the adjustment and to evaluate the effect.The purpose is to familiarize and strengthen the use of Fatigue self management assistant manual.On the third day after operation,the two groups used general information questionnaire,cancer fatigue scale(CFS)and the Chinese version of FACT-H&N to collect baseline data to compare whether there was comparability between the two groups.CFS was measured again one month after operation to understand the trend of cancer related fatigue in both groups.The effect of self-management intervention on cancer-related fatigue and quality of life was evaluated 3 months after operation.2.All the collected data were analyzed by SPSS17.0 statistical software.The measurement data in the general data are described by the mean±standard deviation,and the counting data are described by the frequency and the composition ratio.Analysis of correlation between cancer-induced fatigue and quality of life by Pearson correlation.The effect of cancer-related fatigue on quality of life of patients was analyzed by Multiple stepwise linear regression analysis.Two independent samples t test were used to compare the cancer-induced fatigue and quality of life between the intervention group and the control group before and after intervention.The comparison of the changes of cancer induced fatigue before and after the interventi.on of the two groups of patients by repeated measurement of variance analysis.Comparison of quality of life between control group and intervention group before and after intervention with matched sample t-test.Results:1.The results of cross-sectional study show:The total fatigue score of laryngeal cancer patients was(23.93±7.65),which was in the middle level.The score of emotional fatigue was the highest(55.99%),followed by somatic fatigue(36.87%)and cognitive fatigue(22.80%).The quality of life score of the patients was(70.24±11.51)and the total fatigue score and the scores of each dimension were negatively correlated with the total score of the FACT-H&N scale(P<0.05),and the multiple linear regression analysis showed that the physical fatigue dimension and the emotional fatigue dimension of the patients entered the equation(P<0.05).F=14.757(P<0.001),R~2=0.398.Somatic fatigue and emotional fatigue were the predictors of the decline in quality of life of the patients.Body fatigue contributes the most.2.The results of quasi-experiental study show that:Before intervention,there was no significant difference in general data of patients with cancer fatigue and quality of life between the two groups(P>0.05).The results of repeated analysis of variance showed that there was interaction between time and group about the intervention group and the control group in the total fatigue and fatigue of each dimension.There was no significant difference in total fatigue and dimension fatigue scores between the two groups before intervention(P>0.05),but there was significant difference in the scores of 1 month after operation(P<0.05)and 3 months after intervention(P<0.05).The degree was more obvious than that in the control group.In the intervention group,the scores of total fatigue and fatigue of all dimensions decreased at 1 month after operation,3 months after operation compared with those before intervention,3 months after operation and 1 month after operation.The difference was statistically significant(P<0.05).The cancer-related fatigue status of the patients in the intervention group was obviously improved.The scores of total fatigue and somatic fatigue in the control group decreased at 1month after operation,3 months after operation compared with those before intervention and 3 months after operation compared with 1 month after operation(P<0.05).The scores of emotional fatigue at 1 month after operation were not significantly different from those before intervention(P>0.05),but at 3 months after operation compared with those before intervention and 3 months after operation compared with 1 month after intervention,the difference was statistically significant(P<0.05).There was no significant difference in the scores of cognitive fatigue between 1 month after operation,3 months after operation and before intervention,3 months after operation and 1 month after operation(P>0.05).After intervention,the total score of quality of life and the scores of each dimension in the intervention group were higher than those in the control group(P<0.05).Before and after intervention,the total score of quality of life and the scores of each dimension in the intervention group were significantly different(P<0.05),and the scores of quality of life in the intervention group were improved after intervention.Compared with before intervention,the scores of other dimensions and total scores in the control group were significantly higher than those before intervention(P<0.05),except that there was no significant difference in the scores of emotional status dimension(P>0.05).Conclusion:Cancer-related fatigue is common in postoperative laryngeal cancer patients and is at a moderate level.Cancer-related fatigue,especially somatic fatigue and emotional fatigue,has an impact on the quality of life(QOL).Routine nursing measures played a certain role in relieving fatigue symptoms of patients,but little effect was achieved.Self-management intervention is beneficial to cultivate the consciousness of patients to manage diseases,to improve the initiative of patients to carry out related measures to alleviate cancer-related fatigue,to effectively improve the patient's cancer-induced fatigue status and improve the quality of life.This study shows that self-management intervention is feasible and effective,and it has certain reference value for clinical cancer patients with cancer-related fatigue. |
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