[[alternative]]Associated Factors of Sleep Quality in Ovarian Cancer Patients Receiving Chemotherapy

[[abstract]]研究目的：探討卵巢癌病人接受化學治療前、治療中、治療後其睡眠品質之變化及其相關影響因素。研究方法：採方便取樣，於北區某醫學中心之婦產科病房及門診進行收案，以接受化學藥物治療之卵巢癌病人為對象（n = 51），於病患開始接受化學治療前（Time 0）、第四次化學治療前（Time 1）及第六次化學藥物治療後至門診（Time 2），分別以結構式問卷進行資料收案。問卷內容有基本屬性、疾病治療特性、症狀困擾量表、流行病學研究中心憂鬱量表、一般自我效能量表及匹茲堡睡眠品質量表。以廣義線性模式進行資料分析。結果：卵巢癌病人在接受化學治療前中後，其睡眠品質整體得分隨化學治療時間延長無顯著變化，但在主觀睡眠品質及睡眠持續時間層面治療中（Time 1）優於治療前（Time 0）。影響卵巢癌病人睡眠品質因素有：（一）症狀困擾愈嚴重、愈憂鬱，其整體睡眠品質愈差。特別是在主觀睡眠品質、睡眠潛伏期、睡眠困擾、安眠藥使用及日間功能失調層面。（二）相較於教育程度為中小學畢業者，教育程度為高中職及研究所以上者，其睡眠潛伏期較短﹔相較於接受化學藥物處方Platinum-Paclitaxel組，接受Pegylated Liposomal Doxorubicin組有比較短的睡眠潛伏期。（三）相較於教育程度為中小學畢業者，教育程度為專科大學者，其睡眠困擾較多。（四）相較於無宗教信仰者，宗教信仰為佛教者的睡眠持續時間較長；相較於無工作者，有工作者的睡眠持續時間較長。（五）相較於教育程度為中小學畢業者，教育程度為研究所以上者，其睡眠效率較好；相較於無工作者，有工作者的睡眠效率較好﹔相較癌症分期為第一、二期者，癌症分期為第三期者的睡眠效率較好﹔相較於過去未曾接受治療者，曾接受放射線治療者的睡眠效率較差。（六）卵巢癌病人年齡愈大，其安眠藥使用頻率愈高；相較於家庭月收入為50,000以內者，家庭月收入50,000~100,000者，其安眠藥使用頻率愈高；相較於無癌症復發經驗者，有癌症復發經驗者，安眠藥使用頻率愈高；相較於接受化學藥物處方Platinum- Paclitaxel組，Topotecan組安眠藥使用頻率愈高。結論：透過本研究能瞭解卵巢癌病人隨接受化學治療隨時間延長，其睡眠品質之變化及其相關影響因素。未來臨床醫護人員，可從卵巢癌病人針對每個時間點接受化學治療，評估病人的睡眠品質並提供適當護理措施，降低卵巢癌病人生、心理症狀困擾，以利提高睡眠品質。[[abstract]]Objectives: To explore the sleep quality and the associate factors of sleep quality before, during, and after chemotherapy in women with ovarian cancer.Methods: This study was design with convenience sampling method, 51 women with ovarian cancer who is receive chemotherapy were enrolled in the study at a medical center in Taipei. The data was collect at three time points: before chemotherapy (Time 0), forth chemotherapy (Time 1) and return to outpatient department after sixth chemotherapy (Time 2). The assessment tools are following: the symptom distress scale, the Center for Epidemiologic Studies Depression Scale, the General Self Efficacy Scale and the Pittsburgh Sleeping Quality Index. Generalized Estimating Equations were utilized for data analysis. Results: The results of overall PSQI were not significantly change over time during the chemotherapy period. However, in parameter of subjective sleep quality and sleep duration showed significant improvements at forth cycle of chemotherapy (Time 1) than pre-chemotherapy (Time 0). Result of univariate GEE as follows: (1) higher symptom distress and higher depression are significantly correlated with poor overall PSQI, especially in parameter of subjective sleep quality, sleep latency, sleep disturbances, sleeping pills use and daytime dysfunction. (2) Patients with senior high school or master degree have a shorter sleep latency compare to elementary school or junior high school degree. Patients undergoing Pegylope Liposomal Doxorubicin chemotherapy have a shorter sleep latency compared to patients undergoing platinum-based and paclitaxel chemotherapy. (3) Patients with elementary or junior high school diploma tend to have more severe sleep disturbance compared to patients with a bachelor degree. (4) Buddhist patients tend to have a shorter sleep duration compared to those who are not religious. Patients who are currently employed have a shorter sleep duration compared to those who are unemployed. (5) Patients with senior high school or master degree have worse sleep efficiency compared to those with elementary or junior high school. Patients who are currently employed have worse sleep efficiency compared to those who are unemployed. Patients with FIGO stage III have worse sleep efficiency compared to those with FIGO stage I and stage II. Patients undergoing radiotherapy have a better sleep efficiency compared to those have not received cancer-related therapy. (6) Elderly patients tend to use sleeping pills more frequently. Patients with income between 50,000 to 100,000 NT dollars per month tend to use sleeping pills more frequently compare to those with income below 50,000 NT dollars. Patients with history of cancer recurrence tend to use sleeping pills more frequently compare to those without. Patients undergoing platinum-based and paclitaxel chemotherapy have the tendency to use sleeping pills more frequently compared to patients undergoing Topotecan chemotherapy. Conclusion: This study explored the quality of sleep during chemotherapy period and the associate factors of sleep quality. Clinical provider should assess routinely and provide adequate health care in different cycle of chemotherapy. Hence, we could enhance the sleep quality in ovarian cancer by improving their physical symptom and emotional status degree