Một đề tài fulltext về chủ đề mới lạ: nhận thức và tập luyện thể dục sau phẫu thuật ung thư vú. Ung thư vú là dạng ung thư phổ biến nhất ở phụ nữ. Các bằng chứng khoa học cho thấy vận động thể lực có nhiều lợi ích về tâm lý và thể chất cho người sống sót sau phẫu thuật ung thư vú. Nghiên cứu có tổng cộng 121 bệnh nhân tham gia vào nghiên cứu. Kết quả cho thấy hầu hết bệnh nhân có nhận thức kém về tập luyện thể dục thể thao sau phẫu thuật ung thư vú. Trong vòng 7 ngày đầu sau phẫu thuật tỷ lệ tập luyện thể dục là 86,78%. Tỷ lệ tập luyện thể dục sau >= 6 tuần cũng rất cao. Nghiên cứu có trích dẫn Endnote đầy đủ là nguồn tài liệu tham khảo hay cho sinh viên ngành y.
美美美美美美 美美美美美美美 美美美美 PERCEPTIONS AND PREVALENCE OF EXERCISES AMONG BREAST CANCER SURVIVORS AT ONCOLOGY HOSPITAL, HO CHI MINH CITY 研研研研Mai Thi Minh Nguyet 研研研研研Shiow – Li Hwang 美美美美 103 美 07 美 PERCEPTIONS AND PREVALENCE OF EXERCISES AMONG BREAST CANCER SURVIVORS AT ONCOLOGY HOSPITAL, HO CHI MINH CITY Graduate student: Mai Thi Minh Nguyet Supervisor& Committee: Professor: Shiow- Li Hwang Meiho University Graduate Institute of Health care Thesis A thesis submitted to the Graduate Institute of Health Care of Meiho University In partial fulfillment of the requirement for the degree of Master of Health Care July 2014 Abstract Background: Breast cancer is the most common cancer among women both in the developed and developing countries with an estimation of 521,817 deaths in 2012 worldwide Scientific evidence showed that physical activity could have physiological and psychological benefits toward breast cancer survivors In Vietnam, breast cancer is also the most common cancer among women across the country An existing problem in breast cancer management in Vietnam is that a large amount of breast cancer cases are lately diagnosed and the rate of late diagnosis is up to 49.5% that predispose to difficulty in treatment regimens and reduced effectiveness of breast cancer treatment Another concern comes from the fact that survivors after breast surgery not receive adequate health cares, especially those related to physical activity, to prevent the recurrence of breast cancer Objective: The aim of the study was to describe perceptions on physical activity and the prevalence of exercise performance after surgery among breast cancer survivors Methods: The study was a cross-sectional study carried out in Oncology Hospital, Ho Chi Minh city from January to February 2014 The Health Belief Model was applied in the study to investigate the perceptions of patients The exercise performances of patients were recorded through three interval time after surgery including the first seven days, first weeks and beyond weeks The significance of the results was assessed by ANOVA test, t-test and Chi-Square test at p-value of 0.05 using SPSS version 16 Results: There were a total of 121 patients enrolled in the study The mean age of all breast cancer survivors was 52.75 ± 10.60 Most of patients had the level of education was secondary school or over The mean family income of participants was 4.15 ± 3.71 (1-20) In general, the proportion of patients perceived toward suggestion of performing exercises and barriers of performing exercises were not high Other perception including perceptions of possibility of recurrence of breast cancer, perceptions of severity of breast cancer, perceptions of social support reached at average level, while perception of the benefits of performing exercises gained high level The results showed that in three different phases after surgery, exercise performance among patients was surprising high In the first seven days, the rate of performing exercises was 86.78% In the same token, the rates in the weeks and beyond six weeks were considerable high (94.21% and 82.64%, respectively) Age, education, and marital status had showed significant associations with exercises performance at the first weeks In addition, perceptions of benefits of exercises performance and the prevalence of exercises performance beyond weeks had a statistical significance (p=0.03) Conclusion: Most of aspects in the perceptive model had low percentage of patients being aware of, except perceptions of benefits of exercise performance Patients had high prevalence of performing exercises; however, types of recommended exercises and sports were not abundant and patients did not receive the instructions from healthcare workers, especially in the prolonged stage after surgery The data also showed that perception of benefits of exercise performance had a strong relationship with the prevalence of exercising; therefore education or training on benefits of physical activity on preventing breast cancer was supposed to have positive impacts on prevalence of doing physical activity among breast cancer survivors Key words: breast cancer, exercise, perceptions Acknowledgements This thesis was carried out at Nguyen Tat Thanh University and Meiho University under the guidance of my supervisor, Dr Shiow-li Hwang, and Dr TsueyHuang I would like to express my deep gratitude to my supervisor and other professors who had spent their precious time to instruct and facilitate me complete this thesis I would like to send my thanks to all authors of published works cited in the thesis for providing valuable resources and related knowledge during my studying I would like to give my special thanks to the Director Board, Science Council, Ethical Council, doctors and nurses of the Oncology Hospital for their endless supports in helping me fufill the thesis My thanks also gave to officers of the International and Postgraduate Training Department of Nguyen Tat Thanh University, scientists from the Meiho University, and my classmates who had provided administrative supports and encouragement during my studying There is no success without supports, more or less or directly or indirectly, from others individuals From the beginning to the end of my studying, I had received lots of concerns and supports from my best friends and colleagues With the gratefulness from bottom of my heart, I would like to thank Mr Lam, Dr Cang, Dr Cu and health care staff of Oncology Department and Nursing Deparment of 30/4 Hospital I never foget what my best friends (Minh, Mai, Xuan and Nga) had done to me during hard working days for data collection I would like to be grateful to participants in the study who although suffered physical and mental pains as well as numerous concerns in daily life had spent their valuable time to provide important information those will be used to help other patients receive better health care All of those made a strong motivation to me in completion of the study Finally, my deep gratitude was sent to my beloved husband and two sons, my close friends and colleagues who always encourage, concern and share many aspects of life to me and those made myself more confident to finish my thesis List of tables Page List of figure Page Contents Page Chapter Introduction 1.1 Statement of this research Breast cancer is the most common cancer among women both in the developed and developing countries (Ferlay et al., 2012) It is estimated that worldwide 521,817 women died in 2012 due to breast cancer (Ferlay et al., 2012) Incidence rates vary greatly worldwide from 27 per 100,000 in Middle Africa and Eastern Asia to 96 in Western Europe In most of developing regions the incidence rates are below 40 per 100,000 (Ferlay et al., 2012) The lowest incidence rates are found in most African countries but here breast cancer incidence rates are also increasing Breast cancer survival rates are also reported with a wide range from ≥ 80% in North America, Sweden and Japan to around 60% in middle-income countries and below 40% in lowincome countries (Coleman, 2008) Physical activity is an important contributor to health and the related outcome of quality of life (Farrell, Braun, & Barlow, 2002) One health condition that appears to benefit from a physically active lifestyle is cancer Both physical and psychological benefits are associated with physical activity for cancer survivors Indeed, multiple studies during the past 20 years, coming from North America, Europe, Asia, and Australia, have demonstrated that physical activity contribute to decrease the risk of breast cancer among female populations A 2008 review reported that physical activity was associated with a 25 to 30% decrease in risk of developing breast cancer (Friedenreich & Cust, 2008), while a systematic review reported a 15 to 20% reduction in risk of breast cancer with higher physical activity, and a risk reduction of about 6% per hour of physical activity per week (Monninkhof et al., 2007) The results from the Nurses’ Health Study cohort and the Health, Eating, Activity and Lifestyle Study showed that women who are physically active after a breast cancer diagnosis are at lower risk of a recurrence and death caused by breast cancer (Holmes, Chen, Feskanich, & et al, 2005) In addition, physical activity play an important role in reducing fatigue, breast cancer-related lymphoedema, physical ability and healthrelated of life of breast cancer survivors (Headley, Ownby, & John, 2004; Johansson, Tibe, & Weibull, 2005; Mutrie, Campbell, & Whyte, 2007; Turner, Hayes, & Reul8 Hirche, 2004) In Vietnam, breast cancer is also the most common cancer among women across the country In 2012, there were approximately 11,067 new cases of breast cancer and the incidence rate was 23 per 100,000 women The number of deaths due to breast cancer was 4,671 cases and the mortality rate was 9.9 per 100,000 women (Ferlay et al., 2012) A 2012 report showed that Ha Noi and Ho Chi Minh are two cities in which breast cancer prevalence are highest Namely, the breast cancer prevalence in Ha Noi is approximately 30 per 100,000 women and in Ho Chi Minh city is 20 per 100,000 women (bachmaihospital, 2012) A review of Oncology Hospital, Ho Chi Minh showed that breast cancer was accounted for 17.7% of all cases of cancer among women in the period of 1998-1999; however, it increased up to 19.7% between 2003 and 2004 (Nguyen, Le, Pham, & Dang, 2008) An existing problem in breast cancer management in Vietnam is that a large amount of breast cancer cases are lately diagnosed and the rate of late diagnosis is up to 49.5% that predispose to difficulty in treatment regimens and reduced effectiveness of breast cancer treatment Another concern comes from the fact that survivors after breast surgery not receive adequate health cares, especially those related to physical activity, to prevent the recurrence of breast cancer Indeed, there are lack of consultations for survivors about how to and to what extent the exercises are done during three to seven days after surgery Consequently breast cancer survivors not recognize the importance of physical activity and they are reluctant to practice recommended exercises As they are discharged, there are not any instructions on how to perform physical activities at home provided and health facilities where survivors are treated not follow up their performance of physical activities as well 1.2 Significance of this research The Oncology Hospital in Ho Chi Minh city is one of the largest hospitals in the country that serves as the main cancer center for treatment of patients from the southern of Vietnam It is estimated that 5,243 patients who have hospital admission for treatment of all kinds of cancer at the hospital each year; of these there are 15% women who have suffered and be treated breast cancer After breast surgery, patients are participated in a physiotherapy program in which health care workers instruct patients to perform proper breathing and physical activities These activities are very important for patients to prevent atelectasis, pneumonia, scar contracture and improve the quality of life of patients as well For the first to days after surgery, patients should follow a designed program including essential exercises such as deep breathing, moderate movement of affected arm, and cool-down exercises For six weeks after surgery, patients continue performing the recommended exercises at home and begin to practice jogging for 20 to 30 minutes each day After four months, patients are asked to revisit the hospital for check-up health condition and receive more consultations on physical activities The program has been established and applied for many years but the effectiveness has not been evaluated yet In fact, during the first week after surgery, the performance of recommended exercises of patients could not be assessed because of unknown reasons Moreover, not all patients were instructed and received consultations on physical activity due to the fact that health care workers could not take care of all patients There are not any surveys or studies conducted to investigate what patients have learnt from the program and what they thought about the exercises (unlike or frustrated towards the exercises) Finally patients not report their performance of exercises at home so the evaluation of effectiveness of the program is impossible To get the answers for all of these questions, a study therefore is necessary 1.3 The aim of this research The aim of the present study was to describe perceptions of patients on physical activity after breast surgery and prevalence of exercises performance The following research objectives address the overall aim of this study To describe the perceptions of physical activity among breast cancer survivors To describe prevalence of exercise performance among breast cancer survivors To identify the association between perceptions and other potential factors and performance of exercises among breast cancer survivors 1.4 Chapter summary Breast cancer is one of the most frequent cancers among women with the average 10 Wolf, A M., Wolf, D., & Rumpold, H (2004) Adiponectin induces the antiinflammatory cytokines IL-10 and IL-1RA in human leukocytes Biochem Biophys Res Commun, 323, 630-635 Yu, H., & Rohan, T E (2000) Role of the insulin-like growth factor family in cancer development and progression Journal of Natl Cancer Inst., 92 (18), 14721489 91 Appendix The questionnaire ID No.: Date of investigation:…… ……… THE QUESTIONAIRE FOR INVESTIGATION PERCEPTIONS AND PREVALENCE OF EXERCISES AMONG BREAST CANCER SURVIVORS A A1 A2 A3 A4 A5 SOCIODEMOGRAPHIC CHARACTERISTIC Date of birth Education Family Income Marital status Occupation Illiterature Elementay school Secondary school High school Graduate Postgraduate .dong/mo nth Married/Living with partner Single Disvorced Widow White collar workers Blue collar workers Housekeepers Manual labor Others B GENERAL HEALTH INFORMATION B1 Weight kg B2 Height m B3 BMI kg/m2 92 B4 Menopause status Comorbidities B5 (Multiple B8 Alcohol consumption C2 C3 C4 C5 C6 C7 Post-menopause Diabetes mellitus Immune diseases Other chronic diseases cancer Cigarret smoking C1 Pre-menopause Detail…………… Family history of breast Yes B7 C choices Kidney failure question) B6 Not yet No Yes No Yes No BREAST CANCER TREATMENT Have you ever received Yes chemotheray? No Have you ever received Yes radiotherapy? No Have you ever received Yes immunotherapy? Have you ever No used Yes tamoxifen? No Mastectomy Type of surgery Consevation Others Interval from surgery to study enrollment Recurrence of breast cancer months Yes No 93 D PERCEPTION OF EXCERCISES AFTER SURGERY D1.I am likely to get breast cancer again although I had received surgery Strongly disagree Disagree Undecided Agree Strongly agree D2.I am often worried that I could get breast cancer again Strongly disagree Disagree Undecided Agree Strongly agree D3.I have many things to worry instead thinking of recurrence of breast cancer Strongly disagree Disagree Undecided Agree Strongly agree D4.As I heard someone getting breast cancer, I immediately think that I could get it again Strongly disagree Disagree Undecided Agree Strongly agree D5.Many women getting breast cancer today makes me worry Strongly disagree Disagree Undecided Agree Strongly agree D6.I thought that breast cancer affect my health, so I care about it Strongly disagree Disagree Undecided Agree Strongly agree D7.As aging, I am thinking more and more about breast cancer Strongly disagree Disagree Undecided Agree Strongly agree D8.Breast cancer does not affect much toward my relationships with other people 94 Strongly disagree Disagree Undecided Agree Strongly agree D9.Breast cancer can cause a lot of pain Strongly disagree Disagree Undecided Agree Strongly agree D10 Breast cancer makes me fatique a lot Strongly disagree Disagree Undecided Agree Strongly agree D11 I could die if I get breast cancer again Strongly disagree Disagree Undecided Agree Strongly agree D12 I could get breast cancer-related lymphoedema after breast cancer surgery Strongly disagree Disagree Undecided Agree Strongly agree D13 I could suffer physical impairment after breast cancer surgery Strongly disagree Disagree Undecided Agree Strongly agree D14 I could have weigh gain after breast cancer surgery Strongly disagree Disagree Undecided Agree Strongly agree D15 Breast cancer could decrease my quality of life Strongly disagree Disagree Undecided Agree Strongly agree D16 As I get breast cancer again, I have to pay a lot money for treatment 95 Strongly disagree Disagree Undecided Agree Strongly agree D17 Breast cancer could be a problem for my daily activities Strongly disagree Disagree Undecided Agree Strongly agree D18 Complications of breast cancer are the reasons that make me perform exercises Strongly disagree Disagree Undecided Agree Strongly agree D19 Performing exercises could reduce the risk of developing breast cancer again Strongly disagree Disagree Undecided Agree Strongly agree D20 Performing exercises could reduce the possibility of death from breast cancer Strongly disagree Disagree Undecided Agree Strongly agree D21 Performing exercises could reduce the possibility of recurrence of breast cancer Strongly disagree Disagree Undecided Agree Strongly agree D22 Performing exercises could increase the possibility of survival from breast cancer Strongly disagree Disagree Undecided Agree Strongly agree D23 Performing exercises could reduce complications of breast cancer after surgery 96 Strongly disagree Disagree Undecided Agree Strongly agree Has any obstacle prevented you from exercise ? Strongl Obstacles y Disagre Undecide Agre Strongly disagre e d e agree e D2 D2 D2 Illness Personal problems Places to exercise too D2 far a way Too embarrassed to D2 exercise Cost too much to D2 exercise Inconvenient facility D3 schedules Too few places to D3 exercise People in exercise D3 closes look funny Too much time from D3 family relationships Too much time from D3 family responsibilities Take too much of my D3 time D3 D3 D3 Exercise is tiring Exercise is fatiguing Exercise is hard work Need to spend more time at work 97 D3 D4 D4 D4 D4 Feel lazy No exercise habit No professionals providing exercise consultations Too depressed to exercise My breast cancer does not allow me to exercise D45 Multimedia (TV/radio/internet/magazines/books) often said about breast cancer Strongly disagree Disagree Undecided Agree Strongly agree D46 There are many panels that disseminate knowledge of breast cancer around my living area Strongly disagree Disagree Undecided Agree Strongly agree D47 Multimedia (TV/radio/internet/magazines/books) often said about exercises preventing breast cancer Strongly disagree Disagree Undecided Agree Strongly agree D48 There are many panels that disseminate exercises preventing breast cancer around my living area Strongly disagree Disagree Undecided Agree Strongly agree D49 Health care workers have already consulted to me about breast cancer and exercises preventing breast cancer Strongly disagree Disagree 98 Undecided Agree Strongly agree 99 D50 Many neighborhoods performing exercises Strongly disagree Disagree Undecided Agree Strongly agree D51 My relatives (parents/spouse/children) want me to exercises Strongly disagree Disagree Undecided Agree Strongly agree D52 My friends want me to exercises Strongly disagree Disagree Undecided Agree Strongly agree D53 Local government facilities (Women Association, Elderly Association…) want me to join exercises club at local Strongly disagree Disagree Undecided Agree Strongly agree 100 E PREVALENCE OF EXERCISES Seven days after breast cancer surgery E1 Did you remember that you did the following types of exercises? Perceived intensity is your feeling that the exercises strong, moderate or weak exertion Min/per session is the number of minutes you spend for each of session of exercise Frequency is the number of session you did in each type of exercise Total hours: you not need to fulfill this column For each type of exercise, please see the picture that the collectors provide to you to know how to the exercise Type of exercise Perceived Min/per intensity session Frequency Deep breathing Pump it up Shoulder shrugs and circles Arm lifts Shoulder blade squeeze Others (describe in detail) E2 Does any health professional provide exercise consultations for you? Yes No E3 Do you have any pain associated with exercise ? Yes No (IF NO, GO TO QUESTION E8) E4 IF YES, When you have this pain? During exercise After Continuously E5 The location of pain Sharp Dull 101 Total hours Both Other E6 Severity of pain ( scale of to 10, = mild, = moderate, 10 = severe) Mild Moderate Severe E.7 Duration of pain (days/ wks) The first weeks after surgery E8 Did you remember that you did the following types of exercises? Perceived intensity is your feeling that the exercises strong, moderate or weak exertion Min/per session is the number of minutes you spend for each of session of exercise Frequency is the number of session you did in each type of exercise Total hours: you not need to fulfill this column For each type of exercise, please see the picture that the collectors provide to you to know how to the exercise Type of exercise Perceived Min/per intensity session Frequency Wand exercise Winging it Wall climbing Side wall strech Snow angels Side bends Others (describe in detail) E9 Does any health professional provide exercise consultations for you? Yes No E10 Do you have any pain associated with exercise ? Yes No (IF NO, GO TO QUESTION E15) 102 Total hours E11 IF YES, When you have this pain? During exercise After Continuously E12 The location of pain Sharp Dull Both Other E13 Severity of pain ( scale of to 10, = mild, = moderate, 10 = severe) Mild Moderate Severe E.14 Duration of pain (days/ wks) 103 About weeks after surgery Now we would like to know about your exercise during the past days “Exercise” is any moderate physical activity that you in your discretionary time on a regular basis for at least 20 minutes per session, three times per week in a typical week ( i.e., walking, swimming, bicycling, sports) E15 Are you currently exercising? Yes No (IF NO, END THE QUESTIONNAIRE) E16 If yes, what type, intensity, min/per session, frequency of exercise are you regularly doing during the last weekdays? (Check all that apply) Perceived intensity is your feeling that the exercises strong, moderate or weak exertion Min/per session is the number of minutes you spend for each of session of exercise Frequency is the number of session you did in each type of exercise Total hours: you not need to fulfill this column Type of exercise Perceived Min/per Exertion session Frequency Easy walking Yoga Cycling Ping pong Volley ball Calisthenic Class Home exercise Fast walking Folk dance Double tennis Tai-Chi Swimming Jogging Back packing Badminton Mountain climb Single tennis Running Others E17 Do you have any pain associated with exercise ? Yes No (IF NO, END THE QUESTIONNAIRE) 104 Total hours E18 IF YES, When you have this pain? During exercise After Continuously E19 The location of pain Sharp Dull Both Other E20 Severity of pain ( scale of to 10, = mild, = moderate, 10 = severe) Mild Moderate Severe E.21 Duration of pain (days/ wks) Thank you for joining us in this study! The collector Participants 105 ... and lungs working hard, improves your general physical condition It can help with your recovery and has many benefits It can: Help improve your cardiovascular fitness – how well your heart, lungs... cancer Women with advancing age will have a higher risk of developing breast cancer compared to younger women (Ferlay et al., 2012) Socio-economical factors Women who have higher social class have... study in 1994 examining the role of lifelong exercise 14 participation and breast cancer risk in young women (< 40 yrs) was a landmark study that ignited research on the role of physical activity