ผลของโปรแกรมการจัดการอาการร่วมกับการบริหารกาย-จิตแบบชี่กงต่ออาการเหนื่อยล้า อาการนอนไม่หลับและอาการ วิตกกังวล ในผู้ที่เป็นมะเร็งเต้านมที่ได้รับยาเคมีบำบัดแบบเสริม

Arunsri  Sarnthima; Noppamat  Pudtong

Authors

Arunsri Sarnthima Faculty of Nursing, Chulalongkorn University
Noppamat Pudtong Faculty of Nursing, Chulalongkorn University

Keywords:

Symptom Management Program Combined With Qiqong, Breast Cancer , Adjuvant Chemotherapy, Fatigue , Insomnia, Anxiety

Abstract

Purpose: To compare the effect of the Symptom Management Program combined with Qigong on fatigue insomnia and anxiety in breast cancer patients receiving adjuvant chemotherapy

Design: Quasi-experimental research

Methods: The sample group consisted of 42 female breast cancer patients who were diagnosed by physicians with stage 1 to 3 breast cancer, aged 20 years and older, and who had received adjuvant chemotherapy. The participants were divided into two groups: an experimental group and a control group, with 21 participants in each. They were matched in pairs based on age, cancer stage, chemotherapy regimen, and number of chemotherapy cycles. The control group received standard nursing care, while the experimental group received standard nursing care combined with the Symptom Management program combined with Qigong. This program was developed based on Dodd et al.’s (2001) Symptom Management Model and the Qigong mind-body management concept of Terdsak Dechkong (2002). The program consisted of: 1) Symptom experience assessment, 2) Symptom management combined with Qigong, and 3) Evaluation of the management of fatigue, insomnia, and anxiety. The data collection tools included: 1) Personal information record form, 2) Cancer-related information record form, 3) Symptom assessment tools: The Piper’s fatigue scale, Insomnia severity index scale, and State-Trait Anxiety Inventory. The instruments were tested for content validity by 5 experts and tested for reliability with Cronbach’s alpha coefficient of .96, .81, and .80 respectively. Statistical techniques used in data analysis were percentage, mean, standard deviation and independent t-test

Results:

1. The mean scores for fatigue, insomnia, and anxiety in the experimental group were 2.16 (0.70), 6.67 (2.57), and 34.85 (4.57) respectively, In the control group, the mean scores were 3.85 (0.76), 14.14 (1.27), and 47.85 (4.07) respectively.
2. Mean scores of fatigue, insomnia, and anxiety of the breast cancer patients receiving adjuvant chemotherapy who received symptom management program combined with qigong at posttest was significantly lower than those who receiving a conventional nursing care at the .05 level.

Conclusion: Symptom management program combined with qigong can effectively alleviate fatigue, insomnia, and anxiety in breast cancer patients undergoing adjuvant chemotherapy.

References

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2021; 71(3): 209-249.

Cancer association of Thailand. Breast surgical oncology Thai breast disease society. Bangkok: 2018. [In Thai]

Dusrak D. Nursing care for patients with cancer. Bangkok: Danex intercorporation company limilted; 2017. [In Thai]

Pereira MG, Ribeiro C, Ferreira G, Machado JC, Leite Â. The indirect effect of body image on distress in women with breast cancer undergoing chemotherapy. Health Psychol Rep. 2021 Feb 17; 10(1):47-57. doi:10.5114/hpr.2022. 113381. PMID: 38084367; PMCID: PMC10501426.

Dodd, M., Janson, S., Facione, N., et al. Advancing the science of symptom management. Journal of advanced nursing. 2001:33(5):668-676.

Bower, J. E., Ganz, P. A., Desmond, K. A., et al. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. Journal of clinical oncology. 2000; 18(4): 743.

Lacourt TE, Kavelaars A, Tripathy D, Heijnen CJ. Associations between fatigue and cellular metabolism in breast cancer patients: A longitudinal study. Psychoneuroendocrinology. 2022 Oct; 144: 105866.doi: 10.1016/j.psyneuen. 2022. 105866. Epub 2022 Jul 11. PMID: 35853380; PMCID: PMC12147089.

Lopsunthorn N et al. The Effects of Cancer - Related Fatigue Symptom Management Program through Walking Exercise and Pray Therapy on Quality of Life of Breast Cancer Patients. Journal of the Army Medical Department. 2018; 19 (Special issue): 88-99. [In Thai]

Weng, Y. P., Hong, R. M., Chen, V. C. H., Tsai, C. J., et al. Sleep Quality and Related Factors in Patients with Breast Cancer: A Cross-Sectional Study in Taiwan. Cancer Management and Research. 2021; 13:4725.

Suwisith, N., Hanucharurnkul, S., Dodd, M., Vorapongsathorn, T., Pongthavorakamol, K., & Asavametha, N. Symptom clusters and functional status of women with breast cancer. Pacific Rim International Journal of Nursing Research. 2008; 12(3): 153-165.

Kasetwetin S, Prommin Na.Effects of Providing Information on Anxiety In Breast Cancer Patients Before surgery. udhhosmj [internet]. 2018 Dec. 4 [cited 2025 Jun. 15];25(2):162-70. [In Thai]

Wattananukij P, Srimorakot P, Pongthavornkamol K, Chuthapisith S. Factors predicting anxiety and depression among newly diagnosed breast cancer patients. J Royal Thai Army Nurses [Internet]. 2019 Aug 21 [cited 2025 Jun 15];20(2):262–71. Available from: https://he01.tci-thaijo.org/index.php/JRTAN/article/view/ 171765 [In Thai]

Dodd, M. J., Miaskowski, C., & Paul, S. M. Symptom clusters and their effect on the functional status of patients with cancer. In Oncology nursing forum. 2001; 28(3)

Liu, W., Schaffer, L., Herrs, N., Chollet, C., & Taylor, S. Improved sleep after Qigong exercise in breast cancer survivors: A pilot study. Asia-Pacific journal of oncology nursing; 2015; 2(4): 232-9.

Terdsak Dechkong. Qigong, a powerful method for healing. Bangkok: Moh-Chao-Ban Publishing House; 2009

Piper, B. F., Dibble, S. L., Dodd, M. J., et al. The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. In Oncology nursing forum. Oncology Nursing Society. 1998; 25(4): 677-684

Keawphang P. Ralationships between selected factors and insomnia in adult cancer patients [Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Nursing Science Program]. Bangkok: Chulalongkorn University; 2004. [In Thai]

Zeng Y, Luo T, Xie H, Huang M, Cheng ASK. Health benefits of Qigong or Tai Chi for cancer patients: a systematic review and meta-analyses. Complement Ther Med. 2014 Feb; 22(1):173–86. doi: 10.1016/j.ctim.2013.11.010.