Hyunjin An; Ju-Hee Nho; Sunyoung Yoo; Hyunmin Kim; Minji Nho; Hojeong Yoo

doi:10.4040/jkan.2015.45.6.812

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Original Article
Effects of Lifestyle Intervention on Fatigue, Nutritional Status and Quality of Life in Patients with Gynecologic Cancer: Hyunjin An¹, Ju-Hee Nho², Sunyoung Yoo¹, Hyunmin Kim¹, Minji Nho¹, Hojeong Yoo¹; Journal of Korean Academy of Nursing 2015;45(6):812-822.
DOI: https://doi.org/10.4040/jkan.2015.45.6.812
Published online: December 15, 2015

¹Department of Nursing, Asan Medical Center, Seoul

²College of Nursing, Chonnam National University, Gwangju, Korea

¹Department of Nursing, Asan Medical Center, Seoul

²College of Nursing, Chonnam National University, Gwangju, Korea

Address reprint requests to : Nho, Ju-Hee College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-530-4949 Fax: +82-62-227-4009 E-mail: jhnho@jnu.ac.kr

• Received: June 16, 2015 • Revised: June 24, 2015 • Accepted: August 4, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to examine the effect of lifestyle intervention on the development of fatigue, nutritional status and quality of life of patients with gynecologic cancer.
Methods
A nonequivalent control group quasi-experimental design was used. Participants were 49 patients with gynecologic cancer. They were assigned to the experiment group (n=24) or the control group (n=25). The lifestyle intervention for this study consisted of physical activity, nutritional education, telephone call counseling, health counseling, monitoring for lifestyle, and affective support based on Cox's Interaction Model of Client Health Behavior and was implemented for six weeks.
Results
Significant group differences were found for fatigue (p=.037), nutritional status (p=.034) and social/family well-being (p=.035) in these patients with gynecologic cancer.
Conclusion
Results indicate that this lifestyle intervention is effective in lessening fatigue, and improving nutritional status and social/family well-being. Therefore, nurses in hospitals should develop strategies to expand and provide lifestyle interventions for patients with cancer.
Keywords: Gynecologic neoplasm; Lifestyle; Fatigue; Nutrition; Quality of life

Figure 1.

Conceptual framework of the study.

Figure 2.

Research design.

Table 1.

Contents of the Lifestyle Intervention

Week	Contents	Methods	Time (min)
1	Physical activity	Education	60
	Stretching	Demonstration
	Muscle strength exercise	Correction of posture
	Flexibility exercise	Encouragement
	Nutritional management	Face-to-Face
	Accurate diet, balanced diet
	Ntritional supplement food
	Diet according to side effect of treatment
	Helpful recipe for treatment,dietary life after chemotherapy
	Health counseling
	Checking lifestyle
2	Health counseling	Telephone call	10~20
	Monitoring of lifestyle	Listening
	Affective support	Praise
		Encouragement
3	Health counseling	Telephone call	10~20
	Monitoring of lifestyle	Listening
	Affective support	Praise
		Encouragement
4	Physical activity	Education	60
	Stretching	Demonstration
	Muscle strength exercise	Correction of posture
	Flexibility exercise	Encouragement
	Nutritional management	Face-to-Face
	Accurate diet, balanced diet
	Nutritional supplement food
	Diet according to side effect of treatment
	Helpful recipe for treatment,dietary life after chemotherapy
	Health counseling
	Monitoring of lifestyle
5	Health counseling	Telephone call	10~20
	Monitoring of lifestyle	Listening
	Affective support	Praise
		Encouragement
6	Health counseling	Telephone call	10~20
	Monitoring of lifestyle	Listening
	Affective support	Praise
		Encouragement

Table 2.

Baseline Characteristicsof Participants

Characteristics	Classification	Exp. (n=24)	Cont. (n=25)	χ² or t	p
Characteristics	Classification	n (%) or M±SD	n (%) or M±SD	χ² or t	p
Age (yr)	<40	4 (16.7)	5 (20.0)	0.66	.883
	40~49	4 (16.7)	6 (24.0)
	50~59	13 (54.1)	11 (44.0)
	≥60	3 (12.5)	3 (12.0)
		50.75±10.50	49.76±10.21	− 0.33	.742
Education	Middle school or lower	2 (8.3)	3 (12.0)	2.41	.492
	High school	14 (58.3)	13 (52.0)
	College or higher	8 (33.3)	9 (36.0)
Marriage	Married	17 (70.8)	20 (80.0)	1.56	.669
	Single	4 (16.7)	2 (8.0)
	Others	3 (12.5)	3 (12.0)
Monthly income (10,000 won)	<200	8 (33.3)	3 (12.0)	3.75	.157
	200~499	9 (37.5)	15 (60.0)
	≥500	7 (29.2)	7 (28.0)
Disease period (month)		1.65±0.57	1.50±0.59	− 1.00	.323
Cancer site	Cervix	2 (8.3)	3 (12.0)	0.61	.882
	Ovary	19 (79.2)	17 (68.0)
	Endometrium	3 (12.5)	5 (20.0)
Stage	I	5 (20.8)	3 (12.0))	0.72	.789
	II	4 (16.7)	6 (24.0)
	III	11 (45.8)	12 (48.0)
	IV	4 (16.7)	4 (16.0)
Body weight		54.07±7.98	53.16±8.56	− 0.39	.702
Body mass index	<18.5	3 (12.5)	5 (20.0)	0.68	.804
	18.5~24.9	18 (75.0)	18 (72.0)
	≥25	3 (12.5)	2 (8.0)
Change of body weight (1month)		3.88±3.37	2.88±2.64	− 1.16	.250
Fatigue	Fatigue (≤34)	9 (37.5)	12 (48.0)	0.55	.567
	Non fatigue (> 34)	15 (62.5)	13 (52.0)
		34.58±10.68	33.12±7.99	− 0.54	.589
Nutritional status	Malnutrition (^≥9)	18 (75.0)	20 (80.0)	0.18	.742
	Non-malnutrition (<9)	6 (25.0)	5 (20.0)
		12.83±5.69	13.28±4.78	0.30	.767
Quality of life	Physical well-being	21.25±5.26	20.28±5.68	− 0.62	.539
	Social/family well-being	19.03±5.98	20.60±4.09	1.08	.286
	Emotional well-being	17.04±4.45	17.80±3.99	0.63	.533
	Functional well-being	14.04±6.94	15.92±5.23	1.07	.289
		71.36±14.95	74.60±10.46	0.88	.386

Cont.=Control group; Exp.=Experimental group.

Table 3.

Effectiveness of Lifestyle Intervention

Variables	Cont. (n=25)		Exp. (n=24)		χ² or F^*	p
	Pretest	Posttest	Pretest	Posttest
	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD
Fatigue score	33.12±7.99	33.92±8.62	34.58± 10.68	39.46± 9.47	4.64	.037
Prevalence of fatigue	12 (48.0)	12 (48.0)	9 (37.5)	3 (12.5)	7.27	.007^†
Nutritional status	13.28±4.78	10.36±4.99	12.83± 5.69	7.79± 3.62	4.77	.034
Prevalence of malnutrition	20 (80.0)	17 (68.0)	18 (75.0)	8 (33.3)	5.89	.023^†
Quality of life	74.60±10.46	71.68±15.71	71.36± 14.95	75.32± 17.93	3.58	.065
Physical well-being	20.28±5.68	19.84±6.22	21.25± 5.26	22.67± 4.60	2.83	.099
Social/family well-being	20.60±4.09	18.80±5.02	19.03± 5.98	20.19± 4.95	4.73	.035
Emotional well-being	17.80±3.99	18.28±3.80	17.04± 4.45	16.83± 4.76	0.98	.328
Functional well-being	15.92±5.23	14.76±4.84	14.04±6.94	15.63±7.17	2.19	.146

Cont.=Control group; Exp.=Experimental group;

^*ANCOVA were done after adjusting pretest value;

^†χ²test.

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Effects of Lifestyle Intervention on Fatigue, Nutritional Status and Quality of Life in Patients with Gynecologic Cancer

J Korean Acad Nurs. 2015;45(6):812-822. Published online December 15, 2015

DOI: https://doi.org/10.4040/jkan.2015.45.6.812

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Effects of Lifestyle Intervention on Fatigue, Nutritional Status and Quality of Life in Patients with Gynecologic Cancer

Figure 1. Conceptual framework of the study.

Figure 2. Research design.

Figure 1.

Figure 2.

Effects of Lifestyle Intervention on Fatigue, Nutritional Status and Quality of Life in Patients with Gynecologic Cancer

Week	Contents	Methods	Time (min)
1	Physical activity	Education	60
	Stretching	Demonstration
	Muscle strength exercise	Correction of posture
	Flexibility exercise	Encouragement
	Nutritional management	Face-to-Face
	Accurate diet, balanced diet
	Ntritional supplement food
	Diet according to side effect of treatment
	Helpful recipe for treatment,dietary life after chemotherapy
	Health counseling
	Checking lifestyle
2	Health counseling	Telephone call	10~20
	Monitoring of lifestyle	Listening
	Affective support	Praise
		Encouragement
3	Health counseling	Telephone call	10~20
	Monitoring of lifestyle	Listening
	Affective support	Praise
		Encouragement
4	Physical activity	Education	60
	Stretching	Demonstration
	Muscle strength exercise	Correction of posture
	Flexibility exercise	Encouragement
	Nutritional management	Face-to-Face
	Accurate diet, balanced diet
	Nutritional supplement food
	Diet according to side effect of treatment
	Helpful recipe for treatment,dietary life after chemotherapy
	Health counseling
	Monitoring of lifestyle
5	Health counseling	Telephone call	10~20
	Monitoring of lifestyle	Listening
	Affective support	Praise
		Encouragement
6	Health counseling	Telephone call	10~20
	Monitoring of lifestyle	Listening
	Affective support	Praise
		Encouragement

Characteristics	Classification	Exp. (n=24)	Cont. (n=25)	χ² or t	p
Characteristics	Classification	n (%) or M±SD	n (%) or M±SD	χ² or t	p
Age (yr)	<40	4 (16.7)	5 (20.0)	0.66	.883
	40~49	4 (16.7)	6 (24.0)
	50~59	13 (54.1)	11 (44.0)
	≥60	3 (12.5)	3 (12.0)
		50.75±10.50	49.76±10.21	− 0.33	.742
Education	Middle school or lower	2 (8.3)	3 (12.0)	2.41	.492
	High school	14 (58.3)	13 (52.0)
	College or higher	8 (33.3)	9 (36.0)
Marriage	Married	17 (70.8)	20 (80.0)	1.56	.669
	Single	4 (16.7)	2 (8.0)
	Others	3 (12.5)	3 (12.0)
Monthly income (10,000 won)	<200	8 (33.3)	3 (12.0)	3.75	.157
	200~499	9 (37.5)	15 (60.0)
	≥500	7 (29.2)	7 (28.0)
Disease period (month)		1.65±0.57	1.50±0.59	− 1.00	.323
Cancer site	Cervix	2 (8.3)	3 (12.0)	0.61	.882
	Ovary	19 (79.2)	17 (68.0)
	Endometrium	3 (12.5)	5 (20.0)
Stage	I	5 (20.8)	3 (12.0))	0.72	.789
	II	4 (16.7)	6 (24.0)
	III	11 (45.8)	12 (48.0)
	IV	4 (16.7)	4 (16.0)
Body weight		54.07±7.98	53.16±8.56	− 0.39	.702
Body mass index	<18.5	3 (12.5)	5 (20.0)	0.68	.804
	18.5~24.9	18 (75.0)	18 (72.0)
	≥25	3 (12.5)	2 (8.0)
Change of body weight (1month)		3.88±3.37	2.88±2.64	− 1.16	.250
Fatigue	Fatigue (≤34)	9 (37.5)	12 (48.0)	0.55	.567
	Non fatigue (> 34)	15 (62.5)	13 (52.0)
		34.58±10.68	33.12±7.99	− 0.54	.589
Nutritional status	Malnutrition (^≥9)	18 (75.0)	20 (80.0)	0.18	.742
	Non-malnutrition (<9)	6 (25.0)	5 (20.0)
		12.83±5.69	13.28±4.78	0.30	.767
Quality of life	Physical well-being	21.25±5.26	20.28±5.68	− 0.62	.539
	Social/family well-being	19.03±5.98	20.60±4.09	1.08	.286
	Emotional well-being	17.04±4.45	17.80±3.99	0.63	.533
	Functional well-being	14.04±6.94	15.92±5.23	1.07	.289
		71.36±14.95	74.60±10.46	0.88	.386

Variables	Cont. (n=25)		Exp. (n=24)		χ² or F^*	p
	Pretest	Posttest	Pretest	Posttest
	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD
Fatigue score	33.12±7.99	33.92±8.62	34.58± 10.68	39.46± 9.47	4.64	.037
Prevalence of fatigue	12 (48.0)	12 (48.0)	9 (37.5)	3 (12.5)	7.27	.007^†
Nutritional status	13.28±4.78	10.36±4.99	12.83± 5.69	7.79± 3.62	4.77	.034
Prevalence of malnutrition	20 (80.0)	17 (68.0)	18 (75.0)	8 (33.3)	5.89	.023^†
Quality of life	74.60±10.46	71.68±15.71	71.36± 14.95	75.32± 17.93	3.58	.065
Physical well-being	20.28±5.68	19.84±6.22	21.25± 5.26	22.67± 4.60	2.83	.099
Social/family well-being	20.60±4.09	18.80±5.02	19.03± 5.98	20.19± 4.95	4.73	.035
Emotional well-being	17.80±3.99	18.28±3.80	17.04± 4.45	16.83± 4.76	0.98	.328
Functional well-being	15.92±5.23	14.76±4.84	14.04±6.94	15.63±7.17	2.19	.146

Table 1. Contents of the Lifestyle Intervention

Table 2. Baseline Characteristicsof Participants

Cont.=Control group; Exp.=Experimental group.

Table 3. Effectiveness of Lifestyle Intervention

Cont.=Control group; Exp.=Experimental group;

ANCOVA were done after adjusting pretest value;

†

χ²test.