本研究目的為確認癌症兒童住院接受化學治療期間的症狀群變化與身體活動的變化、以及兩者間的關係。採縱貫式、重複施測之相關性研究設計。以南部某教學醫院住院接受化學治療之癌症兒童為研究對象，藉由修正症狀評估量表與非侵入性儀器-三度空間加速器分別於癌症兒童住院接受化療期間收集症狀分數與身體活動的資料。在取得本人與父母之書面同意書後開始收案，共邀請到15位兒童參與，12位兒童完成住院期間全程佩帶三度空間加速器，三位兒童由於睡眠習慣、病情復發、與腹痛而未佩帶全程，故以12位癌症兒童(Mean ± SD, 11.09 ± 4.13y; Range, 4.66-15.66y)住院期間完成佩帶三度空間加速器104,158分鐘的資料進行分析；BMI平均8.24 ± 4.04 kg•m¯² (Range, 11.99-24.74)。結果發現住院化療期間癌症兒童的症狀分數(Chi-Square = 9.611, p = .022)與身體活動的每分鐘能量消耗(F = 8.048, p = .000)、每分鐘最大向量(F = 8.331, p = .003)之變化皆有顯著差異，癌症兒童化療前一天的症狀分數與身體活動分別顯著高於化療第一天、第二天、與第三天的症狀分數與身體活動；化療第一天至第三天的修正症狀評估量表平均得分變化與化療第一天至第三天的每分鐘能量消耗變化有相關(r = .592, p = .043)；年齡與化療第一天的每分鐘能量消耗(r = .584, p = .046)、以及化療第三天的每分鐘最大向量(r = -.618, p = .032)有相關；BMI與化療第一天的每分鐘能量消耗(r = .666, p = .018)、化療第三天的每分鐘能量消耗(r = .670, p = .017)有相關。因此，癌症兒童在住院化療期間症狀嚴重的程度越增加，身體活動的下降程度也會越增加。

The purpose of the study is to identify the changes of symptom clusters and physical activity, and also the relationship between them in children receiving cancer chemotherapy during hospitalization. The study is a longitudinal, repeated measures and correlation study. The sample consisted of children with cancer who were receiving chemotherapy during hospitalization at one of the teaching hospitals in southern Taiwan. Through the Adapted Symptom Assessment Scale and non-invasive Tri-axial accelerometer, data were collected. After informed consents were obtained from all participants and their parents, fifteen children were recruited in this study. Twelve children wore RT3 Tri-axial Accelerometer during hospitalization, three children failed to do so due to sleep habit, relapse, and abdomen pain. Data were analyzed from twelve children (Mean ± SD, 11.09 ± 4.13y; Range, 4.66-15.66y) with cancer. They completed 104,158 minutes of the RT3 Tri-axial Accelerometer during their hospitalization. Children had mean body mass index (BMI) of 18.24 ± 4.04 kg•m¯² (Range, 11.99-24.74). There were significantly differences in the severity of symptoms (Chi-Square = 9.611, p = .022) and activity calories count per minute (F = 8.048, p = .000), vector maximum count per minute (F = 8.331, p = .003). Children had significantly higher symptom scores and physical activity during hospitalization receiving chemotherapy on Day pre-1 than Day 1, Day 2 and Day 3 respectively; The change scores of Adapted Symptom Assessment Scale were significantly correlated with the change of activity calories count per minute from Day 1 to Day 3 (r = .592, p = .043); Age is significantly correlated with the activity calories count per minute on Day 1 (r = .584, p = .046), and vector maximum count per minute on Day 3 (r = -.618, p = .032). BMI is significantly correlated with the activity calories count per minute on Day 1 (r = .666, p = .018) and Day 3 (r = .670, p = .017). Therefore, the more severity of the symptoms, the less physical activity while children receiving cancer chemotherapy during hospitalization.

一、中文部分
中央圖書出版社(1995)．中英英漢醫學辭海．台北：中央。
中華書局（1989）．大英百科全書．台北：中華。
行政院衛生署衛生統計資訊網(2006)．94年主要死因分析．
http://www.doh.gov.tw/statistic/index.htm。
呂昌明、林旭龍、黃奕清、李明憲、王淑芳（2001）．身體活動自我報告量表之效度及信
度的研究－以TriTrac-R3D三度空間加速器為效標．衛生教育學報，15，99-114。
李明憲、林旭龍、呂昌明（2002）．四種簡易身體活動測量問卷效度、信度之探討－以
RT3 Tri-axial三度空間加速器為效標．衛生教育學報，17，1-14。
邱、駱、陳（2001）．化療癌童營養狀況之評估．腫瘤護理雜誌，1(1)，18-26。
邱、駱、戴（2005）．白血病兒童修正版症狀評估量表之信效度．腫瘤護理雜誌，5(1)，
1-14。
財團法人中華民國兒童癌症基金會(2005年6月5日)．認識兒童癌症．取自
http://ccf.wingnet.com.tw。
唐秀治、林玉娟、鄭春秋、陳貞秀、張美娟、陳秋慧（2003）．癌症症狀徵候護理．台
北：匯華。
陳嬿如、葉芳君、莊紫雲、林小玲(2003)．化學治療癌症病人口腔黏膜炎發生率調查方
案．榮總護理，20，66-74。
楊英威、謝瀛洲（2000）．手術後的噁心與嘔吐．臨床醫學，46(2)，82-86。
顏元叔(1991)．時代双解大辭典．台北：萬人。
蘇家聖、魏志定、邱方遙、劉行哲、吳鋼治、吳維、鄒繼群、江朱雀、葉佐誠（1989）．
消化系統．人體解剖與生理．台北：合記。
二、英文部分
Anonymous. (2003). Oral care update: From prevention to treatment. Nursing
Management, 34(5), 1-11.
Armstrong, N., & Mechelen, W. V. (2000). Paediatric exercise science and
medicine. Oxford: Oxford University.
Armstrong, T. S. (2003). Symptoms experience: A concept analysis. Oncology
Nursing Forum, 30(4), 601-606.
Attard-Montalto, S. P., Hadley, J., Kingston, J. E., Eden, O. B., & Saha, V.
(1998). Ongoing assessment of nutritional status in children with malignant
disease. Pediatric Hematology & Oncology, 15(5), 393-403.
Beghin, L., Michaud, L., Hankard, R., Guimber, D., Marinier, E., Hugot, J. P.,
et al. (2003). Total energy expenditure and physical activity in children
treated with home parenteral nutrition. Pediatric Research, 53(4), 684-690.
Benor, D. E., Delbar, V., & Krulik, T. (1998). Measuring impact of nursing
intervention on cancer patients' ability to control symptoms. Cancer
Nursing, 21(5), 320-334.
Bruera, E., & Higginson, I. (1996). Cachexia-anorexia in cancer patients.
Oxford: Oxford University Press.
Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical
activity, exercise and physical fitness: Definitions and distinctions for
health related research. Public Health Reports, 100(2), 126-131.
Cavill, N., Biddle, S., & Sallis, J. (2001). Health enhancing physical
activity for young people: Statement of the United Kingdom expert consensus
conference. Pediatric Exercise Science, 13(1), 12-25.
Cella, D. (1998). Factors influencing quality of life in cancer patients:
Anemia and fatigue. Seminars in Oncology, 25(3), 43-46.
Cheng, K., & Chang, A. (2003). Palliation of oral mucositis symptoms in
pediatric patients treated with cancer chemotherapy. Cancer Nursing, 26(6),
476-484.
Cleeland, C. S., Mendoza, T. R., Wang, X. S., Chou, C., Harle, M. T.,
Morrissey, M., et al. (2000). Assessing symptom distress in cancer patients.
Cancer, 89(7), 1634-1646.
Coleman, K. J., Saelens, B. E., Wiedrich-Smith, M. D., Finn, J. D., & Epstein,
L. H. (1997). Relationships between TriTrac-R3D vectors, heart rate and self-
report in obese children. Medicine and Science in Sports and Exercise, 29,
1535-1542.
Collins, J. J., Byrnes, M. E., Dunkel, I. J., Lapin, J., Nadel, T., Thaler, H.
T., et al. (2000). The measurement of symptoms in children with cancer.
Journal of Pain and Symptom Management, 19(5), 363-377.
Collins, J. J., Devine, T. D., Dick, G. S., Johnson, E. A., Kilham, H. A.,
Pinkerton, C. R., et al. (2002). The measurement of symptoms in young
children with cancer: The validation of the memorial symptom assessment
scale in children aged 7-12. Journal of Pain and Symptom Management, 23(1),
10-16.
Cunningham, R. S., & Bell, R. (2000). Nutrition in cancer: An overview.
Seminars in Oncology Nursing, 16, 90-98.
Curt, G. A. (2000). Impact of fatigue on quality of life in oncology patients.
Seminars in Hematology, 37(4), suppl 6, 14-17.
Curt, G. A., Breitbart, W., & Cella, D. (2000). Impact of cancer-related
fatigue on the lives of patients: New findings from the fatigue coalition.
Oncologist, 5, 353-360.
Delbecque-Boussard, L., Gottrand, F., Ategbo, S., Nelken, B., Mazingue, F.,
Vic, P., et al. (1997). Nutritional status of children with acute
lymphoblastic leukemia: A longitudinal study. American Journal of Clinical
Nutrition, 65(1), 95-100.
DeVoe, D. (2004). Comparison of the RT3 research tracker and Tritrac R3D
accelerometers during a backpacking expedition by a single subject.
Perceptual and Motor Skills, 99(2), 545-546.
Dodd, M., Janson, S., Facione, N., Faucett, J., Froelicher, E., & Humphreys,
J. (2001). Advancing the science of symptom management. Journal of Advanced
Nursing, 33(5), 668-676.
Dodd, M. J. (2004). The pathogenesis and characterization of oral mucositis
associated with cancer therapy. Oncology Nursing Forum, 31(4), Supplement: 5-
11.
Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001). Symptom clusters and their
effect on the functional status of patients with cancer. Oncology Nursing
Forum, 28(3), 465-470.
El-Mahallawy, H. A., Aly El-Din, N. H., Salah, F., El-Arousy, M., & El-Naga,
S. A. (2004). Epidemiologic profile of symptomatic gastroenteritis in
pediatric oncology patients receiving chemotherapy. Pediatric Blood Cancer,
42, 338-342.
Epstein, L. H., Paluch, K. J., Coleman, K. J., Vito, D., & Anderson, K.
(1996). Determinants of physical activity in obese children assessed by
accelerometer and self-report. Medicine and Science in Sports and Exercise,
28(9), 1157-1164.
Finkbiner, K. L., & Ernst, T. F. (1993). Drug therapy management of the
febrile neutropenic cancer patient. Cancer Practice, 1(4), 295-304.
Gagnon, G., & Bruera, E. (1998). A review of the drug treatment of cachexia
associated with cancer. Drugs, 55, 675-688.
Gary, J. (2000). American college of sports medicine: Guidelines for exercise
testing and prescription (6th ed.). Philadelphia: Lippincott Williams and
Wilkins.
Gaston-Johansson, F., Fall-Dickson, J. M., Bakos, A. B., & Kennedy, M. J.
(1999). Fatigue, pain, and depression in pre-autotransplant breast cancer
patients. Cancer Practice, 7(5), 240-247.
Gavarry, O., Giacomoni, M., Bernard, T., Seymat, M., & Falgairette, G. (2003). Habitual physical activity in children and adolescents during school and free days. Medicine and Science in Sports and Exercise, 35(3), 525-531.
Given, C. W., Given, B., Azzouz, F., Kozachik, S., & Stommel, M. (2001). Pedictors of pain and fatigue in the year following diagnosis among elderly cancer patients. Journal of Pain and Symptom Management, 21(6), 456-466.
Haberman, M. (1999). The measurement of symptom distress. In C. H. Yarbro, M. H. Frogge & M. Goodman (Eds.), Cancer symptom management. Boston: Jones & Barlett.
Harro, M., & Riddoch, C. (2000). Physical activity. In N. Armstrong & W. V. Mechelen (Eds.), Paediatric exercise science and medicine (pp. 77-84). Oxford: Oxford University.
Harvey-Berino, J., Wellman, A., Hood, V., Rourke, J., & Secker-Walker, R. (2000). Preventing obesity in American Indian children: When to begin. Journal of the American Dietetic Association, 100(5), 564-566.
Hinds, P. S., Hockenberry-Eaton, M., Gilger, E., Kline, N., Burleson, C., Bottomley, S., et al. (1999). Comparing patient, parent, and staff descriptions of fatigue in pediatric oncology patients. Cancer Nursing, 22(4), 277-289.
Hinds, P. S., Quargnenti, A., Bush, A. J., Pratt, C., Fairclough, D., Rissmiller, G., et al. (2000). An evaluation of the impact of a self-care coping intervention on psychological and clinical outcomes in adolescents with newly diagnosed cancer. European Journal of Oncology Nursing, 4(1), 6-19.
Hockenberry, M. J., Hinds, P. S., Barrera, P., Bryant, R., Adams-McNeill, J., Hooke, C., et al. (2003). Three instruments to assess fatigue in children with cancer: The child, parent and staff perspectives. Journal of Pain and Symptom Management, 25(4), 319-328.
Irvine, D., Vincent, L., Graydon, J. E., Bubela, N., & Thompson, L. (1994). The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy: A comparison with the fatigue experienced by healthy individuals. Cancer Nursing, 17(5), 367-378.
Janson, R. K., Russ, J., & Goran, M. I. (1998). Physical activity related energy expenditure in children by doubly labeled water as compared with the caltrac accelerometer. International Journal of Obesity, 22, 1046-1052.
King, G. A., Torres, N., Potter, C., Brooks, T. J., & Coleman, K. J. (2004). Comparison of activity monitors to estimate energy cost of treadmill exercise. Medicine and Science in Sports and Exercise, 36(7), 1244-1251.
Kozub, F. M. (2003). Explaining physical activity in individuals with mental retardation: An exploratory study. Education and Training in Developmental Disabilities, 38(3), 302-313.
Kozub, F. M., Oh, H., & Rider, R. A. (2005). RT3 accelerometer accuracy in estimating short term physical activity in individuals with visual impairments. Adapted Physical Activity Quarterly, 22(3), 265-276.
Langeveld, N., Ubbink, M., & Smets, E. (2000). 'I don't have any energy': The experience of fatigue in young adult survivors of childhood cancer. European Journal of Oncology Nursing, 4(1), 20-28.
Laviano, A., Meguid, M. M., & Rossi-Fanelli, F. (2003). Cancer anorexia: Clinical implications, pathogenesis, and therapeutic strategies. The Lancet Oncology, 4(4), 686-694.
Lenz, E. R., Pugh, L. C., Milligan, R. A., Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-27.
Lo, L. H., & Chen, Y. C. (1992). Patterns of chemotherapy-related nausea and vomiting in leukemia children. Journal of Chinese Oncology Association, 8(1), 11-21.
Lyman, G. H. (2003). Neutropenia risk models in oncology. Oncology, 17(Supp11), 5-7.
Martz, C. H. (1996). Diarrhea. In S. L. Groenwald, M. H. Frogge, M. Goodman & C. H. Yarbro (Eds.), Cancer symptom management (pp. 498-520). Boston, MA: Jones and Bartlett.
Mayer, E. I., Reuter, M., Dopfer, R. E., & Ranke, M. B. (2000). Energy expenditure, energy intake and prevalence of obesity after therapy for acute lymphoblastic leukemia during childhood. Hormone Research, 53(4), 193-199.
McArdle, W. D., Katch, F. I., & Katch, V. L. (2000). Essentials of exercise physiology. Philadelphia: Lippincott Williams & Wilkins.
McClement, S. E., Woodgate, R. L., & Degner, L. (1997). Symptom distress in adult patients with cancer. Cancer Nursing, 20, 236-243.
McMurray, R. G., Harrell, J. S., Bradley, C. B., Webb, J. P., & Goodman, E. M. (1998). Comparison of a computerized physical activity recall with a triaxial motion sensor in middle school youth. Medicine and Science in Sports and Exercise, 30(8), 1238-1245.
Miser, A., Dithage, J., Wesley, R., & Miser, J. (1987). The prevalence of pain in a pediatric and young adult cancer population. Journal of Pain and Symptom Management, 29, 73-83.
Murray, M. J., & Murray, A. B. (1979). Anorexia of infection as a mechanism of host defense. American Journal of Clinical Nutrition, 32, 593-596.
Powell, S. M., Jones, D., & Rowlands, A. V. (2003). Technical variability of the RT3 accelerometer. Medicine and Science in Sports and Exercise, 35(10), 1773-1778.
Reilly, J. J., Ventham, J. C., Ralston, J. M., Donaldson, M., & Gibson, B. (1998). Reduced energy expenditure in pre-obese children treated for acute lymphoblastic leukemia. Pediatric Research, 44(4), 557-562.
Rennie, K. L., Livingstone, M. B., Wells, J. C., McGloin, A., Coward, W. A., Prentice, A. M., et al. (2005). Association of physical activity with body-composition indexes in children aged 6-8 y at varied risk of obesity. American Journal of Clinical Nutrition, 82(1), 13-20.
Repetto, L., & Accettura, C. (2003). The importance of prophylactic management of chemotherapy-induced neutropenia. Anti-Cancer Drugs, 14(9), 725-730.
Rhodes, V. A., Janson, M. H., & McDaniel, R. W. (1995). Nausea, vomiting, and retching: The management of the symptom experience. Seminars in Oncology Nursing, 11, 256-265.
Rhodes, V. A., & McDaniel, R. W. (1999). The symptom experience and its impact on quality of life. In C. H. Yarbro, M. H. Frogge & M. Goodman (Eds.), Cancer symptom management. Boston, MA: Jones & Barlett.
Rodriguez, G., Beghin, L., Michaud, L., Moreno, L. A., Turck, D., & Gottrand, F. (2002). Comparison of the TriTrac-R3D accelerometer and a self-report activity diary with heart-rate monitoring for the assessment of energy expenditure in children. British Journal of Nutrition, 87, 623-631.
Rowlands, A. V., Eston, R. G., & Ingledew, D. K. (1997). Measurement of physical activity in children with particular reference to the use of heart rate and pedometry. Sports Medicine, 24, 258-272.
Rowlands, A. V., Eston, R. G., & Ingledew, D. K. (1999). Relationship between activity levels, aerobic fitness, and body fat in 8-10 year old children. Journal of Applied Physiology, 86(4), 1428-1435.
Rowlands, A. V., Ingledew, D. K., & Eston, R. G. (2000). The effect of type of physical activity measure on the relationship between body fatness and habitual physical activity in children: A meta-analysis. Annals of Human Biology, 27(5), 479-497.
Rowlands, A. V., Thomas, P. W. M., Eston, R. G., & Rodney, T. (2004). Validation of the RT3 triaxial accelerometer for the assessment of physical activity. Medicine and Science in Sports and Exercise, 36(3), 518-524.
Sarna, L., & Brecht, M. (1997). Dimensions of symptom distress in women with advanced lung cancer: A factor analysis. Heart & Lung, 26(1), 23-30.
Schwartz, A. (2000). Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Practice, 8(1), 16-24.
Selwood, K., Gibson, F., & Evans, M. (1999). Side effects of chemotherapy. In F. Gibson & M. Evans (Eds.), Paediatric oncology: Acute nursing care (pp. 59-128). London: Whurr.
Sharma, R., Tobin, P., & Clarke, S. J. (2005). Management of chemotherapy-induced nausea, vomiting, oral mucositis, and diarrhoea. Lancet Oncology, 6(2), 93-102.
Siena, S., Secondino, S., Giannetta, L., Carminati, O., & Pedrazzoli, P. (2003). Optimising management of neutropenia and anaemia in cancer chemotherapy-advances cytokine therapy. Critical Reviews in Oncology-Hematology, 48(Suppl), S39-S47.
Stevens, J. (1995). Applied multivariate statistics for the social sciences (3rd ed.). New Jersey: Lawrence Elbaum Associates.
Teel, C. S., Meek, P., McNamara, A. M., & Watson, L. (1997). Perspectives unifying symptom interpretation. Image: Journal of Nursing Scholarship, 29, 175-181.
Tremblay, A., Doucet, E., & Imbeault, P. (1999). Physical activity and weight maintenance. International Journal of Obesity, 23(Suppl3), S50-54.
Trost, S. G., Pate, R. R., Sallis, J. F., Freedson, P. S., Taylor, W. C., Dowda, M., et al. (2002). Age and gender differences in objectively measured physical activity in youth. Medicine and Science in Sports and Exercise, 34(2), 350-355.
Westerterp, K. R. (1999). Physical activity assessment with accelerometers. International Journal of Obesity, 23(Suppl 3), S45-S49.
WHO. (1997). Physical Activities. http://www.who.int/topics/physical_activity/en/index.html.
WHO. (2002). Reducing risks, promoting healthy life. http://www.who.int/whr/2002/en/.
Wilkes, G. M. (1995). Cancer and HIV clinical nutrition nutrition pocket guide. London: Jones and Bartlett.
Wilkes, G. M. (1996). Potential toxicities and nursing management. In M. B. Burke, G. M. Wilkes, K. C. Ingwersen, C. K. Bean & D. Berg (Eds.), Cancer chemotherapy: A nursing process approach (2nd ed.). Sudbury, MA: Jones and Bartlett.
Winningham, M. L., Nail, L. M., & Burke, M. B. (1994). Fatigue and the cancer experience: Estate of the knowledge. Oncology Nursing Forum, 21, 23-26.
Wolfe, J., Grier, H. E., Klar, N., Levin, S. B., Ellenbogen, J. M., Salem-Schatz, S., et al. (2000). Symptoms and suffering at the end of life in children with cancer. New England Journal of Medicine, 342(5), 326-333.