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Objectives of Study：
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With the economic development and emancipation of ideas brought about by reform and opening up, The labor participation rate of Chinese women reached 70% (the first in the world), while that of India, France and the United States were 28%, 50% and 58% respectively in the same period [1]. At the same time, the data show that [2] Breast cancer is the leading cause of cancer in China. With the aging of China, the number of new cases is increasing year by year. The number of new cases of breast cancer in China is about 210 thousand. With the continuous development of medical technology, early detection and treatment, and constantly open up the treatment of breast cancer targeted drugs, radiotherapy and chemotherapy drugs update iteration, so that the survival rate of breast cancer patients to 88.5%[3]. However, due to postoperative pain, anxiety, fear, fear of disease prognosis, worry about recurrence, postoperative self image disorder and other factors, the quality of sleep of breast cancer patients is affected by [4-5]. Studies have shown that the incidence of sleep disorders in breast cancer patients is about 30%-75%, and the incidence of postoperative sleep disorders has climbed to more than 90% of [6]. Lack of sleep will lead to adverse consequences such as fatigue and decline in quality of life, and even increase the risk of cancer recurrence and death [7]. Therefore, understanding the influencing factors of low quality of sleep in breast cancer patients, identifying patients with low sleep quality and giving targeted interventions to improve the sleep quality of breast milk patients have become a realistic problem for medical staff and patients' families.
At present, the sleep quality of breast cancer patients is mainly influenced by many factors, such as treatment style, personality traits, emotional state and so on. However, some breast cancer patients can better face the results of illness and adopt positive coping strategies to cope with adverse environment and stimulation, which depends on the regulation of resilience [8]. As an intrinsic protective factor, resilience can regulate anxiety and depression in breast cancer patients, improve body image, quality of life and sleep quality [9-12]. In addition, physical phenomenon is an important form of expression in human life activities. It refers to the comprehensive and relatively stable inherent characteristics of morphological structure, physiological function and psychological state formed on the basis of congenital endowment and acquired in the process of human life. Studies have shown that breast cancer patients are characterized by qi stagnation and yin deficiency. The mechanism is that chronic stagnation of the liver leads to the deficiency of the chest and collateral channels, which increases the risk of breast cancer by [13]. It is worth noting that sleep disorders in people with different TCM Constitution are significantly different. The sleep quality of patients with Qi deficiency and yin deficiency is lower than that of [14], but there is a lack of research on the influence of sleep disorders on the quality of sleep in patients with breast cancer. As a physiological index, grip strength can directly reflect muscle strength, and muscle can affect the negative mood of cancer patients by secreting myoglobin and maintaining physical activity as the main component of organs [15]. Some studies have pointed out that grip strength is related to sleep quality, and people with poor sleep quality often have lower grip strength value and muscle content [16]. However, due to the fact that there are too many confounding variables and potential factors, it is still necessary to further study the correlation between grip strength and sleep quality in breast cancer patients. So, This study will take Wang Qi [17]'s TCM constitution classification (mild temperament, Qi deficiency, yin deficiency, Yang deficiency, phlegm dampness, dampness heat, blood stasis, qi stagnation and special temperament), psychological resilience and grip strength of breast cancer patients were used as predictors. Based on the development trajectory of sleep quality of breast cancer patients, the psychological resilience and grip strength of breast cancer patients in various stages of disease progression were explored, and the quality of sleep was also investigated. The correlation and causality between different development trajectories and physique, grip strength and toughness were tested. At present, there is no unified theory on the relationship between TCM Constitution, resilience, grip strength and sleep quality of breast cancer patients. There is no prediction model for affecting the sleep quality of breast cancer patients. In this case, there are great differences in the quality of sleep service and sleep quality assessment for breast cancer patients, and the intervention tests for breast cancer patients are difficult to compare horizontally and vertically. This makes the development of the model of TCM Constitution, mental toughness, grip strength and sleep quality and evaluation index for breast cancer patients in the course of disease progression has become a realistic need to be supplemented.
Based on kumpfer's psychological resilience theory, The Resilience Model to Breast Cancer (RM-BC, Figure 1) was constructed and validated by qualitative research. In addition, the team developed the trait Resilience Scale for cancer patients based on RM-BC and Shift-Persist theory. Currently, there are Chinese, English, Portuguese, Malaysia and Farsi. Several versions of language, such as (translation), German (Preparatory) and French (Preparatory), have been widely applied worldwide. Based on this project, based on the Stimulus-Organism-Response mode ("S-O-R"), this project constructs a TCM Constitution, mental toughness, handgrip and sleep quality model of breast cancer patients. (TCM Constitution resilience handgrip sleep quality model for breast cancer, crhsm-bc). In addition, the traditional linear statistical model does not consider the complex nonlinear relationship between longitudinal data and trajectory analysis, so it is difficult to further improve the prediction accuracy. Latent growth mixture modeling (lgmm) is a method to deal with population heterogeneity, Combining the traditional growth model with latent category analysis can not only describe the growth trend, but also consider the group heterogeneity. At present, this model has been widely applied in the prediction of disease risk. It also provides a scientific, objective and efficient analytical method for the prediction and analysis of grip strength, TCM Constitution, resilience and sleep quality of breast cancer patients. Therefore, this project will use LGMM, SEM and other modern statistical technology new ideas, according to the preliminary research basis to build breast cancer patients' TCM Constitution mental toughness grip strength sleep quality model, predict the development path of psychological stress and final sleep quality outcomes of breast cancer patients, and explore the predictive effect of grip strength, TCM Constitution and resilience on the trajectory of sleep quality. In order to provide reference for early recognition and screening of low sleep quality among medical staff, and promote the quality of sleep, mental health and quality of life of breast cancer patients.
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