Cancer-related fatigue and associated disability in post-treatment cancer survivors
Cancer-related fatigue and associated disability in post-treatment cancer survivors
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DOI：
10.1007/s11764-015-0450-2
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发表时间：
2016-02-01
影响因子：
3.7
通讯作者：
Howell, Doris
中科院分区：
文献类型：
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作者：
Jones, Jennifer M.;Olson, Karin;Howell, Doris
癌症相关性疲劳（CRF）是癌症患者和幸存者中最普遍和最令人痛苦的症状。然而，关于其患病率和治疗后生存期相关残疾的研究仍然有限。我们试图描述CRF在治疗后三个时间点内的发生率，并将一份包括癌症治疗功能评估-疲劳（FACT-F）和世界卫生组织残疾评估量表2.0的自填式邮件问卷发送给三个无疾病的乳腺癌、前列腺癌和结直肠癌幸存者队列（治疗后6-18个月; 2-3年; 5-6年）。从病历审查中提取临床信息。研究并比较了诊断组和时间队列的显著疲劳频率。采用多变量logistic回归分析CRF与人口统计学、临床和心理社会变量之间的关系，共回收问卷1294份（应答率63%）。共有29%（95%CI [27%至32%]）的样本报告了显著疲劳（FACT-F千分之一货币符号34），这与更高的残疾水平相关（p < 0.0001）。乳腺癌（40%[35%至44%]）和结直肠癌（33%[27%至38%]）幸存者的疲劳发生率显著高于前列腺癌组（17%[14%至21%]）（p < 0.0001）。疲劳水平在三个时间队列之间没有差异。与CRF相关的主要因素包括躯体症状负担、抑郁和共病（AUC，0.919 [0.903至0.936]）。临床相关水平的CRF存在于约1/3的癌症存活者中，直至治疗后6年，这与高水平的残疾有关。临床医生需要意识到慢性肾功能衰竭的慢性性，并在医疗实践中对其进行常规评估。虽然没有金标准治疗，但具有确定疗效的非药物干预可以降低其严重程度，并可能最大限度地减少其对患者功能的致残影响。必须注意抑郁症和其他共同发生的身体症状作为促成因素的共同发生和可能治疗的需要。
Cancer-related fatigue (CRF) is the most prevalent and distressing symptom among cancer patients and survivors. However, research on its prevalence and related disability in the post-treatment survivorship period remains limited. We sought to describe the occurrence of CRF within three time points in the post-treatment survivorship trajectory.A self-administered mail-based questionnaire which included the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and the World Health Organisation Disability Assessment Schedule 2.0 was sent to three cohorts of disease-free breast, prostate or colorectal cancer survivors (6-18 months; 2-3 years; and 5-6 years post-treatment). Clinical information was extracted from chart review. Frequencies of significant fatigue by diagnostic group and time cohorts were studied and compared. Multivariate logistic regressions were conducted to examine the associations between CRF and demographic, clinical, and psychosocial variables.One thousand two hundred ninety-four questionnaire packages were returned (63 % response rate). A total of 29 % (95 % CI [27 % to 32 %]) of the sample reported significant fatigue (FACT-F a parts per thousand currency sign34), and this was associated with much higher levels of disability (p < 0.0001). Breast (40 % [35 % to 44 %]) and colorectal (33 % [27 % to 38 %]) cancer survivors had significantly higher rates of fatigue compared with the prostate group (17 % [14 % to 21 %]) (p < 0.0001). Fatigue levels did not differ between the three time cohorts. The main factors associated with CRF included physical symptom burden, depression, and co-morbidity (AUC, 0.919 [0.903 to 0.936]).Clinically relevant levels of CRF are present in approximately 1/3 of cancer survivors up to 6 years post-treatment, and this is associated with high levels of disability.Clinicians need to be aware of the chronicity of CRF and assess for it routinely in medical practice. While there is no gold standard treatment, non-pharmacological interventions with established efficacy can reduce its severity and possibly minimize its disabling impact on patient functioning. Attention must be paid to the co-occurrence and need for possible treatment of depression and other co-occurring physical symptoms as contributing factors.