The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer - A pilot study
The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer - A pilot study
复制标题
DOI：
10.1002/cncr.22339
复制
发表时间：
2006-12-15
期刊：
影响因子：
6.2
通讯作者：
Bruera, Eduardo
中科院分区：
文献类型：
--
作者：
Strasser, Florian;Palmer, J. Lynn;Bruera, Eduardo
背景资料。本研究的目的是确定性腺功能减退和自主神经功能障碍是否与晚期不可治愈癌症男性患者的癌症相关性疲劳、性欲下降和抑郁有重要关系。方法：对48名至少2周没有接受主要抗肿瘤干预的患者进行了尤因试验，以检测自主神经功能障碍。测定总睾酮和游离睾酮水平。对这些因素与癌症治疗功能评估(FACT)(厌食症/恶病质治疗功能评估[FAACT]量表和慢性病治疗功能评估-疲劳[Facit-F]子量表)、医院焦虑和抑郁量表(HADS)、Edmonton症状评估量表、性欲问卷和性功能(癌症康复评估系统子量表)的关系进行多因素分析。疲劳的常见原因(贫血、抑郁、营养不良、症状困扰和药物)也被考虑在内。结果：47名患者中有38名(81‘70)有自主神经功能障碍，尽管它与所检查的其他变量没有显著相关性。7例患者中有9例(%)游离睾酮水平低下，与HADS焦虑评分(P=0.002)、情感幸福感评分(P=0.02)、HADS抑郁评分(P=0.04)呈正相关。性腺功能低下的男性在FACT功能幸福感量表(P=.01)和Facit-F子量表(P=.05)上的得分也较低。报告与体重减轻相关症状的男性(FAACT评分)的游离睾酮水平显著较低(r=0.34；P=0.02)，但在实际体重减轻方面与另一组没有差异(P=0.22)。总睾酮水平不适合用于筛查性腺功能减退症，除非患者有100 ng/m L的值。Logistic回归分析未能揭示可预测临床结果的自主神经功能障碍或性腺功能减退的独特多变量模型。结论：性腺功能减退是晚期不治之癌患者的常见症状，并与消极情绪、疲劳和厌食/恶病质相关症状有关。
BACKGROUND. The objective of this study was to determine whether hypogonadism and autonomic dysfunction contribute substantially to cancer-related fatigue, decreased sexual desire, and depression in male patients with advanced, incurable cancer.METHODS. Forty-eight patients who had received no major antineoplastic intervention for at least 2 weeks were tested for autonomic dysfunction by using Ewing tests. Total and free testosterone levels were measured. Multivariate analyses were performed to test the relation of these factors with the Functional Assessment of Cancer Therapy (FACT) (the Functional Assessment of Anorexia/Cachexia Therapy [FAACT] scale and the Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F] subscale), the Hospital Anxiety and Depression Scale (HADS), the Edmonton Symptom Assessment Scale, the Sexual Desire Inventory, and sexual function (Cancer Rehabilitation Evaluation System subscale). Common causes for fatigue (anemia, depression, malnutrition, symptom distress, and medications) also were considered.RESULTS. Thirty-eight of 47 patients (81'70) had autonomic dysfunction, although it was not associated significantly with the other variables examined. 7lventy-nine of 45 patients (64%) had a low level of free testosterone (hypogonadism), which was correlated with the HADS Anxiety score (P=.002), the FACT Emotional Well-Being score (P=.02), and the HADS Depression score (P=.04). Hypogonadal men also had lower scores on the FACT Functional Well-Being scale (P=.01) and the FACIT-F subscale (P=.05). Men who reported symptoms related to weight loss (FAACT scale) had significantly lower levels of free testosterone (r=0.34; P=.02) but did not differ from the other group in actual weight loss (P =.22). The total testosterone level was not appropriate for screening of hypogonadism unless the patients had values < 100 ng/mL. Logistic regression analysis failed to reveal a distinct multivariate model of autonomic dysfunction or hypogonadism that predicted clinical outcomes.CONCLUSIONS. Hypogonadism is a frequent condition in patients with advanced, incurable cancer and is associated with negative mood, fatigue, and symptoms related to anorexia/cachexia.