Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer
Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer
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DOI：
10.1200/jco.2005.07.024
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发表时间：
2005-09-20
影响因子：
45.3
通讯作者：
Jacobsen, PB
中科院分区：
文献类型：
--
作者：
Andrykowski, MA;Schmidt, JE;Jacobsen, PB
目的采用病例定义方法确定癌症相关性疲劳(CRF)的患病率、继发CRF的人口学、临床和心理社会预测因素以及与CRF并发的心理社会因素。患者和方法从两个门诊诊所招募接受早期乳腺癌辅助治疗的患者(n=288)，在辅助治疗前完成基线评估，并在辅助化疗或放射治疗结束后进行治疗后评估。在这两项评估中，女性都完成了临床访谈和疲劳、痛苦、应对和生活质量(QOL)的测量。临床访谈包括《精神疾病诊断与统计手册》第四版(DSM-IV)中的模块和用于识别CRF病例的诊断性访谈。多变量分析确定了与更大风险相关的前瞻性因素，包括在治疗后评估中接受CRF的辅助化疗风险，以及因疲劳而导致灾难性后果的倾向。CRF患者与非CRF患者在疲劳、抑郁、功能和生活质量的多项同时测量上存在差异，平均效应值在1.0标准差范围内。结论CRF是乳腺癌辅助治疗前和辅助治疗过程中出现的一种临床综合征。结果表明，慢性肾功能衰竭有多因素病因，并支持使用拟议的病例定义方法来定义慢性肾功能衰竭。未来的研究是必要的，以确定这些标准的科学价值，以了解肿瘤环境中疲劳的病因和管理。
Purpose Use a proposed case-definition approach to identify the prevalence of cancer-related fatigue (CRF), demographic, clinical and psychosocial predictors of subsequent CRF, and psychosocial factors associated with concurrent CRF.Patients and Methods Women (n = 288) undergoing adjuvant therapy for early-stage breast cancer were recruited from two outpatient clinics, Women completed a baseline assessment before adjuvant therapy and a post-treatment assessment at the conclusion of an initial course of adjuvant chemotherapy or radiotherapy. At both assessments, women completed a clinical interview and measures of fatigue, distress, coping, and quality of life (QOL). The clinical interview consisted of modules from the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) and a diagnostic interview to identify cases of CRF.Results CRF prevalence at the baseline and post-treatment assessments was 10% and 26%, respectively. Multivariate analyses identified factors prospectively associated with greater including receipt of adjuvant chemotherapy risk for CRF at the post-treatment assessment, and a tendency to catastrophize in response to fatigue. Patients with and without CRF differed on a host of concurrent measures of fatigue, depression, functioning, and QOL with mean effect sizes in the range of 1.0 standard deviation.Conclusion CRF is a clinical syndrome experienced before and during adjuvant therapy for breast cancer. Results suggest CRF has a multifactorial etiology and support use of the proposed case definition approach to defining CRF. Future research is necessary to determine the scientific value of these criteria for understanding the etiology and management of fatigue in the oncology setting.