Andrykowski Michael A, Schmidt John E, Salsman John M, Beacham Abbie O, Jacobsen Paul B
Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40536-0086, USA.
J Clin Oncol. 2005 Sep 20;23(27):6613-22. doi: 10.1200/JCO.2005.07.024.
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.
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.
CRF prevalence at the baseline and post-treatment assessments was 10% and 26%, respectively. Multivariate analyses identified factors prospectively associated with greater risk for CRF at the post-treatment assessment, including receipt of adjuvant chemotherapy 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.
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.
采用一种提议的病例定义方法来确定癌症相关疲劳（CRF）的患病率、后续CRF的人口统计学、临床和心理社会预测因素，以及与并发CRF相关的心理社会因素。
从两家门诊诊所招募接受早期乳腺癌辅助治疗的女性（n = 288）。女性在辅助治疗前完成基线评估，并在初始辅助化疗或放疗疗程结束时完成治疗后评估。在两次评估中，女性均完成了临床访谈以及疲劳、痛苦、应对方式和生活质量（QOL）的测量。临床访谈包括《精神障碍诊断与统计手册》第四版（DSM-IV）中的模块以及一个用于识别CRF病例的诊断访谈。
基线评估和治疗后评估时CRF的患病率分别为10%和26%。多变量分析确定了在治疗后评估中与CRF风险增加前瞻性相关的因素，包括接受辅助化疗以及对疲劳产生灾难化反应的倾向。有CRF和无CRF的患者在一系列同时进行的疲劳、抑郁、功能和QOL测量上存在差异，平均效应大小在1.0个标准差范围内。
CRF是乳腺癌辅助治疗前及治疗期间出现的一种临床综合征。结果表明CRF有多种病因，并支持使用提议的病例定义方法来定义CRF。未来有必要进行研究以确定这些标准对于理解肿瘤学环境中疲劳的病因和管理的科学价值。
