Miaskowski Christine, Paul Steven M, Cooper Bruce A, Lee Kathryn, Dodd Marylin, West Claudia, Aouizerat Bradley E, Swift Patrick S, Wara William
Department of Physiological Nursing, University of California, San Francisco, CA 94143-0610, USA.
J Pain Symptom Manage. 2008 Jun;35(6):632-43. doi: 10.1016/j.jpainsymman.2007.07.007. Epub 2008 Mar 20.
Fatigue is the most common and distressing symptom reported by patients undergoing radiation therapy (RT). However, limited information is available on the trajectories of fatigue, as well as on the predictors of interindividual variability in fatigue. This study evaluated a sample of patients who underwent RT for prostate cancer to examine how ratings of evening and morning fatigue changed from the time of simulation to four months after the completion of RT and to investigate whether specific patient, disease, and symptom characteristics predicted the initial levels of fatigue and/or characteristics of the trajectories of evening and morning fatigue. Using hierarchical linear modeling, a large amount of interindividual variability was demonstrated in the trajectories of evening and morning fatigue. Findings from this study suggest that younger men with a higher level of fatigue at the time of the simulation visit were at increased risk for higher levels of evening and morning fatigue over the course of RT. In addition, the level of morning fatigue over the course of RT appears to depend on the patient's level of depression at the time of the simulation visit. In future studies, the use of hierarchical linear modeling as an analytic tool will assist in the identification of patients who are most at risk for prolonged fatigue trajectories. This type of analysis may lead to the identification of subgroups of patients who are at higher risk for negative outcomes and who require different types of interventions for the fatigue associated with RT.
疲劳是接受放射治疗（RT）的患者报告的最常见且令人苦恼的症状。然而，关于疲劳轨迹以及个体间疲劳差异的预测因素的信息有限。本研究评估了一组接受前列腺癌放射治疗的患者样本，以检查从模拟放疗时到放疗结束后四个月期间早晚疲劳评分的变化情况，并调查特定的患者、疾病和症状特征是否能预测疲劳的初始水平和/或早晚疲劳轨迹的特征。使用分层线性模型，研究证明早晚疲劳轨迹存在大量个体间差异。本研究结果表明，在模拟就诊时疲劳程度较高的年轻男性在放疗过程中出现更高水平早晚疲劳的风险增加。此外，放疗过程中早晨疲劳的程度似乎取决于模拟就诊时患者的抑郁水平。在未来的研究中，使用分层线性模型作为分析工具将有助于识别那些疲劳轨迹延长风险最高的患者。这种类型的分析可能会识别出那些出现负面结果风险较高且需要针对放疗相关疲劳采取不同类型干预措施的患者亚组。
