Yennurajalingam Sriram, Palmer J Lynn, Zhang Tao, Poulter Valerie, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Unit 008, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Support Care Cancer. 2008 Oct;16(10):1125-30. doi: 10.1007/s00520-008-0466-5. Epub 2008 May 27.
Although fatigue is the chronic symptom most commonly experienced by patients with advanced cancer, little research has been done on the associations and correlates of fatigue in this population. The aim of this study was, therefore, to determine whether fatigue scores, as measured by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), are associated with age, gender, type of cancer diagnosed, pain, and other cancer-related symptoms measured using the Edmonton Symptom Assessment Scale (ESAS).
We retrospectively reviewed the FACIT-F (when a higher score denotes lower fatigue) and ESAS (when a lower fatigue score denotes lower fatigue intensity) scores of 268 patients with advanced cancer who had been previously enrolled in clinical trials of therapies for fatigue. To determine associations between variables, we performed univariate and multivariate analyses on the data.
We found no univariate association between fatigue score and gender, ethnicity (p = 0.31), or type of cancer diagnosed. Performance status was associated with fatigue (p < 0.0001). On multivariate analysis, we found, however, significant association between fatigue and pain (r = -0.20, p = 0.0012), nausea (r = -0.13, p = 0.04), anxiety (r = -0.27, p < 0.0001), fatigue and depression (r = -0.19, p = 0.0019), drowsiness (r = -0.24, p = 0.0002), dyspnea (r = -0.17, p = 0.007), anorexia (r = -0.29, p < 0.0001), insomnia (r = -0.25, p < 0.0001), and feelings of well-being (r = -0.37, p < 0.0001). Using backward stepwise logistic regression analysis, independent correlative factors associated with fatigue include well-being (p = .0003), drowsiness (0.006), anorexia (0.01), and anxiety (0.03). However, this model only explained 21% of the variation in the intensity of fatigue.
Although we found that fatigue is significantly associated with the severity of psychological symptoms (anxiety and depression) and physical symptoms (pain, dyspnea, insomnia, anorexia, and drowsiness), additional research is required to confirm that these are indeed the main associations of fatigue and, by doing so, enable physicians to better characterize fatigue in patients receiving palliative care.
尽管疲劳是晚期癌症患者最常经历的慢性症状，但针对该人群疲劳的关联因素和相关因素的研究却很少。因此，本研究的目的是确定使用慢性病治疗功能评估-疲劳量表（FACIT-F）测量的疲劳得分是否与年龄、性别、确诊的癌症类型、疼痛以及使用埃德蒙顿症状评估量表（ESAS）测量的其他癌症相关症状有关。
我们回顾性分析了268例先前参加过疲劳治疗临床试验的晚期癌症患者的FACIT-F（得分越高表示疲劳程度越低）和ESAS（得分越低表示疲劳强度越低）得分。为了确定变量之间的关联，我们对数据进行了单变量和多变量分析。
我们发现疲劳得分与性别、种族（p = 0.31）或确诊的癌症类型之间不存在单变量关联。体能状态与疲劳有关（p < 0.0001）。然而，在多变量分析中，我们发现疲劳与疼痛（r = -0.20，p = 0.0012）、恶心（r = -0.13，p = 0.04）、焦虑（r = -0.27，p < 0.0001）、疲劳与抑郁（r = -0.19，p = 0.0019）、嗜睡（r = -0.24，p = 0.0002）、呼吸困难（r = -0.17，p = 0.007）、厌食（r = -0.29，p < 0.0001）、失眠（r = -0.25，p < 0.0001）以及幸福感（r = -0.37，p < 0.0001）之间存在显著关联。使用向后逐步逻辑回归分析，与疲劳相关的独立相关因素包括幸福感（p = 0.0003）、嗜睡（0.006）、厌食（0.01）和焦虑（0.03）。然而，该模型仅解释了疲劳强度变化的21%。
尽管我们发现疲劳与心理症状（焦虑和抑郁）和身体症状（疼痛、呼吸困难、失眠、厌食和嗜睡）的严重程度显著相关，但仍需要进一步研究以确认这些确实是疲劳的主要关联因素，从而使医生能够更好地描述接受姑息治疗患者的疲劳情况。
