Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences; Biobehavioral Medicine Program, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY.
J Oncol Pract. 2008 Mar;4(2):59-63. doi: 10.1200/JOP.0822002.
Fatigue is one of the most frequently reported and adverse effects of cancer chemotherapy. The present study tested the hypothesis that women's levels of emotional distress at the time of their initial outpatient chemotherapy treatment would predict the severity of their postinfusion fatigue.
Sixty stage I (32.6%) and II (67.4%) patients with breast cancer (mean age, 44.5 years) who were receiving standard outpatient chemotherapy participated. The independent variable, emotional distress, was assessed for "last night," "this morning," and "right now" with a visual analog scale (0 to 100). The dependent variable, post-treatment fatigue (PTF), was assessed (0 to 100) over each of the subsequent 6 days using end-of-day diaries, which also included assessments of distress and nausea (0 to 100). For the statistical analyses, post-treatment fatigue was divided into three phases with means calculated for days 1 through 2 (phase 1), 3 to 4 (phase 2), and 5 to 6 (phase 3).
Consistent with the study hypothesis, patients' pretreatment distress level in the clinic was a significant (P < .001) predictor of PTF. There was also a significant (P < .025) interaction with phase, with distress becoming a predictor of PTF after phase 1. Multivariate analysis indicated that prior levels of distress were not independent predictors of PTF.
This study is the first to demonstrate time-specific effects of pretreatment distress on PTF. Possible mechanisms of these effects now warrant investigation, as do possible benefits of brief interventions to reduce patient distress immediately before treatment.
疲劳是癌症化疗最常报告的不良反应之一。本研究检验了以下假设，即女性在接受初始门诊化疗治疗时的情绪困扰程度将预测其输注后疲劳的严重程度。
60 名 I 期（32.6%）和 II 期（67.4%）乳腺癌患者（平均年龄 44.5 岁）参与了标准的门诊化疗。独立变量情绪困扰使用视觉模拟量表（0 到 100）评估“昨晚”、“今天早上”和“现在”。因变量（PTF）在接下来的 6 天内每天使用每日结束时的日记进行评估（0 到 100），日记还包括对困扰和恶心的评估（0 到 100）。对于统计分析，将治疗后疲劳分为三个阶段，分别计算第 1 至 2 天（第 1 阶段）、第 3 至 4 天（第 2 阶段）和第 5 至 6 天（第 3 阶段）的平均值。
与研究假设一致，患者在诊所的预处理困扰程度是 PTF 的显著预测因素（P <.001）。与阶段也存在显著的交互作用（P <.025），在第 1 阶段后，困扰成为 PTF 的预测因素。多变量分析表明，先前的困扰水平不是 PTF 的独立预测因素。
本研究首次证明了预处理困扰对 PTF 的时间特异性影响。这些影响的可能机制现在值得研究，就像在治疗前立即进行简短干预以减少患者困扰的可能益处一样。
