Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Support Care Cancer. 2012 May;20(5):1037-42. doi: 10.1007/s00520-011-1179-8. Epub 2011 May 4.
Advanced cancer patients present with a variety of physical and psychological symptoms. Fatigue is one such symptom which reduces overall quality of life and is difficult to manage. The purpose of this study was to report the presence, severity, and correlating factors of fatigue in advanced cancer patients attending an outpatient palliative radiotherapy clinic.
MATERIALS/METHODS: Patients referred to the Rapid Response Radiotherapy Program between January 1999 and October 2009 completed the Edmonton Symptom Assessment System (ESAS) prior to consultation. Demographic information including age, Karnofsky Performance Status (KPS), gender, and primary cancer sites were collected. Ordinal logistic regression analysis was conducted to determine relationships between demographic information, other ESAS items, and levels of fatigue. Multivariate ordinal logistic regression analysis was used to determine the most significant predictors of fatigue. A p value of <0.05 was considered statistically significant.
A total of 1,397 patients completed the ESAS prior to consultation. Median age was 68 years (range, 21-95), median KPS was 60 (range, 10-100), and slightly more males completed the ESAS (53.0%). Common primary cancers were of the lung (35.8%), breast (20.7%), and prostate (17.7%). Only 179 (12.8%) patients reported no fatigue; the majority of patients reported moderate (31.8%) or severe (34.4%) fatigue. A low KPS (p < 0.0001), being female (p = 0.0056), or being referred for bone metastases (p = 0.0185) significantly correlated with higher levels of fatigue. Patients with a genitourinary primary cancer (p = 0.0078) and/or referred for malignant spinal cord compression (p = 0.0004) reported less fatigue. All other ESAS items were significantly related to fatigue. The most significant predictors of fatigue were pain (p < 0.0001, odds ratio (OR) = 1.07), nausea (p = 0.0010, OR = 1.10), depression (p < 0.0001, OR = 1.10), drowsiness (p < 0.0001, OR = 1.33), dyspnea (p = 0.0003, OR = 1.08), and overall well-being (p < 0.0001, OR = 1.19).
Moderate fatigue was reported in over 66% of our advanced cancer patients prior to radiotherapy. Since radiotherapy inherently causes fatigue, proactive and multidisciplinary management is required for these patients. Similar rates of fatigue severity, in lengthier, fatigue-specific tools, suggest that the ESAS may be a good tool for screening the advanced cancer population.
晚期癌症患者会出现各种身体和心理症状。疲劳就是其中一种症状，它会降低整体生活质量，且难以控制。本研究旨在报告在接受姑息性放疗门诊治疗的晚期癌症患者中，疲劳的出现、严重程度和相关因素。
材料/方法：1999 年 1 月至 2009 年 10 月期间，通过快速反应放疗计划转诊的患者在就诊前完成埃德蒙顿症状评估系统（ESAS）。收集人口统计学信息，包括年龄、卡诺夫斯基表现状态（KPS）、性别和原发癌部位。进行有序逻辑回归分析，以确定人口统计学信息、其他 ESAS 项目与疲劳水平之间的关系。采用多变量有序逻辑回归分析确定疲劳的最显著预测因素。p 值<0.05 被认为具有统计学意义。
共有 1397 例患者在就诊前完成了 ESAS。中位年龄为 68 岁（范围，21-95），中位 KPS 为 60（范围，10-100），接受 ESAS 的男性略多（53.0%）。常见的原发癌为肺癌（35.8%）、乳腺癌（20.7%）和前列腺癌（17.7%）。仅有 179 例（12.8%）患者报告无疲劳；大多数患者报告有中度（31.8%）或重度（34.4%）疲劳。低 KPS（p<0.0001）、女性（p=0.0056）或因骨转移而转诊（p=0.0185）与更高水平的疲劳显著相关。原发癌为泌尿生殖系统（p=0.0078）和/或因恶性脊髓压迫而转诊（p=0.0004）的患者报告疲劳程度较低。所有其他 ESAS 项目均与疲劳显著相关。疲劳的最显著预测因素是疼痛（p<0.0001，比值比（OR）=1.07）、恶心（p=0.0010，OR=1.10）、抑郁（p<0.0001，OR=1.10）、嗜睡（p<0.0001，OR=1.33）、呼吸困难（p=0.0003，OR=1.08）和整体健康状况（p<0.0001，OR=1.19）。
在我们接受放疗的晚期癌症患者中，超过 66%的患者报告有中度疲劳。由于放疗本身会引起疲劳，因此需要对这些患者进行积极的多学科管理。在使用更长的、专门针对疲劳的工具进行评估时，疲劳严重程度相似，这表明 ESAS 可能是筛选晚期癌症患者的良好工具。
