Unit of Environmental Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, Germany.
J Cancer Surviv. 2012 Mar;6(1):11-9. doi: 10.1007/s11764-011-0197-3. Epub 2011 Dec 11.
Fatigue is a frequent problem during and after cancer treatment. We investigated different courses of fatigue from pre-diagnosis, through therapy, to long-term survivorship and evaluated potential implications on long-term quality of life (QoL).
Breast cancer patients diagnosed in 2001-2005 were recruited in a case-control study in Germany (MARIE). At follow-up in 2009 (median 5.8 years, MARIEplus), patients self-reported current fatigue and QoL status using validated questionnaires (FAQ, EORTC QLQ-C30). In addition, survivors retrospectively rated fatigue levels pre-diagnosis, during different treatment phases, and 1 year post-surgery. Our analyses included 1,928 disease-free cancer survivors and comparisons with fatigue and QoL scores from the general population.
Fatigue levels were substantially increased during chemotherapy and radiotherapy. Among patients who received both therapies, 61.4% reported higher, 30.0% same, and 8.6% lower fatigue levels during chemotherapy compared to radiotherapy. Courses of fatigue varied widely between individuals. Survivors with persisting long-term fatigue had significantly and markedly worse scores for all QoL functions and symptoms about 6 years post-diagnosis than other survivors and compared to the general population. Survivors without substantial fatigue post-treatment had QoL scores largely comparable to the general population. DISCUSSIONS/CONCLUSION: Chemotherapy appears to have a stronger impact on fatigue than radiotherapy. Breast cancer survivors may experience long-term QoL comparable to the general population, even when suffering from substantial fatigue during treatment. Yet, persistent fatigue post-treatment may lead to extensive long-term loss in QoL concerning physical, social, cognitive, and financial aspects.
Fatigue management should be obligatory during and post cancer treatment.
疲劳是癌症治疗期间和治疗后的常见问题。我们研究了从诊断前、治疗期到长期生存期间疲劳的不同变化过程，并评估了其对长期生活质量（QoL）的潜在影响。
2001-2005 年在德国（MARIE）进行的病例对照研究中招募了乳腺癌患者。在 2009 年的随访（中位随访时间为 5.8 年，MARIEplus）中，患者使用经过验证的问卷（FAQ、EORTC QLQ-C30）自我报告当前的疲劳和 QoL 状况。此外，幸存者回顾性地评估了诊断前、不同治疗阶段和手术后 1 年的疲劳水平。我们的分析包括 1928 名无疾病的癌症幸存者，并与一般人群的疲劳和 QoL 评分进行了比较。
化疗和放疗期间疲劳水平显著升高。在接受两种治疗的患者中，61.4%的患者报告化疗期间的疲劳程度高于放疗，30.0%的患者报告相同，8.6%的患者报告低于放疗。个体之间的疲劳变化很大。与其他幸存者相比，诊断后约 6 年持续存在长期疲劳的幸存者，所有 QoL 功能和症状的评分明显更差，与一般人群相比差异显著。治疗后没有明显疲劳的幸存者的 QoL 评分与一般人群大致相当。讨论/结论：化疗对疲劳的影响似乎比放疗更强。乳腺癌幸存者即使在治疗期间有明显的疲劳，也可能体验到与一般人群相当的长期 QoL。然而，治疗后持续存在的疲劳可能会导致身体、社会、认知和经济方面的广泛长期 QoL 丧失。
疲劳管理应在癌症治疗期间和治疗后强制进行。
