Department of Palliative Care and Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA.
BMC Palliat Care. 2012 Sep 17;11:16. doi: 10.1186/1472-684X-11-16.
The aim of this study was to determine factors associated with the severity of cancer related fatigue (CRF) and predictors of improvement of CRF at the first follow-up visit in patients with advanced cancer referred to outpatient palliative care clinic (OPC).
We reviewed the records of consecutive patients with advanced cancer presenting to OPC. Edmonton Symptom Assessment System (ESAS) scores were obtained at the initial and subsequent visits between January 2003 and December 2008. All patients received interdisciplinary care led by palliative medicine specialists following an institutional protocol. Fatigue improvement was defined as a reduction of ≥2 points in ESAS score relative to the baseline. Descriptive statistics were used to summarize patient characterstics. Univariate analyses were performed and only significant variables were included in multivariate regression analysis to determine factors associated with severity and improvement in CRF.
A total of 1778 evaluable patients were analyzed (median age, 59 years; 52% male). The median time between visits was 15 days. Median fatigue scores on the ESAS were 6 at baseline and 5 at follow-up. Severity of all ESAS items and low serum albumin were associated with fatigue at baseline (p < 0.0001). The improvement of fatigue was observed in 586 patients (33%). The hierarchical model showed that fatigue improved over time (b = -0.009; p = 0.0009). low appetite (odds ratio [OR] = 1.09 per point; p = 0.0113) and genitourinary cancer (OR = 1.74 per point; p = 0.0458) were significantly associated with improvement of fatigue.
CRF is strongly associated with physical and emotional symptoms. Genitourinary cancer and low appetite at baseline were associated with successful improvement of fatigue.
本研究旨在确定与癌症相关疲劳（CRF）严重程度相关的因素，并预测在接受姑息治疗门诊（OPC）的晚期癌症患者首次随访时 CRF 的改善情况。
我们回顾了 2003 年 1 月至 2008 年 12 月期间连续就诊于 OPC 的晚期癌症患者的病历。在初始和后续就诊时使用埃德蒙顿症状评估系统（ESAS）评分。所有患者均按照机构方案接受由姑息医学专家领导的多学科护理。疲劳改善定义为 ESAS 评分相对于基线降低≥2 分。使用描述性统计来总结患者特征。进行单变量分析，仅将有意义的变量纳入多变量回归分析，以确定与 CRF 严重程度和改善相关的因素。
共分析了 1778 例可评估患者（中位年龄为 59 岁，52%为男性）。两次就诊之间的中位时间为 15 天。ESAS 的中位疲劳评分在基线时为 6 分，随访时为 5 分。所有 ESAS 项目的严重程度和低血清白蛋白与基线时的疲劳有关（p<0.0001）。在 586 例患者（33%）中观察到疲劳改善。分层模型显示疲劳随时间改善（b=-0.009；p=0.0009）。食欲不佳（每点比值比[OR]为 1.09；p=0.0113）和泌尿生殖系统癌症（OR 为 1.74；p=0.0458）与疲劳的改善显著相关。
CRF 与身体和情绪症状密切相关。基线时的泌尿生殖系统癌症和食欲不佳与疲劳的成功改善相关。
