Department of Medical Oncology, Daniel den Hoed Cancer Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Clin Oncol. 2013 Feb 20;31(6):716-23. doi: 10.1200/JCO.2012.44.4216. Epub 2013 Jan 2.
Several guidelines on the treatment of cancer-related fatigue recommend optimizing treatment of accompanying symptoms. However, evidence for this recommendation from randomized clinical trials is lacking. We investigated whether monitoring and protocolized treatment of physical symptoms alleviates fatigue.
In all, 152 fatigued patients with advanced cancer were randomly assigned to protocolized patient-tailored treatment (PPT) of symptoms or care as usual. The PPT group had four appointments with a nurse who assessed nine symptoms on a 0 to 10 numeric rating scale (NRS). Patients received a nonpharmacologic intervention for symptoms with a score ≥ 1 and a medical intervention for symptoms with a score ≥ 4. Fatigue dimensions, fatigue NRS score, interference of fatigue with daily life, symptom burden, quality of life, anxiety, and depression were measured at baseline and after 1, 2, and 3 months. Differences between the groups over time were assessed by using mixed modeling.
Seventy-six patients were randomly assigned to each study arm. Mean age was 58 ± 10 years, 57% were female, and 65% were given palliative chemotherapy. We found significant improvements over time in favor of PPT for the primary outcome general fatigue (P = .01), with significant group differences at month 1 (effect size, 0.26; P = .007) and month 2 (effect size, 0.35; P = .005). Improvements in favor of PPT were also found for the following secondary outcomes: fatigue dimensions "reduced activity" and "reduced motivation," fatigue NRS, symptom burden, interference of fatigue with daily life, and anxiety (all P ≤ .03).
In fatigued patients with advanced cancer, nurse-led monitoring and protocolized treatment of physical symptoms is effective in alleviating fatigue.
有几项关于癌症相关疲劳治疗的指南建议优化伴随症状的治疗。然而，随机临床试验缺乏对此建议的证据。我们研究了监测和规范化治疗躯体症状是否能缓解疲劳。
共有 152 名患有晚期癌症且疲劳的患者被随机分配接受症状规范化患者个体化治疗（PPT）或常规护理。PPT 组有 4 次与护士预约的机会，护士会用 0 到 10 的数字评定量表（NRS）评估 9 种症状。对评分≥1 的症状给予非药物干预，对评分≥4 的症状给予药物干预。在基线时和 1、2、3 个月后测量疲劳维度、疲劳 NRS 评分、疲劳对日常生活的干扰、症状负担、生活质量、焦虑和抑郁。采用混合模型评估组间随时间的差异。
76 名患者被随机分配到每个研究组。平均年龄为 58±10 岁，57%为女性，65%接受姑息化疗。我们发现 PPT 组在主要结局一般疲劳方面有随时间的显著改善（P=.01），在第 1 个月（效应量，0.26；P=.007）和第 2 个月（效应量，0.35；P=.005）时存在显著的组间差异。PPT 组在以下次要结局方面也有改善：疲劳维度“活动减少”和“动机降低”、疲劳 NRS、症状负担、疲劳对日常生活的干扰和焦虑（均 P≤.03）。
在患有晚期癌症且疲劳的患者中，护士主导的躯体症状监测和规范化治疗可有效缓解疲劳。
