Cancer. 2014 Feb 1;120(3):425-32. doi: 10.1002/cncr.28434.
The effective management of fatigue in patients with cancer requires a clear delineation of what constitutes nontrivial fatigue. The authors defined numeric cutpoints for fatigue severity based on functional interference and described the prevalence and characteristics of fatigue in patients with cancer and survivors.
In a multicenter study, outpatients with breast, prostate, colorectal, or lung cancer rated their fatigue severity and symptom interference with functioning on the M. D. Anderson Symptom Inventory numeric scale of 0 to 10. Ratings of symptom interference guided the selection of numeric rating cutpoints between mild, moderate, and severe fatigue levels. Regression analysis identified significant factors related to reporting moderate=severe fatigue .
The statistically optimal cutpoints were 4 for moderate fatigue and 7 for severe fatigue. Moderate=severe fatigue was reported by 983 of 2177 patients (45%) undergoing active treatment and was more likely to occur in patients receiving treatment with strong opioids (odds ratio [OR], 3.00), those with a poor Eastern Cooperative Oncology Group performance status (OR, 2.00), those who had >5% weight loss within 6 months (OR, 1.60), those who were receiving >10 medications (OR, 1.58), those with lung cancer (OR, 1.55), and those with a history of depression (OR, 1.42). Among survivors (patients with complete remission or no evidence of disease, and not currently receiving cancer treatment), 29% of patients (150 of 515 patients) had moderate=severe fatigue that was associated with poor performance status (OR, 3.48) and a history of depression (OR, 2.21).
The current study statistically defined fatigue severity categories related to significantly increased symptom interference. The high prevalence of moderate=severe fatigue in both actively treated patients with cancer and survivors warrants the promoting of the routine assessment and management of patient-reported fatigue.
有效管理癌症患者的疲劳需要明确界定什么是实质性疲劳。作者根据功能障碍定义了疲劳严重程度的数字切点，并描述了癌症患者和幸存者的疲劳发生率和特征。
在一项多中心研究中，患有乳腺癌、前列腺癌、结直肠癌或肺癌的门诊患者使用 MD 安德森症状清单数字量表（0 到 10）对其疲劳严重程度和症状对功能的干扰程度进行评分。症状干扰评分指导选择轻度、中度和重度疲劳水平的数字评分切点。回归分析确定了与报告中度=重度疲劳相关的显著因素。
统计学上最佳的切点是中度疲劳为 4，重度疲劳为 7。正在接受积极治疗的 2177 名患者中有 983 名（45%）报告了中度=重度疲劳，更可能发生在接受强阿片类药物治疗的患者（比值比[OR]，3.00）、东部合作肿瘤学组表现状态较差的患者（OR，2.00）、6 个月内体重减轻>5%的患者（OR，1.60）、服用>10 种药物的患者（OR，1.58）、患有肺癌的患者（OR，1.55）和有抑郁病史的患者（OR，1.42）。在幸存者（完全缓解或无疾病证据且目前未接受癌症治疗的患者）中，29%的患者（515 名患者中有 150 名）有中度=重度疲劳，与表现状态差（OR，3.48）和抑郁病史（OR，2.21）有关。
本研究从统计学上定义了与症状干扰显著增加相关的疲劳严重程度类别。在正在接受治疗的癌症患者和幸存者中，中度=重度疲劳的高发生率需要常规评估和管理患者报告的疲劳。
