Ancoli-Israel Sonia, Liu Lianqi, Rissling Michelle, Natarajan Loki, Neikrug Ariel B, Palmer Barton W, Mills Paul J, Parker Barbara A, Sadler Georgia Robins, Maglione Jeanne
Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA,
Support Care Cancer. 2014 Sep;22(9):2535-45. doi: 10.1007/s00520-014-2204-5. Epub 2014 Apr 15.
Sleep disturbance, fatigue and depression are common complaints in patients with cancer, and often contribute to worse quality of life (QoL). Circadian activity rhythms (CARs) are often disrupted in cancer patients. These symptoms worsen during treatment, but less is known about their long-term trajectory.
Sixty-eight women with stage I-III breast cancer (BC) scheduled to receive ≥4 cycles of chemotherapy, and age-, ethnicity-, and education-matched normal, cancer-free controls (NC) participated. Sleep was measured with actigraphy (nocturnal total sleep time [nocturnal TST] and daytime total nap time [NAPTIME]) and with the Pittsburgh Sleep Quality Index (PSQI); fatigue with the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF); depression with the Center of Epidemiological Studies-Depression (CES-D). CARs were derived from actigraphy. Several measures of QoL were administered. Data were collected at three time points: before (baseline), end of cycle 4 (cycle 4), and 1 year post-chemotherapy (1 year).
Compared to NC, BC had longer NAPTIME, worse sleep quality, more fatigue, more depressive symptoms, more disrupted CARs, and worse QoL at baseline (all p values <0.05). At cycle 4, BC showed worse sleep, increased fatigue, more depressive symptoms, and more disrupted CARs compared to their own baseline levels and to NC (all p values <0.05). By 1 year, BC's fatigue, depressive symptoms, and QoL returned to baseline levels but were still worse than those of NC, while NAPTIME and CARs did not differ from NC's.
Additional research is needed to determine if beginning treatment of these symptoms before the start of chemotherapy will minimize symptom severity over time.
睡眠障碍、疲劳和抑郁是癌症患者常见的主诉，且常常导致生活质量（QoL）下降。昼夜活动节律（CARs）在癌症患者中常常被打乱。这些症状在治疗期间会加重，但对于它们的长期变化轨迹了解较少。
68例计划接受≥4周期化疗的I - III期乳腺癌（BC）女性患者以及年龄、种族和教育程度匹配的正常无癌对照者（NC）参与了研究。通过活动记录仪测量睡眠（夜间总睡眠时间[夜间TST]和白天总小睡时间[NAPTIME]）以及匹兹堡睡眠质量指数（PSQI）；通过多维疲劳症状量表简表（MFSI - SF）测量疲劳；通过流行病学研究中心抑郁量表（CES - D）测量抑郁。CARs由活动记录仪得出。采用了几种生活质量测量方法。在三个时间点收集数据：化疗前（基线）、第4周期结束时（第4周期）以及化疗后1年（1年）。
与NC相比，BC患者在基线时NAPTIME更长、睡眠质量更差、疲劳更严重、抑郁症状更多、CARs更紊乱且生活质量更差（所有p值<0.05）。在第4周期时，与自身基线水平及NC相比，BC患者睡眠更差、疲劳增加、抑郁症状更多且CARs更紊乱（所有p值<0.05）。到1年时，BC患者的疲劳、抑郁症状和生活质量恢复到基线水平，但仍比NC患者差，而NAPTIME和CARs与NC患者无差异。
需要进一步研究以确定在化疗开始前就对这些症状进行治疗是否会随着时间推移将症状严重程度降至最低。
