Dornsife Center for Self-Report Science and Center for Economic and Social Research, University of Southern California, Verna & Peter Dauterive Hall, 635 Downey Way, Los Angeles, CA, 90089-3332, USA,
Support Care Cancer. 2015 Sep;23(9):2579-87. doi: 10.1007/s00520-015-2616-x. Epub 2015 Jan 27.
The goal of this study was to characterize changes in daily fatigue in women undergoing chemotherapy for breast cancer. We examined whether there are subgroups of patients with distinct fatigue trajectories and explored potential psychosocial and biomedical predictors of these subgroups.
Participants were 77 women with breast cancer receiving adjuvant chemotherapy with AC-T (2-week cycle) and TC or TCH (3-week cycle) regimens. They completed 28 daily ratings online using an adapted version of the Patient-Reported Outcomes Measurement Information System (PROMIS®) fatigue instrument.
Both regimens followed an "inverted-U-shaped" fatigue pattern over approximately 2 weeks. Growth mixture modeling identified three patient subgroups with distinct trajectories. Fatigue scores in the "low fatigue" group (23 %) increased following the infusion and quickly abated. The "transient fatigue" (27 %) group had a very pronounced increase. Patients in the "high fatigue" (50 %) group reported consistently elevated fatigue with a relatively small increase. Demographic and medical variables were not associated with fatigue trajectory. Patients in the "high fatigue" group reported significantly poorer physical, emotional, and social functioning, poorer general health, and more depressed mood than patients in the "low fatigue" group. The "transient fatigue" group reported significantly better physical and social functioning than the "high fatigue" group, but emotional distress and depression similar to the "high fatigue" group.
The identification of patient subgroups with distinct fatigue trajectories during chemotherapy is an essential step for developing preventative strategies and tailored interventions. Our results suggest that different trajectories are associated with patients' psychosocial and general health.
本研究旨在描述接受乳腺癌化疗的女性日常疲劳变化。我们检验了是否存在具有不同疲劳轨迹的患者亚组，并探讨了这些亚组的潜在心理社会和生物医学预测因素。
参与者为 77 名接受 AC-T（2 周周期）和 TC 或 TCH（3 周周期）方案辅助化疗的乳腺癌患者。她们使用改良版患者报告结局测量信息系统（PROMIS®）疲劳量表在线完成 28 天的日常评分。
两种方案在大约 2 周内均呈现出“倒 U 形”疲劳模式。增长混合模型确定了具有不同轨迹的三个患者亚组。“低疲劳”组（23%）的疲劳评分在输注后增加，并迅速减轻。“短暂疲劳”（27%）组的增加非常显著。“高疲劳”（50%）组的患者报告持续疲劳，且相对较小的增加。人口统计学和医学变量与疲劳轨迹无关。“高疲劳”组的患者报告身体、情绪和社会功能明显较差，一般健康状况较差，情绪低落较严重，而“低疲劳”组的患者报告身体、情绪和社会功能明显较差。“短暂疲劳”组的身体和社会功能明显优于“高疲劳”组，但其情绪困扰和抑郁程度与“高疲劳”组相似。
在化疗期间识别具有不同疲劳轨迹的患者亚组是制定预防策略和针对性干预措施的关键步骤。我们的结果表明，不同的轨迹与患者的心理社会和一般健康有关。
