Jones Jennifer M, Olson Karin, Catton Pamela, Catton Charles N, Fleshner Neil E, Krzyzanowska Monika K, McCready David R, Wong Rebecca K S, Jiang Haiyan, Howell Doris
Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Street, Munk Building B PMB 148, Toronto, ON, M5G 2C4, Canada.
University of Alberta, Edmonton, AB, Canada.
J Cancer Surviv. 2016 Feb;10(1):51-61. doi: 10.1007/s11764-015-0450-2. Epub 2015 Apr 16.
Cancer-related fatigue (CRF) is the most prevalent and distressing symptom among cancer patients and survivors. However, research on its prevalence and related disability in the post-treatment survivorship period remains limited. We sought to describe the occurrence of CRF within three time points in the post-treatment survivorship trajectory.
A self-administered mail-based questionnaire which included the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and the World Health Organisation Disability Assessment Schedule 2.0 was sent to three cohorts of disease-free breast, prostate or colorectal cancer survivors (6-18 months; 2-3 years; and 5-6 years post-treatment). Clinical information was extracted from chart review. Frequencies of significant fatigue by diagnostic group and time cohorts were studied and compared. Multivariate logistic regressions were conducted to examine the associations between CRF and demographic, clinical, and psychosocial variables.
One thousand two hundred ninety-four questionnaire packages were returned (63 % response rate). A total of 29 % (95 % CI [27 % to 32 %]) of the sample reported significant fatigue (FACT-F ≤34), and this was associated with much higher levels of disability (p < 0.0001). Breast (40 % [35 % to 44 %]) and colorectal (33 % [27 % to 38 %]) cancer survivors had significantly higher rates of fatigue compared with the prostate group (17 % [14 % to 21 %]) (p < 0.0001). Fatigue levels did not differ between the three time cohorts. The main factors associated with CRF included physical symptom burden, depression, and co-morbidity (AUC, 0.919 [0.903 to 0.936]).
Clinically relevant levels of CRF are present in approximately 1/3 of cancer survivors up to 6 years post-treatment, and this is associated with high levels of disability.
Clinicians need to be aware of the chronicity of CRF and assess for it routinely in medical practice. While there is no gold standard treatment, non-pharmacological interventions with established efficacy can reduce its severity and possibly minimize its disabling impact on patient functioning. Attention must be paid to the co-occurrence and need for possible treatment of depression and other co-occurring physical symptoms as contributing factors.
癌症相关疲劳（CRF）是癌症患者和幸存者中最普遍且令人痛苦的症状。然而，关于其在治疗后生存期的患病率及相关残疾情况的研究仍然有限。我们试图描述CRF在治疗后生存轨迹的三个时间点的发生情况。
一份基于邮件的自填式问卷被发送给三组无病的乳腺癌、前列腺癌或结直肠癌幸存者队列（治疗后6 - 18个月；2 - 3年；以及5 - 6年），问卷包括癌症治疗功能评估-疲劳量表（FACT-F）和世界卫生组织残疾评估量表2.0。临床信息从病历审查中提取。研究并比较了按诊断组和时间队列划分的显著疲劳频率。进行多变量逻辑回归以检验CRF与人口统计学、临床和心理社会变量之间的关联。
共返回1294份问卷包（回复率63%）。样本中共有29%（95%置信区间[27%至32%]）报告有显著疲劳（FACT-F≤34），且这与更高水平的残疾相关（p < 0.0001）。与前列腺癌组（17%[14%至21%]）相比，乳腺癌（40%[35%至44%]）和结直肠癌（33%[27%至38%]）幸存者的疲劳发生率显著更高（p < 0.0001）。三个时间队列的疲劳水平无差异。与CRF相关的主要因素包括身体症状负担、抑郁和共病（曲线下面积，0.919[0.903至0.936]）。
在治疗后长达6年的时间里，约三分之一的癌症幸存者存在临床相关水平的CRF，且这与高水平的残疾相关。
临床医生需要意识到CRF的慢性特点，并在医疗实践中常规对其进行评估。虽然没有金标准治疗方法，但已证实有效的非药物干预可以减轻其严重程度，并可能将其对患者功能的致残影响降至最低。必须关注抑郁和其他共病身体症状作为促成因素的同时出现情况以及可能的治疗需求。
