Müller Fabiola, Tuinman Marrit A, Janse Moniek, Almansa Josué, Sprangers Mirjam A G, Smink Ans, Ranchor Adelita V, Fleer Joke, Hagedoorn Mariët
Department of Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands.
Division of Community and Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands.
Br J Health Psychol. 2017 Sep;22(3):627-643. doi: 10.1111/bjhp.12253. Epub 2017 Jun 21.
Most studies on fatigue in patients with cancer aggregate its prevalence and severity on a group level, ignoring the possibility that subgroups of patients may differ widely in their development of fatigue. This study aimed to identify subgroups of patients with clinically distinct trajectories of fatigue from diagnosis to 18 months post-diagnosis. As fatigue might trigger goal disturbance, the study also identified trajectories of concrete and abstract goal disturbance and longitudinally examined their co-occurrence with fatigue.
Prospective design with quantitative and qualitative method of data collection.
Patients with colorectal cancer (n = 183) reported on their levels of fatigue and goal disturbance shortly after diagnosis (T ) and at 7 months (T ) and 18 months (T ) post-diagnosis. Growth mixture model analyses were performed to identify trajectories of fatigue and goal disturbance. Guidelines for the clinical relevance of fatigue were applied.
Four clinically distinct trajectories of fatigue were identified as follows: (1) persistent severe fatigue (25.4%), (2) moderate fatigue (56.1%), (3) no fatigue (13.8%), and (4) rapidly improving fatigue (4.7%). The majority of patients with cancer reported high disturbance of their concrete goals, while high disturbance of abstract goals was less evident. Fatigue and concrete goal disturbance co-occurred longitudinally.
The fatigue and goal disturbance experienced from diagnosis to 18 months post-diagnosis differ considerably for subgroups of patients with cancer. Fatigue and concrete goal disturbance are persistent burdens in the majority of patients. Investigating symptom burden beyond average trends can guide clinicians to identify patients most in need for treatment. Targeting goal disturbance might benefit the psychological well-being in patients suffering from persistent symptoms. Statement of contribution What is already known on this subject? Fatigue is a common and distressing symptom at all stages of the cancer experience. Earlier studies suggest that many patients recover from fatigue after treatment completion. Patients with cancer experience disturbance in their personal goals, which is related to poor psychological well-being. What does this study add? Developments of fatigue and goal disturbance differ between subgroups of patients with cancer but co-occur within these subgroups. About 30% of the patients experience severe fatigue after diagnosis, of which only few patients recover within 18 months post-diagnosis. Targeting goal disturbance might benefit patients with severe and ongoing symptoms.
大多数关于癌症患者疲劳的研究在群体层面汇总其患病率和严重程度，而忽略了患者亚组在疲劳发展方面可能存在巨大差异的可能性。本研究旨在识别从诊断到诊断后18个月具有临床上不同疲劳轨迹的癌症患者亚组。由于疲劳可能引发目标干扰，该研究还确定了具体和抽象目标干扰的轨迹，并纵向检查了它们与疲劳的共现情况。
采用前瞻性设计，运用定量和定性的数据收集方法。
结直肠癌患者（n = 183）在诊断后不久（T1）、诊断后7个月（T2）和18个月（T3）报告他们的疲劳水平和目标干扰情况。进行生长混合模型分析以识别疲劳和目标干扰的轨迹。应用了疲劳临床相关性的指南。
确定了四种临床上不同的疲劳轨迹如下：（1）持续性严重疲劳（25.4%），（2）中度疲劳（56.1%），（3）无疲劳（13.8%），以及（4）快速改善的疲劳（4.7%）。大多数癌症患者报告其具体目标受到高度干扰，而抽象目标受到高度干扰则不太明显。疲劳和具体目标干扰在纵向存在共现情况。
癌症患者亚组从诊断到诊断后18个月所经历的疲劳和目标干扰存在相当大的差异。疲劳和具体目标干扰是大多数患者持续存在的负担。研究平均趋势之外的症状负担可以指导临床医生识别最需要治疗的患者。针对目标干扰可能有益于患有持续性症状的患者的心理健康。贡献声明关于该主题已知的内容是什么？疲劳是癌症经历各个阶段常见且令人痛苦的症状。早期研究表明，许多患者在治疗完成后从疲劳中恢复。癌症患者在个人目标方面经历干扰，这与不良的心理健康有关。本研究增加了什么？癌症患者亚组之间疲劳和目标干扰的发展情况不同，但在这些亚组内会同时出现。约30%的患者在诊断后经历严重疲劳，其中只有少数患者在诊断后18个月内恢复。针对目标干扰可能有益于患有严重且持续症状的患者。
