Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
Cancer Med. 2019 Jun;8(6):3227-3236. doi: 10.1002/cam4.2166. Epub 2019 Apr 22.
Cancer-related fatigue (CRF) is one of the most prevalent symptoms experienced by cancer survivors. However, researchers are only beginning to elucidate the risk factors, underlying mechanism(s), and its association with other outcomes. Research on the association between CRF and mortality is limited.
The study sample comprised 2059 short-term (<5 years postdiagnosis) cancer survivors from four PROFILES registry studies. Survivors diagnosed with stage I-III colorectal cancer (CRC) or stage I-III endometrial cancer (EC), with no evidence of disease, were identified and followed-up by the Netherlands Cancer Registry. Fatigue was assessed with the Fatigue Assessment Scale. Cox proportional hazards models adjusted for demographic, clinical, and lifestyle characteristics were performed to assess the association of CRF with all-cause mortality. Date of censoring was February 1, 2017.
Prevalence of CRF varied between 35.8% (male CRC) and 43.6% (female CRC). After a median follow-up period of 9.0 years, a total of 408 survivors (20%) had died. CRF was associated with increased all-cause mortality in male CRC survivors (HRadj = 1.75, 95% CI [1.31-2.33]). This association remained statistically significant after excluding survivors experiencing anhedonia. For female CRC (HRadj = 1.32, 95% CI [0.90-1.97]) and EC (HRadj = 1.27, 95% CI [0.84-1.90]) survivors, there was no significant association with all-cause mortality for the fatigued group in multivariable analyses.
Our study found that CRF is significantly associated with all-cause mortality in male CRC survivors, irrespective of potential confounders. This result suggests that clinicians should increase their attention towards the recognition and treatment of CRF.
癌症相关疲劳（CRF）是癌症幸存者最常见的症状之一。然而，研究人员才刚刚开始阐明其风险因素、潜在机制及其与其他结果的关系。关于 CRF 与死亡率之间的关联的研究有限。
本研究样本包括来自四个 PROFILES 登记研究的 2059 名短期（<5 年诊断后）癌症幸存者。从荷兰癌症登记处确定并随访了无疾病证据的 I-III 期结直肠癌（CRC）或 I-III 期子宫内膜癌（EC）的幸存者。使用疲劳评估量表评估疲劳情况。采用 Cox 比例风险模型，调整人口统计学、临床和生活方式特征，评估 CRF 与全因死亡率的关系。截止日期为 2017 年 2 月 1 日。
CRF 的患病率在男性 CRC（35.8%）和女性 CRC（43.6%）之间有所不同。中位随访 9.0 年后，共有 408 名幸存者（20%）死亡。CRF 与男性 CRC 幸存者全因死亡率增加相关（HRadj=1.75，95%CI[1.31-2.33]）。在排除经历快感缺失的幸存者后，这种关联仍然具有统计学意义。对于女性 CRC（HRadj=1.32，95%CI[0.90-1.97]）和 EC（HRadj=1.27，95%CI[0.84-1.90]）幸存者，在多变量分析中，疲劳组与全因死亡率之间没有显著关联。
我们的研究发现，CRF 与男性 CRC 幸存者的全因死亡率显著相关，无论潜在的混杂因素如何。这一结果表明，临床医生应更加关注 CRF 的识别和治疗。
