Bonhof Cynthia S, van de Poll-Franse Lonneke V, Vissers Pauline A J, Wasowicz Dareczka K, Wegdam Johannes A, Révész Dóra, Vreugdenhil Gerard, Mols Floortje
Center of Research on Psychology in Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Psychooncology. 2019 Sep;28(9):1926-1933. doi: 10.1002/pon.5176. Epub 2019 Jul 29.
Chemotherapy-induced sensory peripheral neuropathy (CIPN) is common among colorectal cancer (CRC) survivors. The aim of this study was to examine whether CIPN is associated with both psychological distress (ie, anxiety and depression) and fatigue and whether the relationship between CIPN and fatigue can (partly) be explained by psychological distress.
All CRC survivors diagnosed between 2000 and 2009 as registered by the population-based Netherlands Cancer Registry (Eindhoven region) were eligible for participation. Chemotherapy-treated survivors completed questions on CIPN (EORTC QLQ-CIPN20), psychological distress (HADS), and fatigue (FAS) on average 5.6 years after diagnosis. Simple and multiple mediation analyses were performed to examine anxiety and depression as possible mediators in the association between CIPN and fatigue.
Survivors with high (ie, upper 30% of scores) CIPN (n = 172) reported more anxiety and depressive symptoms and more fatigue compared with those with low CIPN (n = 299). Furthermore, among survivors with high CIPN, those who were anxious, depressed, or both reported more fatigue compared with those without psychological distress. These differences were clinically relevant. Finally, mediation analyses showed that while CIPN was directly associated with fatigue, the relationship between CIPN and fatigue was also significantly mediated by both anxiety and depression.
CRC survivors with high CIPN report more fatigue, especially those who are also anxious and/or depressed. More research is needed on the direction of the relationship between CIPN, psychological distress, and fatigue. For now, the treatment of fatigue should also focus on addressing psychological distress, as treating fatigue alone might not be sufficient.
化疗引起的感觉性周围神经病变（CIPN）在结直肠癌（CRC）幸存者中很常见。本研究的目的是探讨CIPN是否与心理困扰（即焦虑和抑郁）及疲劳相关，以及CIPN与疲劳之间的关系是否能（部分）由心理困扰来解释。
所有在2000年至2009年期间被基于人群的荷兰癌症登记处（埃因霍温地区）登记诊断的CRC幸存者均符合参与条件。接受化疗的幸存者在诊断后平均5.6年完成了关于CIPN（欧洲癌症研究与治疗组织QLQ-CIPN20量表）、心理困扰（医院焦虑抑郁量表）和疲劳（疲劳评估量表）的问卷调查。进行了简单和多重中介分析，以检验焦虑和抑郁是否为CIPN与疲劳之间关联的可能中介因素。
与低CIPN（n = 299）的幸存者相比，高CIPN（即得分处于前30%）的幸存者（n = 172）报告有更多的焦虑和抑郁症状以及更多的疲劳。此外，在高CIPN的幸存者中，与没有心理困扰的人相比，焦虑、抑郁或两者皆有的人报告有更多的疲劳。这些差异具有临床意义。最后，中介分析表明，虽然CIPN与疲劳直接相关，但CIPN与疲劳之间的关系也显著地由焦虑和抑郁两者介导。
高CIPN的CRC幸存者报告有更多的疲劳，尤其是那些同时伴有焦虑和/或抑郁的人。关于CIPN、心理困扰和疲劳之间关系的方向还需要更多的研究。目前，疲劳的治疗也应侧重于解决心理困扰，因为仅治疗疲劳可能并不足够。
