Author Affiliations: School of Nursing (Ms Medysky and Drs Dieckmann and Winters-Stone), Knight Cancer Institute (Drs Winters-Stone and Sullivan), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (Dr Sullivan), Oregon Health & Science University, Portland; and Health Services & Research Development, Veterans Affairs Portland Health Care System, Oregon (Dr Sullivan); and Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Lyons).
Cancer Nurs. 2021;44(2):E83-E89. doi: 10.1097/NCC.0000000000000765.
Lung cancer survivors are at risk of accelerated declines in physical functioning attributed to cancer treatment. However, it is unknown whether patients experience the same rate of functional decline and how symptoms may contribute to different trajectories.
The aims of this study were to identify interindividual differences in the pattern and rate of change in self-reported functioning in lung cancer survivors and examine whether and how symptoms are related to physical functioning over time.
This was a secondary data analysis in 72 lung cancer survivors. Multilevel modeling was used to estimate trajectories of self-reported physical functioning over 1 year and assess the relation between functioning, fatigue, depressive symptoms, and pain severity across time.
Within the sample, average physical functioning did not significantly decrease (coefficient, -0.46; 95% confidence interval [CI] = -2.85 to 0.94) over time. However, among individual lung cancer survivors, baseline physical functioning varied significantly (SD, 20.76; 95% CI, 16.84-25.59) and changed at significantly different rates over 1 year (SD, 3.50; 95% CI, 2.13-5.68). Fatigue, assessed over 1 year, was the only significant symptom predictor of physical functioning changes over time (coefficient = 1.03; 95% CI, 0.79-1.27).
In this sample of lung cancer survivors, not all survivors experienced the same rate of self-reported functional decline and those with lower levels of fatigue reported better physical functioning.
Nurses should recognize that some lung cancer survivors may have faster rates of functional declines than others, which may be related to fatigue severity. Early identification and management of fatigue could help avoid or delay future disability.
肺癌幸存者由于癌症治疗而面临身体功能加速下降的风险。然而，目前尚不清楚患者是否经历相同的功能下降速度，以及症状如何导致不同的轨迹。
本研究旨在确定肺癌幸存者自我报告功能变化的模式和速率的个体间差异，并探讨症状与随时间推移的身体功能之间的关系。
这是对 72 名肺癌幸存者的二次数据分析。使用多层次模型来估计自我报告的身体功能在 1 年内的轨迹，并评估功能、疲劳、抑郁症状和疼痛严重程度随时间的关系。
在样本中，平均身体功能在时间上没有显著下降（系数，-0.46；95%置信区间[CI] = -2.85 至 0.94）。然而，在个体肺癌幸存者中，基线身体功能有显著差异（标准差，20.76；95%CI，16.84-25.59），并且在 1 年内以显著不同的速率变化（标准差，3.50；95%CI，2.13-5.68）。在 1 年内评估的疲劳是身体功能随时间变化的唯一显著症状预测因子（系数=1.03；95%CI，0.79-1.27）。
在本样本的肺癌幸存者中，并非所有幸存者都经历了相同的自我报告功能下降速度，那些疲劳程度较低的幸存者报告了更好的身体功能。
护士应认识到，一些肺癌幸存者的功能下降速度可能比其他人快，这可能与疲劳严重程度有关。早期识别和管理疲劳可以帮助避免或延迟未来的残疾。
