Krishnan Sheela, Narayan Hari K, Freedman Gary, Plastaras John P, Maity Amit, Demissei Biniyam, Smith Amanda M, Berman Abigail T, Cengel Keith, Levin William, Swisher-McClure Samuel, Feigenberg Steven, Ky Bonnie
Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pediatrics, University of California San Diego, La Jolla, California.
Int J Radiat Oncol Biol Phys. 2021 Mar 15;109(4):946-952. doi: 10.1016/j.ijrobp.2020.10.018. Epub 2020 Oct 24.
The effects of thoracic radiation therapy (RT) on physical functioning and quality of life (QoL) are incompletely defined. We determined the associations between thoracic RT dose volume metrics, physical activity, and QoL in patients with cancer.
Participants with breast cancer, lung cancer, or mediastinal lymphoma treated with radiation with or without chemotherapy were enrolled in a prospective, longitudinal cohort study. Data were collected pre-RT, immediately post-RT, and 5 to 9 months post-RT. At each timepoint, self-reported physical activity was assessed via the Godin-Shephard Leisure-Time Physical Activity Questionnaire, and QoL metrics were assessed via Functional Assessment of Chronic Illness Therapy Fatigue and Dyspnea Scales. Multivariable adjusted linear regression models were stratified by breast cancer alone and lung cancer and lymphoma combined.
One hundred thirty participants were included in the study. In breast cancer (n = 80), each 1-Gy increase in mean heart dose was associated with worse Functional Assessment of Chronic Illness Therapy Fatigue scores (-1.0; 95% confidence interval [CI], -1.9 to -0.2; P = .021); similar associations were observed between V5 and fatigue (-2.5; 95% CI, -4.4 to -0.6; P = .010 for each 10% increase in V5). In lung cancer and lymphoma (n = 50), each 10% increase in V5 was associated with decreased physical activity (Godin-Shephard Leisure-Time Physical Activity Questionnaire score -2.3; 95% CI, -4.3 to -0.4; P = .017). Although the associations between baseline levels of physical activity and fatigue and dyspnea were of borderline significance in breast cancer alone (P < .10), increased physical activity over time was associated with improvements in fatigue and dyspnea across all cancer types (P < .05 for all).
Higher cardiac RT dose was associated with worse fatigue and physical activity across breast cancer, lung cancer, and mediastinal lymphoma. Longitudinal increases in physical activity were associated with concurrent improvements in QoL measures. Strategies to increase physical activity and decrease cardiac RT dose may improve physical functioning and QoL for patients with cancer.
胸部放射治疗（RT）对身体功能和生活质量（QoL）的影响尚未完全明确。我们确定了癌症患者胸部RT剂量体积指标、身体活动与QoL之间的关联。
对接受放疗（联合或不联合化疗）的乳腺癌、肺癌或纵隔淋巴瘤患者进行了一项前瞻性纵向队列研究。在放疗前、放疗后即刻以及放疗后5至9个月收集数据。在每个时间点，通过戈丁-谢泼德休闲时间身体活动问卷评估自我报告的身体活动情况，并通过慢性病治疗功能评估疲劳和呼吸困难量表评估QoL指标。多变量调整线性回归模型按单独的乳腺癌以及肺癌和淋巴瘤合并进行分层。
130名参与者纳入研究。在乳腺癌患者（n = 80）中，平均心脏剂量每增加1 Gy与慢性病治疗功能评估疲劳评分恶化相关（-1.0；95%置信区间[CI]，-1.9至-0.2；P = 0.021）；V5与疲劳之间也观察到类似关联（V5每增加10%，-2.5；95% CI，-4.4至-0.6；P = 0.010）。在肺癌和淋巴瘤患者（n = 50）中，V5每增加10%与身体活动减少相关（戈丁-谢泼德休闲时间身体活动问卷评分-2.3；95% CI，-4.3至-0.4；P = 0.017）。虽然单独乳腺癌患者中身体活动基线水平与疲劳和呼吸困难之间的关联具有临界显著性（P < 0.10），但随着时间推移身体活动增加与所有癌症类型的疲劳和呼吸困难改善相关（所有P < 0.05）。
较高的心脏RT剂量与乳腺癌、肺癌和纵隔淋巴瘤患者更严重的疲劳和身体活动减少相关。身体活动的纵向增加与QoL指标的同时改善相关。增加身体活动和降低心脏RT剂量的策略可能改善癌症患者的身体功能和QoL。
