University of Rochester Medical Center, James P. Wilmot Cancer Institute, St. Jude Children's Research Hospital, Rochester, USA.
Department of Epidemiology and Cancer Control, Postdoctoral Research Fellow, St. Jude Children's Research Hospital, 262 Danny Thomas Blvd, Memphis, TN, 38106, USA.
Breast Cancer Res Treat. 2021 May;187(1):275-285. doi: 10.1007/s10549-020-06067-6. Epub 2021 Jan 4.
Fatigue and anxiety are common and significant symptoms reported by cancer patients. Few studies have examined the trajectory of multidimensional fatigue and anxiety, the relationships between them and with quality of life.
Breast cancer patients (n = 580) from community oncology clinics and age-matched controls (n = 364) completed fatigue and anxiety questionnaires prior to chemotherapy (A1), at chemotherapy completion (A2), and six months post-chemotherapy (A3). Linear mixed models (LMM) compared trajectories of fatigue /anxiety over time in patients and controls and estimated their relationship with quality of life. Models adjusted for age, education, race, BMI, marital status, menopausal status, and sleep symptoms.
Patients reported greater fatigue and anxiety compared to controls at all time points (p's < 0.001, 35% clinically meaningful anxiety at baseline). From A1 to A2 patients experienced a significant increase in fatigue (β = 8.3 95%CI 6.6,10.0) which returned to A1 values at A3 but remained greater than controls' (p < 0.001). General, mental, and physical fatigue subscales increased from A1 to A2 remaining significantly higher than A1 at A3 (p < 0.001). Anxiety improved over time (A1 to A3 β = - 4.3 95%CI -2.6,-3.3) but remained higher than controls at A3 (p < 0.001). Among patients, fatigue and anxiety significantly predicted one another and quality of life. Menopausal status, higher BMI, mastectomy, and sleep problems also significantly predicted change in fatigue.
Breast cancer patients experience significant fatigue and anxiety up to six months post-chemotherapy that is associated with worse quality of life. Future interventions should simultaneously address anxiety and fatigue, focusing on mental and physical fatigue subdomains.
疲劳和焦虑是癌症患者常见且严重的症状。很少有研究探讨多维疲劳和焦虑的轨迹、它们之间的关系以及与生活质量的关系。
来自社区肿瘤诊所的乳腺癌患者（n=580）和年龄匹配的对照组（n=364）在化疗前（A1）、化疗完成时（A2）和化疗后 6 个月（A3）完成疲劳和焦虑问卷。线性混合模型（LMM）比较了患者和对照组的疲劳/焦虑随时间的轨迹，并估计了它们与生活质量的关系。模型调整了年龄、教育程度、种族、BMI、婚姻状况、绝经状态和睡眠症状。
与对照组相比，患者在所有时间点都报告了更高的疲劳和焦虑（p<0.001，基线时有 35%的患者存在有临床意义的焦虑）。从 A1 到 A2，患者的疲劳感显著增加（β=8.3，95%CI 6.6,10.0），在 A3 时恢复到 A1 值，但仍高于对照组（p<0.001）。一般、心理和身体疲劳子量表从 A1 到 A2 持续增加，在 A3 时仍显著高于 A1（p<0.001）。焦虑感随时间改善（A1 到 A3，β=-4.3，95%CI -2.6,-3.3），但在 A3 时仍高于对照组（p<0.001）。在患者中，疲劳和焦虑显著预测彼此以及生活质量。绝经状态、较高的 BMI、乳房切除术和睡眠问题也显著预测疲劳的变化。
乳腺癌患者在化疗后 6 个月内经历显著的疲劳和焦虑，这与生活质量更差相关。未来的干预措施应同时解决焦虑和疲劳问题，重点关注心理和身体疲劳子领域。
