Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida, USA.
Policlinico Tor Vergata, Roma, Italy.
BMJ Support Palliat Care. 2023 Dec 7;13(e2):e344-e351. doi: 10.1136/bmjspcare-2020-002312.
This study compared the burden of fatigue between treatment-naïve patients with newly diagnosed acute myeloid leukaemia (AML) and the general population and investigated patient factors associated with fatigue severity.
Pretreatment patient-reported fatigue was assessed with the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire in a sample of 463 newly diagnosed patients with AML who were enrolled in a clinical trial. Multivariable linear regression models were used to estimate the adjusted mean differences in fatigue between patients with AML and adults from the general population (n=847) by AML disease risk categories. A clinically meaningful difference in fatigue was defined as ≥3 points. Univariable and multivariable linear regression models were used to identify sociodemographic, clinical and molecular correlates of worse fatigue in patients with AML.
Patients with AML reported adjusted mean fatigue scores that were 7.5 points worse than the general population (95% CI -8.6 to -6.4, p<0.001). Across AML disease risk categories, adjusted mean differences in fatigue compared with the general population ranged from 6.7 points worse (patients with favourable risk: 95% CI -8.6 to -4.8, p<0.001) to 8.9 points worse (patients with poor risk, 95% CI -10.5 to -7.2, p<0.001). Overall, 91% of patients with AML reported fatigue that was equal to or worse than the general population's median fatigue score. Higher pretreatment fatigue was independently associated with female sex, WHO performance status ≥1 and lower platelet levels.
Patients with newly diagnosed AML reported worse fatigue than the general population, and mean differences exceeded twice the threshold for clinical significance. Our findings may help to identify patients with AML most likely to benefit from supportive care interventions to reduce fatigue.
本研究比较了初治初诊急性髓系白血病（AML）患者与普通人群之间的疲劳负担，并探讨了与疲劳严重程度相关的患者因素。
在一项临床试验中，对 463 例新诊断为 AML 的患者进行了治疗前患者报告的疲劳评估，使用慢性疾病治疗功能评估-疲劳问卷（Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire）。使用多变量线性回归模型，按 AML 疾病风险类别，估计 AML 患者与普通人群（n=847）之间疲劳的调整后平均差异。将疲劳的临床显著差异定义为≥3 分。使用单变量和多变量线性回归模型，确定 AML 患者疲劳更严重的社会人口统计学、临床和分子相关性。
AML 患者报告的疲劳调整后平均得分比普通人群差 7.5 分（95%CI-8.6 至-6.4，p<0.001）。在 AML 疾病风险类别中，与普通人群相比，疲劳的调整后平均差异范围从差 6.7 分（风险良好的患者：95%CI-8.6 至-4.8，p<0.001）到差 8.9 分（风险差的患者：95%CI-10.5 至-7.2，p<0.001）。总体而言，91%的 AML 患者报告的疲劳与普通人群的中位数疲劳评分相当或更差。较高的预处理疲劳与女性、WHO 体能状态≥1 和较低的血小板水平独立相关。
初诊 AML 患者报告的疲劳比普通人群更严重，平均差异超过临床意义阈值的两倍。我们的研究结果可能有助于确定最有可能受益于减轻疲劳的支持性护理干预的 AML 患者。
