Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
ESMO Open. 2022 Apr;7(2):100457. doi: 10.1016/j.esmoop.2022.100457. Epub 2022 Mar 31.
Cancer-related fatigue (CRF) is common in patients with advanced solid tumors and several risk factors are described. The possible role of depression is reported by clinicians despite the association with CRF being unclear.
In this monocentric, cross-sectional, prospective study we recruited patients with advanced solid tumors who were hospitalized at Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. The primary objective was to assess the correlation between CRF and depression. Secondary objectives were the estimation of CRF and depression prevalence and the identification of associated clinical risk factors. CRF and depression were evaluated through the Functional Assessment of Cancer Therapy-Fatigue subscale and the Zung Self Depression Scale (ZSDS) questionnaires. The Cochran-Armitage trend test was used to demonstrate the primary hypothesis. Univariate and multivariate logistic regression models were used to investigate the impact of clinical variables.
A total of 136 patients were enrolled. The primary analysis found a linear correlation (P < 0.0001) between CRF and depression. The prevalence of CRF and of moderate to severe depressive symptoms was 43.5% and 29.2%, respectively. In univariate analysis, patients with poor Eastern Cooperative Oncology Group performance status (ECOG PS), anemia, distress, pain, and receiving oncological treatment were at a significantly higher risk for CRF, whereas poor ECOG PS, pain, and distress were risk factors for depression. In multivariate analysis, high levels of ZSDS were confirmed to be correlated to CRF: odds ratio of 3.86 [95% confidence interval (CI) 0.98-15.20) and 11.20 (95% CI 2.35-53.36) for ZSDS of 50-59 and 60-100, respectively (P value for trend 0.002). Moreover, the ECOG PS score was confirmed to be significantly associated with CRF (OR 7.20; 95% CI 1.73-29.96; P = 0.007).
Our data suggest a strong correlation between CRF and depression in patients with advanced solid tumors. Further investigations are needed to better understand this relationship and if depressive disorder therapeutic strategies could also impact on CRF.
癌症相关疲劳（CRF）在晚期实体瘤患者中很常见，并且已经描述了几种风险因素。尽管与 CRF 相关的关联尚不明确，但临床医生报告了抑郁的可能作用。
在这项单中心、横断面、前瞻性研究中，我们招募了在米兰国家肿瘤研究所 Fondazione IRCCS 住院的晚期实体瘤患者。主要目的是评估 CRF 与抑郁之间的相关性。次要目的是估计 CRF 和抑郁的患病率以及确定相关的临床危险因素。通过功能评估癌症治疗-疲劳量表和 Zung 自我抑郁量表（ZSDS）问卷评估 CRF 和抑郁。Cochran-Armitage 趋势检验用于证明主要假设。使用单变量和多变量逻辑回归模型来研究临床变量的影响。
共纳入 136 名患者。主要分析发现 CRF 和抑郁之间存在线性相关性（P<0.0001）。CRF 和中重度抑郁症状的患病率分别为 43.5%和 29.2%。在单变量分析中，ECOG PS 表现状态差、贫血、痛苦、疼痛和接受肿瘤治疗的患者发生 CRF 的风险明显更高，而 ECOG PS 差、疼痛和痛苦是抑郁的危险因素。在多变量分析中，ZSDS 水平较高被证实与 CRF 相关：ZSDS 为 50-59 和 60-100 时，CRF 的比值比分别为 3.86（95%CI 0.98-15.20）和 11.20（95%CI 2.35-53.36）（趋势 P 值为 0.002）。此外，ECOG PS 评分与 CRF 显著相关（OR 7.20；95%CI 1.73-29.96；P=0.007）。
我们的数据表明，晚期实体瘤患者的 CRF 与抑郁之间存在很强的相关性。需要进一步的研究来更好地了解这种关系，如果抑郁障碍治疗策略也能影响 CRF。
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