Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
School of Aging Studies, University of South Florida, Tampa, Florida, USA.
Colorectal Dis. 2023 Oct;25(10):2054-2063. doi: 10.1111/codi.16746. Epub 2023 Sep 12.
This study sought to identify groups of colorectal cancer patients based upon trajectories of fatigue and examine how demographic, clinical and behavioural risk factors differentiate these groups.
Patients were from six cancer centres in the United States and Germany. Fatigue was measured using the fatigue subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) at five time points (baseline/enrolment and 3, 6, 12 and 24 months after diagnosis). Piecewise growth mixture models identified latent trajectories of fatigue. Logistic regression models examined differences in demographic, clinical and behavioural characteristics between fatigue trajectory groups.
Among 1615 participants (57% men, 86% non-Hispanic White, mean age 61 ± 13 years at diagnosis), three distinct groups were identified. In the high fatigue group (36%), fatigue significantly increased in the first 6 months after diagnosis and then showed statistically and clinically significant improvement from 6 to 24 months (P values < 0.01). Throughout the study period, average fatigue met or exceeded cutoffs for clinical significance. In the moderate (34%) and low (30%) fatigue groups, fatigue levels remained below or near population norms across the study period. Patients who were diagnosed with Stage II-IV disease and/or current smokers were more likely to be in the high fatigue than in the moderate fatigue group (P values < 0.05).
A large proportion of colorectal cancer patients experienced sustained fatigue after initiation of cancer treatment. Patients with high fatigue at the time of diagnosis may benefit from early supportive care.
本研究旨在根据疲劳轨迹对结直肠癌患者进行分组，并探讨人口统计学、临床和行为风险因素如何区分这些组。
患者来自美国和德国的 6 个癌症中心。使用欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-C30）的疲劳子量表在五个时间点（基线/入组以及诊断后 3、6、12 和 24 个月）测量疲劳。分段增长混合模型确定了疲劳的潜在轨迹。逻辑回归模型检查了疲劳轨迹组之间人口统计学、临床和行为特征的差异。
在 1615 名参与者中（57%为男性，86%为非西班牙裔白人，诊断时的平均年龄为 61±13 岁），确定了三个不同的组。在高疲劳组（36%）中，疲劳在诊断后 6 个月内显著增加，然后从 6 个月到 24 个月显示出统计学和临床意义上的显著改善（P 值均<0.01）。在整个研究期间，平均疲劳水平达到或超过了临床意义的临界值。在中度（34%）和低（30%）疲劳组中，疲劳水平在整个研究期间均低于或接近人群正常值。诊断为 II 期-IV 期疾病和/或当前吸烟者的患者更有可能处于高疲劳组而不是中度疲劳组（P 值均<0.05）。
很大一部分结直肠癌患者在开始癌症治疗后会持续感到疲劳。诊断时疲劳程度较高的患者可能受益于早期的支持性护理。
