Garcia Philip, Block Astrid, Mark Sueann, Mackin Lynda, Paul Steven M, Cooper Bruce A, Conley Yvette P, Hammer Marilyn J, Levine Jon D, Miaskowski Christine
Author Affiliations: School of Nursing, University of California, San Francisco (Mr Garcia, Ms Block, and Drs Mark, Mackin, Paul, Cooper, and Miaskowski); School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); School of Medicine, University of California, San Francisco (Drs Miaskowski and Levine).
Cancer Nurs. 2025;48(2):E75-E89. doi: 10.1097/NCC.0000000000001304. Epub 2024 Jan 23.
Anxiety and fatigue are common problems in patients receiving chemotherapy. Unrelieved stress is a potential cause for the co-occurrence of these symptoms.
The aims of this study were to identify subgroups of patients with distinct state anxiety and morning fatigue profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, as well as measures of global, cancer-specific, and cumulative life stress and resilience and coping.
Patients (n = 1335) completed measures of state anxiety and morning fatigue 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was used to identify the state anxiety and morning fatigue profiles.
Three distinct joint profiles were identified: Low Anxiety and Low Morning Fatigue (59%), Moderate Anxiety and Moderate Morning Fatigue (33.4%), and High Anxiety and High Morning Fatigue (7.6%). Patients in the 2 highest classes were younger, were less likely to be married/partnered, and had a higher comorbidity burden. All of the stress scores demonstrated a dose-response effect (ie, as anxiety and morning fatigue profiles worsened, stress increased). Patients in the 2 highest classes reported higher rates of emotional abuse, physical neglect, physical abuse, and sexual harassment.
More than 40% of these patients experienced moderate to high levels of both anxiety and morning fatigue. Higher levels of all 3 types of stress were associated with the 2 highest profiles.
Clinicians need to perform comprehensive evaluations of patients' levels of stress and recommend referrals to psychosocial services.
焦虑和疲劳是接受化疗患者的常见问题。压力未得到缓解是这些症状同时出现的一个潜在原因。
本研究的目的是识别具有不同状态焦虑和晨间疲劳特征的患者亚组，并评估这些亚组在人口统计学和临床特征方面的差异，以及整体、癌症特异性和累积生活压力、恢复力及应对措施方面的差异。
1335名患者在2个化疗周期内6次完成状态焦虑和晨间疲劳测量。所有其他测量在化疗的第二个或第三个周期之前完成。采用潜在类别分析来识别状态焦虑和晨间疲劳特征。
识别出三种不同的联合特征：低焦虑和低晨间疲劳（59%）、中度焦虑和中度晨间疲劳（33.4%）以及高焦虑和高晨间疲劳（7.6%）。最高的两个类别中的患者更年轻，结婚/有伴侣的可能性更小，且合并症负担更高。所有压力评分均呈现剂量反应效应（即随着焦虑和晨间疲劳特征恶化，压力增加）。最高的两个类别中的患者报告情感虐待、身体忽视、身体虐待和性骚扰的发生率更高。
这些患者中有超过40%经历了中度至高度的焦虑和晨间疲劳。所有三种类型的压力水平升高均与最高的两个特征相关。
临床医生需要对患者的压力水平进行全面评估，并建议转诊至心理社会服务机构。
