Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, 909 Wilson Road, Road 321, East Lansing, MI, 48824, USA.
College of Nursing, Department of Psychiatry and Mel and Enid Zuckerman College of Public Health, University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, USA.
Qual Life Res. 2024 Apr;33(4):1143-1155. doi: 10.1007/s11136-023-03595-8. Epub 2024 Jan 30.
Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment.
Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time.
Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor.
Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms.
Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.
许多癌症幸存者在完成治疗后，迟发或残留症状会降低其生活质量。
研究与化疗后持续存在的症状负担以及随时间推移症状无改善相关的风险因素。
在两年内完成针对实体瘤的根治性化疗的幸存者被纳入一项症状管理试验。共有 375 名幸存者存在两种或更多合并症或一种合并症和抑郁症状升高（试验设计中定义的风险因素），他们接受了干预，71 名无这些风险因素的幸存者未接受干预。对于所有幸存者，在入组时、第 4 周和第 13 周评估症状，并根据对日常生活的干扰将症状分为轻度、中度或重度。使用广义混合效应模型，分析与合并症、抑郁症状、年龄、性别、种族/民族、就业、化疗完成后时间以及身体功能相关的中度或重度症状和症状改善的概率。多个症状作为嵌套在幸存者内进行处理。
基线时存在中度或重度症状以及随时间推移无改善与年龄较小和身体功能较差有关，这超出了合并症较多和抑郁症状严重程度较高的影响。
本研究确定的风险因素（年龄较小、身体功能较差、合并症较多以及抑郁症状较高）可用于为癌症幸存者的治疗后症状管理分配资源，以缓解随时间推移不一定会缓解的症状。
