Kastelein Anneke, Mols Floortje, Kervezee Laura, Chavannes Niels H, Gelderblom Hans, Neefjes Jacques, Hinnen Chris
Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, Leiden, the Netherlands.
CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
Cancer Med. 2025 Jan;14(1):e70536. doi: 10.1002/cam4.70536.
Inflammation has been reported to drive cancer-related fatigue (CRF). As both obesity and chemotherapy promote inflammatory responses, obese cancer patients may be at risk of more severe CRF, especially when receiving chemotherapy.
We analysed data of 333 colon cancer patients from four hospitals in the Netherlands (data derived from the PROCORE study). Fatigue was assessed with the general fatigue subscale of the Multidimensional Fatigue Inventory at four timepoints: at inclusion (T1), 4 weeks after surgery (T2), and 1 (T3) and 2 years (T4) after diagnosis. Linear mixed-effects models were applied to evaluate the interaction between chemotherapy and body mass index (BMI) on the trajectory of fatigue.
The two-way interactions between time and chemotherapy (p = 0.047) and between time and BMI on fatigue (p = 0.041) were significant. Patients scheduled for chemotherapy reported more fatigue during the treatment phase, while patients not treated with chemotherapy showed a stable trajectory. Obese patients reported more fatigue at follow-up compared to patients with a healthy BMI. The three-way interaction between time, chemotherapy and BMI was not significant (p = 0.39). However, obese chemotherapy-treated patients reported the highest fatigue 2 years after treatment (12.8, 95% CI: 10.6-14.9). Their mean fatigue score was higher compared to baseline (9.2, 95% CI: 7.3-11.0, p < 0.001) and obese patients not treated with chemotherapy (9.6, 95% CI: 7.0-12.2, p = 0.02). Moreover, this group reported more fatigue compared to healthy (8.1, 95% CI: 5.5-10.9, p < 0.001) and overweight (9.7, 95% CI: 7.2-12.3, p = 0.019) chemotherapy-treated patients.
This study indicates that chemotherapy and BMI both influence long-term fatigue in colon cancer patients. Proactive monitoring for CRF and lifestyle interventions may be needed for chemotherapy-treated patients with a high BMI.
据报道，炎症会引发癌症相关疲劳（CRF）。由于肥胖和化疗都会促进炎症反应，肥胖癌症患者可能面临更严重的CRF风险，尤其是在接受化疗时。
我们分析了来自荷兰四家医院的333例结肠癌患者的数据（数据源自PROCORE研究）。在四个时间点使用多维疲劳量表的一般疲劳分量表评估疲劳程度：纳入时（T1）、手术后4周（T2）、诊断后1年（T3）和2年（T4）。应用线性混合效应模型来评估化疗与体重指数（BMI）对疲劳轨迹的相互作用。
时间与化疗之间（p = 0.047）以及时间与BMI对疲劳的影响之间（p = 0.041）的双向相互作用具有统计学意义。计划接受化疗的患者在治疗阶段报告的疲劳更多，而未接受化疗的患者疲劳轨迹稳定。与BMI正常的患者相比，肥胖患者在随访时报告的疲劳更多。时间、化疗和BMI之间的三向相互作用无统计学意义（p = 0.39）。然而，接受化疗的肥胖患者在治疗后2年报告的疲劳程度最高（12.8，95%置信区间：10.6 - 14.9）。与基线（9.2，95%置信区间：7.3 - 11.0，p < 0.001）和未接受化疗的肥胖患者（9.6，95%置信区间：7.0 - 12.2，p = 0.02）相比，他们的平均疲劳评分更高。此外，与BMI正常（8.1，95%置信区间：5.5 - 10.9，p < 0.001）和超重（9.7，95%置信区间：7.2 - 12.3，p = 0.019）且接受化疗的患者相比，该组报告的疲劳更多。
本研究表明，化疗和BMI都会影响结肠癌患者的长期疲劳。对于BMI较高且接受化疗的患者，可能需要对CRF进行主动监测并采取生活方式干预措施。
