Blickle Patricia, Schmidt Martina E, Steindorf Karen
Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT), Heidelberg, a Partnership Between DKFZ and University Medical Center, Heidelberg, Germany.
Cancer Med. 2025 Jan;14(1):e70404. doi: 10.1002/cam4.70404.
Cancer-related fatigue is one of the most common burdens of cancer patients. To date, most studies focused on fatigue during or after treatment. However, investigation of pretreatment fatigue is crucial to identify causal or risk factors other than cancer therapy and to enable timely fatigue management.
Two hundred and thirty-two breast cancer patients (mean age = 55.6) and 41 healthy participants (mean age = 49.3) were recruited via the National Center for Tumor Diseases (NCT) Heidelberg. Patient-reported outcomes were assessed with the EORTC QLQ-FA12 for fatigue, the EORTC QLQ-C30 for functioning, the STAI for anxiety, the CESD-R for depression and the PSQI for sleep disturbance. Descriptive analyses and logistic regression models were performed using baseline data before start of cancer treatment. The thresholds of clinical importance (TCI) were applied to test for clinically relevant fatigue.
Compared to the healthy participants, patients scored significantly higher in physical, emotional, and total fatigue, in depression, in global health status and in all functioning scales except cognitive function (all p < 0.01). 48.7% of all patients reported clinically relevant fatigue. Being younger, being obese, having low education, or low social support was associated with a higher likelihood of clinically relevant fatigue before treatment. Higher depression and anxiety scores, poorer sleep quality and global health status, and impaired functioning seemed to get along with an increased likelihood of scoring above the TCI of fatigue (all p < 0.001).
Our study results suggest that fatigue screening, patient-centered fatigue education and psychosocial support may be needed already from the time of cancer diagnosis.
癌症相关疲劳是癌症患者最常见的负担之一。迄今为止，大多数研究聚焦于治疗期间或治疗后的疲劳。然而，治疗前疲劳的调查对于识别癌症治疗以外的因果或风险因素以及实现及时的疲劳管理至关重要。
通过海德堡国家肿瘤疾病中心（NCT）招募了232名乳腺癌患者（平均年龄 = 55.6岁）和41名健康参与者（平均年龄 = 49.3岁）。使用欧洲癌症研究与治疗组织（EORTC）的QLQ - FA12量表评估疲劳，QLQ - C30量表评估功能，状态特质焦虑量表（STAI）评估焦虑，流行病学研究中心抑郁量表修订版（CESD - R）评估抑郁，匹兹堡睡眠质量指数（PSQI）评估睡眠障碍。使用癌症治疗开始前的基线数据进行描述性分析和逻辑回归模型。应用临床重要性阈值（TCI）来测试临床相关疲劳。
与健康参与者相比，患者在身体、情绪和总疲劳、抑郁、总体健康状况以及除认知功能外的所有功能量表上得分显著更高（所有p < 0.01）。48.7%的患者报告有临床相关疲劳。年龄较小、肥胖、教育程度低或社会支持低与治疗前临床相关疲劳的可能性较高相关。更高的抑郁和焦虑评分、更差的睡眠质量和总体健康状况以及功能受损似乎与得分高于疲劳TCI的可能性增加相关（所有p < 0.001）。
我们的研究结果表明，从癌症诊断时起可能就需要进行疲劳筛查、以患者为中心的疲劳教育和心理社会支持。
