Smets E M, Visser M R, Willems-Groot A F, Garssen B, Schuster-Uitterhoeve A L, de Haes J C
Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands.
Br J Cancer. 1998 Oct;78(7):907-12. doi: 10.1038/bjc.1998.600.
Little is known regarding the prevalence and course of fatigue in cancer patients after treatment has ended and no recurrence found. The present study examines fatigue in disease-free cancer patients after being treated with radiotherapy (n = 154). The following questions are addressed. First, how do patients describe their fatigue 9 months after radiotherapy and is this different from fatigue in a nonselective sample from the general population (n = 139)? Secondly, to what degree is fatigue in patients associated with sociodemographic, medical, physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue 9 months after radiotherapy? Results indicated that fatigue in disease-free cancer patients did not differ significantly from fatigue in the general population. However, for 34% of the patients, fatigue following treatment was worse than anticipated, 39% listed fatigue as one of the three symptoms causing them most distress, 26% of patients worried about their fatigue and patients' overall quality of life was negatively related to fatigue (r = -0.46). Fatigue in disease-free patients was significantly associated with: gender, physical distress, pain rating, sleep quality, functional disability, psychological distress and depression, but not with medical (diagnosis, prognosis, co-morbidity) or treatment-related (target area, total radiation dose, fractionation) variables. The degree of fatigue, functional disability and pain before radiotherapy were the best predictors of fatigue at 9-month follow-up, explaining 30%, 3% and 4% of the variance respectively. These findings are in line with the associations found with fatigue during treatment as reported in the preceding paper in this issue. The significant associations between fatigue and both psychological and physical variables demonstrate the complex aetiology of this symptom in patients and point out the necessity of a multidisciplinary approach for its treatment.
关于癌症患者治疗结束且未发现复发后的疲劳患病率及病程，目前所知甚少。本研究调查了接受放射治疗的无病癌症患者（n = 154）的疲劳情况。研究探讨了以下问题。第一，患者如何描述放疗9个月后的疲劳情况，这与来自普通人群的非选择性样本（n = 139）中的疲劳情况有何不同？第二，患者的疲劳程度与社会人口学、医学、身体和心理因素的关联程度如何？最后，能否预测哪些患者在放疗9个月后会出现疲劳？结果表明，无病癌症患者的疲劳情况与普通人群的疲劳情况无显著差异。然而，34%的患者治疗后的疲劳比预期更严重，39%的患者将疲劳列为最困扰他们的三种症状之一，26%的患者担心自己的疲劳，且患者的总体生活质量与疲劳呈负相关（r = -0.46）。无病患者的疲劳与以下因素显著相关：性别、身体不适、疼痛评分、睡眠质量、功能障碍、心理困扰和抑郁，但与医学因素（诊断、预后、合并症）或治疗相关因素（靶区、总辐射剂量、分割）无关。放疗前的疲劳程度、功能障碍和疼痛程度是9个月随访时疲劳的最佳预测因素，分别解释了30%、3%和4%的方差。这些发现与本期前一篇论文中报道的治疗期间疲劳的相关情况一致。疲劳与心理和身体变量之间的显著关联表明了该症状在患者中的复杂病因，并指出了采用多学科方法进行治疗的必要性。
