综合治疗期乳腺癌患者癌因性疲乏的纵向研究

Longitudinal study on cancer-related fatigue among breast cancer patients during comprehensive treatment period

目的 调查综合治疗期乳腺癌患者在手术期、化疗期、放疗期的癌因性疲乏状况及变化模式,以期为临床干预提供依据.方法 采用方便抽样法抽取2014年2月—2015年11月在某市某肿瘤医院及2所医学院附属医院确诊为乳腺癌准备进行乳腺癌切除术、接受辅助化疗及放射治疗的综合治疗乳腺癌患者242例作为研究对象.分别在在手术后1周、化疗结束时、放疗结束时3个时间点,对其进行癌因性疲乏调查,分析患者在不同治疗时期癌因性疲乏的变化特征.结果 乳腺癌患者在手术期的疲乏程度最轻,疲乏均分（2.59±2.41）分,轻度疲乏者占76%;化疗后疲乏程度明显上升,疲乏均分（6.57±2.43）分,重度疲乏者占75.2%,疲乏程度最重;而放疗期疲乏程度较化疗期有所减轻,疲乏均分（4.38±2.46）分,但仍高于手术期,中度疲乏者占到57%.在整个治疗期,总体癌因性疲乏水平和各维度得分均呈不稳定的轻、重、中度＂波峰样＂波动状态,且3个不同治疗期的疲乏得分比较差异有统计学意义（F=43.16,P〈0.001）.结论 综合治疗期的乳腺癌患者在不同治疗时期都存在着不同程度的癌因性疲乏,手术期最轻,化疗期最重,放疗期介于两者之间,护理人员要关注此变化特征,以便及时干预.

Objective To investigate the level of cancer-related fatigue （CRF） and its trajectory in three different periods including operation,chemotherapy,and radiotherapy among breast cancer patients,in order to provide references for clinical intervention during comprehensive treatment period.Methods By convenience sampling method,242 cases of patients diagnosed with breast cancer who are prepared for breast cancer resection,prepared to be treated with adjuvant chemotherapy and radiotherapy,and conformed to the sample standard from a tumor hospital and two affiliated hospitals of medical college from February 2014 to November 2015 in a city were selected as the research object. The follow-up survey of CRF was conducted respectively in the three different point-in-time for one week after operation,and at the end of chemotherapy and radiotherapy in order to analyze variation characteristics of CRF during comprehensive treatment period.Results In operation period,the fatigue of breast cancer patients was mild,the average scores was （2.59±2.41） and approximately 76% patients experienced fatigue to low-grade degree;After chemotherapy,the fatigue level of patients was significantly increased （6.57±2.43）,and 75.2% patients were accounted for severe fatigue;After radiotherapy, the fatigue level of patients （4.38±2.46） was slightly declined compared with that in chemotherapy period,but it was still higher than that in the operation period. and 57% patients suffered from moderate fatigue. During the whole treatment period,the level for general fatigue and four dimensions of fatigue were in the unstable state of ＂wave＂ of fluctuations with mild,severe,moderate （F=43.16,P〈0.001）.Conclusions There is a certain difference with CRF of breast cancer patients at different stage of comprehensive treatment. CRF in operation period is mild,in radiotherapy period is moderate and in chemotherapy period is severe. We should actively focus on the changes of CRF in order to take timely intervention.