乳腺癌患者化疗期癌因性疲乏轨迹及影响因素的纵向研究

Longitudinal study on the trajectory and influencing factors of cancer-related fatigue in breast cancer patients during chemotherapy

目的探讨乳腺癌患者化疗期癌因性疲乏(CRF)的纵向变化轨迹及影响因素。方法选取2019年3月至2020年1月在上海中医药大学附属龙华医院、上海中医药大学附属岳阳中西医结合医院、北京协和医院就诊的乳腺癌患者作为研究对象,进行追踪调查。调查工具包括一般资料调查问卷、癌因性疲乏评估量表、国际体力活动问卷、匹兹堡睡眠质量指数量表。结果共纳入91例患者,化疗前、化疗3周后及化疗6周后各期重度CRF的发生率分别为1.1%(1/91)、8.8%(5/57)、2.1%(1/48)。广义估计方程显示,CRF总分呈现先升后降趋势,在化疗3周后达到顶峰(35.45±13.07)分,轻度CRF随时间变化有统计学意义(P<0.05)。此外,BMI和睡眠日间功能障碍是CRF总分变化的影响因素;疾病分期、是否存在睡眠障碍和日间功能障碍是不同严重程度CRF变化的影响因素。结论乳腺癌患者化疗期CRF问题突出,医护人员应对BMI异常、日间功能障碍的高危个体给予关注。

Objective To investigate the longitudinal trajectory and influencing factors of cancer-related fatigue(CRF)in breast cancer patients during chemotherapy.Methods From March 2019 to January 2020,breast cancer patients in Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine and Peking Union Medical College Hospital were selected as the research objects to conduct follow-up investigation.The survey tools included general information questionnaire,Cancer-related Fatigue Assessment Scale,International Physical Activity Questionnaire,and the Pittsburgh Sleep Quality Index Scale.Results A total of 91 patients were included in the study.The incidence of severe CRF at each time point before chemotherapy,3 weeks after chemotherapy and 6 weeks after chemotherapy were 1.1%(1/91),8.8%(5/57)and 2.1%(1/48),respectively.The results of the generalized estimation equation showed that the trajectory of the total score CRF firstly increased and then decreased,reaching a peak at 3 weeks after chemotherapy(35.45±13.07),and mild CRF change showed statistical difference(P<0.05).In addition,BMI and sleep and daytime dysfunction were the influencing factors of the total score of CRF.Disease stage,sleep disturbance and daytime dysfunction were the influencing factors of CRF with different severity.Conclusions CRF is a prominent problem in breast cancer patients during chemotherapy.Attention should be paid to high-risk individuals with abnormal BMI and daytime function by medical staff.