疲劳症状量表在非小细胞肺癌患者化疗前后疲劳评估中的应用
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摘要
背景随着医学的进步,疲劳这一症状已越来越得到癌症患者及医务人员的重视.国外对疲劳的诊断、评估、治疗方面的研究已越来越多,但却常得不到国内患者及医务人员足够的认识和重视。
目的通过疲劳症状量表(Fatigue Symptom Inventory ,FSI)来观察非小细胞肺癌患者化疗前后疲劳症状的变化及其影响因素。研究其与CTCAE3.0疲劳不良反应评定标准的相关性,评价改量表的临床应用价值。
方法调查对象为2006年9月1日至2008年8月31日在安徽医科大学第一附属医院肿瘤科住院的非小细胞肺癌患者,所有入组患者均完成两周期化疗。入组患者分别于化疗前一天、化疗第八天完成疲劳症状量表,代表化疗前一周、化疗后一周疲劳状况,研究者每日记录CTCAE3.0疲劳不良反应情况。按照化疗前的年龄、性别、疾病分期、病理类型、手术史、KPS评分、化疗方案、化疗疗效等进行分组比较,探讨疲劳的影响因素及化疗前后的改变情况。采用线性相关分析患者自测FSI得分与研究者观察CTCAE3.0疲劳等级的相关性。
结果共有82例非小细胞肺癌患者入组并完成两周期的含铂方案化疗。其中行术后辅助化疗20例,因局部晚期或复发、转移行姑息化疗62例。性别、年龄、疾病分期、病理类型、手术史、化疗方案等对疲劳无显著影响(P>0.05)。基线状态下姑息化疗者FSI得分较辅助化疗者高(P=0.00),KPS60-70分者FSI得分明显高于KPS80分及KPS90-100分组(P=0.00),而后两组之间无明显差异。82例患者化疗前后一周FSI量表得分有明显差异。进一步按化疗有效、化疗无效及辅助化疗分三组研究化疗前后一周FSI得分发现,化疗有效组FSI得分改变不明显(P=0.08),而辅助化疗与化疗无效组FSI得分均明显增高(P=0.00)。完成两周期化疗后的第一周,化疗有效组疲劳较低(P=0.00),而化疗无效与辅助化疗组之间无显著差别(P=0.07)。一程化疗期间疲劳发生率57.32%,二程化疗期间疲劳发生率62.19%。FSI得分与CTCAE3.0之疲劳评定结果间有高度相关性,两周期化疗中的相关系数均r可达到0.91。
结论非小细胞肺癌患者疲劳症状的发生率高,症状重。性别、年龄、疾病分期、病理类型、手术史等对疲劳无显著影响,KPS评分低者疲劳症状重。局部晚期或复发、转移者疲劳较术后辅助化疗者重。化疗有效者疲劳改变不明显,而化疗无效及辅助化疗者经历化疗后疲劳会明显加重,但随后会逐渐减轻,直至下一周期化疗后再加重。采用多西他赛、吉西他滨或长春瑞滨联合顺铂方案化疗,其对疲劳的影响无明显差异。FSI量表可用于评价中国非小细胞肺癌患者的疲劳。
Background: With the development of medcine, the symptom of fatigue had received more and more attention from cancer patients and medical staff. There were much researches on dignosing, evaluating and treatment of fatigue abroad, but little in our coumtry.
Objective:Using the fatigue symptom inventory (FSI) to investigate cancer-related fatigue and influence factors of fatigue in non-small cell lung cancer patients who were receiving chemotherapy. Finding the relationship between FSI and the fatigue criteria of CTCAE3.0 to evaluate the clinical application value of this scale.
Methods: A survey was undertaken on those in-patients of non-small cell lung cancer in the department of oncology, the first afflilated hospital of Anhui Medical University from September, 2006 to August,2008.All these patients of our research should complete two cycles of chemotherapy and they would be asked to complete the 13-items fatigue symptom inventory before they started chemotherapy and a week after they started chemotherapy.Researchers should evaluate the fatigue level using CTCAE3.0. We compared FSI scores according to age, sex, staging of disease, pathlogy, operation history, KPS scores before chemotherapy, chemo-schemas and responses to chemotherapy. Linear correlation was applied to analyze the relationship between the score of FSI and the level of CTCAE3.0.
Results: A total of 82 cases were enrolled and completed two cycles chemotherapy with platiunm. We had 20 patients receiving adjuvant chemotherapy and 62 patients of local-advanced or with tumor recurrence or metastasis receiving palliative chemotherapy. Age, sex, staging of disease, pathlogy, operation history, chemo-schemas and remission rate were not significantly associated with cancer-ralated fatigue in non-small cell lung cancer patients(P>0.05). Patients receiving palliative chemotherapy got higher FSI scores than adjuvant chemotherapy patients during the baseline(P=0.00)patients with KPS 60-70 got higher FSI scores than those with KPS80 or KPS90-100. FSI scores of 82 patients got higher after chemotherapy. We divided them into three groups of chemotherapy effective, chemotherapy ineffective and adjuvant chemotherapy and found that FSI scores of chemotherapy effective group did not changed after chemotherapy(P=0.08), while FSI scores of chemotherapy ineffective and adjuvant chemotherapy groups got significantly higher(P=0.00).FSI scores of the week after the second chemo-cycle show that chemotherapy effective group was lower(P=0.00),and no difference between chemotherapy ineffective group and adjuvant chemotherapy group(P=0.07). The incidence of fatigue during the first chemotherapy cycle was 57.32% and 62.19% during the second cycle.There was a good correlation between FSI and fatigue criteria of CTCAE3.0 (r=0.91).
Conclusion: Non-small cell lung cancer patients got a high incidence and servere symptom of fatigue. Age, sex, staging of disease, pathlogy, operation history, were not significantly associated with cancer-ralated fatigue in non-small cell lung cancer patients. Those with lower Kanorfsky Performance Score(KPS) got higher fatigue level. Patients of local-advanced or with tumor recurrence or metastasis got higher fatigue level. Patients got effective after chemotherapy did not got a higher fatigue level, while in those didn’t get effective or adjuvant chemotherapy patients, chemotherapy can significantly aggreveate fatigue , and fatigue level would get lower until the next course of chemotherapy. Chemo-schemas did not affect fatigue symptom. Fatigue Symptom Inventory can be used to evaluating fatigue in non-small cell lung cancer of chinese.
目的通过疲劳症状量表(Fatigue Symptom Inventory ,FSI)来观察非小细胞肺癌患者化疗前后疲劳症状的变化及其影响因素。研究其与CTCAE3.0疲劳不良反应评定标准的相关性,评价改量表的临床应用价值。
方法调查对象为2006年9月1日至2008年8月31日在安徽医科大学第一附属医院肿瘤科住院的非小细胞肺癌患者,所有入组患者均完成两周期化疗。入组患者分别于化疗前一天、化疗第八天完成疲劳症状量表,代表化疗前一周、化疗后一周疲劳状况,研究者每日记录CTCAE3.0疲劳不良反应情况。按照化疗前的年龄、性别、疾病分期、病理类型、手术史、KPS评分、化疗方案、化疗疗效等进行分组比较,探讨疲劳的影响因素及化疗前后的改变情况。采用线性相关分析患者自测FSI得分与研究者观察CTCAE3.0疲劳等级的相关性。
结果共有82例非小细胞肺癌患者入组并完成两周期的含铂方案化疗。其中行术后辅助化疗20例,因局部晚期或复发、转移行姑息化疗62例。性别、年龄、疾病分期、病理类型、手术史、化疗方案等对疲劳无显著影响(P>0.05)。基线状态下姑息化疗者FSI得分较辅助化疗者高(P=0.00),KPS60-70分者FSI得分明显高于KPS80分及KPS90-100分组(P=0.00),而后两组之间无明显差异。82例患者化疗前后一周FSI量表得分有明显差异。进一步按化疗有效、化疗无效及辅助化疗分三组研究化疗前后一周FSI得分发现,化疗有效组FSI得分改变不明显(P=0.08),而辅助化疗与化疗无效组FSI得分均明显增高(P=0.00)。完成两周期化疗后的第一周,化疗有效组疲劳较低(P=0.00),而化疗无效与辅助化疗组之间无显著差别(P=0.07)。一程化疗期间疲劳发生率57.32%,二程化疗期间疲劳发生率62.19%。FSI得分与CTCAE3.0之疲劳评定结果间有高度相关性,两周期化疗中的相关系数均r可达到0.91。
结论非小细胞肺癌患者疲劳症状的发生率高,症状重。性别、年龄、疾病分期、病理类型、手术史等对疲劳无显著影响,KPS评分低者疲劳症状重。局部晚期或复发、转移者疲劳较术后辅助化疗者重。化疗有效者疲劳改变不明显,而化疗无效及辅助化疗者经历化疗后疲劳会明显加重,但随后会逐渐减轻,直至下一周期化疗后再加重。采用多西他赛、吉西他滨或长春瑞滨联合顺铂方案化疗,其对疲劳的影响无明显差异。FSI量表可用于评价中国非小细胞肺癌患者的疲劳。
Background: With the development of medcine, the symptom of fatigue had received more and more attention from cancer patients and medical staff. There were much researches on dignosing, evaluating and treatment of fatigue abroad, but little in our coumtry.
Objective:Using the fatigue symptom inventory (FSI) to investigate cancer-related fatigue and influence factors of fatigue in non-small cell lung cancer patients who were receiving chemotherapy. Finding the relationship between FSI and the fatigue criteria of CTCAE3.0 to evaluate the clinical application value of this scale.
Methods: A survey was undertaken on those in-patients of non-small cell lung cancer in the department of oncology, the first afflilated hospital of Anhui Medical University from September, 2006 to August,2008.All these patients of our research should complete two cycles of chemotherapy and they would be asked to complete the 13-items fatigue symptom inventory before they started chemotherapy and a week after they started chemotherapy.Researchers should evaluate the fatigue level using CTCAE3.0. We compared FSI scores according to age, sex, staging of disease, pathlogy, operation history, KPS scores before chemotherapy, chemo-schemas and responses to chemotherapy. Linear correlation was applied to analyze the relationship between the score of FSI and the level of CTCAE3.0.
Results: A total of 82 cases were enrolled and completed two cycles chemotherapy with platiunm. We had 20 patients receiving adjuvant chemotherapy and 62 patients of local-advanced or with tumor recurrence or metastasis receiving palliative chemotherapy. Age, sex, staging of disease, pathlogy, operation history, chemo-schemas and remission rate were not significantly associated with cancer-ralated fatigue in non-small cell lung cancer patients(P>0.05). Patients receiving palliative chemotherapy got higher FSI scores than adjuvant chemotherapy patients during the baseline(P=0.00)patients with KPS 60-70 got higher FSI scores than those with KPS80 or KPS90-100. FSI scores of 82 patients got higher after chemotherapy. We divided them into three groups of chemotherapy effective, chemotherapy ineffective and adjuvant chemotherapy and found that FSI scores of chemotherapy effective group did not changed after chemotherapy(P=0.08), while FSI scores of chemotherapy ineffective and adjuvant chemotherapy groups got significantly higher(P=0.00).FSI scores of the week after the second chemo-cycle show that chemotherapy effective group was lower(P=0.00),and no difference between chemotherapy ineffective group and adjuvant chemotherapy group(P=0.07). The incidence of fatigue during the first chemotherapy cycle was 57.32% and 62.19% during the second cycle.There was a good correlation between FSI and fatigue criteria of CTCAE3.0 (r=0.91).
Conclusion: Non-small cell lung cancer patients got a high incidence and servere symptom of fatigue. Age, sex, staging of disease, pathlogy, operation history, were not significantly associated with cancer-ralated fatigue in non-small cell lung cancer patients. Those with lower Kanorfsky Performance Score(KPS) got higher fatigue level. Patients of local-advanced or with tumor recurrence or metastasis got higher fatigue level. Patients got effective after chemotherapy did not got a higher fatigue level, while in those didn’t get effective or adjuvant chemotherapy patients, chemotherapy can significantly aggreveate fatigue , and fatigue level would get lower until the next course of chemotherapy. Chemo-schemas did not affect fatigue symptom. Fatigue Symptom Inventory can be used to evaluating fatigue in non-small cell lung cancer of chinese.
引文
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