恶性肿瘤患者癌因性疲劳流行状况和相关因素的初步分析
摘要
癌因性疲劳(CRF)相关研究是肿瘤患者生活质量研究的新热点之一。CRF是与癌症疾病本身和各种抗癌治疗有关的一个最常见的症状,也是最困扰肿瘤患者的症状之一。国外对CRF开展的研究较早,并形成多维疲劳症状量表(MFSI)、简明疲劳量表(BFI)、Piper's疲劳量表等研究工具,对CRF的相关致病因素和影响因素的研究也在广泛进行中。目前国内学术界对CRF的研究刚刚起步,中国肿瘤人群中CRF的流行病学特征尚不明确,其发病机制、影响因素及适当的评估标准都有待了解。
针对治疗期和康复期患者,我们分别选取了部分社区肿瘤患者和住院肿瘤患者作为研究对象,了解这两类肿瘤患者人群中CRF的发生率、相关影响因素及其对患者生活质量的影响。对CRF评估的常用量表BFI、FACIT-F中文版在本研究人群中的信度、效度和外在一致性进行评估,选择适用的疲劳分析变量。基于社会心理-生物医学模式,对多维度影响因素进行多变量分析,了解不同人群中CRF发生的独立预测因素。
结果显示,本调查中的社区肿瘤患者的以中老年为主,其疾病分期多数为早中期(Ⅰ、Ⅱ期者占61.5%),病程相对较长。疲劳是社区肿瘤患者中发生率最高的症状(28%),与患者的年龄和病程长短有关,纳差和疼痛则是影响疲劳的症状因素。多维度分析显示低龄和纳差是社区肿瘤患者疲劳发生的独立预测因素。疲劳对社区肿瘤患者的生活质量有明显的影响,包括躯体功能状况和情绪状况都随着疲劳的发生及疲劳程度的加重而变差。患者的抑郁状况评分(ZSDS量表)也随着疲劳的发生及疲劳程度的加重而增高,疲劳程度的加重与抑郁的发生及抑郁程度有关。疲劳的影响因性别的不同而有差异,男性ZSDS量表评分和女性生活质量评分相对更易于受到疲劳的影响。
本研究初步证实了FACIT-F和BFI中文量表在住院肿瘤患者中都具有较好的信效度,为患者的生活质量评估提供了合适的工具。也揭示了量表中部分条目尚需在以后的研究中进一步进行调适,使其评估结果能更加真实全面地反映中国肿瘤患者的疲劳状况和生活质量状况。本研究中FACIT-F量表整体标化Cronbachα系数为0.930,其五个维度的标化Cronbachα系数分别为0.836(身体状况维度)、0.800(情绪状况维度)、0.799(社交家庭维度)、0.827(功能状况维度)和0.929(附加关注维度);BFI量表整体标化Cronbachα系数为0.963,其两个组成部分标化Cronbachα系数分别为0.944和0.947。公因子分析显示,FACIT-F量表各维度和BFI量表内部一致性较高,各条目之间相关性显著,而且两个量表之间具有很高的相关性。最能反映FACIT-F量表疲劳指标的附加关注维度(FACT-F)评分与BFI量表“目前疲劳程度”条目相关性最高;反映患者整体生活质量状况的FACT-G评分与BFI综合影响评分相关性最高,说明BFI综合影响评分能较好地反映患者的生活质量变化。提示BFI量表的目前疲劳程度评分具有较高的敏感性,能较好地反映患者的疲劳状况,可作为住院肿瘤患者癌因性疲劳快速筛查的指标。已知群检验提示,不同KPS评分组间BFI量表评分和除社会家庭维度外的FACIT-F量表评分有明显差异,
对住院患者的研究显示,目前疲劳程度评分(CRF评分)>3、FACT-F(FACIT-F量表附加关注维度)评分<36分应该视为存在有临床意义的CRF,需要加以干预。住院肿瘤患者中,CRF是最常见的症状,发生率达81.4%,中度以上疲劳者60.0%。CRF的存在和加重对生活质量有明显的影响,主要体现在身体状况和功能状况维度评分的下降。对心理层面(ZSAS量表评分、情绪状况维度评分、ZSDS量表评分)也有明显的影响相对较弱,但也有显著的统计学差异。多变量分析显示,外周血单核细胞计数升高、白蛋白含量下降和口干程度等三个变量是住院肿瘤患者CRF发生的独立预测因素,工作状态、气短程度和睡眠不安程度等三个变量是影响CRF程度的独立因素。结果提示了住院肿瘤患者的全身性炎症免疫反应、营养状态和其他相关身心症状在CRF的发生发展中是起主要作用的三个方面。
通过本研究,我们初步了解了我国社区和住院肿瘤人群中CRF发生的基本特征——发生率、预测因素和影响因素;评价了BFI和FACIT-F这两种常用CRF评估工具的应用价值;为进一步探索CRF的发生模式和干预手段提供了研究基础。
Cancer Related Fatigue (CRF) is a new hot spot of tumor patient quality of liferesearch. CRF, the most common symptom of cancer patients, is associated with cancerand anticancer treatments. CRF is a very distressing condition, which has serious impacton the quality of life and is strongly associated with depression. During the last decade,related researches have developed some study tools, such as the multi-dimensionalFatigue Symptom Inventory (MFSI), Brief Fatigue Inventory (BFI), Piper's Fatigue Scale.Some CRF related pathogenic factors and influencing factors having been identified byusing these tools and other approach. At present, the domestic oncology academe juststarted to the CRF research, the CRF epidemiology characteristic of the Chinese cancerpatients crowd was still inexplicit. CRF’s pathogenesis, influencing factors and thesuitable appraisal standard wait for realizing.
In view of the different between under treatment patient and the convalescencepatient, we selected the partial cancer patients in community and some others in hospitalas the object of our study, to understand the incidence of CRF, the mediator of CRF andCRF’s impact to the patient quality of life in the two crowds. We validated the Chineseversion of BFI and FACIT-F in the sample of Chinese cancer patients and chose thesuitable fatigue analysis variable. Based on the social psychology - biomedicine pattern,we identify independent predictors of clinically significant fatigue based upon amultidimensional model.
In the community, the fatigue incidence of cancer patients was: (28.0%). UnivariateAnalysis showed that there had significant relation between fatigue and anorexia,insomnia, constipation, pain, age. In a multiple logistic regression model, age andanorexia symptom predicted fatigue independently with good calibration (HosmerLemeshow Chi Square = 2.58, P = 0.461). A multiple linear regress model showed thatseverity of anorexia and pain could respectively explained the 28.9%, 20.3% change offatigue severity. The development of clinically significant CRF could be predicted by lowage and anorexia symptom. The main factors which impact on the severity of CRF wereseverities of anorexia and pain. These findings support that CRF is a severe problem toChinese cancer patients in community. The low age survivor suffered this symptommore than the older. The mechanism of age’s effect to fatigue in cancer survivorsneeds more study. Anorexia is the most important symptom which affects thedevelopment and progress of fatigue. Uncontrolled pain is another symptom affected theprogress of fatigue. The main strategy for management and treatment of fatigue could bethe control of related symptoms.
We validated the Chinese version of the FACIT-F and BFI in a sample of 106Chinese inpatients with multiple cancer diagnoses. Internal consistency was indicated byCronbach alphas of 0.930 for FACIT-F and 0.963 for BFI. Factor analysis revealed afour-factor structure for the subscale FACT-G, a three-factor structure for the subscaleFACT-F. Convergent validity was examined by correlating the FACT-F scores andBFI-F scores. The present fatigue scores and FACT-F scores had the highest relativity.Known-group validity was established by comparing BFI-T and FACIT-F scores between patients with low functional status and high functional status. The Chineseversion of FACIT-F and BFI is reliable, valid, and sensitive for measuring cancer-relatedfatigue severity and interference among Chinese cancer patients.
The BFI present fatigue severity > 3/10 was defined as clinically significant fatigue.Fatigue was present in 81.4% cancer inpatients, and 60.0% had present fatigue>3. In amultiple logistic regression model, count of monocyte, level of serum albumin andmouth dry predicted fatigue independently with good calibration (Hosmer LemeshowChi Square = 7.19, P = 0.41) and discrimination (area under the receiver operatingcharacteristic curve = 0.85). A multiple linear regress model showed that workingfunction, shortness of breath and sleep disturbance could respectively explained the35.2%, 29.75%, 24.3% change of fatigue severity. The development of clinicallysignificant CRF could be predicted by high count of monocyte, low level of serumalbumin and the present of mouth dry symptoms. The main factors which impact on theseverity of CRF were working function, shortness of breath and sleep disturbance. Thesefindings support that the development of CRF is multi-origin, including inflammatoryresponse, low nutritional status and related symptoms, and CRF severity is mediated byphysical function and symptoms like shortness of breath and sleep disturbance. CRF isthe most prevalent symptom of Chinese cancer inpatient.
Through this study, we found some characteristic of CRF in Chinese cancerpatients, and appraised the value of the Chinese version of BFI and FACIT-F. It wouldbe a good foundation for further exploration the patterns and interventions of CRF.
针对治疗期和康复期患者,我们分别选取了部分社区肿瘤患者和住院肿瘤患者作为研究对象,了解这两类肿瘤患者人群中CRF的发生率、相关影响因素及其对患者生活质量的影响。对CRF评估的常用量表BFI、FACIT-F中文版在本研究人群中的信度、效度和外在一致性进行评估,选择适用的疲劳分析变量。基于社会心理-生物医学模式,对多维度影响因素进行多变量分析,了解不同人群中CRF发生的独立预测因素。
结果显示,本调查中的社区肿瘤患者的以中老年为主,其疾病分期多数为早中期(Ⅰ、Ⅱ期者占61.5%),病程相对较长。疲劳是社区肿瘤患者中发生率最高的症状(28%),与患者的年龄和病程长短有关,纳差和疼痛则是影响疲劳的症状因素。多维度分析显示低龄和纳差是社区肿瘤患者疲劳发生的独立预测因素。疲劳对社区肿瘤患者的生活质量有明显的影响,包括躯体功能状况和情绪状况都随着疲劳的发生及疲劳程度的加重而变差。患者的抑郁状况评分(ZSDS量表)也随着疲劳的发生及疲劳程度的加重而增高,疲劳程度的加重与抑郁的发生及抑郁程度有关。疲劳的影响因性别的不同而有差异,男性ZSDS量表评分和女性生活质量评分相对更易于受到疲劳的影响。
本研究初步证实了FACIT-F和BFI中文量表在住院肿瘤患者中都具有较好的信效度,为患者的生活质量评估提供了合适的工具。也揭示了量表中部分条目尚需在以后的研究中进一步进行调适,使其评估结果能更加真实全面地反映中国肿瘤患者的疲劳状况和生活质量状况。本研究中FACIT-F量表整体标化Cronbachα系数为0.930,其五个维度的标化Cronbachα系数分别为0.836(身体状况维度)、0.800(情绪状况维度)、0.799(社交家庭维度)、0.827(功能状况维度)和0.929(附加关注维度);BFI量表整体标化Cronbachα系数为0.963,其两个组成部分标化Cronbachα系数分别为0.944和0.947。公因子分析显示,FACIT-F量表各维度和BFI量表内部一致性较高,各条目之间相关性显著,而且两个量表之间具有很高的相关性。最能反映FACIT-F量表疲劳指标的附加关注维度(FACT-F)评分与BFI量表“目前疲劳程度”条目相关性最高;反映患者整体生活质量状况的FACT-G评分与BFI综合影响评分相关性最高,说明BFI综合影响评分能较好地反映患者的生活质量变化。提示BFI量表的目前疲劳程度评分具有较高的敏感性,能较好地反映患者的疲劳状况,可作为住院肿瘤患者癌因性疲劳快速筛查的指标。已知群检验提示,不同KPS评分组间BFI量表评分和除社会家庭维度外的FACIT-F量表评分有明显差异,
对住院患者的研究显示,目前疲劳程度评分(CRF评分)>3、FACT-F(FACIT-F量表附加关注维度)评分<36分应该视为存在有临床意义的CRF,需要加以干预。住院肿瘤患者中,CRF是最常见的症状,发生率达81.4%,中度以上疲劳者60.0%。CRF的存在和加重对生活质量有明显的影响,主要体现在身体状况和功能状况维度评分的下降。对心理层面(ZSAS量表评分、情绪状况维度评分、ZSDS量表评分)也有明显的影响相对较弱,但也有显著的统计学差异。多变量分析显示,外周血单核细胞计数升高、白蛋白含量下降和口干程度等三个变量是住院肿瘤患者CRF发生的独立预测因素,工作状态、气短程度和睡眠不安程度等三个变量是影响CRF程度的独立因素。结果提示了住院肿瘤患者的全身性炎症免疫反应、营养状态和其他相关身心症状在CRF的发生发展中是起主要作用的三个方面。
通过本研究,我们初步了解了我国社区和住院肿瘤人群中CRF发生的基本特征——发生率、预测因素和影响因素;评价了BFI和FACIT-F这两种常用CRF评估工具的应用价值;为进一步探索CRF的发生模式和干预手段提供了研究基础。
Cancer Related Fatigue (CRF) is a new hot spot of tumor patient quality of liferesearch. CRF, the most common symptom of cancer patients, is associated with cancerand anticancer treatments. CRF is a very distressing condition, which has serious impacton the quality of life and is strongly associated with depression. During the last decade,related researches have developed some study tools, such as the multi-dimensionalFatigue Symptom Inventory (MFSI), Brief Fatigue Inventory (BFI), Piper's Fatigue Scale.Some CRF related pathogenic factors and influencing factors having been identified byusing these tools and other approach. At present, the domestic oncology academe juststarted to the CRF research, the CRF epidemiology characteristic of the Chinese cancerpatients crowd was still inexplicit. CRF’s pathogenesis, influencing factors and thesuitable appraisal standard wait for realizing.
In view of the different between under treatment patient and the convalescencepatient, we selected the partial cancer patients in community and some others in hospitalas the object of our study, to understand the incidence of CRF, the mediator of CRF andCRF’s impact to the patient quality of life in the two crowds. We validated the Chineseversion of BFI and FACIT-F in the sample of Chinese cancer patients and chose thesuitable fatigue analysis variable. Based on the social psychology - biomedicine pattern,we identify independent predictors of clinically significant fatigue based upon amultidimensional model.
In the community, the fatigue incidence of cancer patients was: (28.0%). UnivariateAnalysis showed that there had significant relation between fatigue and anorexia,insomnia, constipation, pain, age. In a multiple logistic regression model, age andanorexia symptom predicted fatigue independently with good calibration (HosmerLemeshow Chi Square = 2.58, P = 0.461). A multiple linear regress model showed thatseverity of anorexia and pain could respectively explained the 28.9%, 20.3% change offatigue severity. The development of clinically significant CRF could be predicted by lowage and anorexia symptom. The main factors which impact on the severity of CRF wereseverities of anorexia and pain. These findings support that CRF is a severe problem toChinese cancer patients in community. The low age survivor suffered this symptommore than the older. The mechanism of age’s effect to fatigue in cancer survivorsneeds more study. Anorexia is the most important symptom which affects thedevelopment and progress of fatigue. Uncontrolled pain is another symptom affected theprogress of fatigue. The main strategy for management and treatment of fatigue could bethe control of related symptoms.
We validated the Chinese version of the FACIT-F and BFI in a sample of 106Chinese inpatients with multiple cancer diagnoses. Internal consistency was indicated byCronbach alphas of 0.930 for FACIT-F and 0.963 for BFI. Factor analysis revealed afour-factor structure for the subscale FACT-G, a three-factor structure for the subscaleFACT-F. Convergent validity was examined by correlating the FACT-F scores andBFI-F scores. The present fatigue scores and FACT-F scores had the highest relativity.Known-group validity was established by comparing BFI-T and FACIT-F scores between patients with low functional status and high functional status. The Chineseversion of FACIT-F and BFI is reliable, valid, and sensitive for measuring cancer-relatedfatigue severity and interference among Chinese cancer patients.
The BFI present fatigue severity > 3/10 was defined as clinically significant fatigue.Fatigue was present in 81.4% cancer inpatients, and 60.0% had present fatigue>3. In amultiple logistic regression model, count of monocyte, level of serum albumin andmouth dry predicted fatigue independently with good calibration (Hosmer LemeshowChi Square = 7.19, P = 0.41) and discrimination (area under the receiver operatingcharacteristic curve = 0.85). A multiple linear regress model showed that workingfunction, shortness of breath and sleep disturbance could respectively explained the35.2%, 29.75%, 24.3% change of fatigue severity. The development of clinicallysignificant CRF could be predicted by high count of monocyte, low level of serumalbumin and the present of mouth dry symptoms. The main factors which impact on theseverity of CRF were working function, shortness of breath and sleep disturbance. Thesefindings support that the development of CRF is multi-origin, including inflammatoryresponse, low nutritional status and related symptoms, and CRF severity is mediated byphysical function and symptoms like shortness of breath and sleep disturbance. CRF isthe most prevalent symptom of Chinese cancer inpatient.
Through this study, we found some characteristic of CRF in Chinese cancerpatients, and appraised the value of the Chinese version of BFI and FACIT-F. It wouldbe a good foundation for further exploration the patterns and interventions of CRF.
引文
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