4月16日,在线发表在JCO杂志上的一项研究表明,癌症治疗后导致的长期疲劳可能比想象中要更不常见,至少对于早期乳腺癌患者是如此。早期乳腺癌治疗后,有三分之一的病人在治疗结束时出现癌症相关的疲劳,但是只有6%在1年后还存在此问题。以上结果表明,早期乳腺癌治疗后的疲劳会随着时间而消退。
持久的疲劳在癌症治疗后较普遍,但是癌症相关的疲劳的早期自然史还没有得到系统性的研究,其与癌症、手术和辅助治疗的关系还不清楚。
该研究前瞻性的随访了218名接受辅助治疗的早期乳腺癌妇女,这些妇女在手术后被纳入队列,观察时间点是在治疗结束时,1、3、6、9、12个月以及5年。
手术后癌症相关疲劳的发生率为24%(n=51),治疗结束时为31%(n=69)。6个月时持续疲劳的发生率为11%(n=24),12个月为6%(n=12)。在每个时间点,近三分之一的病人存在情绪障碍。癌症相关的疲劳与明显身体障碍和医疗服务利用具有相关性。
这项研究表明,癌症相关的疲劳很常见,但是通常存在一个自限的过程。之前报道中的癌症相关疲劳的长持久性,可能是与癌症或治疗无关的因素造成的。
晚期癌症相关的疲劳是更为复杂的问题——与一个活跃肿瘤的生物学特性和物理效应有关,同时还与使用的药物有关。
本研究的一个特色是使用调查问卷去区别生理和心理症状,这是过去一些研究所没有的。对6个月时仍存在疲劳的妇女进行评估以排除其他原因,例如甲状腺功能减退和抑郁症。
基于针对慢性疲劳的研究,运动联合认知行为治疗可能帮助一些病人。
最近一项针对乳腺癌幸存者的研究发现,饮食中添加更多omega-3的女性疲劳的风险降低,尤其当她们使用鱼油丸时。但是这些发现不能证明omega-3直接影响疲劳的长期风险。研究者也说服用鱼油去抵抗疲劳还为时尚早。他们指出,一个星期吃几次鱼不失为一个好主意。(生物谷Bioon.com)
doi:10.1200/JCO.2011.34.6148
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Cancer-Related Fatigue in Women With Breast Cancer: Outcomes of a 5-Year Prospective Cohort Study.
Webber K,McCourt J,Lloyd AR,et al.
Abstract: PURPOSEProlonged and disabling fatigue is prevalent after cancer treatment, but the early natural history of cancer-related fatigue (CRF) has not been systematically examined to document consistent presence of symptoms. Hence, relationships to cancer, surgery, and adjuvant therapy are unclear. PATIE... PURPOSEProlonged and disabling fatigue is prevalent after cancer treatment, but the early natural history of cancer-related fatigue (CRF) has not been systematically examined to document consistent presence of symptoms. Hence, relationships to cancer, surgery, and adjuvant therapy are unclear. PATIENTS AND METHODSA prospective cohort study of women receiving adjuvant treatment for early-stage breast cancer was conducted. Women (n = 218) were enrolled after surgery and observed at end treatment and at 1, 3, 6, 9, and 12 months as well as 5 years. Structured interviews and self-report questionnaires were used to record physical and psychologic health as well as disability and health care utilization. Patients with CRF persisting for 6 months were assessed to exclude alternative medical and psychiatric causes of fatigue. Predictors of persistent fatigue, mood disturbance, and health care utilization were sought by logistic regression.ResultsThe case rate for CRF was 24% (n = 51) postsurgery and 31% (n = 69) at end of treatment; it became persistent in 11% (n = 24) at 6 months and 6% (n = 12) at 12 months. At each time point, approximately one third of the patients had comorbid mood disturbance. Persistent CRF was predicted by tumor size but not demographic, psychologic, surgical, or hematologic parameters. CRF was associated with significant disability and health care utilization. CONCLUSIONCRF is common but generally runs a self-limiting course. Much of the previously reported high rates of persistent CRF may be attributable to factors unrelated to the cancer or its treatment.