早期乳腺癌患者芳香酶抑制剂所致疲劳的发生情况及其风险因素调查

　　疲劳为癌症生存者常见和困扰的症状。不过，早期乳腺癌生存者芳香酶抑制剂所致疲劳的发生情况及其风险因素尚不明确。

　　2018年7月13日，欧洲癌症治疗研究组织、欧洲癌症组织、欧洲乳腺癌专科学会《欧洲癌症杂志》在线发表纽约纪念医院斯隆凯特林癌症中心、本德海姆整合医学中心、上海中医药大学针灸推拿学院、杜克大学护理学院的研究报告，确定了早期乳腺癌生存者芳香酶抑制剂所致疲劳发生情况及其风险因素。

　　该研究对宾夕法尼亚大学医院乳腺肿瘤门诊接受芳香酶抑制剂辅助治疗的1103例0～III期乳腺癌绝经后女性进行横断面调查，将简化疲劳量表最疲劳项目评分≥4的患者分为中度或重度疲劳，通过多因素逻辑回归分析，评估风险因素。

　　结果，报告中重度疲劳的患者者共616例（55.8%）。

　　根据多因素逻辑回归模型，报告中重度疲劳比例显著较高的风险因素包括：

• 年龄较轻（<55岁与>65岁相比，校正后比值比：1.58，95%置信区间：1.07～2.35，P=0.023）

• 学历较高（≥大学与≤高中相比，校正后比值比：1.40，95%置信区间：1.02～1.91，P=0.037）

• 体重指数（超重、肥胖与正常相比，校正后比值比：1.37、2.08，95%置信区间：1.01～1.84、1.53～2.81，P=0.042、<0.001）

• 疼痛程度（r=0.48，P<0.001）

• 失眠与否（r=0.62，P<0.001）

　　因此，对于早期乳腺癌芳香酶抑制剂辅助治疗绝经后女性，出现中重度疲劳症状者超过50%。疲劳与年龄、学历、体重指数、疼痛程度、失眠显著相关，其中体重指数、疼痛程度、失眠属于可以干预的因素。

相关阅读

• 运动、心理干预可以有效改善乳腺癌相关疲劳

• 中高强度运动可改善乳腺癌患者的记忆、自信、疲劳和痛苦

• 两种自我指压用于乳腺癌患者癌症相关持续疲劳的随机临床研究

Eur J Cancer. 2018 Jul 13;101:47-54. [Epub ahead]

Prevalence and risk factors for fatigue among breast cancer survivors on aromatase inhibitors.

Huijuan Mao, Ting Bao, Xueyong Shen, Qing Li, Christina Seluzicki, Eun-Ok Im, Jun J. Mao.

Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, New York, NY, USA; Shanghai University of Traditional Chinese Medicine, Shanghai, China; Duke University School of Nursing, Durham, NC, USA.

HIGHLIGHTS

• Moderate to severe fatigue complaints exceed 50% among aromatase inhibitor users.

• Obesity, younger age and higher education level were significantly associated with fatigue.

• The majority who experienced either pain or insomnia reported moderate to severe fatigue.

PURPOSE: Fatigue is the most common and distressing symptom experienced by cancer survivors. This study sought to determine the prevalence and risk factors for fatigue among breast cancer (BC) survivors receiving aromatase inhibitors (AIs).

MATERIAL AND METHODS: We conducted a cross-sectional survey study among postmenopausal women with stage 0 to III BC receiving adjuvant AI therapy at the outpatient breast oncology clinic of a large university hospital. Participants with a score ≥4 on the 'worst fatigue' item of the Brief Fatigue Inventory were classified as having moderate or severe fatigue. Multivariate logistic regression analyses were performed to evaluate risk factors.

RESULTS: Among 1103 participants, 616 (55.8%) had moderate or severe fatigue. In the multivariate logistic regression model, women younger than 55 years were significantly more likely to report moderate to severe fatigue than women older than 65 years (adjusted odds ratio [AOR]=1.58, 95% confidence interval [CI]=1.07-2.35; p=0.023). Compared to women with high school or less education, women with college or more education were significantly more likely to report moderate to severe fatigue (AOR=1.40, 95% CI=1.02-1.91; p=0.037). Increasing body mass index (BMI) was significantly associated with increased risk of experiencing moderate to severe fatigue (overweight: AOR=1.37, 95% CI=1.01-1.84, p=0.042; obesity: AOR=2.08, 95% CI=1.53-2.81, p<0.001). Fatigue was significantly correlated with pain severity (r=0.48, p<0.001) and insomnia (r=0.62, p<0.001).

CONCLUSION: Moderate to severe fatigue complaints exceed 50% among AI users. Fatigue is highly related to younger age, higher education level, higher BMI, pain severity and insomnia.

KEYWORDS: Breast cancer, Fatigue, Aromatase inhibitor

DOI: 10.1016/j.ejca.2018.06.009