不容忽视!有疲劳症的癌症患者生存结果更差

2021-07-30 Sunny MedSci原创

警惕疲劳症状

虽然以前有些研究评估了与癌症治疗有关的疲劳与病人生存结果的关系,但很少有研究调查治疗前疲劳与病人发病率和死亡率结果之间的关系。

近期,由 SWOG 癌症研究网络(由美国国家癌症研究所 (NCI) 资助的癌症临床试验小组)对参与四项肺癌或前列腺癌治疗方法临床试验的患者进行的最新研究结果提示,与没有疲劳的患者相比,在治疗开始时报告有临床显著疲劳的癌症患者的总生存时间更短,副作用更多。

研究人员得出结论,疲劳可能是肿瘤治疗试验中的一个重要预后因素。他们的研究结果发表在JCO Oncology Practice杂志上 。最初的结果在 2020 年美国临床肿瘤学会 (ASCO) 质量护理研讨会的演讲中已进行汇报。

该研究证实,表明疲劳的病人报告结果(PRO)措施可以成为一些癌症患者的生存预测因素。研究结果表明,如果有证据表明存在明显的疲劳,就应该告知患者和家属可能存在较高的较差结果的风险,并对其进行咨询。此外,可以制定治疗方案来改善疲劳和可能的癌症长期结果。

研究评估了癌症治疗期间具有临床意义的疲劳 (CSF)、总生存期、不良事件 (AE) 和生活质量 (QOL)。

作者分析了四项 II 期或 III 期化疗临床试验:两项试验招募了晚期激素抵抗性前列腺癌患者(试验S0421和S9916),另外两项招募了晚期非小细胞肺癌患者(试验S0027和S9509)。所有参与者在试验开始时都完成了生活质量和症状调查,使用的是癌症治疗功能评估(FACT)或欧洲癌症研究与治疗组织生活质量调查表——核心30(EORTC QLQ-C30)。这两种调查工具都是对癌症患者生活质量的有效测量。研究人员以每个量表的中点作为分界点,对患者在治疗开始前是否报告了临床上显著的疲劳程度进行分类,评估是否有CSF。CSF 被定义为在癌症治疗疲劳问题的功能评估评分≥2或欧洲癌症研究和治疗组织生活质量问卷 - 核心 30 疲劳症状评分≥50%。

使用 Kaplan-Meier 估计和 Cox 回归模型根据 CSF 比较存活率。通过卡方检验评估 CSF AE 率的差异,并通过线性回归评估从基线到 3 个月的 QOL 变化。

在 1994 名参与者中,1907人有完整的基线 QOL调查数据,其中 52% 报告基线时有CSF。对于两项激素抵抗性性前列腺癌研究,基线 CSF 与较高的死亡率相关,调整后的风险比分别为 1.32和 1.31,并且 3-5 级体质和神经系统的不良事件发生率分别为16.5% vs. 9.4%、11.7% vs. 6.1%。在非小细胞肺癌研究中,基线 CSF 与较高的死亡率相关:风险比为 1.44 和 1.04 。

晚期癌症的疲劳与结果的关联

研究结果显示,报告有疲劳症状的病人的中位总生存时间比没有基线疲劳的病人短大约26%到45%。

研究人员还发现,在他们分析的两项前列腺癌研究中,在癌症治疗前报告有临床意义的疲劳的病人更有可能经历化疗的严重不良事件(副作用),特别是胃肠道、神经系统和医疗事故等的不良事件,尽管在参加两项肺癌试验的病人中没有看到这种关联。

研究表明, 与没有 CSF 的参与者相比,具有基线 CSF 的肿瘤学试验参与者的生存率更差,并且经历了更多的不良事件。这表明疲劳是肿瘤治疗试验中重要的基线预后因素。

原始出处:

Mo J, Darke AK, Guthrie KA, Sloan JA, Unger JM, Hershman DL, O'Rourke M, Bakitas M, Krouse RS. Association of Fatigue and Outcomes in Advanced Cancer: An Analysis of Four SWOG Treatment Trials. JCO Oncol Pract. 2021 Jul 13:OP2001096. doi: 10.1200/OP.20.01096.

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    2021-08-02 鑫**

    学习了

    0

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    2021-08-01 hb2008ye
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