摘要
意义重大：晚间疲劳和抑郁症状与癌症患者的多种不良预后有关。然而，疲劳和抑郁症状对患者预后的影响尚不清楚。本研究确定了具有不同晚间疲劳和抑郁症状联合特征的患者亚组，并评估了人口统计学和临床特征、压力水平（即整体压力、癌症特异性压力和累积性生活压力）和复原力以及常见症状严重程度的差异。 研究方法门诊患者（n = 1334）在两个化疗周期内完成六次李氏疲劳量表和流行病学研究中心抑郁量表。入院时对人口统计学和临床特征、压力和复原力以及其他常见症状进行了评估。采用潜特征分析法确定了晚间疲劳和抑郁症状的联合特征。采用参数和非参数检验对特征差异进行评估。 结果确定了五种特征（即低度晚间疲劳和低度抑郁[均为低度：20.0%]、中度晚间疲劳和低度抑郁[均为中度疲劳和低度抑郁：39.3%]、增加和减少的晚间疲劳和抑郁[均为增加-减少：5.3%]、中度晚间疲劳和中度抑郁[均为中度：27.6%]、高度晚间疲劳和高度抑郁[均为高度：7.8%]）。与 "低度 "和 "中度 "疲劳及 "低度 "抑郁两类患者相比，"中度 "和 "高度 "两类患者的已婚比例较低，报告抑郁的比例较高，功能状况较差，合并症情况较差。中度抑郁和高度抑郁两类人群的总体、癌症特异性和累积性生活压力水平较高，抗压能力较低。 结论研究发现了化疗期间晚间疲劳和抑郁症状水平较高的多种风险因素，包括较低的功能状态、较高的合并症负担、较低的复原力水平，以及较高的整体、癌症特异性和累积性生活压力。这些风险因素可用于识别最有可能出现不良后果的患者，并采取干预措施来减轻这些症状。
Significance: Evening fatigue and depressive symptoms are associated with several negative outcomes for patients with cancer. However, the contribution of BOTH fatigue and depressive symptoms to patient outcomes remains unknown. This study identified subgroups of patients with distinct joint evening fatigue AND depressive symptom profiles and evaluated for differences in demographic and clinical characteristics, levels of stress (i.e., global, cancer-specific, and cumulative life) and resilience, and the severity of common symptoms.
Methods: Outpatients (n = 1334) completed the Lee Fatigue Scale and Center for Epidemiological Studies-Depression scale six times over two cycles of chemotherapy. Demographic and clinical characteristics, stress and resilience, and other common symptoms were assessed at enrollment. Joint evening fatigue and depressive symptom profiles were identified using latent profile analysis. Profile differences were assessed using parametric and nonparametric tests.
Results: Five profiles were identified (i.e., Low Evening Fatigue and Low Depression [Both Low: 20.0%], Moderate Evening Fatigue and Low Depression [Moderate Fatigue and Low Depression: 39.3%], Increasing and Decreasing Evening Fatigue and Depression [Both Increasing–Decreasing: 5.3%], Moderate Evening Fatigue and Moderate Depression [Both Moderate: 27.6%], High Evening Fatigue and High Depression [Both High: 7.8%]). Compared to the Both Low and Moderate Fatigue and Low Depression classes, the Both Moderate and Both High classes were less likely to be married, more likely to report depression, had a lower functional status, and had worse comorbidity profile. Both Moderate and Both High classes had higher levels of global, cancer-specific, and cumulative life stress and lower resilience.
Conclusions: Multiple risk factors for higher levels of evening fatigue AND depressive symptoms during chemotherapy were identified, including lower functional status, higher comorbidity burden, lower levels of resilience, and higher global, cancer-specific, and cumulative life stress. These risk factors may be used to identify patients at greatest risk for poorer outcomes and to prescribe interventions to decrease these symptoms.
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