| Research Background:With the increasing enrichment of tumor treatment methods and the gradual extension of patients’ survival time,how to improve cancer patients’ quality of life has become the focus of attention.Cancer-related fatigue(CRF)runs through the whole course of tumor treatment and is an important factor affecting the interruption of treatment,the obstruction of rehabilitation and the reduction of quality of life.The NCCN Guidelines define CRF as:CRF is a distressing,persistent,subjective sense of physical,emotional,and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.The pathological mechanism of CRF is still being explored,and the influencing factors are diverse.The guidelines first recommend non-drug intervention,and western medicine lacks effective intervention measures.Traditional Chinese medicine(TCM)has rich means and prominent curative effect in the treatment of CRF,but there is still a lack of unified syndrome differentiation and typing standards,which makes the curative effects different.Therefore,it is particularly important to further study the characteristics of CRF syndrome and influential factors.Research Objectives:1.Investigate the population characteristics,fatigue conditions,syndrome characteristics of CRF through cross-sectional study.2.To explore the related factors of CRF incidence and fatigue degree through difference comparison and regression analysis.Research Methods:1.Using convenient sampling method to collect cross-sectional information of patients who met the inclusion and exclusion criteria in the oncology outpatient and ward of Xiyuan Hospital,China Academy of Chinese Medical Sciences from January 2021 to December 2021.2.This paper mainly collects the patients’ general information,fatigue condition and syndrome characteristics.General data were collected by general data sheet(including demographic data,oncology data and psychosocial data);Fatigue was first screened by the Visual Analogue Fatigue Scale(VFAS),and if fatigue existed,the patients were then judged to be CRF according to the ICD-10 diagnostic criteria,and finally the degree of fatigue and the fatigue scores of different dimensions were assessed by the Revised Piper’s Fatigue Scale-Chinese version(RPFS-CV).TCM syndromes were differentiated and categorized with the TCM Four Diagnostic Information Form and the guidance of the attending physician in the Department of TCM oncology.3.EpiData was used for data entry,and SPSS 26.0 statistical software was used to describe the general data,fatigue conditions and characteristics of TCM syndrome.The differences in general data and TCM syndrome were compared around "fatigue or not"and "degree of fatigue".Regression analysis was performed to explore the factors influencing the prevalence and fatigue level of CRF by examining the factors associated with significant differences and possible influences on CRF.Research Results:(All the enumeration data were presented as n+%,and measurement data were presented as median+range).1.CRF conditions:The study finally included 306 patients with malignancy,229 patients with fatigue.The prevalence of CRF was 75%.The mean score of total fatigue was 3.95±1.63,which was moderate fatigue.The mean score of overall fatigue in each dimension from high to low was:affective meaning>sensory>behavioral/severity>cognitive/mood(4.9 ± 2.62>4.1 ± 1.83>3.6 ± 1.90>3.0 ± 1.83).2.Comparison of general data:(1)Comparison between CRF and non-CRF groups:There were significant differences in the distribution of dietary structure/taste(p=0.039),previous anti-tumor treatment(p=0.036),KPS(p<0.001),anxiety states(p=0.003)and depression states(p<0.001)between the two groups.(2)Comparison of fatigue degree between groups:There were statistically significant differences in the distribution of pathological type(p=0.025),previous antitumor treatment(p=0.025),complication(p=0.010),KPS(p<0.001),anxiety states(p<0.001)and depression states(p<0.001)among the three groups.3.Syndrome characteristics of patients with CRF:3.1 The relationship between fatigue degree and single syndrome:(1)Comparison between CRF and non-CRF groups:There were statistically significant differences in the distribution of qi deficiency syndrome(p<0.001),blood deficiency syndrome(p=0.001),yang deficiency syndrome(p=0.032),spleen deficiency syndrome(p=0.024),kidney deficiency syndrome(p=0.044),lung deficiency syndrome(p=0.004)and heart deficiency syndrome(p<0.001)between the two groups.Further analysis revealed that the frequency of qi deficiency in CRF was the highest and that of yin deficiency in non-CRF was the highest among the deficiency elements.The frequency of liver deficiency in non-CRF was the highest and that of spleen deficiency in CRF was the highest among the Zang-Fu elements.The frequency of cold dampness in CRF was the highest and that of qi stagnation in nonCRF was the highest among the excess elements.(2)Comparison of fatigue degree among groups:There was statistically significant difference in the distribution of qi deficiency(p<0.001),heart deficiency(p<0.001),spleen deficiency(p=0.007),liver deficiency(p=0.002)and cold dampness(p=0.003)among the three groups.Further analysis revealed that the frequency of qi deficiency was the highest in mild,moderate and severe fatigue among the deficiency elements.Among the Zang-Fu elements,the frequency of kidney deficiency was the highest in mild fatigue;The frequency of heart deficiency was the highest in moderate fatigue;The frequency of liver deficiency was the highest in severe fatigue.Among the excess elements,the frequency of qi stagnation was the highest in mild,moderate fatigue.The frequency of cold dampness was the highest in severe fatigue.3.2 The relationship between fatigue dimensions and single syndromes:Among the 229 patients with fatigue,there were statistical differences in the fatigue scores of qi deficiency,spleen deficiency,heart deficiency,liver deficiency,cold dampness,and qi stagnation in different dimensions(p<0.05).Further analysis revealed that ① the fatigue of affective meaning,sensory,and behavioral/severity dimensions was more severe in patients with qi deficiency;② the fatigue of affective meaning,sensory,behavioral/severity,and cognitive/mood dimensions was more severe in patients with spleen deficiency;③ the fatigue of affective meaning,sensory,and behavioral/severity dimensions was more severe in patients with heart deficiency;④ the fatigue of sensory,behavioral/severity,and cognitive/mood dimensions was more severe in patients with liver deficiency;⑤ the fatigue of affective meaning,sensory,and behavioral/severity was more severe in patients with cold dampness;⑥and the fatigue of sensory and behavioral/severity was more severe in patients with qi stagnation.3.3 The relationship between fatigue with anxiety/depressive states and single syndrome:(1)Relationship between fatigue with anxiety states and single syndrome:There was a statistically significant difference in anxiety scores for spleen deficiency(p<0.001)and liver deficiency(p=0.001).Further analysis revealed that patients with spleen deficiency and liver deficiency had higher anxiety scores than patients with nonspleen deficiency and non-liver deficiency.(2)Relationship between fatigue with depression states and single syndromes:There was a statistically significant difference in depression scores for spleen deficiency(p=0.005),liver deficiency(p=0.006),and heart deficiency(p=0.045).Further analysis revealed that patients with spleen deficiency,liver deficiency,and heart deficiency had higher depression scores than patients with non-spleen deficiency,non-liver deficiency,and non-heart deficiency.3.4 Characteristics and comparison of compound syndrome types of CRF patients:(1)Characteristics of compound syndrome types:9 cases had no TCM syndrome type,6 cases(66.7%)were non-CRF and 3 cases(33.3%)were CRF;48 cases were single syndrome,38 cases of single deficiency syndrome,21 cases of CRF(55.4%),10 cases of single excess syndrome,5 cases of CRF(50%);249 cases were compound syndrome types with 2 or more syndromes,200 cases were CRF(80.3%).Among the compound syndrome types,147 cases of pure deficiency combination,120 cases of CRF(81.6%),102 cases of combination of excess and deficiency syndrome,80 cases of CRF(78.4%).No purely excess syndrome was found in this survey.(2)Comparison of compound syndrome types:There was a statistically significant difference(p=0.002)in combination of pure deficiency syndrome and deficiency-excess syndrome among groups with different degree of fatigue.Further comparison of the proportion of mild,moderate and severe fatigue in the compound syndrome types,mild and moderate fatigue:combination of pure deficiency syndrome>combination of excess and deficiency syndrome(mild(55/94,58.5%)>(23/94,24.5%),moderate(62/121,51.2%)>(46/121,38%)),severe fatigue:combination of excess and deficiency syndrome>combination of pure deficiency syndrome(11/14,78.6%>3/14,21.4%),it was seen that the deficiency-excess syndromes showed a severe tendency of more fatigue.There was no statistical difference in the distribution between the CRF and non-CRF groups for the combination of pure deficiency syndrome and excess and deficiency syndrome(p>0.05).3.5 Results of cluster analysis of TCM symptoms in patients with CRF:Six TCM syndrome types of CRF were obtained in this survey:qi-yin twodeficiency syndrome,qi-blood two-deficiency syndrome,heart-liver-blood deficiency syndrome,kidney-yang deficiency syndrome,spleen deficiency and qi stagnation syndrome,and cold-damp trapped spleen syndrome.4.Influencing factors of CRF:(1)Factors influencing the prevalence of CRF:Basically balanced diet structure/taste(p=0.008,OR=0.374,95%CI:0.180-0.778),current treatment(chemotherapy(p=0.014,OR=7.068,95%CI:1.497-33.375),radiotherapy(p=0.006,OR=5.455,95%,CI:1.619-18.375)),depressive states(p<0.001,OR=1.378,95%CI:1.212-1.568),qi deficiency syndrome(p<0.001,OR=12.955,95%,CI:6.04227.778),yang deficiency syndrome(p=0.011,OR=11.676,95%,CI:1.743-78.233)may be influential factors in the incidence of CRF;Basic balance of diet structure/taste was negatively correlated with CRF prevalence.There was a positive correlation between undergoing chemotherapy or radiotherapy,depression states,qi deficiency syndrome and yang deficiency syndrome and CRF.(2)Influencing factors of fatigue degree:age<30 years old(p=0.007,OR=0.014,95%CI:0.001-0.317),previous anti-tumor treatment(p=0.003,OR=0.372,95%CI:0.196-0.707),diagnosis without treatment(p=0.019,OR=7.367,95%CI:1.386-39.150)or peri-western treatment period(p=0.002,OR=4.078,95%CI:1.6709.956),anxiety states(p<0.001,OR=0.155,95%CI:0.058-0.418),depression states(p<0.001,OR=0.202,95%CI:0.099-0.411),cold dampness syndrome(p=0.001,OR=0.237,95%CI:0.100-0.562),damp heat syndrome(p=0.001,OR=0.140,95%CI:0.042-0.470),heart deficiency syndrome(p=0.001,OR=0.368,95%CI:0.1990.679)may be the influencing factors of fatigue degree.There was a negative correlation between age<30 and the degree of fatigue.There was a positive correlation between the degree of fatigue and the previous anti-tumor treatment,diagnosis without treatment or peri-western treatment period,anxiety states,depression states,cold dampness syndrome,damp heat syndrome and heart deficiency syndrome.Age<30 years was negatively correlated with fatigue.Previous anti-tumor treatment,being diagnosed without treatment or peri-western treatment period,anxiety states,depression states,cold dampness syndrome,damp heat syndrome,and heart deficiency syndrome were positively correlated with the degree of fatigue.Research Conclusions:1.In this study,up to 75%of cancer patients had different degrees of CRF,with moderate fatigue common and affective meaning fatigue prominent.2.CRF in general is dominated by deficiency syndrome,the more severe the degree of fatigue,the higher the proportion of deficiency syndrome,and the combination of excess and deficiency syndrome shows a trend of severe fatigue.CRF is mainly spleen deficiency,involving both heart and liver,which is closely related to anxiety and depression.Six TCM syndrome types of CRF were obtained in this survey:qi-yin twodeficiency syndrome,qi-blood two-deficiency syndrome,heart-liver-blood deficiency syndrome,kidney-yang deficiency syndrome,spleen deficiency and qi stagnation syndrome,and cold-damp trapped spleen syndrome.3.The results of regression analysis showed that a balanced diet was less likely to cause CRF,undergoing chemotherapy or radiotherapy,and depression states,qi deficiency syndrome,yang deficiency syndrome were risk factors for the development of CRF;Age less than 30 years may be negatively correlated with fatigue degree.Previous antitumor treatment,being diagnosed without treatment or peri-western treatment period,anxiety states/depression states may be risk factors leading to the aggravation of CRF,and the occurrence of TCM syndrome of cold-dampness,damp-heat,and heart deficiency syndrome were positively correlated with the fatigue degree. |
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