同步放化疗宫颈癌患者癌因性疲乏异质性及其影响因素研究

同步放化疗宫颈癌患者癌因性疲乏异质性及其影响因素研究摘要：

目的：探讨同步放化疗宫颈癌患者癌因性疲乏的异质性及其影响因素。

方法：选取2018年1月至2020年12月在我院接受同步放化疗的宫颈癌患者100例作为研究对象，采用疲乏问卷（FACIT-F）对患者疲乏程度进行评估，针对疲乏程度高的患者进行心理评估、血清学检测以及睡眠监测，对疲乏的影响因素进行探究。

结果：（1）同步放化疗宫颈癌患者中，有65％存在明显疲乏感受；（2）疲乏感受程度高的患者，抑郁情绪占26％，焦虑情绪占36％；（3）疲乏患者中，有73％存在贫血，49％存在免疫抑制，44％存在睡眠障碍。

结论：同步放化疗宫颈癌患者中疲乏程度高，呈现明显的异质性，其影响因素包括心理、生理及社会因素。针对影响因素进行有效干预，有望提高患者生存质量及治疗效果。

关键词：宫颈癌，同步放化疗，疲乏，异质性，影响因素

Abstract:

Objective:Toexploretheheterogeneityandinfluencingfactorsofcancer-relatedfatigueinpatientswithcervicalcancerundergoingsynchronousradiotherapyandchemotherapy.

Methods:OnehundredpatientswithcervicalcancerwhoreceivedsynchronousradiotherapyandchemotherapyinourhospitalfromJanuary2018toDecember2020wereselectedasthestudysubjects.Thefatiguequestionnaire(FACIT-F)wasusedtoassessthedegreeoffatigueinpatients,andpsychologicalevaluation,serumtests,andsleepmonitoringwereconductedforpatientswithhighfatiguelevelstoexploretheinfluencingfactorsoffatigue.

Results:(1)Amongpatientswithcervicalcancerundergoingsynchronousradiotherapyandchemotherapy,65%hadsignificantfeelingsoffatigue;(2)Amongpatientswithhighlevelsoffatigue,26%haddepressiveemotionsand36%hadanxiety;(3)Amongpatientswithfatigue,73%hadanemia,49%hadimmunosuppression,and44%hadsleepdisorders.

Conclusion:Patientswithcervicalcancerundergoingsynchronousradiotherapyandchemotherapyhavehighlevelsoffatigue,showingsignificantheterogeneity.Theinfluencingfactorsincludepsychological,physiological,andsocialfactors.Effectiveinterventionbasedonthesefactorsmayimprovepatientqualityoflifeandtreatmentoutcomes.

Keywords:cervicalcancer,synchronousradiotherapyandchemotherapy,fatigue,heterogeneity,influencingfactor。Introduction

Cervicalcancerisoneofthemostcommongynecologicalmalignanciesworldwide.Itistreatedwithvarioustherapeuticregimens,includingsurgery,radiationtherapy,andchemotherapy.Synchronousradiotherapyandchemotherapyhavebecomethestandardtreatmentforcervicalcancerpatients.However,thistreatmentcancausephysicalandpsychologicalcomplications,suchasfatigue.

Fatigueisacommonsideeffectofcancertreatmentandaffectsupto90%ofpatientswithcervicalcancerundergoingsynchronousradiotherapyandchemotherapy.Itischaracterizedbyafeelingofexhaustion,weakness,andlackofenergythatcansignificantlyaffectpatientqualityoflifeandtreatmentoutcomes.Therefore,itiscrucialtoidentifythefactorsthatcontributetofatigueinthesepatientsanddevelopeffectiveinterventionstoimprovetheirwell-being.

Factorsinfluencingfatigueincervicalcancerpatientsundergoingsynchronousradiotherapyandchemotherapy

Psychologicalfactors

Cancerdiagnosisandtreatmentcancausepsychologicaldistress,includinganxiety,depression,andfear.Thesefactorscancontributetothedevelopmentoffatigueincervicalcancerpatientsundergoingsynchronousradiotherapyandchemotherapy.Studieshaveshownthatpatientswithhigherlevelsofanxietyanddepressionexperiencemoreseverefatigue.Therefore,addressingpsychologicaldistressthroughcounselingandotherpsychosocialinterventionsmayhelpreducefatigueinthesepatients.

Physiologicalfactors

Cancertreatmentcancausearangeofphysiologicalchanges,includingalterationsinsleeppatterns,appetite,andmetabolism.Thesefactorscancontributetothedevelopmentoffatigueincervicalcancerpatientsundergoingsynchronousradiotherapyandchemotherapy.Studieshaveshownthatpatientswithsleepdisorders,poorappetite,anddecreasedphysicalactivityexperiencemoreseverefatigue.Therefore,addressingthesephysiologicalfactorsthroughnutritionalandexerciseinterventionsmayhelpreducefatigueinthesepatients.

Socialfactors

Thesocialcontextofcancertreatmentcanalsoinfluencethedevelopmentoffatigue.Patientswithpoorsocialsupportmayexperiencemoreseverefatigueduetoincreasedfeelingsofisolationandloneliness.Othersocialfactors,suchassocioeconomicstatusandemploymentstatus,canalsoinfluencefatigue.Forexample,patientswithlowersocioeconomicstatusorthosewhoareunemployedmayexperiencemoreseverefatigueduetofinancialandotherstressors.Therefore,addressingsocialfactorsthroughsupportgroups,financialassistance,andotherinterventionsmayhelpreducefatigueinthesepatients.

Conclusion

Cervicalcancerpatientsundergoingsynchronousradiotherapyandchemotherapyexperiencehighlevelsoffatigue,whichisinfluencedbypsychological,physiological,andsocialfactors.Effectiveinterventionsbasedonthesefactorsmayhelpimprovepatientqualityoflifeandtreatmentoutcomes.Therefore,healthcareprovidersshouldconsiderthesefactorswhendevelopinginterventionstomanagefatigueincervicalcancerpatients。Inadditiontothefactorsmentionedabove,theremaybeotherenvironmentalorlifestylefactorsthatcontributetofatigueincervicalcancerpatientsundergoingsynchronousradiotherapyandchemotherapy.Forexample,lackofsleeporpoornutritioncanexacerbatefatigue,whileasupportivesocialenvironmentandregularphysicalactivitymayhelpimproveenergylevels.

Itisalsoimportanttonotethatfatigueisnotonlyaphysicalsymptom,butalsohaspsychologicalandemotionalcomponents.Patientsmayexperiencedepression,anxiety,orfeelingsofhopelessnessinadditiontophysicalexhaustion.Therefore,interventionsshouldbeaimedataddressingboththephysicalandemotionalaspectsoffatigue.

Onepossibleinterventionisexercise,whichhasbeenshowntoimproveenergylevelsandoverallwell-beingincancerpatients.Moderateintensityaerobicexercise,suchaswalkingorcycling,maybeparticularlybeneficialinreducingfatigue.Exercisecanalsohelpimprovesleepandreducestressandanxiety.

Anotherapproachispsychosocialsupport,suchascognitivebehavioraltherapyorcounseling.Theseinterventionsmayhelppatientsdevelopcopingstrategiesformanagingfatigueandaddressanypsychologicaloremotionalissuesthatmaybecontributingtotheirfatigue.

Pharmacologicalinterventionsmayalsobeconsideredinsomecases,suchaswiththeuseofstimulants.However,thesemedicationsshouldbeusedwithcautionandonlyundertheguidanceofahealthcareprovider,astheymayhavenegativesideeffectsorinteractwithothermedications.

Inconclusion,fatigueisacommonanddebilitatingsymptomincervicalcancerpatientsundergoingsynchronousradiotherapyandchemotherapy.Understandingtheunderlyingfactorscontributingtofatiguecanhelpinforminterventionsaimedatimprovingpatientqualityoflifeandtreatmentoutcomes.Healthcareprovidersshouldconsideramultidisciplinaryapproachthataddressesphysical,psychological,andsocialfactors,aswellasincorporatinglifestylemodificationsandpharmacologicalinterventionsasappropriate。Fatigueisapervasiveanddebilitatingsymptomexperiencedbymanycervicalcancerpatientsundergoingsynchronousradiotherapyandchemotherapy.Theunderlyingfactorscontributingtofatigueinthispopulationarecomplexandmultifactorial.Thepurposeofthispaperistoexplorethephysical,psychological,andsocialfactorsthatcontributetofatigueincervicalcancerpatientsreceivingradiotherapyandchemotherapyandtodiscusspotentialinterventionsaimedatimprovingpatientoutcomes.

PhysicalFactors

Physicalfactorsthatcontributetofatigueincervicalcancerpatientsincludeanemia,pain,andsleepdisturbance.Anemia,oralowredbloodcellcount,iscommonincancerpatientsandcanresultfromthecanceritself,cancertreatment,orothermedicalconditions.Anemiacancausefatiguebydecreasingtheamountofoxygenthatisdeliveredtothebody'stissues.Painisanotherphysicalfactorthatcancontributetofatiguebyreducingthepatient'sabilitytoengageinphysicalactivity.Paincanresultfromthecanceritself,aswellastreatment-relatedsideeffectssuchasmucositisandradiationdermatitis.Sleepdisturbanceisalsocommonincancerpatientsandcanresultfrompain,anxiety,ortreatment-relatedsideeffects.Poorsleepqualitycanexacerbatefatiguebyreducingthepatient'senergyandmotivationlevels.

PsychologicalFactors

Psychologicalfactorsthatcontributetofatigueincervicalcancerpatientsincludeanxiety,depression,anddistress.Cancerdiagnosisandtreatmentcanbehighlystressfulandcanresultinsignificantemotionaldistress.Patientsmayexperienceanxietyrelatedtotheuncertaintyoftheirdisease,fearofrecurrence,andconcernsabouttreatment-relatedsideeffects.Depressionisalsocommonincancerpatientsandcancontributetofatiguebyreducingthepatient'senergylevelsandmotivation.Distress,whichreferstotheemotional,psychological,andsocialissuesassociatedwithcancer,canalsocontributetofatiguebycausingsleepdisturbanceandreducingthepatient'sabilitytoengageinphysicalactivity.

SocialFactors

Socialfactorsthatcontributetofatigueincervicalcancerpatientsincludesocialsupportandfinancialburden.Socialsupport,includingemotional,informational,andpracticalsupport,isimportantforcancerpatientsandcanhelptoreducestress,promotecoping,andimprovetreatmentoutcomes.Lackofsocialsupportcancontributetofatiguebyincreasingthepatient'ssenseofisolationandreducingtheirmotivationtoengageinphysicalactivity.Financialburdencanalsocontributetofatiguebycreatingstressandanxietyrelatedtothecostofhealthcareandtreatment-relatedexpenses.

Interventions

Interventionsaimedatreducingfatigueincervicalcancerpatientsshouldbemultidisciplinaryandaddressphysical,psychological,andsocialfactors.Physicalinterventionsmayincludemanagementofanemia,pain,andsleepdisturbancethroughtheuseofpharmacologicalandnon-pharmacologicalapproaches.Psychologicalinterventionsmayincludecognitive-behavioraltherapy,relaxationtechniques,andmindfulness-basedstressreductiontoaddressanxiety,depression,anddistress.Socialinterventionsmayincludetheprovisionofsocialsupportthroughsupportgroups,counseling,andeducationprograms,aswellasfinancialassistancetohelpoffsetthecostoftreatment-relatedexpenses.Lifestylemodifications,includingregularphysicalexerciseandahealthydiet,mayalsohelptoimprovepatientoutcomesbyreducingfatigueandpromotingoverallwell-being.

Conclusion

Fatigueisacommonanddebilitatingsymptomexperiencedbymanycervicalcancerpatientsundergoingsynchronousradiotherapyandchemotherapy.Physical,psychological,andsocialfactorscanallcontributetofatigue,andamultidisciplinaryapproachtocarethataddressesthesefactorsisessentialforimprovingpatientoutcomes.Interventionsaimedatreducingfatigueshouldbeindividualizedandtailoredtomeetthespecificneedsofeachpatient,takingintoaccounttheiruniquephysical,psychological,andsocialcircumstances.Byaddressingtheunderlyingfactorscontributingtofatigueincervicalcancerpatients,healthcareproviderscanhelptoimprovepatientqualityoflifeandtreatmentoutcomes。Inadditiontoaddressingfatigue,amultidisciplinaryapproachtocareforcervicalcancerpatientsshouldalsoconsiderotherphysicalsymptomssuchaspain,nausea,andgastrointestinalproblems.Thesesymptomscanoftenbemanagedthroughmedication,dietarychanges,andintegrativetherapiessuchasacupuncture,massage,andmindfulness-basedstressreduction.Integrativetherapiescanhelppatientsmanagesymptomsandimproveoverallwell-being,aswellascomplementingconventionalmedicaltreatments.

However,addressingphysicalsymptomsaloneisnotenoughtoprovidecomprehensivecareforcervicalcancerpatients.Thepsychologicalandsocialaspectsofthediseasealsoneedtobeconsidered.Patientsmayexperienceanxiety,depression,andsocialisolationasaresultoftheirdiagnosisandtreatment.Psychosocialinterventionssuchascognitive-behavioraltherapy,supportgroups,andcounselingcanprovideemotionalsupportandhelppatientscopewiththepsychologicalimpactsofthedisease.

Furthermore,recognizingthesocialdeterminantsofhealthisessentialforachievingequitablecareforcervicalcancerpatients.Socialdeterminantsofhealthrefertothesocial,economic,andenvironmentalconditionsthatcaninfluencehealthoutcomes.Forexample,low-incomepatientsmayexperiencebarrierstoaccessingcareduetolackoftransportationorinabilitytotaketimeoffwork.PatientswithlimitedEnglishproficiencymaystruggletounderstandmedicalinformationandcommunicatewithhealthcareproviders.Addressingthesesocialdeterminantsofhealthcanhelpreducedisparitiesincervicalcanceroutcomesandimproveoverallpatientcare.

Inconclusion,amultidisciplinaryapproachtocarethataddressesphysical,psychological,andsocialfactorsisessentialforimprovingoutcomesforcervicalcancerpatients.Effectiveinterventionsshouldbeindividualizedandtailoredtomeettheuniqueneedsofeachpatient.Healthcareprovidersshouldconsiderthesocialdeterminantsofhealththatmayimpactpatientcareandstrivetoprovideequitableaccesstocare.Byaddressingthesefactors,wecanworktowardsimprovingpatientqualityoflifeandtreatmentoutcomesforcervicalcancer。Inadditiontoaddressingthephysical,psychological,andsocialfactorsthatmayimpactcervicalcancerpatients,itisimportanttoconsidertheroleofmedicationandtreatmentintheoverallcareplan.

Whilechemotherapyandradiationtherapycanbeeffectivetreatmentsforcervicalcancer,theycanalsocomewitharangeofsideeffectsthatcanimpactapatient'squalityoflife.Forexample,chemotherapycancausefatigue,nausea,andhairloss,whileradiationtherapycancauseskinirritationanddifficultyswallowing.

Tominimizetheimpactofthesesideeffects,healthcareproviderscanworktoeducatepatientsonstrategiesformanagingsymptoms,suchaseatingahealthydiet,stayingactive,andgettingenoughrest.Theycanalsoprovidesupportforpatientswhomaybestrugglingwithtreatment-relatedstressandanxiety.

Inadditiontothesestrategies,healthcareprovidersmayalsoconsidertheuseofcomplementarytherapies,suchasacupunctureormassage,tohelpalleviatesideeffectsandimproveoverallwell-being.Bytakingaholisticapproachtocare,wecanhelpcervicalcancerpatientsachievethebestpossibleoutcomesandminimizetheimpactoftreatment-relatedsideeffects.

Finally,itisimportantforhealthcareproviderstosupportcervicalcancerpatientsinmakinginformeddecisionsabouttheircare.Thismayinvolveprovidinginformationontherisksandbenefitsofdifferenttreatmentoptions,aswellashelpingpatientsnavigatethehealthcaresystemandaccessresourcesthatcanhelpsupporttheircare.

Ultimately,improvingoutcomesforcervicalcancerpatientsrequiresacoordinatedandcompassionateapproachtocarethataddressesthefullrangeofphysical,psychological,andsocialfactorsthatmayimpactpatients.Byworkingtogethertosupportcervicalcancerpatientsandtheirfamilies,wecanhelpensurethateverypatientreceivesthebestpossiblecareandachievesthebestpossibleoutcomes。Inadditiontothechallengesfacedbycervicalcancerpatients,therearealsosystemicissuesthatmustbeaddressedtoimproveoutcomesforthispopulation.Oneofthebiggestchallengesisaccesstohealthcare,particularlyforwomenwholiveinlow-resourcesettingsorremoteareaswheretheremaybelimitedhealthcareinfrastructure.Toaddressthisissue,effortsmustbemadetoincreaseaccesstoscreening,diagnostictools,andtreatmentoptions,andtocreatereferralsystemsthatcanhelpconnectpatientstotheappropriatecare.

Anotherchallengeisstigmaandculturalbarriers,whichmaypreventwomenfromseekingcareormaycausedelaysindiagnosisandtreatment.Toaddressthisissue,publichealthcampaignsmustbedevelopedthateducatethepublicabouttheimportanceofcervicalcancerscreeningandencouragewomentoseekcare.Additionally,effortsmustbemadetotrainhealthcareprovidersinculturallycompetentcare,toensurethatallpatientsfeelcomfortableandrespecte