Tumorassoziierte Fatigue in der onkologischen Rehabilitation

Zusammenfassung

Ziel

In der vorliegenden Untersuchung wird die Prävalenz von Fatigue in der stationären Rehabilitation beschrieben und der Zusammenhang mit der krebsspezifischen Behandlung untersucht.

Methodik

In einer multizentrischen Studie wurden Patienten mit unterschiedlichen Krebserkrankungen (27% Brustkrebs, 17% Prostatakrebs u. a.) mittels des Multidimensional-Fatigue-Inventory (MFI-20) befragt (N=693).

Ergebnisse

51% der Patienten erlebten moderate bis schwere Fatigue (n=356). Patienten mit hämato-onkologischen Tumoren, Tumoren der weiblichen Gentalorgane und der Haut gaben die höchsten Belastungen an. Fatigue ist signifikant erhöht gegenüber der Allgemeinbevölkerung (p≤0,001). Einen substantiellen Einfluss auf Fatigue hat die Kombination aus Operation und Bestrahlung (p≤0,05).

Schlussfolgerung

Die hohe Prävalenz von Fatigue erfordert es, alle Patienten zu Beginn der Rehabilitation auf Fatigue zu screenen und Fatigue nach differenzialdiagnostischer Abklärung fest in die Behandlungspläne zu integrieren.

Abstract

Purpose

Aim of the study was to provide information about the prevalence of cancer related fatigue and the association between treatment-related factors and fatigue in cancer patients during the rehabilitation care.

Patients and Methods

In a multicenter study 693 cancer patients (27% breast cancer, 17% prostate cancer etc.) completed the Multidimensional Fatigue Inventory (MFI-20) and sociodemographic and treatment information was noted.

Results

51% of the patients suffer from fatigue (n=356). Fatigue prevalence differed according to tumour localization (p≤0.001). There was a substantial association between fatigue and treatment condition in terms of the combination of surgery and radiation (p≤0.05).

Conclusion

Fatigue was high prevalent in patients in the rehabilitation care. Thus, fatigue should be routinely screened and after differentiated diagnostics be considered in rehabilitation care plans.

Schlüsselwörter

Fatigue - Krebspatienten - Prävalenz - Rehabilitation

Key words

fatigue - cancer survivors - prevalence - rehabilitation

• Literatur

• 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA: a cancer journal for clinicians 2016; 66: 7-30
• 2 Aaronson NK, Mattioli V, Minton O. et al. Beyond treatment – psychosocial and behavioural issues in cancer survivorship research and practice. Eur J Cancer 2014; 12: 54-64
• 3 Wang XS, Zhao F, Fisch MJ. et al. Prevalence and characteristics of moderate to severe fatigue: a multicenter study in cancer patients and survivors. Cancer 2014; 120: 425-432
• 4 National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue (01.2014). Im Internet: www.nccn.org Stand: 28.11.2016
• 5 Minton O, Berger A, Barsevick A. et al. Cancer-related fatigue and its impact on functioning. Cancer 2013; 119 (Suppl. 11) 2124-2130
• 6 Curt GA. Impact of Cancer-Related Fatigue on the Lives of Patients: New Findings From the Fatigue Coalition. The Oncologist 2000; 5: 353-360
• 7 Kreissl S, Müller H, Goergen H. et al. Cancer-related fatigue in patients with and survivors of Hodgkin’s lymphoma: a longitudinal study of the German. Lancet Oncology 2016; 17: 1453-1462
• 8 Husson O, Mols F, van de Poll-Franse Lonneke V. et al. The course of fatigue and its correlates in colorectal cancer survivors: a prospective cohort study of the PROFILES registry. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2015; 23: 3361-3371
• 9 Saligan LN, Olson K, Filler K. et al. The biology of cancer-related fatigue: a review of the literature. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2015; 23: 2461-2478
• 10 Taunk NK, Haffty BG, Chen S. et al. Comparison of radiation-induced fatigue across 3 different radiotherapeutic methods for early stage breast cancer. Cancer 2011; 117: 4116-4124
• 11 Skerman HM, Yates PM, Battistutta D. Cancer-related symptom clusters for symptom management in outpatients after commencing adjuvant chemotherapy, at 6 months, and 12 months. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2012; 20: 95-105
• 12 Goedendorp MM, Gielissen MFM, Verhagen C. et al. Development of fatigue in cancer survivors: a prospective follow-up study from diagnosis into the year after treatment. Journal of pain and symptom management 2013; 45: 213-222
• 13 Fisch MJ, Zhao F, O‘Mara AM. et al. Predictors of significant worsening of patient-reported fatigue over a 1-month timeframe in ambulatory patients with common solid tumors. Cancer 2014; 120: 442-450
• 14 Pryce J, Munir F, Haslam C. Cancer survivorship and work: symptoms, supervisor response, co-worker disclosure and work adjustment. Journal of occupational rehabilitation 2007; 17: 83-92
• 15 Mehnert A. Employment and work-related issues in cancer survivors. Critical reviews in oncology/hematology 2011; 77: 109-130
• 16 Deutsche Rentenversicherung. Reha-Bericht. 2015; http://www.deutsche-rentenversicherung.de/Allgemein/de/Inhalt/6_Wir_ueber_uns/03_fakten_und_zahlen/03_statistiken/02_statistikpublikationen/02_rehabericht_2015.pdf
• 17 Bundesarbeitsgemeinschaft für Rehabilitation (BAR). Rahmenempfehlungen zur ambulanten onkologischen Rehabilitation (22.1.2004). Im Internet: www.bar-frankfurt.de/fileadmin/dateiliste/publikationen/empfehlungen/downloads/Rahmenempfehlung_zur_onkologischen_Rehabilitation.pdf Stand: 15.03. 2016
• 18 Bartsch HH, Weis J, Moser MT. Cancer-related fatigue in patients attending oncological rehabilitation programs: prevalence, patterns and predictors. Onkologie 2003; 26: 51-57
• 19 Heim ME, Krauss O, Schwarz R. Effects of cancer rehabilitation on fatigue and quality of life parameters. Psychooncology 2001; 10: 26 (Suppl. S)
• 20 Mehnert A, Koch U, Schulz H. et al. Prevalence of mental disorders, psychosocial distress and need for psychosocial support in cancer patients - study protocol of an epidemiological multi-center study. BMC psychiatry 2012; DOI: 10.1186/1471-244X-12-70.
• 21 Schwarz R, Krauss O, Hinz A. Fatigue in the General Population. Onkologie 2003; 26: 140-144
• 22 Smets E, Garssen B, Bonke B. et al. The multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. Journal of Psychosomatic Research 1995; 39: 315-325
• 23 Löwe B, Kroenke K, Herzog W. et al. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health. Journal of Affective Disorders 2004; 81: 61-66
• 24 Daniëls LA, Oerlemans S. Krol et al. Persisting fatigue in Hodgkin lymphoma survivors: a systematic review. Annals of hematology 2013; 92: 1023-1032
• 25 Loge JH, Abrahamsen AF, Ekeberg O. et al. Hodgkin’s disease survivors more fatigued than the general population. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 1999; 17: 253-261
• 26 Daniëls LA, Oerlemans S, Krol ADG. et al. Chronic fatigue in Hodgkin lymphoma survivors and associations with anxiety, depression and comorbidity. British journal of cancer 2014; 110: 868-874
• 27 Köhler N, Gansera L, Holze S. et al. Cancer-related fatigue in patients before and after radical prostatectomy. Results of a prospective multi-centre study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2014; 22: 2883-2889
• 28 Weis J, Tomaszewski KA, Hammerlid E et al. International psychometric validation of an EORTC quality of life module measuring cancer related fatigue (EORTC QLQ-FA12). J National Cancer Institute [im Druck]