肺癌化疗患者癌因性疲乏变化轨迹及其影响因素的纵向研究

目的: 识别肺癌化疗患者从首次化疗至6次化疗结束后癌因性疲乏变化轨迹，探讨肺癌化疗患者癌因性疲乏的影响因素。 方法 : 采用前瞻性研究设计，选取2020年12月至2021年12月在复旦大学附属中山医院接受肺癌化疗患者250例，分别调查患者6次化疗前、化疗结束时、化疗结束后1周共18次的癌因性疲乏情况。运用增长混合模型（growth mixture model，GMM）识别轨迹类型，Logistic回归分析癌因性疲乏的影响因素。 结果: 本研究识别出肺癌首次化疗患者6条癌因性疲乏的变化轨迹，将其命名为：轻度疲乏稳定型(45.78%)、轻度疲乏缓慢增长型 (12.85%)、轻度疲乏高增长型 (5.22%)、中度疲乏缓慢增长型(19.68%)、中度疲乏缓解型（6.83%）及高度疲乏缓解型 (9.64%)。Logistic回归分析显示：职业、居住方式、家庭人均月收入、医疗负担、咳嗽、吸烟状况、BMI指数、呕吐、是否患有合并症、红细胞计数为癌因性疲乏的影响因素。 结论: 肺癌化疗患者从首次化疗至6次化疗结束癌因性疲乏呈现出6种不同的发展轨迹，大部分患者以轻度疲乏稳定型为主，37.7%的患者随着化疗进程疲乏程度逐渐升高，根据不同疲乏程度应给予相应干预；16.47%的患者治疗后癌因性疲乏症状减轻，与治疗后肿瘤缩小，咳嗽、气急等症状减轻有关；5.22%的患者属于轻度疲乏高增长型，需加强评估，避免发展为重度疲乏患者。医护人员可根据患者不同的发展特点及影响因素在不同时期提供个性化、针对性的干预措施，逐步改善肺癌化疗患者癌因性疲乏状况，从而提高其生存质量。

A longitudinal study of the trajectory of cancer-related fatigue in patients with lung cancer chemotherapy and its influencing factors

Objective] To identify the trajectory of cancer-induced fatigue in lung cancer chemotherapy patients from the first chemotherapy to the end of six chemotherapy treatments, and to explore the influencing factors of cancer-induced fatigue in lung cancer chemotherapy patients. Methods] A prospective study design was used to investigate the cancer-induced fatigue of 250 patients admitted to the hospital from December 2020 to December 2021 before, at the end of 6 chemotherapy, and 1 week after 6 chemotherapy. The growth mixture model (GMM) was used to identify trajectory types, and logistic regression analysis was used to identified the influencing factors of cancerous fatigue. Results] Six different trajectories of cancer-induced fatigue were identified: mild fatigue stable type (45.78%), mild fatigue slow growth type (12.85%), mild fatigue high growth type (5.22%), moderate fatigue slow growth type (19.68%), moderate fatigue relief type (6.83%), and high fatigue relief type (9.64%). Logistic regression analysis showed that occupation, mode of living, medical burden, cough, smoking status, BMI, vomiting, comorbidities, red blood cell count, and hemoglobin count were the influencing factors of cancer-induced fatigue. Conclusions] Lung cancer chemotherapy patients from the first chemotherapy to the end of 6 chemotherapy cancer-induced fatigue showed 6 different development trajectories, most of the patients are mild fatigue stable type, 37.7% of patients with the chemotherapy process fatigue gradually increased, according to different fatigue should be given corresponding intervention; 16.47% of patients reduced the symptoms of cancer-induced fatigue after treatment, which was related to the reduction of tumors after treatment, cough, shortness of breath and other symptoms; 5.22% of patients are mild fatigue and high growth type, and evaluation needs to be strengthened to avoid developing into patients with severe fatigue. Medical staff can provide personalized and targeted interventions at different times according to the different development characteristics and influencing factors of patients, and gradually improve the cancer-induced fatigue of lung cancer chemotherapy patients, thereby improving their quality of life.