Changes in fatigue, health-related quality of life and physical activity after a one-week educational program for cancer survivors

<b>Background:</b> Rehabilitation aims to improve function, but the effects of different programs are not clear. The aims of the present study were to: (1) compare the level of fatigue and health-related quality of life (HRQOL) of cancer survivors admitted to a one-week inpatient educational program (IEP) to the general population (NORMS), (2) examine changes in fatigue, HRQOL and physical activity after the IEP and (3) examine the proportions of survivors for female and male separately with clinically relevant improvement (&gt;10% of maximum scale). <b>Methods:</b> Cancer survivors ≥18 years, diagnosed with breast-, prostate- or gastrointestinal cancer within the last 10 years, about to attend a one-week IEP were invited to an observational study with a pre-post design. The IEP included lectures, group discussions and physical activity. The participants completed a questionnaire on the arrival day (T0) and three months after the stay (T1). Fatigue was assessed by the Fatigue Questionnaire and HRQOL by Short Form-36. <b>Results:</b> Compared to NORMS, both female and male participants had significantly higher mean levels of fatigue and poorer HRQOL at T0 and T1. From T0 to T1, among all participants physical fatigue was reduced from 12.6 (SD 3.9) to 11.8 (SD 3.8; <i>p</i> p = .044) and total fatigue from 19.0 (SD 5.3) to 17.8 (SD 5.4; <i>p</i> = .001). Among female participants, 30% experienced clinically relevant improvement in physical fatigue, 28% in total fatigue and 36% in general health. Of male participants, 31% displayed a clinically relevant improvement in role limitations physical. <b>Conclusion:</b> Participants in the IEP reduced their levels of fatigue and improved aspects of HRQOL, more often observed among female participants than among males. Because of the lack of a control group it is not possible to conclude whether the changes were due to the IEP.

背景：康复干预旨在改善机体功能，但不同康复项目的疗效尚不明确。本研究旨在达成以下目标：（1）对比参与为期1周住院教育项目（inpatient educational program, IEP）的癌症幸存者的疲劳水平与健康相关生活质量（health-related quality of life, HRQOL），并与普通人群（NORMS）进行对照；（2）探究参与IEP后，受试者的疲劳状况、HRQOL与身体活动水平的变化；（3）分别分析女性与男性癌症幸存者中，出现具有临床意义的改善（即达到量表满分的10%以上）的人群比例。
方法：本研究采用前后对照的观察性研究设计，招募对象为年龄≥18岁、近10年内确诊乳腺癌、前列腺癌或胃肠道癌症且即将参与为期1周IEP的癌症幸存者。该IEP包含讲座、小组讨论与身体活动环节。受试者分别于入组当日（T0）及出院后3个月（T1）完成问卷调研。疲劳状况采用疲劳量表（Fatigue Questionnaire）进行评估，HRQOL则采用简明健康调查问卷36（Short Form-36）进行测评。
结果：与普通人群（NORMS）相比，无论女性还是男性受试者，在T0与T1两个时间点的平均疲劳水平均显著更高，HRQOL则更差。从T0至T1，全体受试者的躯体疲劳得分从12.6（标准差SD=3.9）降至11.8（SD=3.8；p=0.044），总疲劳得分从19.0（SD=5.3）降至17.8（SD=5.4；p=0.001）。女性受试者中，30%的人群躯体疲劳出现具有临床意义的改善，28%的人群总疲劳得到改善，36%的人群总体健康状况获得提升。男性受试者中，31%的人群在躯体角色功能受限方面出现具有临床意义的改善。
结论：参与IEP的受试者疲劳水平有所降低，HRQOL的多个维度得到改善，且上述改善在女性受试者中较男性更为常见。由于本研究未设置对照组，因此无法确定上述变化是否由IEP所致。