The Cancer-related Fatigue And Its Associated Factors Among Colorectal Cancer Patients Based On The Theory Of Unpleasant Symptoms

Objectives:To investigate the status of cancer-related fatigue(CRF)in colorectal cancer patients;to explore the effects of physiological/psychological/social environmental factor on CRF,the relationship between CRF and outcome,and build the path of physiological/psychological/environmental factor-CRF-outcome based on the theory of unpleasant symptoms,so as to provide a theoretical basis for reducing CRF in colorectal cancer patients.Methods:Using convenient sampling method,a total of 229 colorectal cancer inpatients from the oncology department,gastrointestinal surgery department and chemotherapy department of two hospitals in shandong province were recruited.The survey tools included general situation questionnaire,Cancer Fatigue Scale(CFS),Insomnia Severity Index(ISI),Connor-Davidson Resilience Scale(CD-RISC-10),Family APGAR Index(APGAR),and the 10-item Kessler Psychological Distress Scale(K10).SPSS 22.0 software was used for descriptive statistics,t test,ANOVA,pearson correlation,linear hierarchical regression,and AMOS22.0 software was used for path analysis.Results:1.General information in colorectal cancer patientsThe age range of 229 colorectal cancer patients was 27?87 years old,with an average age of(58.4±12.0)years old.Among them,64.6%were male,88.2%were married,58.1%were junior high school or below,44.1%were break-even regarding family economy,51.1%lived in the cities or towns.The primary carers were their children(59.0%),and 52.8%had normal BMI.59.0%were diagnosed with rectal cancer,41.0%were colon cancer.The course was mostly within 1 year(86.5%),non-metastatic patients accounted for 60.3%,92.6%had received treatment,patients with ostomy accounted for 25.3%,and 34.5%had chronic disease history2.The status of CRF among colorectal cancer patientsThe total score of CRF ranged from 2 to 54,with an average score of(33.24±9.26),and the incidence of CRF was 92.1%(score>18).The average scores of items were physical fatigue(2.49±0.80),affective fatigue(2.26±0.73)and cognitive fatigue(1.70±1.05)in a descending order.The results of univariate analysis showed that CRF and three sub-dimensions were statistically different in terms of age,residence,education level,family economic,disease diagnosis,disease course,stage,treatment,and whether or not having an ostomy(Ps<0.05).3.Analysis of the relation between physiological/psychological/environmental factors and CRFThe scores of insomnia,resilience,and family care were 16.90±6.34,22.07±7.35,and 6.1412.11,respectively.Pearson correlation showed that total CRF and three sub-dimensions had significant correlations with insomnia(r = 0.540?0.906),resilience(r =-0.882?-0.514)and family care(r =-0.750?-0.381)(Ps<0.001)All variables were standardized.In regression analysis,CRF was regarded as the indpendent variable,significant demographic and clinical variables were put in the first layer;the score of insomnia,resilience,family care were put into the second layer;the interactions of two in three were put into the third layer;the interaction of three was put into the forth layer.The results showed that insomnia,resilience,and insomniax family care could predict CRF in colorectal cancer patients(? = 0.532,-0.390,-0.161,Ps<0.001).4.Analysis of the relation between CRF and psychological distressThe average psychological distress score was(21.6±17.26),and the incidence was 78.2%(?16).Pearson correlation showed that CRF and the three sub-dimensions positively correlated with psychological distress(r = 0.390?0.856,Ps<0.001).Linear regression showed that CRF had a positive effect on psychological distress(?= 0.390,P<0.001).5.The path of physiological/psychological/environmental factors-CRF-outcome based on the theory of unpleasant symptomsThe path model of physiological/psychological/environmental factors-CRF-psychological distress based on the theory of unpleasant symptoms was fit among colorectal cancer patients(Fit indices:x2/df= 1.093;GFI = 0.977;CFI = 0.999;TLI =0.997;IFI = 0.999;NFI = 0.999;RMSEA = 0.020),and insomnia,resilience,and insomniaxfamily care could predict CRF(?= 0.425,-0.300,-0.671,Ps<0.001),and CRF had a predictive role on psychological distress(?=0.413,P<0.001)Conclusions:1.The incidence of CRF was high in colorectal cancer patients,and physical fatigue was the most obvious in the three sub-dimensions2.Insomnia,resilience,and insomniax family care could predict CRF3.CRF could predict psychological distress in colorectal cancer patients.4.The path of physiological/psychological/environmental factors-CRF-psychological distress based on the theory of unpleasant symptoms was applicative,which provided a theoretical basis for finding the intervention targets of CRF in clinic.