Prevalence and independent influencing factors of moderate-to-severe cancer-related fatigue (CRF) and its association with Buzhong-Yiqi (BZYQ) use among patients with locally advanced cervical squamous cell carcinoma (LACSCC): a retrospective observational study using propensity-score weighting (PSW) logistic regression model.

purposeCancer-related fatigue (CRF) is a debilitating syndrome in cervical cancer patients, resistant to conventional bedrest. This study analyzed CRF drivers and observed the real-world correlation of the Traditional Chinese Medicine (TCM) formulation, Buzhong Yiqi, in the incidence of the moderate-to-severe CRF patients with stage IIB-IVA cervical carcinoma.

methodsThis was a retrospective observational study conducted at Chengdu Xinjin District People's Hospital and Sichuan Provincial People's Hospital. According to inclusion and exclusion criteria, we enrolled patients diagnosed with stage IIB-IVA cervical squamous carcinoma (FIGO 2018 criteria). We identified factors influencing CRF severity using Electronic Medical Records and patient questionnaires. The prevalence of CRF was estimated among patients diagnosed with locally advanced cervical squamous cell carcinoma (LACSCC). According to the univariate and multivariate analysis, we want to find the independent influencing factors of moderate-to-severe CRF. Independent sample t-tests and Chi-squared tests were performed to assess differences in symptom scores between BZYQ (Buzhong-Yiqi)-treated and non BZYQ-treated groups. A propensity score-weighted(PSW) logistic regression model was employed to evaluate the association between the real-world BZYQ treatment and the risk of moderate-to-severe CRF.

resultsWe enrolled 144 patients diagnosed with stage IIB-IVA cervical squamous carcinoma (FIGO 2018 criteria) who underwent chemoradiation, chemotherapy alone, radiation therapy alone, targeting therapy or no anticancer treatment. Among them, 50% had moderate-to-severe CRF. Independent factors significantly influencing the incidence of moderate-to-severe CRF included disease stage (P = 0.001), Eastern Cooperative Oncology Group Performance Status (ECOG-PS) (P = 0.003), cancer pain (P < 0.001), anemia (P < 0.001), poor appetite (P < 0.001), proactive clinician attention (P = 0.042) and BZYQ treatment (P = 0.001). After propensity-score weighting, the BZYQ-treatment group exhibited a 68.3% reduction in the odds of moderate to severe CRF (OR = 0.317; P < 0.001).

conclusionsCRF is a complex, multifactorial syndrome driven by tumor burden, synergistic symptoms, and quality of supportive care. Among patients with LACSCC, CRF is common. In clinical practice, CRF should be included in routine screening to achieve early identification and early intervention. Throughout the course of diagnosis and treatment, long-term dynamic assessment and timely interventions should be implemented for modifiable risk factors such as cancer-related pain, anemia and poor appetite, so as to reduce the risk and severity of CRF. Meanwhile, clinicians should actively attend to patients' complaints of fatigue and strengthen awareness for the identification and standardized management of this symptom. This real-world observational study suggests that BZYQ treatment is correlated with the decreased incidence of moderate-to-severe CRF, providing preliminary clues for further exploring its application value in CRF management.