br The prevalence of cancer related fatigue has been estimat
The prevalence of cancer-related fatigue has been estimated to range from 59 to nearly 100%, depending on the clinical status and
types of the cancer.3 Cancer-related fatigue can lead to a poor quality of life 4 and the latter is associated with a poor prognosis and low survival rate in cancer patients.5 Since there is currently no standard treatment for cancer-related fatigue,6 cancer patients often turn to the use of complementary and alternative medicine to relieve their fatigue.7–9 In Asia, cancer patients often use traditional Chinese Medicine (TCM) to relieve the side eﬀects of chemotherapy.10,11
According to TCM theory, Yang and Qi are the driving forces of biological activities in the human body. Deficiencies in Yang and Qi are common in patients with “fatigue syndrome”.12 Cancer patients often suﬀer from vital Qi deficiency,13 and those with cancer-related fatigue and Qi deficiency is associated with a poor quality of life.14 Therefore, identifying patients with Qi deficiency is critical for predicting prog-nosis or disease progression and guide the corresponding treatment
Corresponding author at: Department of Chinese Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 62247, Taiwan.
Corresponding author at: Graduate Institute of Chinese Medicine, China Medical University, Taichung City 40402, Taiwan. E-mail addresses: [email protected] (C.-C. Yeh), [email protected] (T.-M. Li). 1 Ming-Hsien Yeh, Chiu-Hui Chao, and Malcolm Koo contributed equally to this work.
principles of Chinese Medicine.
Traditional Chinese Medicine body constitution (TCMBC) (“Tizhi” in Chinese) refers to an integrated, relatively stable, and natural system of classifying individuals according to developmental, physiological, and psychological characteristics, innate or acquired over time.15 The TCMBC includes nine constitutions: Gentleness (Neutral, Balance), Qi-deficiency, Yang-deficiency, Qi-depression (Qi stagnation), Yin-defi-ciency, Phlegm-wetness (Phlegm-dampness), Blood-stasis, Wetness-heat (Dampness-heat), and Special diathesis (Inherited special constitu-tion).16 Based on the sign and symptoms presented, the type of TCMBC of a patient can be determined. The TCMBC not only relates to the susceptibility and predisposition to certain pathogens and diseases, but it Ferrostatin 1 can also influence the prognosis and treatment of diseases.17 There-fore, the aim of the present study was to investigate the association between TCMBC and cancer-related fatigue in cancer patients.
2. Materials and methods
2.1. Study design and data collection
This was a cross-sectional design study with convenience sampling. Cancer patients were recruited from both inpatients and outpatients from the Department of Chinese Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation from January 2013 to July 2014. All participants completed a structured questionnaire to collect their demographic information and other relevant information, including cancer type, cancer stage, and cancer treatment. The questionnaires were administered using face-to face interviews by a research assistant either at the outpatient waiting room or in the ward of the study hos-pital. The study protocol was approved by the Ethical Committee for Human Research at Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (approval number: B10204015).
2.2. Study participants
Based on the results of a study on the correlation of Qi deficiency and cancer-related fatigue in patients with breast cancer,18 we esti-mated a sample size of 150 would be required to able to use logistic regression analysis to detect a significant diﬀerence in cancer-related fatigue (a proportion of 0.24) between patients with (a proportion of 0.65) or without Qi deficiency (a proportion of 0.33) with an alpha level of 0.05 and a power of 90%.19 We further increased the sample size by 25% from 150 to 190 patients to compensate for the possibility of nonresponse and diﬀerences in the types of cancer in our study sample.
A total of 190 patients of ages between 20 and 80 years with cancer diagnosed by pathology or imaging and receiving radiotherapy or chemotherapy were recruited in the study. Due to incomplete ques-tionnaire responses, 20 patients were excluded from the study (Fig. 1).
2.3. Measurement of traditional Chinese medicine body constitution
All of the participants completed a Constitution in Chinese Medicine Questionnaire (CCMQ) developed by Qi Wang for measuring the type of TCMBC.15,20 The scale consisted of 60 items with nine sub-scales scored on a 5-point Likert scale for classifying a person into one or more of the nine types of TCMBC, namely, Gentleness (8 items), Qi-deficiency (8 items), Yang-deficiency (7 items), Yin-deficiency (8 items), Phlegm-wetness (8 items), Wetness-heat (6 items), Blood-stasis (7 items), Qi-depression (7 items), and Special diathesis (7 items). The coexistence of multiple TCMBC types is possible and is consistent with the traditional Chinese medicine theory. A score of 30 or higher on each of the nine sub-scales of the CCMQ was set as the threshold for the respective TCMBC, following original CCMQ scoring algorithm.21 In this study, we selected CCMQ over other TCMBC scales such as the Body Constitution Questionnaire (BCQ) 22,23 because we believe that dictyosomes is necessary to use