Fatigue and radiotherapy: (A) experience in patients undergoing treatment

Comparison of radiation-induced fatigue across 3 different radiotherapeutic methods for early stage breast cancer

BACKGROUND

Radiation-induced fatigue is a common side effect of breast cancer radiotherapy (RT). This study compares the induction and persistence of radiation-induced fatigue in accelerated partial breast irradiation (APBI), accelerated hypofractionated RT, and standard whole breast RT.

METHODS

Eighty patients were treated with a novel, 3-week accelerated regimen with 333 centigrays (cGy) for 15 fractions to 4995 cGy; of these, 45 were treated using APBI, whereas 35 patients were treated using accelerated hypofractionated RT. These patients were matched with patients receiving 200 cGy for 30 fractions using standard whole breast irradiation. Fatigue score, using Common Terminology Criteria for Adverse Events version 4.0, was obtained at 5 time points: consultation before RT, first on-treatment visit, halfway through treatment, last on-treatment visit, and first follow-up.

RESULTS

Maximum fatigue and average fatigue since treatment were calculated. Maximum fatigue was 1.5, 2.4, and 2.3, and average fatigue was 0.46, 0.81, and 0.92 for the APBI, accelerated hypofractionated RT, and standard whole breast RT groups, respectively. The accelerated schedules did not have significantly less fatigue than standard whole breast RT at first on-treatment visit. Maximum fatigue in APBI was reduced compared with standard whole breast RT. Accelerated hypofractionated RT had fatigue trajectory similar to standard whole breast RT. Multivariate analysis found that increased age and whole breast treatment are associated with more fatigue. Chemotherapy, hormone therapy, race, and T stage were not significant predictors of maximum fatigue. Results were similar for average fatigue, except that magnitudes were smaller.

CONCLUSIONS

Field sizes and age in breast RT were positively associated with maximum radiation-induced fatigue. Accelerated hypofractionated RT and standard whole breast RT had similar fatigue trajectories compared with APBI, which reduced fatigue at all times.

One-year longitudinal study of fatigue, cognitive functions, and quality of life after adjuvant radiotherapy for breast cancer

PURPOSE

Most patients with localized breast cancer (LBC) who take adjuvant chemotherapy (CT) complain of fatigue and a decrease in quality of life during or after radiotherapy (RT). The aim of this longitudinal study was to compare the impact of RT alone with that occurring after previous CT on quality of life.

METHODS AND MATERIALS

Fatigue (the main endpoint) and cognitive impairment were assessed in 161 CT-RT and 141 RT patients during RT and 1 year later. Fatigue was assessed with Functional Assessment of Cancer Therapy-General questionnaires, including breast and fatigue modules.

RESULTS

At baseline, 60% of the CT-RT patients expressed fatigue vs. 33% of the RT patients (p <0.001). Corresponding values at the end of RT were statistically similar (61% and 53%), and fatigue was still reported at 1 year by more than 40% of patients in both groups. Risk factors for long-term fatigue included depression (odds ratio [OR] = 6), which was less frequent in the RT group at baseline (16% vs. 28 %, respectively, p = 0.01) but reached a similar value at the end of RT (25% in both groups). Initial mild cognitive impairments were reported by RT (34 %) patients and CT-RT (24 %) patients and were persistent at 1 year for half of them. No biological disorders were associated with fatigue or cognitive impairment.

CONCLUSIONS

Fatigue was the main symptom in LBC patients treated with RT, whether they received CT previously or not. The correlation of persistent fatigue with initial depressive status favors administering medical and psychological programs for LBC patients treated with CT and/or RT, to identify and manage this main quality-of-life-related symptom.

Exploring a link between fatigue and intestinal injury during pelvic radiotherapy

BACKGROUND

The association between cancer-related fatigue and pathological processes in the body is largely unknown. This study was designed to investigate a possible linkage between fatigue and intestinal injury during pelvic radiotherapy.

METHODS

Twenty-nine women undergoing pelvic radiotherapy for anal or uterine cancer were prospectively followed. Fatigue and diarrhea were assessed using patient self-reported questionnaires. Plasma citrulline concentration, as a sign of intestinal injury, and C-reactive protein, orosomucoid, albumin, α(1)-antitrypsin, and haptoglobin, as signs of systemic inflammation, were analyzed.

RESULTS

Fatigue increased significantly (p < .001) and citrulline decreased significantly (p < .001) during treatment. A significant negative correlation (r = -0.40; p < .05) was found between fatigue and epithelial atrophy in the intestine (as assessed by plasma citrulline) after 3 weeks of treatment and a significant positive correlation (r = 0.75; p < .001) was found between fatigue and diarrhea. Signs of systemic inflammation were evident, with significant increases in serum orosomucoid, serum haptoglobin (p < .05) and serum α(1)-antitrypsin (p < .001) and a significant decrease in serum albumin (p < .001).

CONCLUSION

The present study indicates a link between fatigue and intestinal injury during pelvic radiotherapy. This observation should be considered as a preliminary finding because of the small sample size but may serve as a rationale for therapeutic interventions aimed at alleviating both fatigue and gastrointestinal symptoms during pelvic radiotherapy.

A multidimensional examination of correlates of fatigue during radiotherapy

BACKGROUND

Cancer-related fatigue can be measured as both a unidimensional and a multidimensional construct. Unidimensional fatigue and its symptom correlates have undergone some previous investigation; however, minimal research has considered the differential effect of correlates on individual dimensions of fatigue. The objective of the current study was to investigate cancer-related fatigue in a radiotherapy sample using a multidimensional conceptualization to determine whether correlates of fatigue are consistent across all dimensions or whether each fatigue dimension has its own unique pattern of correlates.

METHODS

The study used a prospective cohort design with data collected from radiotherapy patients at 3 time points; before, after, and 6 weeks after radiotherapy treatment.

RESULTS

A total of 210 participants were enrolled in the study. Results indicated the following relations. Increased general fatigue was found to be associated with lower performance status, being in a de facto relationship, depression, having treatment to the brain, and reduced vigorous physical activity. Increased physical fatigue was associated with lower performance status, depression, reduced physical activity, reduced productive hours, and nausea. Higher levels of reduced activity were associated with depression, decreased participation in activities of daily living, decreased number of productive hours, and lower performance status. Higher levels of reduced motivation were associated with radiotherapy to the brain, reduced moderate physical activity, and depression. Increased mental fatigue was associated with diagnosis of a brain tumor, anxiety, depression, and sleep problems.

CONCLUSIONS

The results of the current study support the recognition of multiple dimensions of fatigue, because each dimension examined had various correlates. These findings further develop our understanding of fatigue and may help clinicians provide more targeted information to people with cancer-related fatigue. Furthermore, these results can guide the development of group or individually tailored interventions that ultimately may reduce the impact of this distressing symptom on people with cancer.

Fatigue in gynecological cancer patients during and after anticancer treatment

CONTEXT

Research has indicated that individuals with gynecological cancer experience severe fatigue.

OBJECTIVES

This longitudinal survey aimed to analyze the fatigue experienced over the course of one year by a gynecological cancer population, to determine if the fatigue was more severe than that reported by females without cancer, and to identify variables associated with cancer-related fatigue (CRF).

METHODS

Data were collected over a 12-month period before, during, and after anticancer treatment. Fatigue was assessed using the Multidimensional Fatigue Symptom Inventory-Short Form. Participants with cancer also completed the Rotterdam Symptom Checklist.

RESULTS

Sixty-five cancer patients (mean age = 57.4 years, standard deviation [SD] = 13.9) and 60 control subjects (mean age = 55.4 years, SD = 13.6) participated. Descriptive analysis and repeated measurements modeling indicated that the cancer participants reported worse fatigue than the noncancer individuals before, during, and after anticancer treatment (P < 0.001) and that the level of fatigue in persons with cancer changed with time (P = 0.02). A forward stepwise regression demonstrated that psychological distress level was the only independent predictor of CRF during anticancer treatment (P < 0.00), explaining 44% of the variance in fatigue. After treatment, both psychological distress level (P < 0.00) and physical symptom distress (P = 0.03) were independent predictors of fatigue, accounting for 81% of the variance.

CONCLUSION

Psychological distress level is an important indicator of CRF in gynecological cancer. Interventions focused on the reduction of psychological distress may help alleviate CRF.

Cancer-related fatigue and its associations with depression and anxiety: a systematic review

BACKGROUND

Fatigue is an important symptom in cancer and has been shown to be associated with psychological distress.

OBJECTIVE

This review assesses evidence regarding associations of cancer-related fatigue with depression and anxiety.

METHOD

Database searches yielded 59 studies reporting correlation coefficients or odds ratios.

RESULTS

The combined sample size was 12,103. Almost all studies showed a correlation of fatigue with depression and with anxiety. However, 31 different instruments were used to assess fatigue, suggesting a lack of consensus on measurement.

CONCLUSION

This review confirms the association of fatigue with depression and anxiety. Directionality needs to be better delineated in longitudinal studies.

Cancer-related fatigue and its associations with depression and anxiety: a systematic review

BACKGROUND

Fatigue is an important symptom in cancer and has been shown to be associated with psychological distress.

OBJECTIVE

This review assesses evidence regarding associations of cancer-related fatigue with depression and anxiety.

METHOD

Database searches yielded 59 studies reporting correlation coefficients or odds ratios.

RESULTS

The combined sample size was 12,103. Almost all studies showed a correlation of fatigue with depression and with anxiety. However, 31 different instruments were used to assess fatigue, suggesting a lack of consensus on measurement.

CONCLUSION

This review confirms the association of fatigue with depression and anxiety. Directionality needs to be better delineated in longitudinal studies.

Predictors of the intensity of symptoms in a cluster in patients with breast cancer

PURPOSE

To examine the influence of selected demographic and clinical variables on the intensity of symptoms in two previously identified symptom clusters (psychoneurological and upper gastrointestinal) across the treatment trajectory for breast cancer.

DESIGN

A secondary analysis was conducted with a sample of 282 female breast-cancer patients who were receiving chemotherapy or radiation therapy in two American cancer centers. Data were collected three times across the treatment trajectory: baseline (before chemotherapy or radiation treatment) and two follow-up times after treatment initiation.

METHOD

Multiple regression analyses were done at each time point to examine the influence of selected demographic and clinical variables on the intensity of symptoms in each cluster.

FINDINGS

Baseline physical performance status was a consistent predictor of symptom intensity in the psychoneurological cluster across time whereas age and treatment modality were consistent predictors of symptom intensity in the upper gastrointestinal cluster. Poor physical performance at baseline predicted more intense psychoneurological symptoms. Younger women and women undergoing chemotherapy experienced more intense gastrointestinal symptoms. In addition, at the second follow-up treatment modality also influenced intensity of symptoms in the psychoneurological cluster and race and baseline physical performance status also influenced the intensity of symptoms in the upper gastrointestinal cluster.

CONCLUSIONS

Clinicians can anticipate that younger patients, patients with poor baseline physical performance status, and patients who receive chemotherapy will have more intense treatment-related gastrointestinal and psychoneurological symptoms during adjuvant breast cancer therapy. Further research is needed to determine whether collective management for symptoms in a cluster may be beneficial.

CLINICAL RELEVANCE

Clinicians can use findings from the present study to identify patients who need greater attention to symptom assessment and management, including anticipatory counseling of patients and families.

Determinants of fatigue 6 and 12 months after surgery in women with early-stage breast cancer: a comparison with women with benign breast problems

OBJECTIVE

The objective of this study was to examine the predictors of fatigue 6 and 12 months after surgical treatment in women with early-stage breast cancer (BC group) and in women with benign breast problems (BBP group) in a prospective follow-up study.

METHODS

Women entered the study prior to diagnosis and completed questionnaires on personality factors, psychological factors, and social support. Fatigue was assessed 6 and 12 months after diagnosis (BBP group) or surgical treatment (BC group). Clinical data were taken from medical records.

RESULTS

In the BC group (n=117), fatigue at 6 months was predicted by trait anxiety (P<.001) and extraversion (P<.05). Trait anxiety (P<.05), extraversion (P<.05), and depressive symptoms (P<.05) predicted fatigue at 12 months. In the BBP group (n=190), the predictors were trait anxiety (P<.001) for fatigue at 6 months, and trait anxiety (P<.001) and neuroticism (P<.01) for fatigue at 12 months.

CONCLUSION

Many patients who are already fatigued before diagnosis remain tired regardless of diagnosis. Trait anxiety is strongly related to fatigue in both groups.

Determining the minimal clinically important difference criteria for the Multidimensional Fatigue Inventory in a radiotherapy population

PURPOSE

The Multidimensional Fatigue Inventory (MFI) is a commonly used cancer-related fatigue assessment tool. Unlike other fatigue assessments, there are no published minimal clinically important difference (MCID) criteria for the MFI in cancer populations. MCID criteria determine the smallest change in scores that can be regarded as important, allowing clinicians and researchers to interpret the meaning of changes in patient's fatigue scores. This research aims to improve the clinical utility of the MFI by establishing MCID criteria for the MFI sub-scales in a radiotherapy population.

MATERIALS AND METHODS

Two hundred ten patients undergoing radiotherapy were recruited to a single-centre prospective cohort study. Patients were assessed at three time points, at the start of radiotherapy, the end of radiotherapy and 6 weeks after radiotherapy completion. Assessment consisted of four clinically relevant constructs: (1) treatment impact on fatigue, (2) health-related quality of life, (3) performance status and (4) occupational productivity. These constructs were used as external or anchor-based measures to determine MCIDs for each sub-scale of the MFI.

RESULTS

Multiple MCIDs were identified, each from a different perspective based on the constructs cited. Researchers seeking to use a generic MCID may wish to use a two-point reference for each MFI sub-scale as it was consistent across the pre- and post-radiotherapy comparison and occupational productivity anchors.

CONCLUSIONS

MCIDs validated in this study allow better interpretation of changes in MFI sub-scale scores and allow effect size calculations for determining sample size in future studies.

Patterns of fatigue related to advanced disease and radiotherapy in patients with cancer-a comparative cross-sectional study of fatigue intensity and characteristics

GOALS OF WORK

This cross-sectional comparative study was designed to explore and describe the prevalence and patterns of cancer-related fatigue in patients with advanced cancer as well as patients undergoing curative radiotherapy. Another aim was to explore the association of anxiety and depression with fatigue.

MATERIALS AND METHODS

Patients with an advanced stage of disease (n = 228) and patients receiving radiotherapy (n = 81) completed the Borg Category Ratio Scale, the Multidimensional Fatigue Inventory and the Hospital Anxiety and Depression Scale.

MAIN RESULTS

Patients with advanced disease had an increased probability of experiencing all aspects of fatigue except for mental fatigue as compared to patients undergoing radiation, e.g., odds ratio 11.5 (CI 5.8-22.7) for physical fatigue. Higher scores for depression than for anxiety were reported when patients had high levels of fatigue, with 23% of the patients classified as anxious and 39% depressed.

CONCLUSIONS

The present study was carried out in order to address a gap in research by comparing the multidimensional aspects of fatigue in different groups of cancer patients. It is the intensity of fatigue that seems to be related to the underlying exposure to radiation or to the level of disease burden rather than the different fatigue profiles, such as the relation between physical and mental aspects.

Trajectories of fatigue in men with prostate cancer before, during, and after radiation therapy

Fatigue is the most common and distressing symptom reported by patients undergoing radiation therapy (RT). However, limited information is available on the trajectories of fatigue, as well as on the predictors of interindividual variability in fatigue. This study evaluated a sample of patients who underwent RT for prostate cancer to examine how ratings of evening and morning fatigue changed from the time of simulation to four months after the completion of RT and to investigate whether specific patient, disease, and symptom characteristics predicted the initial levels of fatigue and/or characteristics of the trajectories of evening and morning fatigue. Using hierarchical linear modeling, a large amount of interindividual variability was demonstrated in the trajectories of evening and morning fatigue. Findings from this study suggest that younger men with a higher level of fatigue at the time of the simulation visit were at increased risk for higher levels of evening and morning fatigue over the course of RT. In addition, the level of morning fatigue over the course of RT appears to depend on the patient's level of depression at the time of the simulation visit. In future studies, the use of hierarchical linear modeling as an analytic tool will assist in the identification of patients who are most at risk for prolonged fatigue trajectories. This type of analysis may lead to the identification of subgroups of patients who are at higher risk for negative outcomes and who require different types of interventions for the fatigue associated with RT.

Fatigue in Advanced Cancer: A Prospective Study

Fatigue is a common advanced cancer symptom. Clinical features are not well known. The authors surveyed consecutive patients admitted to a palliative medicine program to identify clinical correlates of fatigue. Data collected included age, sex, performance status, primary site, prior chemotherapy/radiation therapy, and blood transfusions. Visual analogue scales assessed fatigue, quality of life, and ability to perform daily activities. Weight change was estimated. Laboratory results including lactate dehydrogenase and hemoglobin were recorded. Fatigue severity was associated with brain metastases, poor performance status, poor quality of life, and reduced ability to perform activities. Prior radiation therapy was associated with less severe fatigue. Age, sex, and hemoglobin level were not associated with fatigue. Fatigue was universal on referral. Brain metastases and poor quality of life independently predicted severity. Hemoglobin level did not predict fatigue. Further studies are necessary to define the clinical features and relationships of fatigue.

Cancer related fatigue: a focus on breast cancer and Hodgkin's disease survivors

BACKGROUND AND PURPOSE

Fatigue is one of the most common and troubling symptoms in cancer survivors. In this paper we review information about cancer related fatigue in survivors of breast cancer and Hodgkin's disease, discuss some of the potential biological mechanisms for this problem in cancer survivors, and briefly discuss potential interventions.

FINDINGS

Cancer-related fatigue persists long after cancer treatments end, and is associated with more intensive treatments (combined chemotherapy and radiation therapy) in these cancers. Fatigue prior to the onset of treatment is a strong predictor of persistent fatigue. Studies in breast cancer survivors suggest elevated levels of pro-inflammatory cytokines in association with persistent fatigue, as well as abnormalities in the hypothalamic-pituitary axis. Psychosocial and physical activity interventions have been shown in some studies to alleviate fatigue.

CONCLUSIONS

Recognizing the syndrome of cancer-related fatigue is a high priority for the many cancer survivors who continue to experience this complaint as a chronic health problem.

Breast Cancer and Fatigue

Fatigue is a common and disabling symptom in breast cancer patients and survivors. A rather nebulous concept, fatigue overlaps with sleepiness and depressed mood. In this chapter, we cover methods for assessing fatigue; describe the occurrence of fatigue before, during and after initial treatment; present possible underlying mechanisms of fatigue; and, enumerate approaches to its treatment.

Clinically relevant fatigue in cancer outpatients: the Edinburgh Cancer Centre symptom study

BACKGROUND

Fatigue is associated with cancer and its treatment but we know little about how many and which patients suffer fatigue of clinical severity. We aimed to determine the prevalence of clinically relevant fatigue (CRF) and its associations in outpatients with various cancer diagnoses.

PATIENTS AND METHODS

A survey of outpatients with colorectal, breast, gynaecological, genitourinary, sarcoma, melanoma and miscellaneous tumours at a regional cancer centre. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) fatigue subscale and the Hospital Anxiety and Depression Scale (HADS). These self-report data were linked to demographic and clinical variables. Data were available on 2867 outpatients.

RESULTS

The prevalence of CRF (EORTC fatigue subscale > or =40) was 32% (95% confidence interval 31-34%). The variables independently associated with CRF were primary cancer site, having disease present, type of cancer treatment and emotional distress (total HADS score > or =15). Emotional distress had the strongest association with fatigue but half the cases of CRF were not distressed.

CONCLUSION

CRF is common in cancer outpatients and is associated with type of disease and treatment, as well as with emotional distress. The association between CRF and emotional distress is strong but they are not equivalent conditions.

Self-Administered Stress Management Training in Patients Undergoing Radiotherapy

Purpose

This study sought to continue research on psychosocial interventions for patients being treated with radiation therapy across multiple centers and to replicate positive findings of a single-center study of patients being treated with chemotherapy. The primary objective of this study was to determine if a stress management intervention was effective in improving quality of life and decreasing psychological distress in patients undergoing radiotherapy for cancer.

Patients and Methods

A total of 310 patients about to begin radiotherapy treatment were randomly assigned to receive usual care only or self-administered stress management training. Quality-of-life assessments occurred at baseline and for 3 weeks after the beginning of radiotherapy treatment.

Results

Overall, patients assigned to receive stress management training did not report significantly less psychological distress on the Medical Outcomes Study 36-Item Short Form (SF-36) Mental Component Summary Scale than did those assigned to usual care. When divided into subgroups based on the SF-36 Mental Component Summary Scale scores immediately after their first radiotherapy treatment, patients with above-average levels of psychological distress (scores ≤ 50) who were randomly assigned to the intervention condition reported significant improvement in their distress compared with those assigned to usual care only on the SF-36 Mental Health Subscale and the Center for Epidemiologic Studies Depression Scale.

Conclusion

This study found that self-administered stress management training is effective only in those radiotherapy patients with initially higher levels of psychological distress. Additional research should examine the benefits of stress management training targeted specifically to patients experiencing heightened distress.

Fatigue and Physical Activity in Older Adults With Cancer

Cancer is a disease predominantly affecting older adults. Cancer fatigue is the most common and often most distressing symptom associated with cancer and its treatment, often persisting months to years after treatment. Untreated cancer fatigue may lead to significant reductions in physical activity, physical functioning, and quality of life and may interfere with patients' adherence to cancer treatment. Physical activity has the strongest supporting evidence as an intervention to reduce cancer fatigue, maintain physical function, and optimize quality of life. This article reviews the literature related to fatigue and physical activity in older adults with cancer. Nine experimental and 10 observational studies that enrolled subjects 65 years or older were synthesized in the review and provided evidence that physical activity may be an effective intervention for cancer fatigue in older adults. The generalizability of the findings to older adults was limited by the poor representation of this age group in the studies. Few studies provided an analysis of age-related effects of physical activity on fatigue, physical function, and quality of life.

Assessment of cancer-related fatigue: implications for clinical diagnosis and treatment

Cancer-related fatigue (CRF) is a highly prevalent and debilitating symptom experienced by most cancer patients during, and often for considerable periods after, treatment. The recognition of the importance of CRF to patients' psychosocial and cognitive functioning, as well as to their quality of life, has driven the development of a wide range of assessment tools for screening and diagnosis of CRF. Over 20 different measures have been used to assess CRF from either a unidimensional or multi-dimensional perspective. Unidimensional measures are often single-question scales that generally focus on identifying the occurrence and severity of CRF, whereas multidimensional measures may also examine the effect of CRF across several domains of physical, socio-emotional, and cognitive functioning. This paper provides an overview and critique of measures commonly used to assess CRF. Single-question assessment is the most commonly used and the most useful methodology. Strategies to facilitate reliable assessment of CRF are also discussed. Disclosure of potential conflicts of interest is found at the end of this article.

Cancer-related fatigue: the scale of the problem

Fatigue is one of the most common and debilitating symptoms experienced by patients with cancer. Cancer-related fatigue (CRF) is characterized by feelings of tiredness, weakness, and lack of energy, and is distinct from the "normal" drowsiness experienced by healthy individuals in that it is not relieved by rest or sleep. It occurs both as a consequence of the cancer itself and as a side effect of cancer treatment, although the precise underlying pathophysiology is largely unknown. CRF may be an early symptom of malignant disease and is reported by as many as 40% of patients at diagnosis. Virtually all patients expect fatigue from cancer therapy. Up to 90% of patients treated with radiation and up to 80% of those treated with chemotherapy experience fatigue. CRF continues for months and even years ollowing completion of treatment in approximately one third of the patients with cancer. The impact of CRF on a patient's quality of life (QoL), particularly in relation to physical functioning and the ability to perform activities of daily living, is both profound and pervasive. In addition, CRF is associated with considerable psychological distress and can impose a significant financial burden by limiting a patient's ability to work. These effects can extend to caregivers and family members, who may also have to reduce their working capacity in order to provide additional care for a patient with CRF. This paper examines the prevalence of CRF and explores the impact of this distressing symptom on patients' functioning and QoL. Disclosure of potential conflicts of interest is found at the end of this article.

Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue

Cancer-related fatigue (CRF) is a debilitating, multi-faceted biopsychosocial symptom experienced by the majority of cancer survivors during and after treatment. CRF begins after diagnosis and frequently persists long after treatments end, even when the cancer is in remission. The etiological pathopsychophysiology underlying CRF is multifactorial and not well delineated. Mechanisms may include abnormal accumulation of muscle metabolites, dysregulation of the homeostatic status of cytokines, irregularities in neuromuscular function, abnormal gene expression, inadequate ATP synthesis, serotonin dysregulation, abnormal vagal afferent nerve activation, as well as an array of psychosocial mechanisms, including self-efficacy, causal attributions, expectancy, coping, and social support. An important first step in the management of CRF is the identification and treatment of associated comorbidities, such as anemia, hypothyroidism, pain, emotional distress, insomnia, malnutrition, and other comorbid conditions. However, even effective clinical management of these conditions will not necessarily alleviate CRF for a significant proportion of cancer survivors. For these individuals, intervention with additional therapeutic modalities may be required. The National Comprehensive Cancer Network guidelines recommend that integrative nonpharmacologic behavioral interventions be implemented for the effective management of CRF. These types of interventions may include exercise, psychosocial support, stress management, energy conservation, nutritional therapy, sleep therapy, and restorative therapy. A growing body of scientific evidence supports the use of exercise and psychosocial interventions for the management of CRF. Research on these interventions has yielded positive outcomes in cancer survivors with different diagnoses undergoing a variety of cancer treatments. The data from trials investigating the efficacy of other types of integrative nonpharmacologic behavioral therapies for the management of CRF, though limited, are also encouraging. This article provides an overview of current research on the relative merits of integrative nonpharmacologic behavioral interventions for the effective clinical management of CRF and makes recommendations for future research. Disclosure of potential conflicts of interest is found at the end of this article.

Fatigue, depression, and insomnia: evidence for a symptom cluster in cancer

OBJECTIVES

To review the evidence for considering fatigue, depression, and insomnia as a symptom cluster in cancer.

DATA SOURCES

Empirical studies, clinical articles, and review articles.

CONCLUSION

The single- and multi-symptom measurement approaches are of limited usefulness in distinguishing fatigue, depression, and insomnia. Studies in which these symptoms have been measured concurrently in patients with cancer yield consistent evidence of high positive correlations. Results do not appear to be solely a function of overlap in measurement approaches.

IMPLICATIONS FOR NURSING PRACTICE

Successful management of fatigue, depression, and insomnia in cancer patients are likely to combine pharmacologic and nonpharmacologic therapies.

The Relationship of Fatigue and Meaning in Life in Breast Cancer Survivors

PURPOSE/OBJECTIVES

To determine relationships among (a) cancer-related fatigue and meaning in life, (b) overall symptom distress and meaning in life, (c) fatigue and performance, and (d) overall symptom distress and performance in breast cancer survivors.

DESIGN

Cross-sectional and correlational.

SETTING

Community-based setting in eastern Pennsylvania.

SAMPLE

34 women who had completed their last treatment for breast cancer within the prior 16 months.

METHODS

Data were collected using the Piper Fatigue Scale (PFS), Life Attitude Profile-Revised (LAP-R), Memorial Symptom Assessment Scale-Short Form (MSAS-SF), and Medical Outcomes Study-Short Form 36 (SF-36).

MAIN RESEARCH VARIABLES

Fatigue and meaning in life.

FINDINGS

One moderate negative correlation was found between the PFS sensory subscale and the choice or responsibleness dimension of the LAP-R. Significant moderate to strong negative correlations were found between the MSAS-SF total score and two subscale scores and the existential transcendence dimension of the LAP-R. Significant moderate to strong negative correlations were found between four subscales of the SF-36 representing performance and the MSAS-SF total score.

CONCLUSIONS

Meaning in life may influence fatigue and overall symptoms in breast cancer survivors.

IMPLICATIONS FOR NURSING

Assessment of meaning in life may be important in the management of fatigue and overall symptoms in women after treatment for breast cancer.

Fatigue During Head-And-Neck Radiotherapy: Prospective Study on 117 Consecutive Patients

PURPOSE

Fatigue is an underevaluated cancer-related and treatment-related symptom. We analyzed fatigue in head and neck cancer patients undergoing radiotherapy (RT).

METHODS AND MATERIALS

A total of 117 patients were enrolled (mean age, 58 years). Radiation therapy (median dose, 66 Gy) was given with either exclusive or postoperative intent in 52 and 65 patients, respectively. Chemotherapy (CT) was added before and/or during RT in 61 patients. The patients completed a 20-item questionnaire (Multidimensional Fatigue Inventory [MFI-20]) before, during (weekly), and after RT. The impact of patient-, tumor-, and treatment-related factors on fatigue was evaluated with unifactorial and multifactorial tests.

RESULTS

Fatigue level increased during RT reaching a maximum at Week 6 and then slowly decreased. In multivariate stepwise regression analysis age (inversely related, p < 0.05), psychologic disorders (p < 0.005), and previous head-and-neck surgery (inversely related, p < 0.005) were correlated with higher pre-RT fatigue level. Pre-RT fatigue score (p < 0.0001), induction and/or concomitant CT (p = 0.035), need of cortisone during RT (p = 0.005), and thyroid disorders (p = 0.032) were correlated with higher during-RT fatigue level. Pre-RT fatigue score (p < 0.0001), induction and/or concomitant CT (p < 0.001), and need of cortisone during RT (p < 0.005) were correlated with higher post-RT fatigue level. No impact of gender, performance status, comorbidities other than psychologic and thyroid, tumor stage/site, RT intent, dose, volume, duration, or toxicity was observed.

CONCLUSION

Fatigue affects all patients undergoing RT for head-and-neck cancer, reaches maximum score at the 6th week of RT, and slowly decreases thereafter. Age, thyroid dysfunction, psychologic disorders, pre-RT fatigue score, CT, and cortisone use are correlated with RT-related fatigue levels.

Impact of fatigue on overall quality of life in lung and breast cancer patients selected for high-dose radiotherapy

BACKGROUND

Although studies show that cancer patients consider fatigue as an important problem, few, if any, studies have quantified the impact of fatigue on overall quality of life (QoL) in cancer patients. In the present study, we evaluated the relative impact of different QoL domains/subscales, including fatigue, on overall QoL in cancer patients preceding radiotherapy.

PATIENTS AND METHODS

Sixty-four patients with lung or breast cancer selected for high-dose radiotherapy on the primary tumour completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Multivariate models were fitted to define the impact of QLQ-C30 subscales, including fatigue, on overall QoL.

RESULTS

Of all QLQ-C30 subscales, fatigue showed by far the strongest univariate correlation with overall QoL (r = -0.76, P < 0.001); correlations for functioning subscales (r = 0.44-0.55) and symptom subscales (r = -0.31 to -0.45) were considerably lower. In multivariate analyses, adjusting for potential confounders, fatigue was the only subscale that independently contributed to overall QoL (standardized regression coefficient-0.57, P < 0.001).

CONCLUSION

Our results indicate that, of all QoL domains/subscales, fatigue is by far the predominant contributor to patient-perceived overall QoL in both lung and breast cancer patients preceding high-dose radiotherapy.

Cancer‐Related Fatigue and Sleep Disorders

Sleep disorders, such as difficulty falling asleep, problems maintaining sleep, poor sleep efficiency, early awakening, and excessive daytime sleepiness, are prevalent in patients with cancer. Such problems can become chronic in some patients, persisting for many months or years after completion of cancer therapy. For patients with cancer, sleep is potentially affected by a variety of factors, including the biochemical changes associated with the process of neoplastic growth and anticancer treatments, and symptoms that frequently accompany cancer, such as pain, fatigue, and depression. Fatigue is highly prevalent and persistent in patients with cancer and cancer survivors. Although cancer-related fatigue and cancer-related sleep disorders are distinct, a strong interrelationship exists between these symptoms, and a strong possibility exists that they may be reciprocally related. The majority of studies that have assessed both sleep and fatigue in patients with cancer provide evidence supporting a strong correlation between cancer-related fatigue and various sleep parameters, including poor sleep quality, disrupted initiation and maintenance of sleep, nighttime awakening, restless sleep, and excessive daytime sleepiness. This paper reviews the data from these studies with a view toward suggesting further research that could advance our scientific understanding both of potential interrelationships between sleep disturbance and cancer-related fatigue and of clinical interventions to help with both fatigue and sleep disturbance. Disclosure of potential conflicts of interest is found at the end of this article.

Crohn’s disease, fatigue, and infliximab: Is there a role for cytokines in the pathogenesis of fatigue?

AIM: To study the effect of infliximab on fatigue in relation to cytokine levels in Crohn’s disease (CD) patients.

METHODS: Fourteen CD patients were blinded for treatment and received placebo at baseline, and infliximab 2 wk later, with a follow-up of 4 wk. Blood samples were drawn on a regular basis, and questionnaires on fatigue, depression, quality of life, and clinical disease activity were completed at regular intervals.

RESULTS: After placebo infusion, fatigue scores decreased within 3 d (3.5 points ± 1.1, P≤ 0.01), but returned to baseline values 14 d after this infusion. The drop of fatigue scores following infliximab infusion sustained until the end of the study (3.8 points ± 1.4, P≤ 0.05). Quality of life was increased at the end of the study compared to baseline values (138.6 ± 9.4 vs 179.4 ± 6.7; P≤ 0.005), whereas depression scores were decreased (20.4 ± 9.4 vs 11.3 ± 2.2; P≤ 0.01). No correlation between the severity of fatigue and the level of cytokines was observed.

CONCLUSION: The reduction of fatigue after infliximab infusion is subjective to a placebo effect. The effect of infliximab on fatigue, however, persists while the placebo effect disappears after a short period of time. A clear role of cytokines could not be substantiated.

Experiences of Fatigue and Self-management of Thai Buddhist Cancer Patients Undergoing Radiation Therapy

The purpose of this study was to describe (a) the subjective feelings of fatigue of Thai Buddhist cancer patients undergoing radiation therapy (RT) and identify possible gender differences, (b) their beliefs about the main cause of fatigue, and (c) their ways of self-management for relief of fatigue. One hundred thirty-three voluntary and randomly selected patients, 55 men and 78 women, completed a questionnaire with a Thai version of the Revised Piper Fatigue Scale. After 1 week of treatment, the largest group (42.1%) of the patients had felt fatigue during the last few hours (from 1 to 5 hours). The patients perceived a mild level of fatigue, but the sensory/cognitive fatigue scores were high. Five categories of beliefs about the main cause of fatigue emerged: (a) receiving RT; (b) feelings of anxiety, depression, and fright/fear; (c) cancer; (d) long travel to hospital and long waiting time for RT; and (e) difficulty with sleep and weak body. For relief of fatigue, 5 categories of self-management emerged: (1) getting moral support from family and friends; (2) practicing religion, reciting prayers, doing merit, and meditating; (3) practicing self-care for symptomatic problems; (4) accepting the situation and doing the best of one's life; and (5) consulting with doctor and nurse. In conclusion, healthcare providers need to be concerned about RT patients' symptoms of fatigue, beliefs about causes of fatigue, and ways of self-management for relief of fatigue. They also need understanding of cultural and religious beliefs to plan holistic care.

The influence of resilience on fatigue in cancer patients undergoing radiation therapy (RT)

PURPOSE

The primary goal of the study was to determine if resilience influences fatigue in a consecutive sample of cancer patients treated with radiotherapy (RT) at the beginning and at the end of the treatment.

METHODS

Out of an initial sample of 250 patients, 239 could be assessed at the beginning of their RT. Two hundred and eight patients were reassessed at the end of RT 4-8 weeks later. Measures comprised the Resilience Scale (RS), the Multidimensional Fatigue Inventory (MFI), and the SF-12 as a measure of health related Quality of Life (QoL). Medical data were continuously registered.

RESULTS

As hypothesized, the sample revealed higher scores in the MFI and lower scores in the SF-12 than normative samples. Resilience scores were higher than in the norm population. Fatigue increased during RT. Using multiple regression analyses, fatigue scores at the beginning of treatment were shown to be higher in inpatients and patients undergoing palliative treatment. Initial fatigue was best predicted by the patients' initial resilience scores. Changes of fatigue scores during RT depended on initial scores, decrease in Hb and the patients' experience with RT. Resilience could not be determined as a predictor of changes in fatigue during RT.

CONCLUSIONS

The study confirmed that fatigue is an important problem among RT patients. Resilience turned out to powerfully predict the patients' fatigue at least early in RT. This result is in line with other studies, showing resilience to be an important psychological predictor of QoL and coping in cancer patients. On the other hand, resilience seems to have little influence on treatment related fatigue during RT.

Personality and fatigue in patients with benign or malignant breast disease

GOALS OF WORK

The aim of the study was to examine the role of five general personality traits in fatigue in a group of patients with breast cancer (BC) and a group with benign breast problems (BBP).

MATERIALS AND METHODS

Of the 304 participating women, 127 patients had BC and 177 BBP. A fatigue scale was completed before diagnosis and 1, 3, and 6 months after diagnosis (benign patients) or surgical treatment (BC patients). A personality questionnaire (NEO-FFI) and a depression scale (CES-D) were completed before diagnosis.

MAIN RESULTS

The BC group was less tired before diagnosis, more tired 1 month after diagnosis, and equally tired 3 and 6 months after diagnosis. In the total group, women were more tired over time when they were more neurotic, less agreeable, or more introverted. After controlling for depressive symptoms, demographics, and medical factors, baseline depressive symptoms (beta = 0.29, p < 0.05), neuroticism (beta = 0.29, p < 0.05), and extraversion (beta = -0.25, p < 0.05) predicted fatigue 6 months later. After also including baseline fatigue, only neuroticism (beta = 0.22, p < 0.05) and baseline fatigue (beta = 0.79, p < 0.001) predicted fatigue.

CONCLUSIONS

Personality is more strongly related to fatigue than demographics, the diagnosis cancer, receiving cancer treatment, and baseline depressive symptoms and fatigue. When replicated, screening and treating women who are at risk to experience high levels of fatigue is recommended.

Radiation Therapy in the Treatment of Breast Cancer

OBJECTIVES

To explore the advancements in radiation therapy for patients with breast cancer. To review the side effects associated with radiation therapy to the breast.

DATA SOURCES

Medical and nursing journals and texts.

CONCLUSION

Advances in technology and a shift in the paradigm used to treat breast cancer are leading to newer and accelerated methods of treatment. APBI has gained increased attention and is the subject of numerous clinical trials.

IMPLICATIONS FOR NURSING PRACTICE

Nurses must be aware of the technical aspects associated with new technology and the rationale and implications associated with its use. The focus for nurses working in radiation therapy continues to be patient education and side effect management. Nurses must understand the ramifications such treatment entails so as to provide optimal care.

The state of the art in radiation therapy

OBJECTIVES

To describe the modalities used to administer radiation therapy and discuss the acute effects and long-term survivorship issues experienced by patients who receive radiation therapy.

DATA SOURCES

Radiation oncology, surgical, and oncology nursing journals, textbooks, electronic resources.

CONCLUSION

New technology and state-of-the-art equipment has resulted in improved treatment modalities, thereby expanding traditional treatment paradigms and exploring new frontiers.

IMPLICATIONS FOR NURSING PRACTICE

It is critical that oncology nurses remain cognizant of advanced technology and its influence on treatment outcomes and patient toxicity. Such knowledge will better serve patients and hopefully influence evidence-based treatment interventions.

Prospective Assessment of Fatigue and Health Status in Greek Patients With Breast Cancer Undergoing Adjuvant Radiotherapy

PURPOSE/OBJECTIVES

To describe fatigue in women with breast cancer undergoing radiotherapy and to explore the impact of fatigue on their health status.

DESIGN

Prospective, descriptive, repeated measures.

SETTING

A major oncology center, Saint Savvas Cancer Hospital, in Athens, Greece.

SAMPLE

Consecutive sample of 106 women (mean age = 55 + 12), with histologically confirmed diagnosis for stage I or II breast cancer who were receiving adjuvant radiotherapy for approximately six weeks.

METHODS

Data were collected with the Revised Piper Fatigue Scale (PFS) and the Short Form-36 (SF-36) Health Survey Scale in the first two days of radiotherapy (T0), during the third week (T1), and during the last week of treatment (T2).

MAIN RESEARCH VARIABLES

Fatigue, health status.

FINDINGS

Across-subjects analysis revealed that fatigue increased during radiotherapy in patients with breast cancer regardless of stage, type of surgery, or whether they received chemotherapy (p 0.05). Between-subject analysis revealed that no differences existed in the PFS between different groups (chemotherapy versus no chemotherapy, breast conservation versus mastectomy, stage I versus stage II) at each measurement point. A negative correlation was found between the subscales of the PFS and all of the subscales of the SF-36.

CONCLUSIONS

Fatigue intensity increased significantly during the course of radiotherapy, and patients experienced a significant deterioration in their overall health status.

IMPLICATIONS FOR NURSING

Findings contribute to the growing body of evidence regarding fatigue and its impact on health status in Greek patients with breast cancer and provide insights for effective nursing assessment, patient education, and symptom management.

Fatigue states after cancer treatment occur both in association with, and independent of, mood disorder: a longitudinal study

BACKGROUND

Persistent fatigue is recognised as one of the most common, ongoing symptoms reported by patients following cancer treatment and may have profound effects on the quality of life. However, recent cross-sectional studies also highlight the close relationship between cancer related fatigue (CRF) and diagnoses of depression or anxiety disorder. There is currently limited information about the relationships between these conditions over time. We sought to examine the longitudinal relationships between fatigue and mood disorder in women treated with adjuvant therapy for early stage breast cancer.

METHODS

Women who had recently completed adjuvant therapy for Stage I or II breast cancer (n = 212) were sent a questionnaire with established case thresholds for clinically-significant fatigue and psychological disorder, as well as a questionnaire assessing disability. Potentially relevant variables linked to fatigue states, including age, treatment modality, menopausal status, and hematological indices were recorded. The illness outcomes were assessed over 48 months of follow-up.

RESULTS

The 176 women who responded to the questionnaire (84%) had a mean age of 55 (range 24-83) years and had completed adjuvant treatment on average 10 (range 4.7-16.3) months previously. Radiotherapy had been administered, either alone (50% of women) or in combination with chemotherapy (36%). Responses from 87 women (48%) indicated a significant fatigue state (termed here post-cancer fatigue; PCF), and from 59 women (33%) responses indicated significant psychological distress. Thirty-four women (19%) were cases of fatigue alone (i.e. unaccompanied by psychological disorder), whereas 52 (30%) were cases of both disorders. Multivariate analysis did not reveal any association between demographic, clinical or laboratory variables, and caseness for PCF. Self-reported functional disability was significantly associated with fatigue. Follow-up at 24, 36 and 48 months revealed high rates of ongoing PCF in conjunction with psychological distress, despite falling rates of psychological distress alone and fatigue alone.

CONCLUSION

Post-cancer fatigue was prevalent and sustained on follow-up. Concurrent psychological disorder was evident in the majority, but not all, cases of PCF and tended to be sustained over time. Further prospective cohort studies to define the longitudinal co-morbid relationships between fatigue, mood disorder, and ongoing disability after cancer treatment are indicated.

Psychometric properties of the revised Piper Fatigue Scale in Dutch cancer patients were satisfactory

OBJECTIVE

To examine the psychometric properties of the revised Piper Fatigue Scale (PFS) in Dutch cancer patients.

STUDY DESIGN AND SETTING

Participants were 64 patients with lung (any stage, nonsurgery) and breast (any stage) cancer, selected for curative high-dose radiotherapy (> or =50 Gy). Prior to radiotherapy, patients completed the revised PFS (translated into Dutch), the Multidimensional Fatigue Inventory (MFI), and the Rotterdam Symptom Checklist (RSCL). Reliability and construct and criterion validity of the PFS were investigated.

RESULTS

Overall, the structure of the Dutch revised PFS appeared appropriate, with corrected item-subscale correlations being higher than the correlations of the same item with the three other subscales; furthermore, internal consistency was excellent (Cronbach's alpha > or =0.90). Lung cancer patients were significantly more tired then breast cancer patients, supporting construct validity. Criterion validity was also satisfactory, with highest correlations of PFS total fatigue with the MFI subscale general fatigue (0.84) and RSCL overall quality of life score (0.74). Internal consistency was similar in Dutch and U.S. breast cancer patients; fatigue scores were lower on several PFS subscales in the Dutch study population.

CONCLUSION

Psychometric properties of the Dutch version of the revised PFS, as tested in cancer patients prior to radiotherapy, were satisfactory.

Cancer-related fatigue: A critical appraisal

This aim of this systematic review was to determine the prevalence and pattern of cancer-related fatigue (CRF), and identify factors associated with its development. Relevant literature was identified through an electronic database search using specified keywords. Included studies investigated CRF in adult cancer patients using a multidimensional fatigue measure. The methodological quality was assessed using six published standards. CRF is apparent both during and after anti-cancer therapy, however, the prevalence of CRF varied between studies. The variables associated with the development and persistence of CRF remain to be identified. Inconsistencies were evident in the pattern of CRF and its associated factors. This is likely to have arisen from the inherent difficulties in the measurement of a subjective sensation, further complicated by the myriad of outcome measures used. More methodologically sound research; assessing CRF from the commencement of therapy, considering all pertinent variables is needed.

Quality-of-Life Outcomes in Oncology

QOL outcomes have become an integral component of many clinical oncology trials. Much work has been performed testing the validity and reliability of Q OL instruments. The current challenge is to understand better the clinical relevance of QOL research in oncology. QOL studies should focus on phase III trials with clear hypotheses that can lead to clinically meaningful interventions.

Frequency, severity, clinical course, and correlates of fatigue in 372 patients during 5 weeks of radiotherapy for cancer

BACKGROUND

Patients often describe fatigue as the most distressing of the symptoms they experienced during their cancer treatment. Fatigue may increase from initial levels experienced during cancer treatment with the addition of radiotherapy (RT).

METHODS

Three hundred seventy-two patients completed a Symptom Inventory at the initiation of RT and weekly for 4 weeks thereafter. Descriptive statistics were used to evaluate differences in fatigue at baseline by demographics and diagnosis. Changes over the course of treatment were evaluated by repeated-measures analysis of variance and Student t tests for paired data. The effect of diagnosis, age, gender, and previous treatment on fatigue was investigated by linear and hierarchical regression.

RESULTS

Fifty-seven percent of patients reported some degree of fatigue at the initiation of RT. The proportion increased to 76% by Week 3 and then to 78% at Week 5. Eighty-four percent of patients with initial fatigue remained fatigued throughout the 5-week course. Of the 160 patients without initial fatigue, 70% subsequently developed it. By Week 5, only 13% of patients had never reported any fatigue. Severity was found to be related to diagnosis, with patients with prostate carcinoma reporting the least severe fatigue and patients with lung, alimentary, and head and neck carcinoma reporting the most severe fatigue. Neither gender, age, nor total dose of RT predicted significant variance in severity.

CONCLUSIONS

Fatigue was a common adverse effect of RT for cancer, reported by more than three-fourths of patients by the third to fifth weeks of treatment. Cancer diagnosis was the only factor found to be significantly related to variation in fatigue severity. Additional studies should be devised to identify other underlying causes of RT-related fatigue.

Occurrence, severity, and longitudinal course of twelve common symptoms in 1129 consecutive patients during radiotherapy for cancer

Little is known about the frequency, severity, and course of symptoms experienced by patients receiving radiotherapy (RT). For this descriptive study, 1129 patients with a variety of cancer diagnoses completed a 12-item Symptom Inventory (SI) at the start of RT; 419 of these patients also completed the SI weekly for an additional 4 weeks (five data points). Eighty-four percent of the 1129 patients were already experiencing symptoms when treatment began. All symptoms significantly increased in frequency over a typical 5 week RT course (all Ps<0.001). Skin problems showed the largest increase. The most common symptoms (fatigue, drowsiness, and sleep problems) were also the most severe. Female patients and patients younger than the median age (59 years) reported significantly more symptoms than males and those 59 years or older. Symptom frequency and severity varied significantly by cancer diagnosis. Improved understanding about the time course and dose response of radiation-induced toxicity will permit more accurate presentation of side effect risk at the time patient consent is obtained.

A longitudinal study of symptoms and self-care activities in women treated with primary radiotherapy for breast cancer

The purpose of this prospective longitudinal study was to describe the occurrence, severity, and pattern of symptoms experienced by women during and after primary radiation therapy for breast cancer. A convenience sample of 30 women was recruited from a community hospital. The Symptom Profile by King et al (Oncology Nursing Forum. 1985;12(4):55-61) was adapted to measure 11 symptoms, and the Profile of Mood States assessed psychological status. Data were collected weekly during radiation and monthly for 3 months after treatment. There was a pattern of increasing incidence during treatment for the most commonly reported symptoms: fatigue (33%-93%), skin changes (36%-100%), sensation changes (28%-79%), and breast swelling (11%-38%), with gradual improvement over the following 3 months. Sleep problems were reported by nearly half of the subjects during and after treatment. Severity ratings of symptoms were mild to moderate but significantly higher by the end of therapy (P </= .01). There were no significant differences in psychological mood states during or after treatment except for the fatigue subscale (P </= .05). These findings will assist the nurse in preparing women for predictable symptoms during and after a course of breast irradiation and direct assessment, and provide data to support evidence-based interventions to minimize symptom distress.

Factors related to persistent fatigue following completion of breast cancer treatment

PURPOSE/OBJECTIVES

To verify the predictive capacity of the stress-process theory to emeanplain persistent fatigue following completion of breast cancer treatments; to verify the relationship between interleukin-1b and fatigue.

DESIGN

Correlational.

SETTING

Tertiary medical center in Quebec City, Canada.

SAMPLE

A systematic sample of 103 women in remission from breast cancer was recruited. The mean age was 54 years. Participants with a depressive mood, insomnia, or stage IV cancer were emeancluded.

METHODS

Participants were met during their follow-up appointment after the end of radiation therapy. Questionnaires on fatigue, stress variables, and other confounding variables were completed by telephone interview. Blood samples also were collected to measure the serum level of interleukin-1b.

MAIN RESEARCH VARIABLES

Fatigue, several variables from the stress-process theory, pain, menopausal symptoms, and demographic and medical variables.

FINDINGS

Fatigue was related theoretically and coherently to many stress-process variables. By controlling for pain, the final regression model included cancer stressors and passive and active coping as predictors, which accounted for 41% of the variance in fatigue. No relationship was found between fatigue and interleukin-1b.

CONCLUSIONS

The results supported the relevance of the stress-process theory for emeanplaining cancer-related fatigue.

IMPLICATIONS FOR NURSING

Nursing interventions based on this theoretical framework could be developed. In addition, further clinical research that tests the efficacy of these psycho-educative interventions in preventing persistent fatigue and improving the quality of life of women with breast cancer is recommended.

Fatigue, psychological distress, coping resources, and functional status during radiotherapy for uterine cancer

PURPOSE/OBJECTIVES

To evaluate how patients diagnosed with uterine cancer experience fatigue, psychological distress, coping resources, and functional status before, during, and after treatment with radiation therapy and to study whether significant correlations exist among these variables.

DESIGN

Longitudinal, descriptive, and correlational.

SETTING

The Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.

SAMPLE

60 women diagnosed with uterine cancer who were receiving curative external radiation therapy. Typical participants were 64 years old, married, and on sick leave or retired from work.

METHODS

Data were collected through self-report instruments. Demographic and clinical data were extracted from the patients' records.

MAIN RESEARCH VARIABLES

Cancer-related fatigue, psychological distress, coping resources, and functional status.

FINDINGS

Patients' fatigue scores increased significantly during and after completion of radiotherapy. The participants reported normal levels of anxiety and depression, and their coping resources changed over time. After completing therapy, all dimensions of function had decreased; for social function, the decrease was significant. The correlation over time was significant among fatigue and physical function, role function, and cognitive function. The variation of the change in fatigue after therapy was completed was explained only by the level of fatigue experienced at baseline.

CONCLUSIONS

Fatigue is a symptom that increases in connection with radiotherapy. Functional status is influenced by the variation in fatigue levels. Fatigue level before treatment may be an important variable when trying to find a risk factor for the development of fatigue over the course of treatment.

IMPLICATIONS FOR NURSING

Nurses must inform patients receiving radiotherapy about the expected changes in fatigue and functional status. Pretreatment screening for fatigue is needed to identify patients at risk for developing fatigue.

The experience of fatigue, other symptoms and global quality of life during radiotherapy for uterine cancer

This paper reports on how patients with uterine cancer, receiving radiotherapy, experience fatigue, other symptoms and global quality of life. The results showed that fatigue increased significantly during the therapy. Also the other symptoms; loss of appetite, nausea/vomiting and diarrhoea increased significantly and were significantly correlated to general fatigue. Global quality of life decreased significantly during treatment compared to baseline. The variation of the level in general fatigue after completed therapy was only explained by the level of general fatigue experienced at baseline. The result can lead to a better understanding of the severity of symptoms experienced by patients with uterine cancer treated with radiotherapy.