Fatigue, pain, and depression in pre-autotransplant breast cancer patients

Course of mental fatigue and motivation in breast cancer patients receiving adjuvant chemotherapy

BACKGROUND

The purpose of this study is to determine the course of fatigue referring to cognitive symptoms (scale 'mental fatigue') as well as the motivation to start any activity (scale 'reduced motivation'), as a function of chemotherapy, in breast cancer patients undergoing adjuvant chemotherapy.

PATIENTS AND METHODS

In a prospective cohort study a sample of 157 patients with breast cancer was interviewed at the first, third and fifth cycle of adjuvant chemotherapy as well as 4 and 12 weeks after completion of adjuvant chemotherapy. Patients were treated with standard adjuvant chemotherapy, either a doxorubicin containing schedule or CMF (cyclophosphamide, methotrexate and fluorouracil). The psychological dimensions of fatigue were measured by the Multidimensional Fatigue Inventory. A linear multilevel model was used for analysing the courses.

RESULTS

The course of mental fatigue and motivation were not affected by the type of chemotherapy. The course of mental fatigue and motivation varied, but seemed to be stable during the treatment of chemotherapy. After the completion of chemotherapy, a weak improvement was seen. Relatively many patients experienced depressive symptoms during the study. These symptoms were correlated with both dimensions of fatigue. At all measurements mental fatigue was influenced by type of operation where women with a mastectomy were significantly more mentally fatigued than women that had undergone a lumpectomy, but nevertheless they were significantly more motivated to start any activity. Age, marital status, number of treatments and the interval between the operation and the first treatment of chemotherapy also seemed to be important determinants.

CONCLUSIONS

An unequivocal pattern of mental fatigue and reduced motivation during as well as after adjuvant chemotherapy was not found. Depressive symptoms were definitely related to these variables. Type of operation had a significant impact on mental fatigue and motivation to start any activity. Health care providers should be aware of the high rate of patients who experience depressive symptoms during and after the treatment of chemotherapy. Further research should include the trajectory preceding adjuvant chemotherapy and a longer study period afterwards. Moreover, the exact influence of the variables 'age', 'marital status', 'number of treatments' and 'the interval between the operation and the first treatment of chemotherapy' on fatigue is unclear and needs further study.

Adjustment to breast cancer: the contribution of resources and causal attributions regarding the illness

The study examined personal resources (sense of coherence and social support) and attributions concerning the causes of illness, and their relationship to adjustment to breast cancer. The research sample included 60 Israeli women with breast cancer, who responded to questionnaires at two stages of their illness: the stage of initial discovery (after first learning of the illness) and approximately six months later (the stage of mitigation and accommodation). The overall level of adjustment to the illness was moderate. While the patients adjusted relatively well in the family and domestic environments, their adjustment in the dimensions of health care, psychological distress, and sexual relations was relatively low. The most frequent causal attributions were psychological factors and family history of illness. The patients' subjective state of health, sense of coherence, and levels of social support were related to most of the adjustment dimensions examined, although both internal and external causal attributions correlated negatively with adjustment in every dimension.

Physical symptom profiles of depressed and nondepressed patients with cancer

Depression and symptom severity are predictive of survival in cancer patients, but are often correlated with each other. This paper compares the physical symptom profiles of depressed and nondepressed cancer patients and further examines the predictive ability of multiple symptoms on depressive status. Data were collected from 121 hospitalized patients with breast, oesophageal and head and neck cancer. Patients were categorized as depressed (n = 30) or nondepressed (n = 91) using the Hospital Anxiety and Depression Scale. Occurrence of symptoms was evaluated with the Patient Disease Symptom/Sign Assessment Scale. The most prevalent symptom in the total sample was insomnia (occurrence rate = 67%). Insomnia, pain, anorexia, fatigue, and wound or pressure sore occurred significantly more often in depressed patients, with no difference in occurrence rates of nausea/vomiting and dyspnoea. Significantly more symptoms were observed in depressed than in nondepressed patients (mean = 3.77 versus 2.52). Both groups showed similar rankings of symptom occurrence rates. Patients simultaneously experiencing insomnia, pain, anorexia and fatigue had a higher risk of depression (odds ratio = 5.03).

Psychological distress, fatigue, burden of care, and quality of life in primary caregivers of patients with breast cancer undergoing autologous bone marrow transplantation

PURPOSE/OBJECTIVES

To determine the effects of sociodemographic variables, psychological distress, fatigue, and quality of life (QOL) on burden of care in primary caregivers of patients with breast cancer undergoing autologous bone marrow transplantation (BMT).

DESIGN

Descriptive, correlational, predictive.

SETTING

Urban National Cancer Institute-designated comprehensive cancer center in the eastern United States.

SAMPLE

Convenience sample of 102 primary caregivers.

METHODS

Participants completed the sociodemographic data form, Piper Fatigue Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, QOL Index, and Measurement of Objective and Subjective Burden Scales prior to BMT during an oncology clinic visit.

MAIN RESEARCH VARIABLES

Depression, anxiety, fatigue, QOL, and burden of care.

FINDINGS

Mean fatigue scores were low. Primary caregivers experienced moderate state anxiety and low trait anxiety. Some experienced severe depression. The objective burden of care mean score was slightly higher than the subjective mean score. Mean QOL scores were low. All variables were significantly intercorrelated, except subjective burden and temporal and sensory fatigue. Significant correlations were found between age and subjective burden, and income with fatigue temporal subscale, and state and trait anxiety. Family subscale of QOL was a significant predictor of objective burden. Age and trait anxiety were significant predictors of subjective burden.

CONCLUSIONS

Primary caregivers of patients with breast cancer scheduled for BMT experience fatigue, anxiety, burden of care, and low QOL. These caregivers may have tried to meet their needs and the patients' needs simultaneously.

IMPLICATIONS FOR NURSING

Healthcare providers need to proactively assess primary caregivers of patients for fatigue, psychological distress, burden of care, and decreased QOL and provide nursing interventions tailored to individual needs.

Presurgery distress and specific response expectancies predict postsurgery outcomes in surgery patients confronting breast cancer

Prior to scheduled surgery, patients frequently experience particularly high levels of distress and expect a variety of postsurgery symptoms. Surgery patients who confront breast cancer are no exception. It has been suggested that such presurgery distress and response expectancies are predictive of postsurgery outcomes. To test the contribution of presurgery distress and expectancies to common postsurgery symptom outcomes (pain, nausea, fatigue, and discomfort), 63 female patients undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery nausea, fatigue, and discomfort; specific expectancies uniquely contributed to pain intensity, pain unpleasantness, and fatigue (ps < .05). Consistent with expectancy theory, associations between response expectancies and postsurgery outcomes were not due to presurgery distress.

Fatigue and depression in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation

PURPOSE/OBJECTIVES

To describe the patterns of depression and fatigue, including its dimensions, and the relationship between these two variables in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation (PBSCT).

DESIGN

Prospective, descriptive, correlational, repeated measures.

SETTING

Midwestern university National Cancer Institute-designated clinical cancer center.

SAMPLE

27 patients with lymphoma aged 19 to 71 undergoing autologous PBSCT.

METHODS

The revised Piper Fatigue Scale was used to measure fatigue and its dimensions. The Center for Epidemiologic Studies' Depression Scale was used to measure depression on selected days at baseline and during chemotherapy and recovery.

MAIN RESEARCH VARIABLES

Fatigue and its four dimensions (behavioral/severity, sensory, cognitive/mood, and affective meaning) and depression.

FINDINGS

Total fatigue, fatigues four dimension scores, and depression scores changed significantly over time, with the highest scores at day + 7 after transplant. Total fatigue and the four dimension scores were highly and positively correlated with depression, with the highest correlation reported between the affective fatigue dimension and depression.

CONCLUSIONS

The findings support the importance of assessing fatigue and depression in patients undergoing autologous PBSCT at baseline, during chemotherapy, and throughout recovery.

IMPLICATIONS FOR NURSING

Routine clinical assessment with close observation around day +7 after transplant and patient education about the patterns of fatigue and depression will help the healthcare team to intervene at the appropriate time and may help patients to better manage these symptoms.

Prevalence and course of fatigue in breast cancer patients receiving adjuvant chemotherapy

BACKGROUND

The purpose of this study was to determine the prevalence of fatigue and the course of fatigue as a function of chemotherapy in breast cancer patients undergoing adjuvant chemotherapy.

PATIENTS AND METHODS

In a prospective cohort study, a sample of 157 patients with breast cancer were interviewed, using the Rotterdam Symptom Checklist and the Multidimensional Fatigue Inventory, at the first, third and fifth cycle of adjuvant chemotherapy, as well as 4 and 12 weeks after the last cycle of adjuvant chemotherapy. Patients were treated with either a doxorubicin-containing schedule, or cyclophosphamide, methotrexate and 5-fluorouracil (CMF).

RESULTS

The courses of general and physical fatigue are to a large extent similar. After the last cycle of chemotherapy, the CMF group reported a significant increase in fatigue, which was followed by a significant reduction. In the doxorubicin group a significant increase in fatigue was only seen during the first cycles of chemotherapy. The fatigue experienced at the first and the last measurements do not differ significantly.

CONCLUSIONS

The prevalence of fatigue increased significantly after the start of chemotherapy. After chemotherapy treatment the prevalence rate seemed to decline. A different impact of chemotherapy on the course of fatigue was found. In the doxorubicin group a direct increase in fatigue was found. In the CMF group a moderate direct increase occurred, followed by a delayed strong increase. An increase in fatigue was associated with a decrease in daily functioning. At all measurement occasions fatigue was affected by type of operation, such that women with a mastectomy were more fatigued than women that underwent a lumpectomy. Receiving radiotherapy also led to an increase in fatigue. With this knowledge breast cancer patients can be better informed about what they can expect. Further research should include interventions addressing how to reduce or cope with fatigue during as well as after receiving adjuvant chemotherapy.

Assessment and management of cancer-related fatigue in adults

Fatigue is one of the most prevalent and distressing symptoms of cancer, and is a common side-effect of many of the treatments available for the management of malignant disease. We critically assess the evidence for cancer-related fatigue and its treatment in adults. Little is known about the cause and mechanisms of fatigue, and research into methods of alleviating the condition has focused on treatment for anaemia and behavioural interventions, such as exercise, both of which are effective in reducing fatigue. Although research into the condition has increased considerably in the past decade, important gaps in knowledge remain.

Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults

This study compared the severity of fatigue in patients with cancer to the fatigue reported by depressed psychiatric patients and community-dwelling adults. Data were collected for this study during the process of validating a new fatigue assessment tool, the Brief Fatigue Inventory (BFI). The sample included 354 cancer patients, 72 psychiatric patients, and 290 non-patient volunteers. Study subjects reported severity of fatigue and the degree to which fatigue interfered with various aspects of life. Data were also collected on sleep disturbance and demographic variables that might correlate with fatigue. The psychiatric patients reported significantly higher levels of fatigue and fatigue-related interference than the cancer patients, who reported more severe fatigue and interference than the community subjects. The sleep disturbance scores of the cancer patients and the community subjects were significantly correlated with fatigue severity. Although the majority of the psychiatric patients reported sleep disturbance, their sleep disturbance scores were not significantly associated with fatigue severity.

Fatigue in patients with breast cancer receiving adjuvant chemotherapy: a review of the literature

The aim of this literature review was to evaluate the prevalence and course of fatigue in patients with breast cancer undergoing adjuvant chemotherapy and to examine factors relating to fatigue. Fatigue is one of the most common side effects of chemotherapy. High and fluctuating prevalence rates of fatigue have been found not only during but also after adjuvant chemotherapy. The intensity of fatigue seems to be stable throughout the treatment cycles, despite the common perception that more chemotherapy treatments lead to greater fatigue. The first two days after a chemotherapy treatment seem to be the worst period. The influence of factors such as pain, impaired quality of sleep, and depression are be highly consistent across several studies, although it is often not clear whether it is the symptoms that cause the fatigue or vice versa. The outcomes of the studies indicate that several symptoms are interrelated in a network of symptoms. Factors such as changes in weight, menopausal symptoms, coping, social support, and biochemical changes have been mentioned in the literature as potentially contributing to fatigue. Results have been conflicting and need further study.

Pain and fatigue management: results of a nursing randomized clinical trial

PURPOSE/OBJECTIVES

Through a randomized clinical trial, to compare patients undergoing an initial course of chemotherapy who report pain and fatigue at baseline and who are receiving conventional care alone with those receiving conventional care plus a nursing intervention on outcomes reported at 20 weeks.

SETTING

Chemotherapy clinics of two comprehensive and two community cancer centers.

METHODS

Interviews were conducted at baseline and 10 and 20 weeks. An 18-week, 10-contact nursing intervention utilizing problem-solving approaches to symptom management and improving physical functioning and emotional health was implemented.

SAMPLE

The sample consisted of 53 patients in the experimental arm and 60 in the control arm who reported pain and fatigue at baseline.

VARIABLES

Pain and fatigue, numbers of other symptoms, and physical role impact and social-functioning subscales from the Medical Outcomes Study 36 Short Form.

FINDINGS

Patients who received the intervention reported a significant reduction in the number of symptoms experienced and improved physical and social functioning. Fewer patients in the experimental arm reported both pain and fatigue at 20 weeks.

CONCLUSIONS

Behavioral interventions targeted to patients with pain and fatigue can reduce symptom burden, improve the quality of the daily life of patients, and demonstrate the "value-added" role of nursing care for patients undergoing chemotherapy.

IMPLICATIONS FOR NURSING

These data support the "value-added" role of nursing interventions for symptom management and improved quality of life during the course of cancer treatment.

Self-rated health as a predictor of survival among patients with advanced cancer

PURPOSE

Evidence is emerging about the strong predictive relationship between self-rated health (SRH) and survival, although there is little evidence on palliative populations where an accurate prediction of survival is valuable. Thus, the relative importance of SRH in predicting the survival of ambulatory patients with advanced cancer was examined. SRH was compared to clinical assessments of performance status, as well as to quality-of-life measures.

PATIENTS AND METHODS

By use of a prospective cohort design, 181 patients (76% response rate) with advanced cancer were recruited into the study, resurveyed at 18 weeks, and observed to record deaths.

RESULTS

The average age of patients was 62 years (SD = 12). The median survival time was 10 months. SRH was the strongest predictor of survival from baseline. Also, a Cox regression comparing changes in SRH over time yielded hazard ratios suggesting the relative risk (RR) of dying was greater for fair ratings at 18 weeks (approximately 3 times) compared with consistent good or better ratings; the RR was even greater (4.2 and 6.2 times) for poor ratings, especially when ratings were poor at baseline and 18 weeks (31 times). Improvement in SRH over time yielded the lowest RR.

CONCLUSION

SRH is valid, reliable, and responsive to change as a predictor of survival of advanced cancer. These qualities suggest that SRH should be considered as an additional tool by oncologists to assess patients. Similarly, health managers could use SRH as an indicator of disease severity in palliative care case mix. Finally, SRH could provide a key to help us understand the human side of disease and its relationship with medicine.

Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions

Research on the relationship between cancer and fatigue has increased considerably in recent years. In this review, we focus on fatigue observed in patients during and after treatment for cancer, using data from empirical studies. The results from these studies indicate that fatigue is mostly studied during active treatment for cancer, and is an important problem during this period. Studies that focused on fatigue in disease-free cancer patients, although less prominent, also indicate fatigue is an important complaint in this time period. It is hard to draw conclusions with regard to the relationships between fatigue and disease- and treatment-related characteristics, because these relationships are seldom properly investigated. Relationships between fatigue and psychological, social, behavioural and physical factors have been established in several studies. However, most studies focused on the depression-fatigue association. Finally, most intervention studies to reduce fatigue appear to be successful, but the follow-up analyses are lacking.

The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation

Patients with breast cancer who undergo autologous bone marrow/peripheral blood stem cell transplantation (ABMT) cope not only with a life-threatening medical treatment, but also with multiple, interrelated symptoms including pain, fatigue, psychological distress, and nausea. The purpose of this study was to determine, in a randomized controlled clinical trial, whether a comprehensive coping strategy program (CCSP) was effective in significantly reducing pain, fatigue, psychological distress, and nausea in patients with breast cancer who underwent ABMT. The CCSP was composed of preparatory information, cognitive restructuring, and relaxation with guided imagery. Randomization placed 52 patients in the CCSP treatment group and 58 patients in the control group. The CCSP was found to be effective in significantly reducing nausea as well as nausea combined with fatigue 7 days after the ABMT when the side effects of treatment were most severe. These results are important given the high incidence of nausea and fatigue in the ABMT population. The CCSP-treated group experienced mild anxiety as compared with the control group who reported moderate anxiety. The greatest effectiveness of CCSP may correspond to the time of the greatest morbidity for patients with breast cancer who have undergone ABM.