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Avis NE, Levine BJ, Klepin HD, Mihalko SL, Brubaker PH, Moore T, Ladd AC, Dent SF, Hackney MH, Ky B, Ntim WO, Wagner LI, Weaver KE, Hundley WG. The impact of non- and anthracycline-based chemotherapy on fatigue in breast cancer survivors: results from WF-97415. Support Care Cancer 2024; 32:528. [PMID: 39028321 PMCID: PMC11271320 DOI: 10.1007/s00520-024-08717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE To examine the differential effect of non- and anthracycline-based chemotherapy on fatigue over 12 months post-diagnosis among breast cancer survivors. METHODS This study is based on a prospective Wake Forest NCI Community Oncology Research Program (NCORP) multicenter cohort study (WF-97415) of women with stage I to III breast cancer and non-cancer controls. Analyses compared those: 1) receiving, or 2) not receiving anthracycline chemotherapy, 3) receiving aromatase inhibitors (AIs) without chemotherapy, with 4) a comparator group without a history of cancer. In-person clinic assessments were conducted at: baseline (prior to chemotherapy or start of AI therapy), and 3 and 12 months after baseline. The Functional Assessment of Chronic Illness Therapy-Fatigue scale was the primary outcome. Estimated least squares means by group using mixed models with a random subject effect, fixed effects of time and group, and the interaction between time and group was used to compare groups across time, controlling for age, comorbidities, and treatment variables. RESULTS Among 284 women (mean age = 53.4 years, sd 11.9 years), there was a significant (p < 0.0001) group by time interaction, with a sharp increase in fatigue at 3 months in the two chemotherapy groups in comparison to the non-chemotherapy and non-cancer controls. The two chemotherapy groups did not significantly differ in fatigue at any time point. CONCLUSION Women with breast cancer who receive non- or anthracycline-based chemotherapy experience similar trends in and levels of fatigue within the first year of treatment and greater fatigue than women receiving AIs alone or women without breast cancer.
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Affiliation(s)
- Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
| | - Beverly J Levine
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
| | - Heidi D Klepin
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shannon L Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Tonya Moore
- Section On Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amy C Ladd
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Susan F Dent
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Mary Helen Hackney
- Department of Hematology, Oncology, and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Bonnie Ky
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William O Ntim
- UNC School of Medicine, Novant Health Campus, Novant Heart & Vascular Institute, Charlotte, NC, USA
| | - Lynne I Wagner
- UNC Gillings School of Global Public Health, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
| | - W Gregory Hundley
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Komariah M, Hatthakit U, Boonyoung N, Ibrahim K, Susilaningsih FS, Mediani HS, Rahayuwati L, Hermayanti Y, Pahria T, Arifin H. Islamic Mindfulness-Based Caring as an Intervention to Manage Fatigue. J Holist Nurs 2024; 42:S87-S98. [PMID: 37455340 DOI: 10.1177/08980101231180363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Purpose: This study aims to determine the effects of Islamic Mindfulness-based Caring (IMC) on fatigue among breast cancer patients. Design: A quasi-experimental study was undertaken in the chemotherapy unit of a hospital, in Bandung, Indonesia. Methods: A total of 112 females with stage III breast cancer undertaking chemotherapy treatment were recruited by purposive sampling technique. The experimental group (n = 53) was given both IMC and usual care, whereas the control group (n = 59) received only the usual care. Data were collected on days 1, 3, 23, and 44 using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and demographic information tools. Data analyses were carried out with the Mixed-Effects Linear Regression. Findings: We found a significant difference in fatigue between the control and experimental groups on days 23 (mean: 29.34-34.92; p = .001) and 44 (mean: 28.68-37.89; p < .001) after IMC intervention. The increase of time was significantly associated with a lower fatigue score (p < .05). Mixed-Effect Linear Regression showed a significant interaction between time and intervention of IMC effect on fatigue score on time-4 (adjusted β coefficient: 6.62; 95% CI: 2.17-11.06). Conclusions: Nurse-administered IMC is capable of reducing fatigue among breast cancer patients who underwent chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tuti Pahria
- Universitas Padjadjaran, Sumedang, Indonesia
| | - Hidayat Arifin
- Universitas Airlangga, Surabaya, Indonesia
- Universitas Padjadjaran, Sumedang, Indonesia
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Cahyono HD, Irawaty D, Adam M. The effect of Benson relaxation application ('Bens app') on reducing fatigue in patients with breast cancer undergoing chemotherapy: A quasi-experimental study. BELITUNG NURSING JOURNAL 2022; 8:304-310. [PMID: 37546495 PMCID: PMC10401370 DOI: 10.33546/bnj.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/11/2021] [Accepted: 06/04/2022] [Indexed: 08/08/2023] Open
Abstract
Background Fatigue is the most common symptom in patients with breast cancer undergoing chemotherapy. Benson's relaxation technique is considered effective to reduce fatigue, but its effect in combination with smartphone technology is limited. Objective This study aimed to analyze and determine the effect of the Benson relaxation application (Bens app) on fatigue in patients with breast cancer undergoing chemotherapy. Methods A quasi-experimental design with a pretest-posttest comparison group was used. Fifty-six patients were included using consecutive sampling technique, of which 28 were assigned to the experimental group (received Benson relaxation technique using Bens app) and comparison group (obtained Benson relaxation technique using booklet). The Benson relaxation was done two times per day for seven days, and the Brief Fatigue Inventory questionnaire was used to measure the patients' fatigue levels. Data were analyzed using paired and independent t-tests. Results The experimental group (p = 0.001) and the comparison group (p = 0.015) showed a significant reduction in fatigue after receiving the Benson relaxation for seven days. However, there was a statistically significant difference in fatigue between the experiment and comparison groups after the intervention (t55 = 2.481, p = 0.016). Conclusion Benson relaxation could reduce fatigue in patients with breast cancer using the Bens app and booklet. However, the Bens app is considered more effective than a booklet. Therefore, the Bens app can be viewed as an alternative to help patients perform Benson relaxation and integrated into the nurse palliative care program for patients with cancer.
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Affiliation(s)
- Hendra Dwi Cahyono
- Postgraduate Program of Medical-Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
| | - Dewi Irawaty
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
| | - Muhamad Adam
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
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Cai T, Zhou T, Yuan C, Yu C, Ni F, Sheng Z. Heterogeneity of symptoms and functions among women receiving chemotherapy for breast cancer in China: A multicentre, cross-sectional study. Front Public Health 2022; 10:952710. [PMID: 35991024 PMCID: PMC9381982 DOI: 10.3389/fpubh.2022.952710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCurrently, few studies have explored the heterogeneity of symptoms and functions in patients with breast cancer. This study aimed to identify the subgroups of symptoms and functions in women receiving chemotherapy for breast cancer and determine whether the subgroups differed in demographic and clinical characteristics.MethodsA cross-sectional multicenter survey involving five hospitals in Zhejiang, Shanghai, Shandong, and Guangxi provinces of Mainland China was implemented between August 2020 to December 2021. Participants completed questionnaires that included the PROMIS-57, PROMIS cognitive function short form, and demographic and clinical characteristics. Latent class analysis was performed, followed by chi-square test and analysis of variance. Subsequently, significant variables were included in multinomial logistic regression.ResultsA total of 1,180 patients were investigated, with an average age of 48.9 years. Three classes were identified: low symptom burdens and functions group (26.2%, Class 1), moderate symptom burdens and functions group (16.9%, Class 2), and low symptom burdens and high functions group (56.9%, Class 3). Compared with patients in Class 1 and 3, those in Class 2 consistently showed a higher tendency of having urban employee health insurance (odds ratio = 2.506, P < 0.05) and rural health insurance (odds ratio = 2.207, P < 0.05). Additionally, patients in Class 2 tended to be in their fourth cycle of chemotherapy. However, receiving chemotherapy and surgery increased the likelihood of belonging to Class 1.ConclusionsA high proportion of patients experienced varying degrees of symptom and function issues, suggesting that attention is warranted for women with breast cancer undergoing chemotherapy. Patients with the urban employee basic medical system, the new rural cooperative medical system and in the early stage of chemotherapy cycles were more likely to have symptom burdens. Middle-aged postmenopausal women reported varying degrees of cognitive issues. Additionally, surgery increased the presence of potential long-term effects in functional levels.
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Affiliation(s)
- Tingting Cai
- School of Nursing, Fudan University, Shanghai, China
| | - Tingting Zhou
- School of Nursing, Fudan University, Shanghai, China
| | | | - Chunfang Yu
- Department of Hematology, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China
| | - Feixia Ni
- School of Nursing, Fudan University, Shanghai, China
| | - Zhiren Sheng
- Nursing Department, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
- *Correspondence: Zhiren Sheng
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Hare CJ, Crangle C, McGarragle K, Ferguson SE, Hart TL. Change in cancer-related fatigue over time predict health-related quality of life in ovarian cancer patients. Gynecol Oncol 2022; 166:487-493. [PMID: 35835613 DOI: 10.1016/j.ygyno.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There is limited research examining how change in cancer-related fatigue (CRF) over time predicts change in health-related quality of life (HRQOL), and no studies have examined this relationship in ovarian cancer patients, specifically. The purpose of this study was to explore the prevalence and trajectory of CRF over time and examine how change in CRF over time predicts change in HRQOL in ovarian cancer patients. METHODS Ovarian cancer patients (N = 202) were recruited from Princess Margaret Cancer Centre in Toronto, Canada. Consenting participants completed measures at baseline (beginning of study) and again three months later. Data were analyzed using a longitudinal multilevel mixed model design. RESULTS Four groups of CRF trajectories emerged. Fifty-four percent reported CRF as always present, 16% reported CRF subsided, 21% reported CRF developed, and 9% reported CRF as never present. As CRF developed, functional and physical wellbeing decreased. As CRF subsided, functional, physical, and emotional wellbeing improved. CRF trajectory was not associated with change in social wellbeing over time. CONCLUSIONS Our findings suggest CRF negatively impacts all domains of HRQOL except for social wellbeing in ovarian cancer patients. Among patients who reported that CRF improved over time, all HRQOL domains impacted by CRF showed recovery to normal endorsement rates. Among patients who reported development of CRF, impacted HRQOL domains significantly declined over time. Implications from this research indicate that fatigue management should be prioritized during and after cancer treatment to ensure optimal physical, functional, and emotional wellbeing.
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Affiliation(s)
- Crystal J Hare
- Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | | | - Sarah E Ferguson
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health Systems, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Tae L Hart
- Toronto Metropolitan University, Toronto, Ontario, Canada.
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6
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Cai T, Huang Y, Huang Q, Xia H, Yuan C. Symptom trajectories in patients with breast cancer: An integrative review. Int J Nurs Sci 2022; 9:120-128. [PMID: 35079613 PMCID: PMC8766784 DOI: 10.1016/j.ijnss.2021.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to synthesize the available knowledge of symptom trajectories in patients with breast cancer and identify predictors associated with these trajectories. Methods Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in four databases (PubMed, Embase, Web of Science, and CINAHL). The retrieved articles’ publication time was limited to 2010 to 2020, and only peer-reviewed English articles were included. Results Twenty-seven articles were included. The findings of the relevant studies were analyzed using thematic analysis. They were grouped into two themes: symptom trajectories of patients with breast cancer (symptom trajectories in patients with breast cancer, in patients who underwent surgery, and in patients who received cancer-related treatment) and associated factors (socioeconomic factors, health characteristics, cancer-related treatment characteristics). Newly diagnosed patients tended to report high trajectories of depression and persistent sleep disturbance. Most patients who underwent surgery reported significant sleep disturbance and anxiety shortly after surgery. For patients who received cancer-related treatment, only a small proportion had a high level of physical activity after cancer-related therapy over time. A high body mass index, a low relationship quality, parental responsibilities, insufficient social support, a low educational background, and an unhealthy lifestyle may increase the risk of negative symptom trajectories in patients with breast cancer. Additionally, old patients were more likely to report cognitive impairment after chemotherapy, while young patients tended to report trajectories of persistent sexual dysfunction. Concurring symptoms and poor health status also contributed to adverse symptom trajectories. Conclusion The findings of this review add to the body of knowledge of the interindividual variability of symptom trajectories in patients with breast cancer. Despite the overall similarity in appraisal at baseline, the patients reported varied symptom trajectories over time. It is recommended that nurses consider sociodemographic, clinical and cancer-related treatment characteristics and perform targeted early preventive interventions for patients with breast cancer.
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Affiliation(s)
- Tingting Cai
- School of Nursing, Fudan University, Shanghai, China
| | - Yueshi Huang
- School of Nursing, Fudan University, Shanghai, China
| | - Qingmei Huang
- School of Nursing, Fudan University, Shanghai, China
| | - Haozhi Xia
- School of Nursing, Fudan University, Shanghai, China
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Changrong Yuan
- School of Nursing, Fudan University, Shanghai, China
- Corresponding author.
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7
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Bean HR, Diggens J, Ftanou M, Weihs KL, Stanton AL, Wiley JF. Insomnia and Fatigue Symptom Trajectories in Breast Cancer: A Longitudinal Cohort Study. Behav Sleep Med 2021; 19:814-827. [PMID: 33470847 DOI: 10.1080/15402002.2020.1869005] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: Insomnia and fatigue are common, although not inevitable, during breast cancer. This study is one of the first aiming to describe distinct trajectory classes of insomnia and fatigue symptoms, and their correlates, from diagnosis through treatment.Methods: This longitudinal cohort study was conducted at a comprehensive cancer center and community oncology practices. Participants (N = 460) were women diagnosed with any stage of breast cancer in the previous 4 months. Primary outcomes for this ancillary study of the existing cohort were self-reported insomnia and fatigue symptoms assessed repeatedly across 12 months.Results: Four distinct classes of insomnia symptoms emerged: persistently very high, clinically elevated symptoms (13.7%); high, clinically elevated symptoms (65.9%); stable low (17.2%) or very low (2.6%) symptoms. Five fatigue symptom classes included high, increasing fatigue (9.6%), two recovery classes starting at high (26.3%), or moderate (18.0%) severity at diagnosis, stable low (33.3%) or very low (12.2%) classes. In multivariate analyses, higher depressive symptoms, anxiety, and chronic life stress were associated with being in the very high insomnia class versus the low symptom class. Oncologic factors were not associated with insomnia class membership. Receiving chemotherapy was linked significantly to high and recovery fatigue symptom classes versus the low class. Higher chronic life stress was associated with more persistent fatigue symptoms.Conclusions: Distinct classes of insomnia and fatigue symptoms were evident; 79.6% of the women had clinically elevated, persistent insomnia symptoms, 53.9% had elevated fatigue. A substantial minority evidenced low symptoms, suggesting targeted or stepped-care approaches to symptom management.
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Affiliation(s)
- Helena R Bean
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University
| | - Justine Diggens
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne
| | - Karen L Weihs
- Department of Psychiatry, University of Arizona.,University of Arizona Cancer Center
| | - Annette L Stanton
- Department of Psychology, University of California Los Angeles.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University
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Bower JE, Ganz PA, Irwin M, Cole SW, Garet D, Petersen L, Asher A, Hurvitz SA, Crespi CM. Do all patients with cancer experience fatigue? A longitudinal study of fatigue trajectories in women with breast cancer. Cancer 2021; 127:1334-1344. [PMID: 33606273 PMCID: PMC8562726 DOI: 10.1002/cncr.33327] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Fatigue is a common and expected side effect of cancer treatment. However, the majority of studies to date have focused on average levels of fatigue, which may obscure important individual differences in the severity and course of fatigue over time. The current study was designed to identify distinct trajectories of fatigue from diagnosis into survivorship in a longitudinal study of women with early-stage breast cancer. METHODS Women with stage 0 to stage IIIA breast cancer (270 women) were recruited before (neo)adjuvant therapy with radiotherapy, chemotherapy, and/or endocrine therapy and completed assessments at baseline; posttreatment; and at 6 months, 12 months, and 18 months of follow-up. Growth mixture modeling was used to identify trajectories of fatigue, and differences among the trajectory groups with regard to demographic, medical, and psychosocial variables were examined. RESULTS Five distinct trajectories of fatigue were identified: Stable Low (66%), with low levels of fatigue across assessments; Stable High (13%), with high fatigue across assessments; Decreasing (4%), with high fatigue at baseline that resolved over time; Increasing (9%), with low fatigue at baseline that increased over time; and Reactive (8%), with increased fatigue after treatment that resolved over time. Both psychological and treatment-related factors were found to be associated with fatigue trajectories, with psychological factors most strongly linked to high fatigue at the beginning of and over the course of treatment. CONCLUSIONS There is considerable variability in the experience of fatigue among women with early-stage breast cancer. Although the majority of women report relatively low fatigue, those with a history of depression and elevated psychological distress may be at risk of more severe and persistent fatigue.
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Affiliation(s)
- Julienne E. Bower
- UCLA Department of Psychology
- UCLA Department of Psychiatry and Biobehavioral Sciences
- Cousins Center for Psychoneuroimmunology
- Jonsson Comprehensive Cancer Center
| | - Patricia A. Ganz
- Jonsson Comprehensive Cancer Center
- UCLA Schools of Medicine and Public Health
| | - Michael Irwin
- UCLA Department of Psychiatry and Biobehavioral Sciences
- Cousins Center for Psychoneuroimmunology
| | - Steve W. Cole
- UCLA Department of Psychiatry and Biobehavioral Sciences
- Cousins Center for Psychoneuroimmunology
- UCLA Department of Medicine
| | | | | | - Arash Asher
- Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center
| | - Sara A. Hurvitz
- Jonsson Comprehensive Cancer Center
- UCLA Department of Medicine
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9
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Music interventions can alleviate cancer-related fatigue: a metaanalysis. Support Care Cancer 2021; 29:3461-3470. [DOI: 10.1007/s00520-021-05986-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
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10
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Tran TXM, Park J, Lee J, Jung YS, Chang Y, Cho H. Utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) to measure primary health outcomes in cancer patients: a systematic review. Support Care Cancer 2020; 29:1723-1739. [PMID: 33058000 DOI: 10.1007/s00520-020-05801-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To systematically review the literature on how the Patient-Reported Outcomes Measurement Information System (PROMIS) measure system is used to assess patient-reported outcomes (PROs) in cancer patients. METHODS We conducted a systematic review following the PRISMA guidelines. Articles were identified through searches of PubMed, EMBASE, and additional manual review of the publications listed on the PROMIS website. We included studies measuring outcomes, including physical function, fatigue, pain, anxiety, and depression in cancer patients. Eligible articles included interventional and observational studies published in English between 2009 and 2019. RESULTS A total of 1789 records were identified and screened by three reviewers, 118 articles were reviewed in full text, and 42 articles met the inclusion criteria. The majority of studies used the PROMIS measure system to prospectively assess longitudinal changes in PROs; the number of measurements ranges from 2 to 4 with the time points of follow-up set at 3, 6, and 12 months after the baseline assessment. Depression and fatigue were the most frequently measured outcomes. Fixed-length short forms with four items were the most common measure types. A transition toward utilizing a web- or smartphone-based electronic tool was observed to limit the burden of the conventional paper-based survey to collect and store PROs. CONCLUSION The PROMIS measure system is increasingly popular to measure PROs in cancer patients with acceptance of its various short forms and electronic-based systems to administer data electronically. Findings from this review highlight various aspects of PROMIS and may help health professionals in their choice of PRO tools for optimizing care and support for cancer patients.
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Affiliation(s)
- Thi Xuan Mai Tran
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-based healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Joonki Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yuh-Seog Jung
- Cancer Knowledge and Information Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
- Division of Tumor Immunology, Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Yoonjung Chang
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- National Cancer Survivorship Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Hyunsoon Cho
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
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Martino G, Catalano A, Agostino RM, Bellone F, Morabito N, Lasco CG, Vicario CM, Schwarz P, Feldt-Rasmussen U. Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer. PLoS One 2020; 15:e0230681. [PMID: 32214378 PMCID: PMC7098625 DOI: 10.1371/journal.pone.0230681] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Aromatase inhibitors (AIs) dramatically increased breast cancer (BC) survival, leading to enhanced attention to their long-term consequences on psychological functioning. Conflicting data has been examined regarding the association between AIs administration and the clinical psychological features in BC survivors (BCSs). PURPOSE As psychological symptoms often occur in such chronic diseases, our study aimed at exploring anxious and depressive symptoms and the perceived quality of life (QoL) in BCSs assessed for osteoporosis. METHODS The total sample consisted of a clinical sample of 51 outpatient postmenopausal women, diagnosed with BC, and a control group composed of 51 healthy postmenopausal women. All recruited participants were evaluated through the clinical gold standard interview and completed the following self-rating scales: the Hamilton Anxiety Rating Scale, Beck Depression Inventory II edition, and 36-Item Short Form Health Survey, which were administered at baseline and after 6 months in BCSs in AIs treatment, compared with controls. Moreover, all participants were assessed for vitamin D status, bone mineral density (BMD) and subclinical vertebral fractures. Data regarding age, age at menopause, body mass index (BMI), smoking habits and alcohol consumption was collected. RESULTS BCSs (n = 51) showed higher anxious and depressive symptoms, and lower perceived QoL vs. controls (n = 51) (p<0.05 for all). After 6 months of treatment with AIs, BCSs showed significant reduction of anxious and depressive symptoms and a significantly higher perceived QoL for both physical and mental components, vs. controls. CONCLUSIONS The improvement of clinical psychological features and perceived QoL was associated with AIs treatment in women being treated with, for early breast cancer. Further studies are needed to obtain a deeper comprehension of the correlation between clinical psychological and physical features in BCSs.
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Affiliation(s)
- Gabriella Martino
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
- * E-mail:
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Rita Maria Agostino
- Unit of Medical Oncology, Grand Metropolitan Hospital Bianchi Melacrino Morelli, Reggio-Calabria, Italy
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Nunziata Morabito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Carmen Giulia Lasco
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Peter Schwarz
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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12
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Wiggins AT, Pavlik EJ, Andrykowski MA. Psychological Response to a False Positive Ovarian Cancer Screening Test Result: Distinct Distress Trajectories and Their Associated Characteristics. Diagnostics (Basel) 2019; 9:diagnostics9040128. [PMID: 31557857 PMCID: PMC6963193 DOI: 10.3390/diagnostics9040128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022] Open
Abstract
Routine screening for ovarian cancer (OC) can yield an abnormal result later deemed benign. Such false positive (FP) results have been shown to trigger distress, which generally resolves over time. However, women might differ in the trajectory of the distress experience. Women participating in a routine OC screening program (n = 373) who received an abnormal screening result completed a baseline assessment prior to a follow-up screening test to clarify the nature of their abnormal result. All women were subsequently informed that no malignancy was present, and follow-up assessments were completed one and four months post-baseline. Demographic, clinical, dispositional (optimism, monitoring), and social environmental (social constraint, social support) variables were assessed at baseline. OC-specific distress was assessed at all three assessments. Trajectory analyses identified three distress trajectories differing in the baseline level of distress. A high decreasing trajectory, representing about 25% of women, was characterized by high levels of distress at baseline with distress declining over time, but still elevated at four-month follow-up. In contrast, a no distress trajectory group, representing about 30% of women, was characterized by essentially no distress at any time point. Principal risk factors for membership in the high decreasing trajectory group included a family history of OC, lower dispositional optimism, and greater social constraint. These risk factors could be used to target resources efficiently towards managing women at risk for potentially clinically-significant distress after receipt of an FP OC screening test.
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Affiliation(s)
- Amanda T Wiggins
- Nursing Instruction, University of Kentucky College of Nursing, Lexington, KY 40536, USA.
| | - Edward J Pavlik
- Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, KY 40506, USA.
| | - Michael A Andrykowski
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
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13
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Person H, Guillemin F, Conroy T, Velten M, Rotonda C. Factors of the evolution of fatigue dimensions in patients with breast cancer during the 2 years after surgery. Int J Cancer 2019; 146:1827-1835. [PMID: 31228259 DOI: 10.1002/ijc.32527] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 11/12/2022]
Abstract
Women with breast cancer are increasingly being cured of the disease but fatigue remains the most frequently reported symptom. The aims of our study were to identify distinct trajectories in four fatigue dimensions during 2 years after breast cancer surgery and to explore the demographic, clinical and personality characteristics associated with these profiles. We included women from the prospective longitudinal multicenter FATSEIN cohort in France. They completed the Multidimensional Fatigue Inventory for nine follow-ups over 24 months after surgery. A group-based trajectory model identified distinct trajectories in each fatigue dimension. Multinomial logistic regression determined the factors associated with each profile. From the 459 women followed, 3-5 fatigue trajectories were revealed in each fatigue dimension, from its absence to its severest degree. In our multivariate analysis, the risk of severe fatigue was decreased in all dimensions by a high quality of life before surgery (measured by the European Organization for Research and Treatment of Cancer 30-item QoL questionnaire; e.g., for general and physical fatigue: OR = 0.93, 95% CI 0.91, 0.96), especially a high physical and emotional functions for general and physical fatigue, and a high cognitive function for mental fatigue. Both severe mental fatigue and severely reduced motivation worsened with low optimism before surgery (e.g., for mental fatigue: OR = 0.93, 95% CI 0.89, 0.97). Severely reduced activities increased by having chemotherapy (OR = 9.41, 95% CI 2.28, 38.79). Targeting women at risk for severe fatigue can provide early preventive and curative treatment and appropriate psychological support.
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Affiliation(s)
- Hélène Person
- Université de Lorraine, APEMAC, équipe MICS, Nancy, France.,CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
| | - Francis Guillemin
- Université de Lorraine, APEMAC, équipe MICS, Nancy, France.,CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France.,The French National Platform Quality of Life and Cancer, France
| | - Thierry Conroy
- Université de Lorraine, APEMAC, équipe MICS, Nancy, France.,Medical Oncology Department, Institut de Cancérologie en Lorraine, Nancy, France
| | - Michel Velten
- Département d'Épidémiologie et de Santé Publique, Faculté de médecine, Université de Strasbourg, Strasbourg, France.,Centre Paul Strauss, Département de Santé Publique, Strasbourg, France
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14
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Weis J, Wirtz MA, Tomaszewski KA, Hammerlid E, Arraras JI, Conroy T, Lanceley A, Schmidt H, Singer S, Pinto M, Alm El-Din M, Compter I, Holzner B, Hofmeister D, Chie WC, Harle A, Flechtner HH, Bottomley A. Sensitivity to change of the EORTC quality of life module measuring cancer-related fatigue (EORTC QlQ-Fa12): Results from the international psychometric validation. Psychooncology 2019; 28:1753-1761. [PMID: 31225669 DOI: 10.1002/pon.5151] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The European Organisation for Research and Treatment of Cancer Quality of Life Group (EORTC QLG) has developed a multidimensional instrument measuring cancer-related fatigue, the EORTC QLQ-FA12. The analysis of sensitivity to change is an essential part of psychometric validation. With this study, we investigated the EORTC QLQ-FA12's sensitivity to change. METHODS The methodology follows the EORTC guidelines of EORTC QLG for phase IV validation of modules. We included cancer patients undergoing curative and palliative treatment at t1 and followed them up prospectively over the course of their treatment (t2) and 4 weeks after completion of treatment (t3). Data were collected prospectively at 17 sites in 11 countries. Sensitivity to change was investigated using analysis of variance. RESULTS A total sample of 533 patients was enrolled with various tumour types, different stages of cancer, and receiving either curative treatment (n=311) or palliative treatment (n=222). Over time all fatigue scores were significantly higher in the palliative treatment group compared with the curative group (p < .001). Physical fatigue increased with medium effect size over the course of treatment in the curative group (standardized response mean [SRM] (t1,t2) = 0.44]. After treatment physical [SRM (t2,t3) = 0.39], emotional [SRM (t2,t3)= 0.28] and cognitive fatigue (SRM [t2,t3] = 0.22) declined significantly in the curative group. In the palliative group, emotional (SRM [t2,t3] = 0.18) as well as cognitive [SRM [t2,t3] = 0.26) fatigue increases significantly. CONCLUSIONS The EORTC-QLQ-FA12 proved to identify clinically significant changes in fatigue in the course of curative and palliative cancer treatment.
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Affiliation(s)
- Joachim Weis
- Comprehensive Cancer Center, University Clinic Center Freiburg, Freiburg, Germany
| | - Markus A Wirtz
- Department of Research Methods, University of Education, Freiburg, Germany
| | - Krzysztof A Tomaszewski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Eva Hammerlid
- Department of Otolaryngology Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden
| | | | - Thierry Conroy
- Department of Medical Oncology, Lorraine Cancer Institute, Institut de Cancérologie de Lorraine et Université de Lorraine, Nancy, France
| | - Anne Lanceley
- Institute for Women's Health, University College London, London, UK
| | - Heike Schmidt
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre Mainz, Mainz, Germany
| | - Monica Pinto
- Department of Supportive Care, Rehabilitation Medicine Unit, Istituto Nazionale Tumori - IRCCS - "Fondazione G. Pascale", Napoli, Italy
| | - Mohamed Alm El-Din
- Department of Clinical Oncology, Tanta Faculty of Medicine, Tanta, Egypt
| | - Inge Compter
- Department of Radiation Oncology (MAASTRO), GROW (School for Oncology and Developmental Biology), University of Maastricht Medical Center, Maastricht, The Netherlands
| | - Bernhard Holzner
- Department of Psychiatry and Psychotherapy, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Dirk Hofmeister
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Wei-Chu Chie
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - Amelie Harle
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Andrew Bottomley
- Quality of Life Department, EORTC Headquarters, Brussels, Belgium
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15
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Cancer-related fatigue stratification system based on patient-reported outcomes and objective outcomes: A cancer-related fatigue ambulatory index. PLoS One 2019; 14:e0215662. [PMID: 31009501 PMCID: PMC6476532 DOI: 10.1371/journal.pone.0215662] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/05/2019] [Indexed: 12/16/2022] Open
Abstract
Although breast cancer mortality is decreasing, morbidity following treatment remains a significant issue, as patients face symptoms such as cancer-related fatigue (CRF). The aim of the present study is to develop a classification system that monitors fatigue via integration of an objective clinical assessment with patient self-report. Forty-three women participated in this research. Participants were post-treatment breast cancer survivors who had been surgically treated for their primary tumour with no evidence of neoplastic disease at the time of recruitment. Self-perceived fatigue was assessed with the Spanish version of the Piper Fatigue Scale-Revised (R-PFS). Objective fatigue was assessed by the 30 second Sit-to-Stand (30-STS) test. Confirmatory factor analysis was done with Maximum Likelihood Extraction (MLE). Internal consistency was obtained by Cronbach's α coefficients. Bivariate correlation showed that 30-STS performance was negatively-inversely associated with R-PFS. The MANOVA model explained 54.3% of 30-STS performance variance. Using normalized scores from the MLE, a classification system was developed based on the quartiles. This study integrated objective and subjective measures of fatigue to better allow classification of patient CRF experience. Results allowed development of a classification index to classify CRF severity in breast cancer survivors using the relationship between 30-STS and R-PFS scores. Future research must consider the patient-perceived and clinically measurable components of CRF to better understand this multidimensional issue.
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16
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Porro B, Michel A, Zinzindohoué C, Bertrand P, Monrigal E, Trentini F, Baussard L, Cousson-Gélie F. Quality of life, fatigue and changes therein as predictors of return to work during breast cancer treatment. Scand J Caring Sci 2019; 33:467-477. [PMID: 30664270 DOI: 10.1111/scs.12646] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To our knowledge, only one study has assessed Quality of Life (QOL) as a predictor of return to work (RTW) during breast cancer treatment and one has evaluated multidimensional cancer-related fatigue (CRF) as a determinant of RTW. However, no study has assessed the impact of changes in these variables on RTW. The objective of this study was to evaluate QOL, multidimensional CRF and changes in these variables as determinants of RTW during breast cancer treatment. METHODS We performed a longitudinal study of 68 patients with a mean age of 46.97 years (SD = 6.92), who were employed at the time of diagnosis. Women were assessed at the beginning of adjuvant treatments (T0) and followed up with by telephone at three (T1) and 6 months later (T2), using questionnaires (QLQ-C30; MFI-20). RESULTS Global QOL, OR = 1.12 [1.01-1.25], sleep disturbance, OR = 1.04 [1.002-1.08], fatigue (QLQ-C30), OR = 0.93 [0.88-0.99], nausea-vomiting, OR = 0.84 [0.73-0.97], reduced motivation, OR = 1.49 [1.05-2.11] and general fatigue, OR = 0.79 [0.63-0.99] at T0 were associated with RTW at T1. At T2 global QOL, OR = 1.09 [1.01-1.17], cognitive functioning, OR = 1.10 [1.03-1.17], general fatigue, OR = 1.82 [1.04-3.17] and mental fatigue, OR = 0.29 [0.11-0.81] were associated with RTW. Furthermore, changes in mental fatigue were associated with RTW at T2, OR = 0.02 [0.001-0.29]. CONCLUSIONS Quality of life, fatigue and their changes in them, especially cognitive functioning and mental fatigue, can play an important role in predicting the RTW of women with breast cancer. This confirms the importance of multidisciplinary care for cancer and the emergence of a theoretical psychological model of RTW.
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Affiliation(s)
- Bertrand Porro
- University Paul Valéry Montpellier 3, University Montpellier, EPSYLON EA 4556, Montpellier, France
| | - Aude Michel
- University Paul Valéry Montpellier 3, University Montpellier, EPSYLON EA 4556, Montpellier, France.,Montpellier Breast Institute (MIS), Montpellier, France
| | | | | | | | | | - Louise Baussard
- University Paul Valéry Montpellier 3, University Montpellier, EPSYLON EA 4556, Montpellier, France.,Epidaure Prevention Department of the Regional Institute of Cancer of Montpellier (ICM)-Val d'Aurelle, Montpellier, France
| | - Florence Cousson-Gélie
- University Paul Valéry Montpellier 3, University Montpellier, EPSYLON EA 4556, Montpellier, France.,Epidaure Prevention Department of the Regional Institute of Cancer of Montpellier (ICM)-Val d'Aurelle, Montpellier, France
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17
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Bower JE. The role of neuro-immune interactions in cancer-related fatigue: Biobehavioral risk factors and mechanisms. Cancer 2019; 125:353-364. [PMID: 30602059 DOI: 10.1002/cncr.31790] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
Abstract
Fatigue is a common and distressing symptom in both patients with cancer and cancer survivors. There is substantial variation in the severity and persistence of cancer-related fatigue that may be driven by individual differences in host factors, including characteristics that predate the cancer experience as well as responses to cancer and its treatment. This review examines biobehavioral risk factors linked to fatigue and the mechanisms through which they influence fatigue across the cancer continuum, with a focus on neuro-immune processes. Among psychosocial risk factors, childhood adversity is a strong and consistent predictor of cancer-related fatigue; other risk factors include history of depression, catastrophizing, lack of physical activity, and sleep disturbance, with compelling preliminary evidence for loneliness and trait anxiety. Among biologic systems, initial work suggests that alterations in immune, neuroendocrine, and neural processes are associated with fatigue. The identification of key risk factors and underlying mechanisms is critical for the development and deployment of targeted interventions to reduce the burden of fatigue in the growing population of cancer survivors. Given the multidimensional nature of fatigue, interventions that influence multiple systems may be most effective.
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Affiliation(s)
- Julienne E Bower
- Department of Psychology, Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
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18
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Nyrop KA, Deal AM, Shachar SS, Basch E, Reeve BB, Choi SK, Lee JT, Wood WA, Anders CK, Carey LA, Dees EC, Jolly TA, Reeder-Hayes KE, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Muss HB. Patient-Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer. Oncologist 2018; 24:762-771. [PMID: 30552158 DOI: 10.1634/theoncologist.2018-0590] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/07/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study explores the incidence of patient-reported major toxicity-symptoms rated "moderate," "severe," or "very severe"-for chemotherapy regimens commonly used in early breast cancer. PATIENTS AND METHODS Female patients aged 21 years or older completed a validated Patient-Reported Symptom Monitoring instrument and rated 17 symptoms throughout adjuvant or neoadjuvant chemotherapy. Fisher's exact tests compared differences in percentages in symptom ratings, and general linear regression was used to model the incidence of patient-reported major toxicity. RESULTS In 152 patients, the mean age was 54 years (range, 24-77), and 112 (74%) were white; 51% received an anthracycline-based regimen. The proportion of patients rating fatigue, constipation, myalgia, diarrhea, nausea, peripheral neuropathy, and swelling of arms or legs as a major toxicity at any time during chemotherapy varied significantly among four chemotherapy regimens (p < .05). The mean (SD) number of symptoms rated major toxicities was 6.3 (3.6) for anthracycline-based and 4.4 (3.5) for non-anthracycline-based regimens (p = .001; possible range, 0-17 symptoms). Baseline higher body mass index (p = .03), patient-reported Karnofsky performance status ≤80 (p = .0003), and anthracycline-based regimens (p = .0003) were associated with greater total number of symptoms rated major toxicities (alternative model: chemotherapy duration, p < .0001). Twenty-six percent of dose reductions (26 of 40), 75% of hospitalizations (15 of 20), and 94% of treatment discontinuations (15 of 16) were in anthracycline-based regimens. CONCLUSION Capturing multiple toxicity outcomes throughout chemotherapy enables oncologists and patients to understand the range of side effects as they discuss treatment efficacies. Continuous symptom monitoring may aid in the timely development of interventions that minimize toxicity and improve outcomes. IMPLICATIONS FOR PRACTICE: This study investigated patient-reported toxicities for 17 symptoms recorded prospectively during adjuvant and neoadjuvant chemotherapy regimens for early breast cancer. An analysis of four commonly used chemotherapy regimens identified significant differences among regimens in both individual symptoms and total number of symptoms rated moderate, severe, or very severe. Longer chemotherapy regimens, such as anthracycline-based regimens followed by paclitaxel, had higher proportions of symptoms rated major toxicities. The inclusion of patient perspectives on multiple toxicity outcomes at the same time at multiple time points during chemotherapy has the potential for improving patient-provider communication regarding symptom management, patient satisfaction, and long-term clinical outcomes.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Ethan Basch
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Seul Ki Choi
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jordan T Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William A Wood
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carey K Anders
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth C Dees
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Trevor A Jolly
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine E Reeder-Hayes
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Raquel E Reinbolt
- Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - JoEllen C Speca
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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19
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Bower JE, Wiley J, Petersen L, Irwin MR, Cole SW, Ganz PA. Fatigue after breast cancer treatment: Biobehavioral predictors of fatigue trajectories. Health Psychol 2018; 37:1025-1034. [PMID: 30321021 DOI: 10.1037/hea0000652] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Fatigue is a common side effect of cancer treatment, but there is considerable variability in fatigue severity and persistence among survivors. This study aimed to characterize longitudinal trajectories of fatigue after breast cancer treatment and to identify predictors of varying fatigue trajectories. METHODS Women (N = 191) from the Mind-Body Study completed assessments after primary treatment for early stage breast cancer and at regular follow-ups that occurred up to 6 years after treatment (M = 4.3 years). Growth mixture models were used to characterize fatigue trajectories, and demographic, medical, and biobehavioral risk factors were examined as predictors of trajectory group. RESULTS Five trajectories were identified, characterized as High, Recovery, Late, Low, and Very Low fatigue. The High and Recovery groups (40% of sample) evidenced elevated fatigue at posttreatment that declined in Recovery but persisted in the High group. In bivariate analyses, trajectory groups differed significantly on depressive symptoms, sleep disturbance, childhood adversity, body mass index, and the inflammatory marker soluble TNF receptor type II, which were higher in the High and/or Recovery groups. In multivariate models, depressive symptoms and childhood adversity distinguished High and Recovery from other groups. Rates of chemotherapy were higher in the Recovery than in the High or Late group, whereas rates of endocrine therapy were higher in the High than in the Recovery group. CONCLUSIONS There are distinct longitudinal trajectories of fatigue after breast cancer treatment. Psychological factors are strongly associated with adverse fatigue trajectories, and together with treatment exposures may increase risk for cancer-related fatigue. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | - Laura Petersen
- Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA
| | - Michael R Irwin
- Department of Psychology, University of California, Los Angeles
| | - Steve W Cole
- Cousins Center for Psychoneuroimmunology, Semel Institute at University of California, Los Angeles
| | - Patricia A Ganz
- Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA
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20
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Fabi A, Falcicchio C, Giannarelli D, Maggi G, Cognetti F, Pugliese P. The course of cancer related fatigue up to ten years in early breast cancer patients: What impact in clinical practice? Breast 2017; 34:44-52. [PMID: 28500901 DOI: 10.1016/j.breast.2017.04.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/29/2022] Open
Abstract
Little is known about the cancer related fatigue (CRF) along cancer course and risk factors that could predict CRF development and persistence in breast cancer (BC) survivors. This prospective study detected incidence, timing of onset, duration of CRF, impact on QoL and psychological distress. Seventy-eight early BC patients, undergoing chemotherapy (CT) followed or not by hormonal therapy were assessed for QoL and psychological distress by EORTC QLQC30 and HADs questionnaires. Fatigue was investigated with mix methods, structured interview and psychometric measures. A qualitative analysis was added to assess the behavioral pattern of CRF. Low fatigue levels were identified after surgery (9%), increasing during (49%) and at the end of CT (47%), maintaining after 1 year (31%) and declining up to ten years of follow-up. Prevalence of CRF was higher at the end of CT and lower at follow-up. At the end and after 1 and 2 years from CT, persistence of CRF was associated to anxiety in 20%, 11% and 5% and to depression in 15%, 10% and 5% respectively. A relationship between CRF and psychological distress was observed; patients presenting depression and anxiety before CT were at higher risk for fatigue onset at a later period. A relationship between fatigue and QoL was noted at the end of CT. Our study shows the fatigue timely trend in early BC patients from surgery, CT and follow-up. Identification of biological, psychological, social predictor factors related to fatigue could be helpful for early interventions in patients at higher risk of developing fatigue.
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Affiliation(s)
- Alessandra Fabi
- Regina Elena National Cancer Institute, Division of Medical Oncology 1, via Elio Chianesi 53, 00124, Rome, Italy.
| | - Chiara Falcicchio
- Regina Elena National Cancer Institute, Service of Psiconcology, via Elio Chianesi 53, 00124, Rome, Italy
| | - Diana Giannarelli
- Regina Elena National Cancer Institute, Biostatistic Unit, via Elio Chianesi 53, 00124, Rome, Italy
| | - Gabriella Maggi
- Regina Elena National Cancer Institute, Service of Psiconcology, via Elio Chianesi 53, 00124, Rome, Italy
| | - Francesco Cognetti
- Regina Elena National Cancer Institute, Division of Medical Oncology 1, via Elio Chianesi 53, 00124, Rome, Italy
| | - Patrizia Pugliese
- Regina Elena National Cancer Institute, Service of Psiconcology, via Elio Chianesi 53, 00124, Rome, Italy
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21
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Schneider S, Stone AA. Ambulatory and diary methods can facilitate the measurement of patient-reported outcomes. Qual Life Res 2016; 25:497-506. [PMID: 26101141 PMCID: PMC4689672 DOI: 10.1007/s11136-015-1054-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE Ambulatory and diary methods of self-reported symptoms and well-being have received increasing interest in recent years. These methods are a valuable addition to traditional strategies for the assessment of patient-reported outcomes (PROs) in that they capture patients' recent symptom experiences repeatedly in their natural environments. In this article, we review ways that incorporating diary methods into PRO measurement can facilitate research on quality of life. METHODS Several diary methods are currently available, and they include "real-time" (Ecological Momentary Assessment) and "near-real-time" (end-of-day assessments, Day Reconstruction Method) formats. We identify the key benefits of these methods for PRO research. RESULTS (1) In validity testing, diary assessments can serve as a standard for evaluating the ecological validity and for identifying recall biases of PRO instruments with longer-term recall formats. (2) In research and clinical settings, diaries have the ability to closely capture variations and dynamic changes in quality of life that are difficult or not possible to obtain from traditional PRO assessments. (3) In test construction, repeated diary assessments can expand understanding of the measurement characteristics (e.g., reliability, dimensionality) of PROs in that parameters for differences between people can be compared with those for variation within people. CONCLUSIONS Diary assessment strategies can enrich the repertoire of PRO assessment tools and enhance the measurement of patients' quality of life.
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Affiliation(s)
- Stefan Schneider
- Dornsife Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-3332, USA.
| | - Arthur A Stone
- Dornsife Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-3332, USA
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22
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Araújo JKL, Giglio AD, Munhoz BA, Fonseca FLA, Cruz FM, Giglio AD. Chemotherapy-Induced Fatigue Correlates With Higher Fatigue Scores Before Treatment. Am J Hosp Palliat Care 2016; 34:404-411. [PMID: 26847709 DOI: 10.1177/1049909116629134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Cancer chemotherapy can induce fatigue in about 20% to 30% of patients. So far, there is very little information as to the predictors of chemotherapy-induced fatigue (CIF). We evaluated potential predictors of CIF in a sample of patients with cancer with several types of solid tumors scheduled to receive chemotherapy according to institutional protocols. METHODS Before their first and second chemotherapy cycles, patients answered to the Brief Fatigue Inventory (BFI), Chalder, Mini Nutritional Assessment (MNA), Stress thermometer, and HADS questionnaires as well as provided blood samples for inflammatory markers. RESULTS We evaluated 52 patients, 37 (71%) were female and mean age was 53 years. The most common tumors were breast cancer 21 (40%) and gastrointestinal tumors 12 (23%). Although 14 (25.2%) patients had an increase in their fatigue BFI scores equal or above 3 points from baseline, we observed no significant overall differences between BFI scores before and after chemotherapy. The only 2 factors associated with an increase of 3 points in the BFI scores after chemotherapy were race and higher baseline BFI levels. By multivariate analysis, overall BFI and Chalder scores after chemotherapy also correlated significantly with their respective baseline scores before treatment. HADS scores before treatment correlated with overall BFI scores postchemotherapy, whereas MNA scores before chemotherapy and female sex correlated with higher Chalder scores after treatment. CONCLUSION We conclude that fatigue induced by chemotherapy is common and consistently associated with higher fatigue scores before treatment. Screening for fatigue before chemotherapy may help to identify patients who are prone to develop CIF.
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