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McGovern KA, Durham WJ, Wright TJ, Dillon EL, Randolph KM, Danesi CP, Urban RJ, Sheffield-Moore M. Impact of Adjunct Testosterone on Cancer-Related Fatigue: An Ancillary Analysis from a Controlled Randomized Trial. Curr Oncol 2022; 29:8340-8356. [PMID: 36354718 PMCID: PMC9689748 DOI: 10.3390/curroncol29110658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Many cancer patients undergoing treatment experience cancer-related fatigue (CRF). Inflammatory markers are correlated with CRF but are not routinely targeted for treatment. We previously demonstrated in an NIH-funded placebo-controlled, double-blind, randomized clinical trial (NCT00878995, closed to follow-up) that seven weekly injections of 100 mg adjunct testosterone preserved lean body mass in cancer patients undergoing standard-of-care treatment in a hospital setting. Because testosterone therapy can reduce circulating proinflammatory cytokines, we conducted an ancillary analysis to determine if this testosterone treatment reduced inflammatory burden and improved CRF symptoms and health-related quality of life. Randomization was computer-generated and managed by the pharmacy, which dispensed testosterone and placebo in opaque syringes to the administering study personnel. A total of 24 patients were randomized (14 placebo, 10 testosterone), and 21 were included in the primary analysis (11 placebo, 10 testosterone). Testosterone therapy did not ameliorate CRF symptoms (placebo to testosterone difference in predicted mean multidimensional fatigue symptom inventory scores: -5.6, 95% CI: -24.6 to 13.3), improve inflammatory markers, or preserve health-related quality of life and functional measures of performance in late-stage cancer patients.
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Affiliation(s)
- Kristen A. McGovern
- Department of Internal Medicine, The University of Texas Medical Branch (UTMB), 301 University Blvd., Galveston, TX 77555, USA
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Goodman ZT, Banerjee N, Rooks J, McInerney K, Sun X, Getz S, Kaur S, Sun-Suslow N, Junco B, Levin BE. Measuring the Frailty Phenotype and its Association with Cognition in Mid-Life and Older Age. J Alzheimers Dis 2022; 89:415-426. [DOI: 10.3233/jad-215475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Frailty is directly linked to physical robustness and cognitive decline in older age. The Fried Frailty phenotype (FP) is a construct composed of five core symptoms that has been studied predominately in older age. There is little research contrasting the psychometric properties of the FP in mid-life versus older age. Objective: We compared the psychometric properties of the FP in mid-life and older age and investigated relationships between the FP and cognition. Methods: Frailty and neuropsychological assessments were completed on 361 adults, between 45 and 92 years of age, without primary neurological disorders. Confirmatory factor analysis was used to examine FP, indicated by Grip Strength, Gait Speed, Physical Activity, Fatigue, and Weight Loss. Measurement invariance was tested in mid-life (45–64 years) versus older age (≥65 years). Associations were examined between FP and language, executive functions, memory, processing speed, and visuospatial domains as well as a Generalized Cognition factor. Age was tested as a moderator of these associations. Results: Weight Loss was a poor indicator of FP. Factor loadings were comparable across age groups; however, Fatigue was disproportionately higher among those in mid-life. FP was negatively associated with all cognitive domains and remained invariant across age groups. Conclusion: Results support the construct validity of the FP and document its stable associations with poorer cognition in middle and older life. Future research investigating central features of frailty earlier in life may offer avenues for developing targeted prevention measures and better characterization of individuals with elevated dementia risk.
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Affiliation(s)
- Zachary T. Goodman
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Nikhil Banerjee
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua Rooks
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katalina McInerney
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Xiaoyan Sun
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sarah Getz
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonya Kaur
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ni Sun-Suslow
- UCSD School of Medicine, Department of Psychiatry, San Diego, CA, USA
| | - Barbara Junco
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie E. Levin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Lai TL, Au CK, Chung HY, Leung MC, Ng WL, Lau CS. Fatigue in psoriatic arthritis: Is it related to disease activity? Int J Rheum Dis 2021; 24:418-425. [PMID: 33506651 DOI: 10.1111/1756-185x.14069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 12/01/2022]
Abstract
AIM Fatigue is commonly associated with psoriatic arthritis (PsA). However, information about its prevalence and associated factors is sparse. The primary objective here was to find the prevalence and magnitude of PsA fatigue. The secondary objective was to explore its associated risk factors, particularly emphasis on the effect of disease activity control. METHODS PsA patients who fulfilled Classification Criteria For Psoriatic Arthritis were consecutively recruited from local rheumatology clinics. Fatigue was assessed by a 13-item self-administered questionnaire (Functional Assessment of Chronic Illness Therapy - Fatigue [FACIT-F]) (0-52). Data collected and analyzed included: demographic data, disease activity data, comorbidities and medications use. RESULTS There were 231 eligible PsA patients recruited. The mean FACIT-F score was 37.5 ± 9.1. Severe fatigue, defined as FACIT-F score < 30, was found in 49 (22.1%) of them. The univariate model identified these associated factors of fatigue: tender and swollen joint count, dactylitis count, Psoriasis Area and Severity Index (PASI) score, pain and general health perception, Disease Activity in Psoriatic Arthritis (DAPSA) score, Health Assessment Questionnaire, the use of cyclosporine, sulphasalazine and biologic agents. The final regression model identified DAPSA and PASI were closely associated with severe fatigue (P = .003 and P = .04 respectively). No associations with fatigue were found between age, gender, disease duration, comorbidities and medication use. However, there were weak correlations between the magnitude of FACIT-F score, DAPSA and PASI with r = -.3 and r = -.26 respectively. CONCLUSION Severe fatigue was common in PsA patients, and its magnitude was closely correlated with DAPSA and PASI score, indicating its multifactorial nature. Achieving DAPSA and PASI remission could significantly alleviate the fatigue intensity to a certain extent. However, treatment for PsA-related fatigue should adopt a multidisciplinary approach in addition to disease activity control.
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Affiliation(s)
- Tin Lok Lai
- Rheumatology Team, Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Chi Kit Au
- Rheumatology Team, Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Ho Yin Chung
- Rheumatology & Clinical Immunology team, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Man Chi Leung
- Rheumatology Team, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, Hong Kong
| | - Woon Leung Ng
- Rheumatology Team, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, Hong Kong
| | - Chak Sing Lau
- Rheumatology Team, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, Hong Kong
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Padilla AH, Palmer PM, Rodríguez BL. The Relationship Between Culture, Quality of Life, and Stigma in Hispanic New Mexicans With Dysphagia: A Preliminary Investigation Using Quantitative and Qualitative Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:485-500. [PMID: 31136241 DOI: 10.1044/2018_ajslp-18-0061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this investigation was to (a) identify the relationship between level of acculturation, and quality of life (QOL) and stigma and (b) explore the QOL experiences for Hispanic New Mexicans with dysphagia. Method This study includes 7 New Mexicans who self-identified as Hispanic. This prospective investigation was completed in 2 phases. In the quantitative phase, all participants completed the (a) the SWAL-QOL ( McHorney et al., 2000 ), (b) the Neuro-QoL Stigma subtest ( Gershon et al., 2012 ), and (c) the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II; Cuellar, Arnold, & Maldonado, 1995 ). In the qualitative phase, 3 participants were selected from the quantitative phase to complete the qualitative phase. These participants were selected to allow for distribution across levels of acculturation, and each of them participated in interviews designed to explore QOL experiences. Interviews were analyzed to identify themes. The occurrence of themes is discussed as a function of level of acculturation. Results There is no clear relationship between acculturation and QOL. A strong nonsignificant correlation was observed between acculturation and stigma. QOL experiences, as identified from the interviews, were classified into 2 broad categories: emotional experiences (stigma, distrust, fear, frustration, religion, and impact) and swallow safety (symptoms, treatment, triggers, and compensatory strategies). Conclusions Level of acculturation did not relate to measures of mental health or fatigue. Yet, both quantitative and qualitative analyses support a relationship between level of acculturation, and symptom reporting and religion, as well as patient perception of stigma.
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Affiliation(s)
- Aaron H Padilla
- Department of Speech & Hearing Sciences, The University of New Mexico, Albuquerque
- Department of Speech-Language Pathology, Presbyterian Healthcare Services, Albuquerque, NM
| | - Phyllis M Palmer
- Department of Speech & Hearing Sciences, The University of New Mexico, Albuquerque
| | - Barbara L Rodríguez
- Department of Speech & Hearing Sciences, The University of New Mexico, Albuquerque
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In vivo β-adrenergic receptor responsiveness: ethnic differences in the relationship with symptoms of depression and fatigue. Int J Behav Med 2015; 21:843-50. [PMID: 24114717 DOI: 10.1007/s12529-013-9359-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Depressive symptoms and fatigue frequently overlap in clinical samples and the general population. The link of depressive symptoms and fatigue with increased risk of cardiovascular disease has been partly explained by shared biological mechanisms including sympathetic overactivity. Prolonged sympathetic overactivity downregulates the responsiveness of the β-adrenergic receptor (β-AR), a receptor that mediates several end-organ sympathetic responses. PURPOSE The authors studied whether depression and fatigue are related to reduced β-AR responsiveness within the human body (in vivo) in an ethnically diverse sample of African and Caucasian Americans. METHODS The chronotropic25 dose (CD25) was used to determine in vivo β-AR responsiveness in 93 healthy participants. Psychometric measures included the Center of Epidemiological Studies-Depression Scale and the Multidimensional Fatigue Symptom Inventory. RESULTS Hierarchical regression analyses (adjusted for age, gender, body mass index, blood pressure, smoking, and ethnicity) revealed that mental fatigue was significantly related to reduced β-AR responsiveness (i.e., higher CD25 values) in the whole sample. Moderation analyses indicated significant ethnicity × depression/fatigue interactions. Depressive symptoms, total fatigue, emotional fatigue, mental fatigue, and physical fatigue were related to reduced β-AR responsiveness in Caucasian American but not in African Americans. CONCLUSIONS Our findings suggest that symptoms of depression and fatigue are related to decreased in vivo β-AR responsiveness in Caucasian Americans. The lack of this association in African Americans highlights the importance for considering ethnicity as a potential moderator in research focusing on associations between psychological variables and cardiovascular function.
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Systematic review of the Multidimensional Fatigue Symptom Inventory-Short Form. Support Care Cancer 2014; 23:191-212. [DOI: 10.1007/s00520-014-2389-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/05/2014] [Indexed: 12/18/2022]
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Dolan P, Kudrna L. More years, less yawns: fresh evidence on tiredness by age and other factors. J Gerontol B Psychol Sci Soc Sci 2013; 70:576-80. [PMID: 24270099 DOI: 10.1093/geronb/gbt118] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/15/2013] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES It is commonplace for people to complain about being tired. There have been actually few studies of tiredness in large general population samples, and where studies do exist, the measures often rely on external assessments. We use a diary-based method to overcome these limitations in a representative sample of U.S. residents. METHODS Data come from the 2010 American Time Use Survey. Around 13,000 respondents provided a diary about the prior day and rated how tired they felt during selected activities. Regression analysis is used to explain variance in tiredness by age. RESULTS Regression analysis reveals that tiredness decreases with age. This relationship exists when we control for hours of sleep, gender, self-rated health, ethnic group, number of children, marital status, employment status, level of education, and the amount of time participants spent doing tiring activities. DISCUSSION Contrary to much previous research, tiredness decreases with age. People who are more than 65 years of age are almost one point on a 0-6 scale less tired than people aged between 15 and 24. Clinical implications and methodological limitations are discussed.
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Affiliation(s)
- Paul Dolan
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Laura Kudrna
- Department of Social Policy, London School of Economics and Political Science, London, UK.
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