The Value of Fatigue Severity to Rule Out Depression in Older Adult Patients With Cancer

Educational technology for fatigue management related to antineoplastic chemotherapy

ABSTRACT Objective: To construct and validate an educational technology (ET) on fatigue and non-pharmacological strategies for the management of this symptom in people with cancer undergoing outpatient antineoplastic chemotherapy. Method: This is a methodological study composed of three stages: 1) elaboration of the ET using the theoretical-methodological model of Doak, Doak and Root; 2) validation of content and appearance by seven nurses via the content validity index (CVI); and 3) a pilot test with 10 patients. Results: The ET “Knowing and coping with fatigue” contemplates the definition of fatigue, its causes and the interventions of physical exercise practice, sleep hygiene, energy conservation and behavioral intervention. The overall CVI obtained with the judges was 0.95. Conclusion: The ET presented content and appearance validity for health education regarding fatigue related to antineoplastic chemotherapy in outpatient cancer patients.

Functional status decline in older patients with breast and colorectal cancer after cancer treatment: A prospective cohort study

OBJECTIVES

The aim of the present study was to disentangle the impact of age and that of cancer diagnosis and treatment on functional status (FS) decline in older patients with cancer.

MATERIALS AND METHODS

Patients with breast and colorectal cancer aged 50-69years and aged ≥70years who had undergone surgery, and older patients without cancer aged ≥70years were included. FS was assessed at baseline and after 12months follow-up, using the Katz index for activities of daily living (ADL) and the Lawton scale for instrumental activities of daily living (IADL). FS decline was defined as ≥1 point decrease on the ADL or IADL scale from baseline to 12months follow-up.

RESULTS

In total, 179 older patients with cancer (≥ 70years), 341 younger patients with cancer (50-69years) and 317 older patients without cancer (≥ 70years) were included. FS decline was found in 43.6%, 24.6% and 28.1% of the groups, respectively. FS decline was significantly worse in older compared to younger patients with cancer receiving no chemotherapy (44.5% versus 17.6%, p<0.001), but not for those who did receive chemotherapy (39.4% versus 30.8%, p=0.33). Among the patients with cancer, FS decline was significantly associated with older age (OR 2.63), female sex (OR 3.72), colorectal cancer (OR 2.81), polypharmacy (OR 2.10) and, inversely, with baseline ADL dependency (OR 0.44).

CONCLUSION

Cancer treatment, and older age are important predictors of FS decline. The relation of baseline ADL dependency and chemotherapy with FS decline suggest that the fittest of the older patients with cancer were selected for chemotherapy.

Co-occurrence and symptomatology of fatigue and depression

OBJECTIVE

Fatigue and depression are highly comorbid phenotypes with partially overlapping symptoms. The main aims of the present study are to: (i) identify the risk of current fatigue and depression; (ii) determine if the depression symptoms experienced by individuals who are fatigued (N=766) and non-fatigued (N=1849) are different; and (iii) identify if the fatigue symptoms experienced by depressed (N=275) and non-depressed (N=2340) individuals are different, in a community-based sample of Australian twins aged over 50years.

METHODS

Fatigue and depression symptom profiles and classifications were generated using the Schedule of Fatigue and Anergia (SOFA); the General Health Questionnaire; and the Delusions-Symptoms-States Inventory, States of Anxiety and Depression questionnaires. The association between co-occurring fatigue and depression was assessed using prevalence ratios. Differences in the preponderance of fatigue and depression symptoms were assessed using logistic regression modeling.

RESULTS

Individuals with either fatigue or depression have an approximately two-fold increased risk for comorbid presentation of both traits, compared to the general population. Logistic regression analysis indicated that fatigued individuals were significantly more likely to report all of the Diagnostic and Statistical Manual of Mental Disorders (DSM) depression symptoms assessed in the study. Similarly, depressed individuals were significantly more likely to report all SOFA fatigue symptoms.

CONCLUSIONS

Fatigue and depression are highly correlated traits within the community. Depression symptomatology and prevalence are significantly increased in fatigued individuals. Fatigue and especially the symptoms of insomnia and poor concentration are strong predictors of depression. Notably, the association between fatigue and depression is independent of their overlapping symptomatology. Therefore, presentation with fatigue, and in particular the symptoms of insomnia and poor concentration, should be considered as warning signs of depression in older adults.

Disability and quality of life in community-dwelling elderly cancer survivors: Case-control study in the Korean population

PURPOSE

Advanced age is a significant risk factor for cancer and functional disabilities increase with age. The purpose of this case-control study of Korean individuals was to determine the effect of cancer and cancer treatment on functional disability and quality of life (QOL). Thus, we compared community-dwelling elderly cancer patients (ECPs) with individuals from the general elderly population (GEP) who never had diagnoses of cancer.

METHODS

We selected 1776 ECP who were at least 65 years-old from the 2008 Korean Community Health Survey data and used propensity score matching to randomly select 1766 individuals from the GEP who closely resembled the ECPs. Functional disability was measured using the Instrumental Activities of Daily Living (IADL) scale, and QOL was measured by the EuroQol Group EQ-5D.

RESULTS

ECPs were more dependent in preparation of food, doing laundry, and shopping (IADL scale), and in mobility and usual activities (EQ-5D). Although ECP had more problems with pain, discomfort, anxiety, and depression, they were more independent in self-care and handling of financial responsibilities.

CONCLUSIONS

ECPs had multiple physical and psychological symptoms that adversely affected functional disability and QOL, but higher functional ability, such as self-care and handling of financial responsibilities. Promotion of self-care by ECPs is pivotal for effective management in community practice.

Geriatric assessment for oncologists

The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment (GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.