1
|
Cathcart-Rake EJ, Tevaarwerk AJ, Haddad TC, D'Andre SD, Ruddy KJ. Advances in the care of breast cancer survivors. BMJ 2023; 382:e071565. [PMID: 37722731 DOI: 10.1136/bmj-2022-071565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Breast cancer survivors may experience significant after effects from diagnoses of breast cancer and cancer directed therapies. This review synthesizes the evidence about optimal management of the sequelae of a diagnosis of breast cancer. It describes the side effects of chemotherapy and endocrine therapy and evidence based strategies for management of such effects, with particular attention to effects of therapies with curative intent. It includes strategies to promote health and wellness among breast cancer survivors, along with data to support the use of integrative oncology strategies. In addition, this review examines models of survivorship care and ways in which digital tools may facilitate communication between clinicians and patients. The strategies outlined in this review are paramount to supporting breast cancer survivors' quality of life.
Collapse
|
2
|
Yifei sanjie Pills Alleviate Chemotherapy-Related Fatigue by Reducing Skeletal Muscle Injury and Inhibiting Tumor Growth in Lung Cancer Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2357616. [PMID: 36045663 PMCID: PMC9423986 DOI: 10.1155/2022/2357616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022]
Abstract
Chemotherapy-related fatigue (CRF), one of the most severe adverse effects observed in cancer patients, has been theoretically related to oxidative stress, and antioxidant treatment might be one of the most valuable therapeutic approaches. However, there are still few effective pharmacological therapies. Yifei Sanjie pills (YFSJ), a classical formula used to treat lung cancer as complementary and alternative medicine, have been proved to alleviate CRF of lung cancer patients in clinical practices. However, the underlying mechanisms have not been clarified. In this study, our data showed that YFSJ alleviated CRF presented as reversing the decline of swimming time and locomotor activity induced by cisplatin (DDP). Moreover, YFSJ significantly reduces the accidence of mitophagy and mitochondrial damage and reduces apoptosis in skeletal muscle tissues caused by DDP. It probably works by decreasing the oxidative stress, inhibiting the activation of the AMPK/mTOR pathway, decreasing protein expression levels of Beclin1 and other autophagy-related proteins, and attenuating the activation of Cytochrome c (cyto. C), Cleaved Caspase-9 (c-Casp 9), and other apoptosis-related proteins. Furthermore, YFSJ enhanced DDP sensitivity by specifically promoting oxidative stress and activating apoptosis and autophagy in the tumor tissues of mice. It was also found that YFSJ reduced the loss of body weight caused by DDP, reversed the ascent of serum concentrations of alanine aminotransferase (ALT), aminotransferase (AST), and creatinine (CREA), increased the spleen index, and prolonged the survival time of mice. Taken together, these results revealed that YFSJ could alleviate CRF by reducing mitophagy and apoptosis induced by oxidative stress in skeletal muscle; these results also displayed the effects of YFSJ on enhancing chemotherapy sensitivity, improving quality of life, and prolonging survival time in lung cancer mice received DDP chemotherapy.
Collapse
|
3
|
Vaz-Luis I, Di Meglio A, Havas J, El-Mouhebb M, Lapidari P, Presti D, Soldato D, Pistilli B, Dumas A, Menvielle G, Charles C, Everhard S, Martin AL, Cottu PH, Lerebours F, Coutant C, Dauchy S, Delaloge S, Lin NU, Ganz PA, Partridge AH, André F, Michiels S. Long-Term Longitudinal Patterns of Patient-Reported Fatigue After Breast Cancer: A Group-Based Trajectory Analysis. J Clin Oncol 2022; 40:2148-2162. [PMID: 35290073 PMCID: PMC9242405 DOI: 10.1200/jco.21.01958] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Fatigue is recognized as one of the most burdensome and long-lasting adverse effects of cancer and cancer treatment. We aimed to characterize long-term fatigue trajectories among breast cancer survivors. METHODS We performed a detailed longitudinal analysis of fatigue using a large ongoing national prospective clinical study (CANcer TOxicity, ClinicalTrials.gov identifier: NCT01993498) of patients with stage I-III breast cancer treated from 2012 to 2015. Fatigue was assessed at diagnosis and year 1, 2, and 4 postdiagnosis. Baseline clinical, sociodemographic, behavioral, tumor-related, and treatment-related characteristics were available. Trajectories of fatigue and risk factors of trajectory-group membership were identified by iterative estimates of group-based trajectory models. RESULTS Three trajectory groups were identified for severe global fatigue (n = 4,173). Twenty-one percent of patients were in the high-risk group, having risk estimates of severe global fatigue of 94.8% (95% CI, 86.6 to 100.0) at diagnosis and 64.6% (95% CI, 59.2 to 70.1) at year 4; 19% of patients clustered in the deteriorating group with risk estimates of severe global fatigue of 13.8% (95% CI, 6.7 to 20.9) at diagnosis and 64.5% (95% CI, 57.3 to 71.8) at year 4; 60% were in the low-risk group with risk estimates of 3.6% (95% CI, 2.5 to 4.7) at diagnosis and 9.6% (95% CI, 7.5 to 11.7) at year 4. The distinct dimensions of fatigue clustered in different trajectory groups than those identified by severe global fatigue, being differentially affected by sociodemographic, clinical, and treatment-related factors. CONCLUSION Our findings highlight the multidimensional nature of cancer-related fatigue and the complexity of its risk factors. This study helps to identify patients with increased risk of severe fatigue and to inform personalized interventions to ameliorate this problem.
Collapse
Affiliation(s)
- Ines Vaz-Luis
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Antonio Di Meglio
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Julie Havas
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Mayssam El-Mouhebb
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Pietro Lapidari
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Daniele Presti
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Davide Soldato
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Barbara Pistilli
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Agnes Dumas
- Universite de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | | | | | | | | | - Sarah Dauchy
- Gustave Roussy, Supportive Care, IPLESP, Paris, France
| | | | | | | | | | - Fabrice André
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, INSERM, University Paris-Saclay, Villejuif, France
- Equipe labellisée Ligue Contre le Cancer, Villejuif, France
| |
Collapse
|
4
|
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.
Collapse
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
| | | |
Collapse
|
5
|
Al Maqbali M, Al Sinani M, Al Naamani Z, Al Badi K, Tanash MI. Prevalence of Fatigue in Patients With Cancer: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2021; 61:167-189.e14. [PMID: 32768552 DOI: 10.1016/j.jpainsymman.2020.07.037] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness among patients with cancer. OBJECTIVES The objective of this meta-analysis is to examine the present status of fatigue prevalence in patients with cancer. METHODS The following databases were searched: PubMed, MEDLINE, EMBASE, PsycINFO, Cochrane Library, from inception up to February 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. RESULTS A total of 129 studies (N = 71,568) published between 1993 and 2020 met the inclusion criteria. The overall prevalence of fatigue was 49% (34,947 of 71,656 participants, 95% CI = 45-53) with significant heterogeneity between studies (P < 0.000; τ2 = 0.0000; I2 = 98.88%). Subgroup analyses show that the prevalence of fatigue related to type of cancer ranged from 26.2% in patients with gynecological cancer to 56.3% in studies that included mixed types of cancer. In advanced cancer stage patients, the highest prevalence of fatigue (60.6%) was reported. Fatigue prevalence rates were 62% during treatment and 51% during mixed treatment status. The prevalence of fatigue decreased from 64% in studies published from 1996 to 2000 to 43% in studies published from 2016 to 2020. Metaregression identified female gender as a significant moderator for higher prevalence of fatigue, whereas mean age is not associated with fatigue. CONCLUSION This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce fatigue and improve the quality of life of patients with cancer.
Collapse
Affiliation(s)
| | - Mohammed Al Sinani
- Reproductive and Developmental Biology Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Zakariya Al Naamani
- School of Nursing and Midwifery, Queen's University Medical Biology Centre, Belfast, Northern Ireland
| | - Khalid Al Badi
- Al Khawarizmi International College, Abu Dhabi, United Arab Emirates
| | - Mu'ath Ibrahim Tanash
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| |
Collapse
|
6
|
Whisenant M, Wong B, Mitchell SA, Beck SL, Mooney K. Trajectories of Depressed Mood and Anxiety During Chemotherapy for Breast Cancer. Cancer Nurs 2020; 43:22-31. [PMID: 31805023 PMCID: PMC6901090 DOI: 10.1097/ncc.0000000000000670] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women are at risk of mood disturbance during treatment for breast cancer. OBJECTIVE The aims of this study were to identify classes of women experiencing similar trajectories of depressed mood and anxiety while receiving chemotherapy for breast cancer and to determine associated antecedents and outcomes. The specific aims were to (1) determine the distinct trajectory classes associated with severity of depressed mood and anxiety reported by women undergoing cycles 2 and 3 of chemotherapy for breast cancer, (2) determine if class membership is associated with various antecedent variables, and (3) determine if class membership is associated with days of missed work and hours spent lying down. METHODS In a secondary analysis, classes were identified using Latent Growth Mixture Modeling. Antecedents and outcomes related to class membership were explored. RESULTS Participants (n = 166; mean age, 53 [SD, 10.8] years) were mostly white (91.46%); half had early-stage disease. Two trajectories of depressed mood and anxiety were identified. Receipt of doxorubicin was associated with the higher severity class for depressed mood (P < .01) and anxiety (P = .04). No college education (P = .03) or spending more hours lying down (P = .03) was associated with the higher severity class for anxiety. CONCLUSIONS Distinct trajectories of mood disturbance are distinguished by baseline severity. Further study is needed to determine if biologic or genomic factors are associated with class membership. IMPLICATIONS FOR PRACTICE Identification of women at risk of mood disturbance may allow clinicians to intensify symptom management. Mood disturbance early in the treatment trajectory warrants management to improve outcomes.
Collapse
Affiliation(s)
- Meagan Whisenant
- Author Affiliations: Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston (Dr Whisenant); College of Nursing (Drs Wong, Beck, and Mooney) and Huntsman Cancer Institute (Drs Beck and Mooney), University of Utah, Salt Lake City; and Outcomes Research Brant, National Cancer Institute, Rockville, Maryland (Dr Mitchell)
| | | | | | | | | |
Collapse
|
7
|
Ruiz-Casado A, Álvarez-Bustos A, de Pedro CG, Méndez-Otero M, Romero-Elías M. Cancer-related Fatigue in Breast Cancer Survivors: A Review. Clin Breast Cancer 2020; 21:10-25. [PMID: 32819836 DOI: 10.1016/j.clbc.2020.07.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/12/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
Fatigue has been the most distressing and frequent symptom in breast cancer (BC) survivors after treatment. Although fatigue can occur in other cancer survivors, women with a history of BC might share some distinctive features. The present study aimed to recapitulate the knowledge about risk factors and correlates of cancer-related fatigue (CRF) in BC survivors after oncologic therapy. An electronic data search was conducted in PubMed using the terms "fatigue," "breast," "cancer," and "survivors." Records were included if they were original articles, available in English, had used a quantitative scale, had > 100 participants, and had excluded women with BC relapse. BC survivors were required to have finished their treatments ≥ 2 months before, except for hormonal therapy. The physiopathology and other interventions were considered beyond the scope of our review. The correlates were subsequently classified into 7 main categories: (1) sociodemographic data, (2) physical variables, (3) tumor- and treatment-related variables, (4) comorbidities, (5) other symptoms, (6) psychological issues, and (7) lifestyle factors. Fatigue was consistently greater in younger, obese, and diabetic women. Women reporting fatigue often communicated symptoms such as pain, depression, insomnia, and cognitive dysfunction. Coping strategies such as catastrophizing could play an important role in the persistence of fatigue. However, tumor characteristics, previous treatments received, and physical activity were not consistently reported. CRF was a strong predictor of the quality of life of BC survivors after treatment. In conclusion, we found CRF was a frequent and serious symptom that severely affects the quality of life of BC survivors after treatment. Health practitioners require more awareness and information about CRF.
Collapse
Affiliation(s)
- Ana Ruiz-Casado
- Department of Medical Oncology, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain.
| | | | - Cristina G de Pedro
- Department of Medical Oncology, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Marta Méndez-Otero
- Department of Medical Oncology, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - María Romero-Elías
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University of Elche, Alicante, Spain
| |
Collapse
|
8
|
Dong X, Yi X, Gao D, Gao Z, Huang S, Chao M, Chen W, Ding M. The effects of the combined exercise intervention based on internet and social media software (CEIBISMS) on quality of life, muscle strength and cardiorespiratory capacity in Chinese postoperative breast cancer patients:a randomized controlled trial. Health Qual Life Outcomes 2019; 17:109. [PMID: 31242926 PMCID: PMC6595606 DOI: 10.1186/s12955-019-1183-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background Breast cancer (BC) patients who undergo surgery followed by radiotherapy and chemotherapy have limitations on physical activity which will lead to a decreased quality of life and poor physical fitness level. The purpose of this study was to investigate the effects of the combined exercise intervention based on internet and social media software (CEIBISMS) on postoperative breast cancer patients by evaluating their quality of life, muscle strength and cardiorespiratory capacity. Methods This study was a randomized control trial with an intervention period of 12 weeks. Sixty participants (30 in each group, 42–60 years old, female) were recruited through an outpatient department. Procedure of exercise in the intervention group included: via phone step-recording app, ask the individuals to complete the target number of steps within a specified period of exercise, four times per week; face-to-face remote video instruction of individuals on muscle training, three times per week; via social media apps daily push common knowledge of physical exercise BC rehabilitation. The control group received traditional treatment and rehabilitation according to daily specifications of the hospital. The primary outcome was quality of life and the secondary outcomes were muscle strength and cardiorespiratory capacity. Results Experiments using a Short Form 36 showed that the CEIBISMS yielded significantly better results than traditional methods, in vitality (p = 0.009), mental health (p = 0.001) and reported health transition (p = 0.048) by week 12. The CEIBISMS resulted in significant improvement in the stand-up and sit-down chair test (p < 0.0001), arm lifting test (p = 0.017). Conclusion The CEIBISMS offered rehabilitative effects in quality of life (QOL) and muscle strength of postoperative patients with breast cancer (BC) in China. Trial registration ChiCTR-IPR-17012368. Trial registered on 14 August, 2017.
Collapse
Affiliation(s)
- Xiaosheng Dong
- College of Physical Education, Shandong Normal University, 88 Wenhuaxi Road, Jinan, 250014, China
| | - Xiangren Yi
- College of Physical Education, Shandong University, Jinan, 250011, China
| | - Dezong Gao
- The Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, 250033, China
| | - Zan Gao
- School of Kinesiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Shuyuan Huang
- College of Physical Education, Shandong University, Jinan, 250011, China
| | - Mengyao Chao
- College of Physical Education, Shandong Normal University, 88 Wenhuaxi Road, Jinan, 250014, China
| | - Wenxin Chen
- College of Physical Education, Shandong University, Jinan, 250011, China
| | - Meng Ding
- College of Physical Education, Shandong Normal University, 88 Wenhuaxi Road, Jinan, 250014, China.
| |
Collapse
|
9
|
Whisenant M, Wong B, Mitchell SA, Beck SL, Mooney K. Symptom Trajectories Are Associated With Co-occurring Symptoms During Chemotherapy for Breast Cancer. J Pain Symptom Manage 2019; 57:183-189. [PMID: 30453052 PMCID: PMC6348053 DOI: 10.1016/j.jpainsymman.2018.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT Symptoms are reported to co-occur during treatment for breast cancer. We previously identified three patterns of fatigue and two patterns of disturbed sleep, depressed mood, and anxiety in women undergoing chemotherapy for breast cancer using a Latent Growth Mixture Model. OBJECTIVES The purpose of this study was to explore whether membership in symptom classes of fatigue, disturbed sleep, depressed mood, and anxiety is associated with other symptoms at moderate-to-severe levels. METHODS Using data from three longitudinal studies, Wilcoxon rank-sum tests and Jonckheere-Terpstra tests for trend were used to distinguish between classes of women on co-occurring symptoms. Summative scores were calculated, including the number of days subjects reported moderate-to-severe levels (4 or higher on a 0-10 scale) of seven symptoms during two cycles of chemotherapy and compared to class membership. RESULTS Participants (n = 166) in the higher fatigue severity class reported more days with moderate-to-severe disturbed sleep, depressed mood, anxiety, nausea, and trouble thinking. Women in the higher severity disturbed sleep class reported more days with moderate-to-severe fatigue, depressed mood, anxiety, and trouble thinking. Women in the higher depressed mood severity class reported more days with moderate-to-severe fatigue, disturbed sleep, anxiety, and nausea. Women in the higher anxiety severity class reported more days with moderate-to-severe fatigue, disturbed sleep, and depressed mood. CONCLUSION Moderate-to-severe symptoms co-occur during cancer treatment for breast cancer. The dynamic process of multiple symptoms may be altered by future identification of a shared etiology.
Collapse
Affiliation(s)
- Meagan Whisenant
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, National Cancer Institute, Rockville, Maryland, USA
| | - Susan L Beck
- College of Nursing, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Kathi Mooney
- College of Nursing, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
10
|
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).
Collapse
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
| |
Collapse
|
11
|
Abrahams H, Gielissen M, Verhagen C, Knoop H. The relationship of fatigue in breast cancer survivors with quality of life and factors to address in psychological interventions: A systematic review. Clin Psychol Rev 2018; 63:1-11. [DOI: 10.1016/j.cpr.2018.05.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 12/24/2022]
|
12
|
Transfusion practice patterns in patients with anemia receiving myelosuppressive chemotherapy for nonmyeloid cancer: results from a prospective observational study. Support Care Cancer 2018; 26:2031-2038. [PMID: 29349622 PMCID: PMC5919983 DOI: 10.1007/s00520-017-4035-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/28/2017] [Indexed: 01/28/2023]
Abstract
Purpose The decision to prescribe packed red blood cell (PRBC) transfusions in patients with chemotherapy-induced anemia (CIA) includes assessment of clinical features such as the patient’s cancer type and treatment regimen, severity of anemia symptoms, and presence of comorbidities. We examined contemporary transfusion practices in patients with nonmyeloid cancer and CIA. Methods Key inclusion criteria were age ≥ 18 years with nonmyeloid cancer, receiving first/second-line myelosuppressive chemotherapy, baseline hemoglobin (Hb) ≤ 10.0 g/dL, and planned to receive ≥ 1 PRBC transfusions. Exclusion criteria were receipt of erythropoiesis-stimulating agents within 8 weeks of screening and/or chronic renal insufficiency. Data were collected from patients’ medical records, laboratory values, and physician/provider questionnaires. Proportion of patients for each clinical consideration leading to a decision to prescribe a PRBC transfusion and 95% exact binomial confidence intervals were determined. Results The study enrolled 154 patients at 18 sites in USA; 147 (95.5%) received a PRBC transfusion. Fatigue was the most common symptom affecting the decision to prescribe a PRBC transfusion (101 [69.2%] patients). Of the three reasons selected as primary considerations for prescribing a PRBC transfusion, anemia symptoms (106 [72.1%] patients) was the most frequently reported, followed by Hb value (37 [25.2%] patients) and medical history (4 [2.7%] patients). Conclusions In this study, the primary consideration for prescribing a PRBC transfusion was anemia symptoms in 72.1% of patients, with only 25.2% of patients prescribed a transfusion based exclusively on Hb value. Results indicate that clinical judgment and patient symptoms, not just Hb value, were used in decisions to prescribe PRBC transfusions. Electronic supplementary material The online version of this article (10.1007/s00520-017-4035-7) contains supplementary material, which is available to authorized users.
Collapse
|
13
|
Whisenant M, Wong B, Mitchell SA, Beck SL, Mooney K. Distinct Trajectories of Fatigue and Sleep Disturbance in Women Receiving Chemotherapy for Breast Cancer. Oncol Nurs Forum 2017; 44:739-750. [PMID: 29052653 PMCID: PMC5856248 DOI: 10.1188/17.onf.739-750] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE/OBJECTIVES To examine self-reported severity of fatigue and disturbed sleep experienced daily by women with breast cancer during multiple cycles of chemotherapy, exploring potential classes of women experiencing similar symptom trajectories.
. DESIGN In a secondary analysis, classes of women experiencing similar patterns of fatigue and disturbed sleep were identified.
. SETTING Oncology clinics in the United States.
. SAMPLE 166 women with breast cancer receiving chemotherapy.
. METHODS Severity scores were self-reported daily using an automated system. Classes of fatigue and disturbed sleep severity were identified using latent growth mixture modeling.
. MAIN RESEARCH VARIABLES Fatigue, disturbed sleep, age, stage of disease, education, employment, marital status, chemotherapy regimen, hours lying down, and missed work.
. FINDINGS Three fatigue classes were identified. CONCLUSIONS Patterns of symptom trajectories for fatigue and disturbed sleep were distinguished by baseline symptom severity.
. IMPLICATIONS FOR NURSING Identification of women at risk for fatigue and disturbed sleep may allow clinicians to intensify symptom management.
Collapse
|
14
|
Protective Effect of a Polyherbal Aqueous Extract Comprised of Nigella sativa (Seeds), Hemidesmus indicus (Roots), and Smilax glabra (Rhizome) on Bleomycin Induced Cytogenetic Damage in Human Lymphocytes. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28626752 PMCID: PMC5463188 DOI: 10.1155/2017/1856713] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was carried out to determine the chemoprotective potential of a polyherbal aqueous decoction comprised of Nigella sativa (seeds), Hemidesmus indicus (roots), and Smilax glabra (rhizome) against bleomycin induced cytogenetic damage in human lymphocytes. Isolated peripheral blood lymphocytes (PBLs) were exposed to bleomycin at a dose of 40 µg/mL for 2 hrs in the presence or absence of different doses of the decoction (100, 300, and 600 µg/mL). Modulatory effect of the decoction on bleomycin induced cytogenetic damage was evaluated by (a) degree of chromosomal aberrations (CA), (b) formation of micronuclei (MN), and (c) induction of γH2AX foci in lymphocytes exposed to bleomycin. Lymphocytes pretreated with the decoction showed that a significant reduction (p < 0.05) in bleomycin induced (a) stable and unstable chromosome aberrations (CA), (b) MN formation, and (c) formation of γH2AX foci, when compared to lymphocytes treated only with bleomycin. The decoction by itself did not induce any significant cytogenetic damage in PBLs. Overall results of the present study confirm that the decoction can attenuate the cytogenetic damage mediated by bleomycin in human PBLs.
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Concerns about Breast Cancer, Pain, and Fatigue in Non-Metastatic Breast Cancer Patients Undergoing Primary Treatment. Healthcare (Basel) 2016; 4:healthcare4030062. [PMID: 27571115 PMCID: PMC5041063 DOI: 10.3390/healthcare4030062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 01/21/2023] Open
Abstract
Women diagnosed with breast cancer often endorse psychosocial concerns prior to treatment, which may influence symptom experiences. Among these, low perceived social support relates to elevated fatigue. Those with low social support perceptions may also experience a greater sense of rejection. We sought to determine if social rejection concerns post-surgery predict fatigue interference 12 months later in women with non-metastatic breast cancer. Depressive symptoms and pain severity after completion of adjuvant therapy (six months post-surgery) were examined as potential mediators. Women (N = 240) with non-metastatic breast cancer were recruited 2–10 weeks post-surgery. Multiple regression analyses examined relationships among variables adjusting for relevant covariates. Greater rejection concerns at study entry predicted greater fatigue interference 12 months later (p < 0.01). Pain severity after adjuvant therapy partially mediated the relationship between social rejection concerns and fatigue interference, with significant indirect (β = 0.06, 95% CI (0.009, 0.176)) and direct effects (β = 0.18, SE = 0.07, t(146) = 2.78, p < 0.01, 95% CI (0.053, 0.311)). Therefore, pain levels post-treatment may affect how concerns of social rejection relate to subsequent fatigue interference. Interventions targeting fears of social rejection and interpersonal skills early in treatment may reduce physical symptom burden during treatment and into survivorship.
Collapse
|
17
|
Roe K, Visovatti MK, Brooks T, Baydoun M, Clark P, Barton DL. Use of complementary therapies for side effect management in breast cancer: evidence and rationale. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt-2016-0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Women diagnosed with breast cancer can experience chronic side effects after curative treatment concludes, negatively impacting survivorship. The most prevalent side effects addressed in the medical and nursing literature include symptoms such as hot flashes, fatigue, myalgias/arthralgias and cognitive impairment. Complementary therapies, particularly natural products including herbs, dietary supplements, vitamins, minerals, and probiotics, and mind–body techniques that include such modalities as yoga, meditation, massage, acupuncture, relaxation, tai chi and hypnosis show promise for treatment of some of these symptoms associated with cancer care. However, the research in this area is nascent and much more work is needed to understand symptom physiology and mechanisms of action of complementary therapies. The purpose of this paper was to summarize key evidence from Phase II and III randomized clinical trials in order to provide guidance to distinguish promising versus nonpromising interventions for symptom management.
Collapse
Affiliation(s)
- Kelly Roe
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Trevor Brooks
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mohamad Baydoun
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Patricia Clark
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Debra L Barton
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| |
Collapse
|
18
|
Abrahams H, Gielissen M, Schmits I, Verhagen C, Rovers M, Knoop H. Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Ann Oncol 2016; 27:965-974. [DOI: 10.1093/annonc/mdw099] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
|
19
|
Prinsen H, van Laarhoven HWM, Pots JM, Duiveman-de Boer T, Mulder SF, van Herpen CML, Jacobs JFM, Leer JWH, Bleijenberg G, Stelma FF, Torensma R, de Vries IJM. Humoral and cellular immune responses after influenza vaccination in patients with postcancer fatigue. Hum Vaccin Immunother 2016; 11:1634-40. [PMID: 25996472 PMCID: PMC4514289 DOI: 10.1080/21645515.2015.1040207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to compare humoral and cellular immune responses to influenza vaccination in cancer survivors with and without severe symptoms of fatigue. Severely fatigued (n = 15) and non-fatigued (n = 12) disease-free cancer survivors were vaccinated against seasonal influenza. Humoral immunity was evaluated at baseline and post-vaccination by a hemagglutination inhibition assay. Cellular immunity was evaluated at baseline and post-vaccination by lymphocyte proliferation and activation assays. Regulatory T cells were measured at baseline by flow cytometry and heat-shock protein 90 alpha levels by ELISA. Comparable humoral immune responses were observed in fatigued and non-fatigued patients, both pre- and post-vaccination. At baseline, fatigued patients showed a significantly diminished cellular proliferation upon virus stimulation with strain H3N2 (1414 ± 1201 counts), and a trend in a similar direction with strain H1N1 (3025 ± 2339 counts), compared to non-fatigued patients (3099 ± 2401 and 5877 ± 4604 counts, respectively). The percentage of regulatory T lymphocytes was significantly increased (4.4 ± 2.1% versus 2.4 ± 0.8%) and significantly lower amounts of interleukin 2 were detected prior to vaccination in fatigued compared to non-fatigued patients (36.3 ± 44.3 pg/ml vs. 94.0 ± 45.4 pg/ml with strain H3N2 and 28.4 ± 44.0 pg/ml versus 74.5 ± 56.1 pg/ml with strain H1N1). Pre-vaccination heat-shock protein 90 alpha concentrations, post-vaccination cellular proliferation, and post-vaccination cytokine concentrations did not differ between both groups. In conclusion, influenza vaccination is favorable for severely fatigued cancer survivors and should be recommended when indicated. However, compared to non-fatigued cancer survivors, fatigued cancer survivors showed several significant differences in immunological reactivity at baseline, which warrants further investigation.
Collapse
Key Words
- CBT, cognitive behavior therapy
- CIS-fatigue, Checklist Individual Strength fatigue subscale
- HI, hemagglutination-inhibition
- HSP90α, human heat shock protein 90 alpha
- IFN- γ, interferon gamma
- IL-10, interleukin 10
- IL-2, interleukin 2
- IL-4, interleukin 4
- IL-5, interleukin 5
- PBMC, peripheral blood mononuclear cells
- PHA, phytohemagglutinin
- Radboudumc, Radboud University Medical Center
- Treg, regulatory T lymphocytes
- cancer
- fatigue
- immunity
- influenza
- vaccination
Collapse
Affiliation(s)
- Hetty Prinsen
- a Department of Medical Oncology; Radboud University Medical Center ; Nijmegen , the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Xu H, Xu L, Page JH, Cannavale K, Sattayapiwat O, Rodriguez R, Chao C. Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013. Clin Epidemiol 2016; 8:61-71. [PMID: 27186078 PMCID: PMC4847604 DOI: 10.2147/clep.s89480] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to evaluate and characterize the risk of anemia during the course of chemotherapy among patients with five common types of solid tumors. Patients and methods Patients diagnosed with incident cancers of breast, lung, colon/rectum, stomach, and ovary who received chemotherapy were identified from Kaiser Permanente Southern California Health Plan (2010–2012). All clinical data were collected from the health plan’s electronic medical records. Incidence proportions of patients developing anemia and 95% confidence intervals were calculated overall and by anemia severity and type, as well as by stage at cancer diagnosis, and by chemotherapy regimen and cycle. Results A total of 4,426 patients who received chemotherapy were included. Across cancers, 3,962 (89.5%) patients developed anemia during the course of chemotherapy (normocytic 85%, macrocytic 10%, microcytic 5%; normochromic 47%, hyperchromic 44%, hypochromic 9%). The anemia grades were distributed as follows: 58% were grade 1, 34% grade 2, 8% grade 3, and <1% grade 4. The incidence of grade 2+ anemia ranged from 26.3% in colorectal cancer patients to 59.2% in ovarian cancer patients. Incidence of grade 2+ anemia increased from 29% in stage I to 49% in stage IV. Incidence of grade 2+ anemia varied from 18.2% in breast cancer patients treated with cyclophosphamide + docetaxel regimen to 59.7% in patients with ovarian cancer receiving carboplatin + paclitaxel regimen. Conclusion The incidence of moderate-to-severe anemia (hemoglobin <10 g/dL) remained considerably high in patients with solid tumors receiving chemotherapy. The risk of anemia was greater in patients with distant metastasis.
Collapse
Affiliation(s)
- Hairong Xu
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Lanfang Xu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John H Page
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Kim Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Olivia Sattayapiwat
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Roberto Rodriguez
- Department of Hematology Oncology, Los Angeles Medical Center, Kaiser Permanente Southern California, Psadena, CA, USA
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| |
Collapse
|
21
|
Xu L, Xu H, Cannavale K, Sattayapiwat O, Rodriguez R, Page JH, Chao C. Trends in anemia treatment among patients with five non-myeloid malignancies treated with chemotherapy in a large integrated health care delivery system in California, 2000–2013. Support Care Cancer 2016; 24:2989-98. [DOI: 10.1007/s00520-016-3078-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/03/2016] [Indexed: 11/30/2022]
|
22
|
Han CJ, Yang GS. Fatigue in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis of Pooled Frequency and Severity of Fatigue. Asian Nurs Res (Korean Soc Nurs Sci) 2016; 10:1-10. [PMID: 27021828 DOI: 10.1016/j.anr.2016.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 12/11/2015] [Accepted: 01/06/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Fatigue is the third most common "extraintestinal" complaint of patients with irritable bowel syndrome (IBS), but it is still poorly understood. This study aimed to review characteristics of IBS-associated fatigue and to examine pooled frequency, severity of fatigue, and correlations of related factors with fatigue in IBS via meta-analyses. METHODS Publications were searched in eight databases from 1995 to 2014. Random effects meta-analyses were applied with standard error, weighted effect size, and correlation-based measure of effect size. RESULTS Twenty-four studies were included in systematic review. Seventeen studies were used for meta-analyses (2 studies were excluded in the frequency of fatigue analysis due to data unavailability). Using "tiredness" to define fatigue, and Fatigue Impact Scale to assess fatigue were the most frequently used across the studies. Gastrointestinal symptoms, psychological distress, and health-related quality of life were the most common correlates with fatigue. The pooled frequency of fatigue was 54.2% [95% confidence interval (38.5, 69.4)]. Metaregression on the frequency of fatigue showed positive and significant relations with tertiary care settings, female sex, and younger age. There was a negatively moderate relationship between the severity of fatigue and health-related quality of life score (correlation-based measure of effect size: -.378). CONCLUSIONS Fatigue is prevalent among patients with IBS and commonly co-occurs with other symptoms. This is the first study to fully examine fatigue in IBS, which shed light on the comprehensive management of fatigue in this patient group. Future research is warranted to further explore fatigue-related factors and underlying mechanisms of fatigue in IBS.
Collapse
Affiliation(s)
- Claire Jungyoun Han
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, USA.
| | - Gee Su Yang
- Department of Pain and Symptom Translational Science, School of Nursing, University of Maryland, College Park, USA
| |
Collapse
|
23
|
Bellin MH, Oktay J, Scarvalone S, Appling S, Helzlsouer K. A Qualitative Description of a Family Intervention for Breast Cancer Survivors Experiencing Fatigue. J Psychosoc Oncol 2015; 33:395-413. [PMID: 25996056 DOI: 10.1080/07347332.2015.1046010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Breast cancer survivors commonly experience fatigue, but family-focused interventions as a means to reduce fatigue are understudied. This qualitative study explored the experience of adding a family component to a multimodal group intervention for fatigue. Data were collected from group observations, in-depth interviews, and debriefing sessions with the program social worker. Fourteen survivors completed the family intervention (mean age 57 years) with a family member or close friend. Four themes associated with the family intervention were identified: (a) importance of family inclusion, (b) education of family members about fatigue,
Collapse
Affiliation(s)
- Melissa H Bellin
- a University of Maryland School of Social Work , Baltimore , MD , USA
| | | | | | | | | |
Collapse
|
24
|
|
25
|
Wagland R, Richardson A, Armes J, Hankins M, Lennan E, Griffiths P. Treatment-related problems experienced by cancer patients undergoing chemotherapy: a scoping review. Eur J Cancer Care (Engl) 2014; 24:605-17. [DOI: 10.1111/ecc.12246] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- R. Wagland
- Faculty of Health Sciences, Highfield; University of Southampton; Southampton UK
| | - A. Richardson
- Faculty of Health Science, Southampton General Hospital; University of Southampton & University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - J. Armes
- Florence Nightingale School of Nursing & Midwifery King's College London; London UK
| | - M. Hankins
- Centre for Innovation and Leadership in Health Sciences, Faculty of Health Sciences; University of Southampton; Southampton UK
| | - E. Lennan
- University Hospital Southampton; Southampton UK
| | - P. Griffiths
- Centre for Innovation and Leadership in Health Sciences, Faculty of Health Sciences, Highfield; University of Southampton; Southampton UK
| |
Collapse
|
26
|
Xu H, Kaye JA, Saltus CW, Crawford J, Gasal E, Goodnough LT. Blood utilization and hemoglobin levels in cancer patients after label and coverage changes for erythropoiesis-stimulating agents. Expert Rev Hematol 2014; 7:617-33. [DOI: 10.1586/17474086.2014.943730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
27
|
Schmidt ME, Chang-Claude J, Seibold P, Vrieling A, Heinz J, Flesch-Janys D, Steindorf K. Determinants of long-term fatigue in breast cancer survivors: results of a prospective patient cohort study. Psychooncology 2014; 24:40-6. [DOI: 10.1002/pon.3581] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/03/2014] [Accepted: 04/29/2014] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | - Alina Vrieling
- German Cancer Research Center; Heidelberg Germany
- Radboud University Medical Center; Nijmegen The Netherlands
| | - Judith Heinz
- Radboud University Medical Center; Nijmegen The Netherlands
| | - Dieter Flesch-Janys
- Center for Experimental Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | | |
Collapse
|
28
|
Kenyon M, Mayer DK, Owens AK. Late and Long‐Term Effects of Breast Cancer Treatment and Surveillance Management for the General Practitioner. J Obstet Gynecol Neonatal Nurs 2014; 43:382-98. [DOI: 10.1111/1552-6909.12300] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
29
|
Fisch MJ, Zhao F, O'Mara AM, Wang XS, Cella D, Cleeland CS. Predictors of significant worsening of patient-reported fatigue over a 1-month timeframe in ambulatory patients with common solid tumors. Cancer 2014; 120:442-50. [PMID: 24151111 PMCID: PMC4134680 DOI: 10.1002/cncr.28437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/28/2013] [Accepted: 09/10/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Understanding the determinants of fatigue worsening may help distinguish between different fatigue phenotypes and inform clinical trial designs. METHODS Patients with invasive cancer of the breast, prostate, colon/rectum, or lung were enrolled from multiple sites. At enrollment during an outpatient visit and 4 or 5 weeks later, patients rated their symptoms on a numerical rating scale from zero to 10. A 2-point change on that scale was considered clinically significant for a change in fatigue. Effects of demographic and clinical factors on patient-reported fatigue were examined using logistic regression models. RESULTS In total, 3123 patients were enrolled at baseline, and 3032 patients could be analyzed for fatigue change. At baseline, 23% of patients had no fatigue, 35% had mild fatigue, 25% had moderate fatigue, and 17% had severe fatigue. Key parameters in a model of fatigue worsening included fatigue at baseline (odds ratio [OR], 0.75), disease status (OR, 1.99), performance status (OR, 1.38), history of depression (OR, 1.28), patient perception of bother because of comorbidity (OR, 1.26), and treatment exposures, including recent cancer treatment (OR, 1.77) and receipt of corticosteroids (OR, 1.37). The impact of sex was examined only in patients with colorectal and lung cancer, and it was a significant factor, with men most likely to experience worsening of fatigue (OR, 1.46). CONCLUSIONS Predictors of fatigue worsening included multiple factors that were difficult to modify, including the baseline fatigue level, sex, disease status, performance status, recent cancer treatment, bother because of comorbidity, and history of depression. Future fatigue prevention and treatment trial designs should account for key predictors of worsening fatigue.
Collapse
Affiliation(s)
- Michael J. Fisch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fengmin Zhao
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Xin Shelley Wang
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | |
Collapse
|
30
|
Prinsen H, Heerschap A, Bleijenberg G, Zwarts MJ, Leer JWH, van Asten JJ, van der Graaf M, Rijpkema M, van Laarhoven HWM. Magnetic resonance spectroscopic imaging and volumetric measurements of the brain in patients with postcancer fatigue: a randomized controlled trial. PLoS One 2013; 8:e74638. [PMID: 24040301 PMCID: PMC3770709 DOI: 10.1371/journal.pone.0074638] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 08/05/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Postcancer fatigue is a frequently occurring problem, impairing quality of life. Until now, little is known about (neuro) physiological factors determining postcancer fatigue. For non-cancer patients with chronic fatigue syndrome, certain characteristics of brain morphology and metabolism have been identified in previous studies. We investigated whether these volumetric and metabolic traits are a reflection of fatigue in general and thus also of importance for postcancer fatigue. METHODS Fatigued patients were randomly assigned to either the intervention condition (cognitive behavior therapy) or the waiting list condition. Twenty-five patients in the intervention condition and fourteen patients in the waiting list condition were assessed twice, at baseline and six months later. Baseline measurements of 20 fatigued patients were compared with 20 matched non-fatigued controls. All participants had completed treatment of a malignant, solid tumor minimal one year earlier. Global brain volumes, subcortical brain volumes, metabolite tissue concentrations, and metabolite ratios were primary outcome measures. RESULTS Volumetric and metabolic parameters were not significantly different between fatigued and non-fatigued patients. Change scores of volumetric and metabolic parameters from baseline to follow-up were not significantly different between patients in the therapy and the waiting list group. Patients in the therapy group reported a significant larger decrease in fatigue scores than patients in the waiting list group. CONCLUSIONS No relation was found between postcancer fatigue and the studied volumetric and metabolic markers. This may suggest that, although postcancer fatigue and chronic fatigue syndrome show strong resemblances as a clinical syndrome, the underlying physiology is different. TRIAL REGISTRATION ClinicalTrials.gov NCT01096641.
Collapse
Affiliation(s)
- Hetty Prinsen
- Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands
- * E-mail:
| | - Arend Heerschap
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - Gijs Bleijenberg
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, Noord-Brabant, The Netherlands
| | | | - Jan Willem H. Leer
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - Jack J. van Asten
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - Marinette van der Graaf
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands
- Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - Mark Rijpkema
- Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| |
Collapse
|
31
|
A Comparative Study of Symptoms and Quality of Life Among Patients With Breast Cancer Receiving Target, Chemotherapy, or Combined Therapy. Cancer Nurs 2013; 36:317-25. [DOI: 10.1097/ncc.0b013e318268f86d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Eickmeyer SM, Gamble GL, Shahpar S, Do KD. The role and efficacy of exercise in persons with cancer. PM R 2013; 4:874-81. [PMID: 23174553 DOI: 10.1016/j.pmrj.2012.09.588] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 12/25/2022]
Abstract
Improvements in cancer screening, diagnosis, and treatment have resulted in an increasing population of cancer survivors with impairments in physical function, cancer-related symptoms, and reduced quality of life. Exercise and physical activity have therapeutic value at multiple points along the cancer disease continuum, spanning disease prevention, treatment, survivorship, prognostic outcomes, and end-of-life issues. Molecular mechanisms for the influence of exercise in persons with cancer include altering tumor initiation pathways and affecting hormonal, inflammatory, immune, and insulin pathways. Physical activity has been found to play a role in the prevention of certain malignancies, including breast, colon, and other cancers. An increasing amount of evidence indicates that physical activity may affect prognostic outcomes in certain cancer diagnoses, especially breast cancer. Structured exercise and physical activity interventions can be helpful in addressing specific survivorship issues, including overall quality of life, cardiorespiratory impairment, cancer-related fatigue, and lymphedema. Exercise also may be helpful during the palliative care phase to alleviate symptoms and increase physical well-being. This article will familiarize physiatrists with the current state of evidence regarding the role and efficacy of exercise in persons with cancer.
Collapse
Affiliation(s)
- Sarah M Eickmeyer
- Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA.
| | | | | | | |
Collapse
|
33
|
The role of physical activity and physical fitness in postcancer fatigue: a randomized controlled trial. Support Care Cancer 2013; 21:2279-88. [DOI: 10.1007/s00520-013-1784-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 03/04/2013] [Indexed: 11/26/2022]
|
34
|
Goedendorp MM, Gielissen MFM, Verhagen CAHHVM, Bleijenberg G. Development of fatigue in cancer survivors: a prospective follow-up study from diagnosis into the year after treatment. J Pain Symptom Manage 2013; 45:213-22. [PMID: 22926087 DOI: 10.1016/j.jpainsymman.2012.02.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/02/2012] [Accepted: 02/14/2012] [Indexed: 11/18/2022]
Abstract
CONTEXT There is a lack of longitudinal studies investigating fatigue from before cancer treatment to long after successful cancer treatment. OBJECTIVES This prospective follow-up study aimed to determine the prevalence and predictors of persistent fatigue in cancer survivors in the first year after completion of cancer treatment. METHODS Sixty patients with various malignancies were assessed before (T1), shortly after curative cancer treatment (T2), and one year after T2 (T3). Fatigue was assessed monthly between T2 and T3. Fatigue severity was measured using the subscale of the Checklist Individual Strength. Questionnaires were used to measure impaired sleep and rest, physical activity, social support, fatigue catastrophizing, and somatic-related attributions regarding fatigue. Linear regression analyses were performed to identify predictors of persistent fatigue. RESULTS In total, 22% of survivors had severe persistent fatigue over the last six months in the first year after cancer treatment. Fatigue at T1, T2, and negative interactions predicted the severity of persistent fatigue. Analyses without fatigue showed that more negative interactions, impaired sleep and rest, fatigue catastrophizing, and lower self-reported physical activity at T2 were associated with the severity of persistent fatigue. CONCLUSION Twenty-two percent of the survivors had severe persistent fatigue in the year after cancer treatment. Fatigue and cognitive behavioral factors predicted persistent fatigue in the year after cancer treatment. Diagnosis or cancer treatment did not predict persistent fatigue. The implication is that cognitive behavioral therapy for postcancer fatigue, aimed at the fatigue-perpetuating factors, could be offered from two months after successful cancer treatment.
Collapse
Affiliation(s)
- Martine M Goedendorp
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | | | | |
Collapse
|
35
|
Liu L, Rissling M, Neikrug A, Fiorentino L, Natarajan L, Faierman M, Sadler GR, Dimsdale JE, Mills PJ, Parker BA, Ancoli-Israel S. Fatigue and Circadian Activity Rhythms in Breast Cancer Patients Before and After Chemotherapy: A Controlled Study. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2013; 1:12-26. [PMID: 23412418 DOI: 10.1080/21641846.2012.741782] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND: Breast cancer (BC) patients often experience cancer-related fatigue (CRF) before, during, and after their chemotherapy. Circadian rhythms are 24-hour cycles of behavior and physiology that are generated by internal pacemakers and entrained by zeitgebers (e.g., light). A few studies have suggested a relationship between fatigue and circadian rhythms in some clinical populations. METHODS: One hundred and forty-eight women diagnosed with stage I-III breast cancer and scheduled to receive at least four cycles of adjuvant or neoadjuvant chemotherapy, and 61 controls (cancer-free healthy women) participated in this study. Data were collected before (Baseline) and after four cycles of chemotherapy (Cycle-4). Fatigue was assessed with the Short Form of Multidimensional Fatigue Symptom Inventory (MFSI-SF); circadian activity rhythm (CAR) was recorded with wrist actigraphy (six parameters included: amplitude, acrophase, mesor, up-mesor, down-mesor and F-statistic). A mixed model analysis was used to examine changes in fatigue and CAR parameters compared to controls, and to examine the longitudinal relationship between fatigue and CAR parameters in BC patients. RESULTS: More severe CRF (total and subscale scores) and disrupted CAR (amplitude, mesor and F-statistic) were observed in BC patients compared to controls at both Baseline and Cycle-4 (all p's<0.05); BC patients also experienced more fatigue and decreased amplitude and mesor, as well as delayed up-mesor time at Cycle-4 compared to Baseline (all p's<0.05). The increased total MFSI-SF scores were significantly associated with decreased amplitude, mesor and F-statistic (all p's<0.006). CONCLUSION: CRF exists and CAR is disrupted even before the start of chemotherapy. The significant relationship between CRF and CAR indicate possible underlying connections. Re-entraining the disturbed CAR using effective interventions such as bright light therapy might also improve CRF.
Collapse
Affiliation(s)
- Lianqi Liu
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Samuels N, Maimon Y, Zisk-Rony RY. Effect of the Botanical Compound LCS101 on Chemotherapy-Induced Symptoms in Patients with Breast Cancer: A Case Series Report. INTEGRATIVE MEDICINE INSIGHTS 2013; 8:1-8. [PMID: 23400272 PMCID: PMC3562080 DOI: 10.4137/imi.s10841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The treatment of breast cancer invariably results in severe and often debilitating symptoms that can cause significant distress and severely impair daily function and quality-of-life (QOL). We treated a series of 20 female breast cancer patients with the botanical compound LCS101 as adjuvant to conventional chemotherapy. At the end of the treatment regimen, patients rated their symptoms. 70% reported that they had either no or mildly severe levels of fatigue; 60% none to mildly severe weakness; 85% none to mildly severe pain; 70% none to mildly severe nausea; and 80% none to mildly severe vomiting. Only 20% reported severe impairment of overall function, and only 40% severely impaired QOL. No toxic effects were attributed by patients to the LCS101 treatment, and 85% reported that they believed the botanical compound had helped reduce symptoms. The effects of LCS101 on clinical outcomes in breast cancer should be tested further using randomized controlled trials.
Collapse
Affiliation(s)
- Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | |
Collapse
|
37
|
Kwekkeboom KL, Abbott-Anderson K, Cherwin C, Roiland R, Serlin RC, Ward SE. Pilot randomized controlled trial of a patient-controlled cognitive-behavioral intervention for the pain, fatigue, and sleep disturbance symptom cluster in cancer. J Pain Symptom Manage 2012; 44:810-22. [PMID: 22771125 PMCID: PMC3484234 DOI: 10.1016/j.jpainsymman.2011.12.281] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/29/2011] [Accepted: 12/01/2011] [Indexed: 11/21/2022]
Abstract
CONTEXT Pain, fatigue, and sleep disturbance commonly co-occur in patients receiving treatment for advanced cancer. OBJECTIVES A pilot randomized controlled trial was conducted to assess initial efficacy of a patient-controlled cognitive-behavioral (CB) intervention for the pain, fatigue, and sleep disturbance symptom cluster. METHODS Eighty-six patients with advanced lung, prostate, colorectal, or gynecologic cancers receiving treatment at a comprehensive cancer center were stratified by recruitment clinics (chemotherapy and radiation therapy) and randomized to intervention or control groups. Forty-three patients were assigned to receive training in and use of up to 12 relaxation, imagery, or distraction exercises delivered via an MP3 player for two weeks during cancer treatment. Forty-three patients were assigned to a waitlist control condition for the same two week period. Outcomes included symptom cluster severity and overall symptom interference with daily life measured at baseline (Time 1) and two weeks later (Time 2). RESULTS Eight participants dropped out; 78 completed the study and were analyzed (36 intervention and 42 control subjects). Participants used the CB strategies an average of 13.65 times (SD=6.98). Controlling for baseline symptom cluster severity and other relevant covariates, it was found that the symptom cluster severity at Time 2 was lower in the intervention group (M(Adj)=2.99, SE=0.29) than in the waitlist group (M(Adj)=3.87, SE=0.36), F(1, 65)=3.57, P=0.032. Symptom interference with daily life did not differ between groups. No significant adverse events were noted with the CB intervention. CONCLUSION Findings suggest that the CB intervention may be an efficacious approach to treating the pain, fatigue, and sleep disturbance symptom cluster. Future research is planned to confirm efficacy and test mediators and moderators of intervention effects.
Collapse
|
38
|
Cameron BA, Bennett B, Li H, Boyle F, deSouza P, Wilcken N, Friedlander M, Goldstein D, Lloyd AR. Post-cancer fatigue is not associated with immune activation or altered cytokine production. Ann Oncol 2012; 23:2890-2895. [PMID: 22674147 DOI: 10.1093/annonc/mds108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Prolonged fatigue after cancer treatment is common. The pathophysiology of such post-cancer fatigue (PCF) is unknown, although cross-sectional studies suggest increased pro-inflammatory cytokine production. This study investigated the association between cytokine levels and fatigue from the time of treatment to 12 months later. PATIENTS AND METHODS A representative nested case-control series was derived from a prospective cohort of women treated for early-stage breast cancer, including 13 PCF cases and 15 matched control subjects who recovered uneventfully. Serum levels and in vitro production of the cytokines interleukin (IL)-1α, IL-2, interferon (IFN)-γ, IL-4, IL-6, IL-10, IL-12, and tumour necrosis factor (TNF)-β were measured by multiplex immunoassay in longitudinally collected samples. In addition, serum levels of neopterin and the anti-inflammatory regulators, IL-1 receptor antagonist, sIL-6R, and sTNF-rII, were assayed by enzyme-linked immunosorbent assay. Flow cytometric analysis of activated leukocyte subsets was performed. RESULTS No significant differences in any of these parameters were found between cases and control subjects. Cytokine levels and symptoms showed no clear correlation pattern. CONCLUSION The findings in this well-characterised subject group argue against the notion that PCF is mediated by peripheral inflammation.
Collapse
Affiliation(s)
- B A Cameron
- Infection and Inflammation Research Centre, School of Medical Sciences, University of New South Wales, Sydney.
| | - B Bennett
- Infection and Inflammation Research Centre, School of Medical Sciences, University of New South Wales, Sydney; Prince of Wales Clinical School, University of NSW, Sydney
| | - H Li
- Infection and Inflammation Research Centre, School of Medical Sciences, University of New South Wales, Sydney
| | - F Boyle
- Patricia Ritchie Centre, The Mater Hospital, Sydney
| | - P deSouza
- Cancer Care Centre, St George Hospital, Sydney
| | - N Wilcken
- Westmead and Nepean Hospitals, Sydney, Australia
| | - M Friedlander
- Prince of Wales Clinical School, University of NSW, Sydney
| | - D Goldstein
- Prince of Wales Clinical School, University of NSW, Sydney
| | - A R Lloyd
- Infection and Inflammation Research Centre, School of Medical Sciences, University of New South Wales, Sydney
| |
Collapse
|
39
|
Appling SE, Scarvalone S, MacDonald R, McBeth M, Helzlsouer KJ. Fatigue in breast cancer survivors: the impact of a mind-body medicine intervention. Oncol Nurs Forum 2012; 39:278-86. [PMID: 22543386 DOI: 10.1188/12.onf.278-286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate a mind-body medicine (MBM) program for its impact on persistent fatigue following breast cancer treatment. DESIGN Quasiexperimental. SETTING An urban community hospital and a health department in a semirural county, both in Maryland. SAMPLE 68 breast cancer survivors who were at least six months postadjuvant chemotherapy and/or radiation therapy and had a baseline fatigue score of 50 or lower per the vitality subscale of the SF-36® Health Survey. METHODS A 10-week group-based MBM program for breast cancer survivors with persistent fatigue was evaluated using a pretest/post-test study design. MAIN RESEARCH VARIABLES Sustained change in fatigue severity as measured by the Piper Fatigue Scale (PFS), SF-36 vitality subscale, and 10 cm visual analog scale (VAS). FINDINGS Participants were 2.6 years post-treatment, with a mean age of 56.8 years. Overall, fatigue scores improved by 40%. The mean PFS improved from a score of 6 (SD = 1.6) at baseline to 4.2 (SD = 2) at the end of the program (p < 0.001), with additional improvement at two months and sustained at six months (X = 3.6, SD = 2, p < 0.001). Results from the SF-36 and VAS also showed significant improvement in fatigue (p < 0.001). CONCLUSIONS The findings support the use of a holistic MBM intervention to reduce persistent fatigue in breast cancer survivors. Results should be confirmed with a randomized clinical trial. IMPLICATIONS FOR NURSING Nurses and other healthcare team members can effectively impact persistent fatigue in breast cancer survivors through the use of a multipronged MBM program.
Collapse
|
40
|
Incidence and risk factors of anemia in patients with early breast cancer treated by adjuvant chemotherapy. Breast 2012; 21:464-7. [DOI: 10.1016/j.breast.2011.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 10/25/2011] [Accepted: 10/31/2011] [Indexed: 01/24/2023] Open
|
41
|
Prinsen H, Hopman MTE, Zwarts MJ, Leer JWH, Heerschap A, Bleijenberg G, van Laarhoven HWM. Maximal exercise performance in patients with postcancer fatigue. Support Care Cancer 2012; 21:439-47. [DOI: 10.1007/s00520-012-1531-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 06/20/2012] [Indexed: 11/27/2022]
|
42
|
Prinsen H, Bleijenberg G, Zwarts MJ, Hopman MTE, Heerschap A, van Laarhoven HWM. Physiological and neurophysiological determinants of postcancer fatigue: design of a randomized controlled trial. BMC Cancer 2012; 12:256. [PMID: 22708881 PMCID: PMC3418177 DOI: 10.1186/1471-2407-12-256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 06/18/2012] [Indexed: 01/04/2023] Open
Abstract
Background Postcancer fatigue is a frequently occurring, severe, and invalidating problem, impairing quality of life. Although it is possible to effectively treat postcancer fatigue with cognitive behaviour therapy, the nature of the underlying (neuro)physiology of postcancer fatigue remains unclear. Physiological aspects of fatigue include peripheral fatigue, originating in muscle or the neuromuscular junction; central fatigue, originating in nerves, spinal cord, and brain; and physical deconditioning, resulting from a decreased cardiopulmonary function. Studies on physiological aspects of postcancer fatigue mainly concentrate on deconditioning. Peripheral and central fatigue and brain morphology and function have been studied for patients with fatigue in the context of chronic fatigue syndrome and neuromuscular diseases and show several characteristic differences with healthy controls. Methods/design Fifty seven severely fatigued and 21 non-fatigued cancer survivors will be recruited from the Radboud University Nijmegen Medical Centre. Participants should have completed treatment of a malignant, solid tumour minimal one year earlier and should have no evidence of disease recurrence. Severely fatigued patients are randomly assigned to either the intervention condition (cognitive behaviour therapy) or the waiting list condition (start cognitive behaviour therapy after 6 months). All participants are assessed at baseline and the severely fatigued patients also after 6 months follow-up (at the end of cognitive behaviour therapy or waiting list). Primary outcome measures are fatigue severity, central and peripheral fatigue, brain morphology and function, and physical condition and activity. Discussion This study will be the first randomized controlled trial that characterizes (neuro)physiological factors of fatigue in disease-free cancer survivors and evaluates to which extent these factors can be influenced by cognitive behaviour therapy. The results of this study are not only essential for a theoretical understanding of this invalidating condition, but also for providing an objective biological marker for fatigue that could support the diagnosis and follow-up of treatment. Trial registration The study is registered at http://ClinicalTrials.gov (NCT01096641).
Collapse
Affiliation(s)
- Hetty Prinsen
- Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
| | | | | | | | | | | |
Collapse
|
43
|
Berger AM, Hertzog M, Geary CR, Fischer P, Farr L. Circadian rhythms, symptoms, physical functioning, and body mass index in breast cancer survivors. J Cancer Surviv 2012; 6:305-14. [PMID: 22484807 DOI: 10.1007/s11764-012-0218-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 03/13/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Research has been limited in circadian activity rhythms and their relationship with health status in early-stage breast cancer survivors. Maintaining strong circadian parameters may reduce symptoms and improve physical functioning and disease-free survival. METHODS This is a descriptive, correlational, secondary analysis of data from a randomized controlled trial collected 1 year after the first chemotherapy treatment; n = 156 cases with 7 days of wrist actigraph data of six circadian activity rhythm parameters; measures of function, fatigue, sleep, and anxiety/depression; and demographic/medical data including body mass index (BMI). RESULTS In the total sample and three BMI categories, acrophase was the only circadian parameter that reached means established in healthy adults. In the total sample, phase-delayed acrophase was associated with higher depression (r = 0.180, p = 0.025) and lower morning energy (r = -0.194, p = 0.016) and trended for higher fatigue (r = 0.153, p = 0.057). Lower morning energy was also associated with a lower circadian quotient (r = 0.158, p = 0.05). As BMI increased, weaker circadian parameters were recorded consistently. When compared with women in normal BMI categories, obese women's amplitude and 24-h autocorrelation coefficient were significantly weaker (p = 0.011-0.015). In obese women, phase-delayed acrophase was correlated with higher fatigue and anxiety and with lower morning energy and physical functioning. DISCUSSION/CONCLUSIONS Amplitude and 24-h autocorrelation parameters were significantly weaker, and phase-delayed acrophase was linked to several more intense symptoms and lower physical functioning in obese women. IMPLICATIONS FOR CANCER SURVIVORS Clinicians need to target high-risk women with phase-delayed rhythms, higher symptoms, and lower physical functioning for intervention.
Collapse
Affiliation(s)
- Ann M Berger
- College of Nursing, 985330 NE MED CENTER, Omaha, NE 68198-5330, USA.
| | | | | | | | | |
Collapse
|
44
|
Fagundes CP, Glaser R, Alfano CM, Bennett JM, Povoski SP, Lipari AM, Agnese DM, Yee LD, Carson WE, Farrar WB, Malarkey WB, Kiecolt-Glaser JK. Fatigue and herpesvirus latency in women newly diagnosed with breast cancer. Brain Behav Immun 2012; 26:394-400. [PMID: 21988771 PMCID: PMC3298030 DOI: 10.1016/j.bbi.2011.09.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/22/2011] [Accepted: 09/26/2011] [Indexed: 01/04/2023] Open
Abstract
Fatigue is a notable clinical problem in cancer survivors, and understanding its pathophysiology is important. The current study sought to determine biomarkers of fatigue that exist before cancer treatment. Relationships between the expression of latent Epstein-Barr virus (EBV) and cytomegalovirus (CMV) and fatigue were examined in 158 women newly diagnosed with breast cancer or awaiting a positive diagnostic result. Higher CMV antibody titers, but not EBV antibody titers, were associated with a greater likelihood of being fatigued. Associations between fatigue and higher CMV antibody titers remained after controlling for alcohol use, smoking, comorbidities, depressive symptoms, age, BMI, cancer stage, and sleep problems. More sleep problems and higher levels of depressive symptoms were also associated with a greater likelihood of being fatigued. CMV antibody titers, but not EBV antibody titers, were associated with higher levels of C-reactive protein (CRP), but CRP was not associated with fatigue. When the cellular immune system is compromised, reactivation of latent herpesviruses may fuel chronic inflammatory responses. Prior work has suggested that fatigue may be related to inflammation and its associated sickness behaviors; accordingly, our findings may be tapping into this same physiological substrate.
Collapse
Affiliation(s)
- Christopher P. Fagundes
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, USA,Corresponding author. Address: Institute for Behavioral Medicine Research, Ohio State University College of Medicine, 460 Medical Center Drive, Columbus, OH 43210, USA. (C.P. Fagundes)
| | - Ronald Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, USA,Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University College of Medicine, USA,Department of Internal Medicine, The Ohio State University College of Medicine, USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, USA
| | - Catherine M. Alfano
- Office of Cancer Survivorship, National Cancer Institute, National Institute of Health, USA
| | - Jeanette M. Bennett
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, USA,Division of Oral Biology, The Ohio State University College of Dentistry, USA
| | - Stephen P. Povoski
- Comprehensive Cancer Center, The Ohio State University College of Medicine, USA,Department of Surgery, The Ohio State University College of Medicine, USA
| | - Adele M. Lipari
- Department of Radiology, The Ohio State University College of Medicine, USA
| | - Doreen M. Agnese
- Comprehensive Cancer Center, The Ohio State University College of Medicine, USA,Department of Surgery, The Ohio State University College of Medicine, USA
| | - Lisa D. Yee
- Comprehensive Cancer Center, The Ohio State University College of Medicine, USA,Department of Surgery, The Ohio State University College of Medicine, USA
| | - William E. Carson
- Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University College of Medicine, USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, USA,Department of Surgery, The Ohio State University College of Medicine, USA
| | - William B. Farrar
- Comprehensive Cancer Center, The Ohio State University College of Medicine, USA,Department of Surgery, The Ohio State University College of Medicine, USA
| | - William B. Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, USA,Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University College of Medicine, USA,Department of Internal Medicine, The Ohio State University College of Medicine, USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, USA,Department of Psychiatry, The Ohio State University College of Medicine, USA
| | - Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, USA,Department of Psychiatry, The Ohio State University College of Medicine, USA
| |
Collapse
|
45
|
Goedendorp MM, Andrykowski MA, Donovan KA, Jim HS, Phillips KM, Small BJ, Laronga C, Jacobsen PB. Prolonged impact of chemotherapy on fatigue in breast cancer survivors: a longitudinal comparison with radiotherapy-treated breast cancer survivors and noncancer controls. Cancer 2011; 118:3833-41. [PMID: 22086766 DOI: 10.1002/cncr.26226] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/22/2011] [Accepted: 03/31/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND In this study, the authors examined the influence of prior treatment on the course of fatigue in breast cancer survivors. Patients who received chemotherapy were expected to have greater fatigue than patients who received radiotherapy and noncancer controls 6 months after the completion of treatment, but they were expected to recover to levels similar to those of the other 2 groups 3 years later. METHODS Patients with stage 0 through II breast cancer completed the Fatigue Symptom Inventory (FSI) and the Profile of Mood States Fatigue Scale (POMS-FAT) 6 months (T1) and 42 months (T2) after completing chemotherapy with or without radiotherapy (the CT group; n = 103) or radiotherapy only (the RT group; n = 102). An age-matched group of women with no history of cancer (the NC group; n = 193) was assessed over a similar interval. RESULTS A significant (P = .041) group × time effect for FSI severity scores revealed that fatigue worsened over time in the CT group but remained stable and lower in the RT and NC groups. There also were significant group effects for FSI days (P < .001) and POMS-FAT (P = .010) scores, indicating that fatigue was significantly greater across time in the CT group than in the NC group (POMS-FAT) or the RT and NC groups (FSI days). CONCLUSIONS Contrary to expectations, fatigue did not diminish over time in patients with breast cancer who received chemotherapy. This finding has important implications for patient education and for fatigue monitoring during follow-up. The authors concluded that future research should seek to examine possible mechanisms to explain the apparent prolonged impact of chemotherapy on fatigue in breast cancer survivors.
Collapse
Affiliation(s)
- Martine M Goedendorp
- Expert Center for Chronic Fatigue, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Van Lente E, Barry MM, Molcho M, Morgan K, Watson D, Harrington J, McGee H. Measuring population mental health and social well-being. Int J Public Health 2011; 57:421-30. [PMID: 22048275 DOI: 10.1007/s00038-011-0317-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 10/16/2011] [Accepted: 10/17/2011] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This paper examines the relationships between indicators of positive and negative dimensions of mental health, social well-being and physical health. METHODS The paper reports on data collected in the third National Survey of Lifestyle, Attitudes and Nutrition (SLÁN 2007), a cross-sectional survey conducted with a representative sample of 10,364 Irish adults. The survey included measures of positive mental health and non-specific psychological distress from the SF-36 questionnaire, together with measures of social well-being, subjective health, and selected health behaviours. RESULTS Positive mental health is predicted by lower levels of loneliness and higher levels of social support. Better self-rated health, positive health behaviours and lower GP consultation rates are associated with higher levels of positive mental health. Lower levels of social well-being, were found to be the strongest predictors of negative mental health. CONCLUSIONS Social well-being and health behaviours correlate with both positive and negative mental health. These findings highlight the need to endorse comprehensive approaches to population mental health promotion. The inclusion of both positive and negative mental health indicators in future population health surveys is supported by the findings.
Collapse
Affiliation(s)
- Eric Van Lente
- Health Promotion Research Centre, National University of Ireland, 16 Distillery Road, Galway, Ireland
| | | | | | | | | | | | | |
Collapse
|
47
|
Quality of life in endometrial cancer survivors: what does obesity have to do with it? Obstet Gynecol Int 2011; 2011:308609. [PMID: 22135678 PMCID: PMC3205677 DOI: 10.1155/2011/308609] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 08/01/2011] [Accepted: 09/07/2011] [Indexed: 11/18/2022] Open
Abstract
Objective. Most women with type I endometrial cancer (EC) are obese, increasing the risk of morbidity and mortality in this population. The study objective was to evaluate the impact of obesity on quality of life (QOL) and general health status in EC survivors with early-stage disease. Methods. A prospective ancillary analysis of stage I/II EC survivors. The association of BMI with QOL questionnaire variables measured with the functional assessment of cancer therapy (subscales: physical (PWB), functional (FWB), social, and emotional well-being) and the physical (PCS) and mental component summary subscales of the short-form medical outcomes survey was determined. Results. 152 women completed both questionnaires; 81% were obese. After multiple linear regression, BMI was inversely associated with PWB (P = .001), FWB (P = 0.048), and PCS (P = .001). Conclusions. Despite the good prognosis associated with early-stage EC, QOL, and physical health are not optimized in obese survivors. This paper highlights the importance of incorporating health-related QOL assessments and obesity interventions during the survivorship period.
Collapse
|
48
|
Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health-related quality of life. Support Care Cancer 2011; 20:1901-9. [PMID: 21994001 DOI: 10.1007/s00520-011-1293-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 09/27/2011] [Indexed: 11/12/2022]
Abstract
PURPOSE Fatigue is a phenomenon that may persist for years after completion of adjuvant therapy, and is one of the most frequent symptoms associated with breast cancer survivors. The purposes of this study were to investigate the occurrence of fatigue in disease-free breast cancer survivors after treatment, to identify variables associated with fatigue, and to evaluate the impact of fatigue on health-related quality of life. METHODS A cross-sectional study was conducted on 202 consecutive women diagnosed with in-situ to Stage III breast cancer attending in outpatient facilities of two large hospitals, one year or more after diagnosis. They completed the Piper Fatigue Scale-Revised and the European Organization for Research and Treatment of Cancer QLQ-C30. Multiple logistic regression models were used to identify predictive factors associated with fatigue. EORTC QLQC-30 scores for fatigued survivors were compared to non-fatigued survivors. RESULTS The prevalence of fatigue reported by the breast cancer survivors was 37.6%. Multiple logistic regression analysis revealed that predictive factors for fatigue included younger age (odds ratio [OR]=2.23, 95% confidence interval [CI]=1.11-4.45, p = 0.024); presence of pain (OR = 3.87, 95% CI = 1.88-7.98, p = 0.000); dyspnea (OR = 3.72, 95% CI = 1.46-9.50, p = 0.006); insomnia (OR = 2.40, 95% CI = 1.19-4.86, p = 0.015); and nausea and vomiting (OR = 12.25, 95% CI = 1.18-126.75, p = 0.036). Fatigued women had poorer health-related quality of life than non-fatigued women in all domains. CONCLUSION Our results suggest that many disease-free breast cancer survivors after treatment experienced fatigue that compromises their health-related quality of life.
Collapse
|
49
|
Lamino DDA, Mota DDCDF, Pimenta CADM. Prevalência e comorbidade de dor e fadiga em mulheres com câncer de mama. Rev Esc Enferm USP 2011; 45:508-14. [DOI: 10.1590/s0080-62342011000200029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 08/24/2010] [Indexed: 11/22/2022] Open
Abstract
O estudo analisou a prevalência e a comorbidade de dor e fadiga em mulheres com câncer de mama. Trata-se de estudo transversal, com amostra, não probabilística de 182 mulheres em tratamento ambulatorial para câncer de mama, entrevistadas no período de julho 2006 a março de 2007. Fadiga, avaliada pela Escala de Fadiga de Piper, foi dividida em duas categorias (escore 0,1-4,9 e >5-10). Dor, avaliada pela escala de 0-10, foi categorizada do mesmo modo que fadiga. Fadiga ocorreu em 94 mulheres (51,6%), sendo >5 em 44 (46,8%) delas. Dor ocorreu em 86 mulheres (47,2%), sendo >5 em 50 (58,1%). Fadiga e dor correlacionaram-se (r=0,38, p=0,003) e a comorbidade fadiga e dor foi de 38,3%. Dor intensa acentuou a fadiga (p=0,089) e fadiga intensa acentuou a dor (p=0,016). Tais dados são inéditos em nosso meio, confirmam a existência de um cluster de sintoma e dos prejuízos decorrentes dessa comorbidade.
Collapse
|
50
|
Lemieux J, Goodwin PJ, Bordeleau LJ, Lauzier S, Théberge V. Quality-of-life measurement in randomized clinical trials in breast cancer: an updated systematic review (2001-2009). J Natl Cancer Inst 2011; 103:178-231. [PMID: 21217081 DOI: 10.1093/jnci/djq508] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Quality-of-life (QOL) measurement is often incorporated into randomized clinical trials in breast cancer. The objectives of this systematic review were to assess the incremental effect of QOL measurement in addition to traditional endpoints (such as disease-free survival or toxic effects) on clinical decision making and to describe the extent of QOL reporting in randomized clinical trials of breast cancer. METHODS We conducted a search of MEDLINE for English-language articles published between May-June 2001 and October 2009 that reported: 1) a randomized clinical trial of breast cancer treatment (excluding prevention trials), including surgery, chemotherapy, hormone therapy, symptom control, follow-up, and psychosocial intervention; 2) the use of a patient self-report measure that examined general QOL, cancer-specific or breast cancer-specific QOL or psychosocial variables; and 3) documentation of QOL outcomes. All selected trials were evaluated by two reviewers, and data were extracted using a standardized form for each variable. Data are presented in descriptive table formats. RESULTS A total of 190 randomized clinical trials were included in this review. The two most commonly used questionnaires were the European Organization for Research and Treatment of Cancer QOL Questionnaire and the Functional Assessment of Cancer Therapy/Functional Assessment of Chronic Illness Therapy. More than 80% of the included trials reported the name(s) of the instrument(s), trial and QOL sample sizes, the timing of QOL assessment, and the statistical method. Statistical power for QOL was reported in 19.4% of the biomedical intervention trials and in 29.9% of the nonbiomedical intervention trials. The percentage of trials in which QOL findings influenced clinical decision making increased from 15.2% in the previous review to 30.1% in this updated review for trials of biomedical interventions but decreased from 95.0% to 63.2% for trials of nonbiomedical interventions. Discordance between reviewers ranged from 1.1% for description of the statistical method (yes vs no) to 19.9% for the sample size for QOL. CONCLUSION Reporting of QOL methodology could be improved.
Collapse
Affiliation(s)
- Julie Lemieux
- Santé des populations: Unité de recherche en santé des populations (URESP), Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québec (CHA), Service d'hémato-oncologie du CHA and Centre des Maladies du Sein Deschênes-Fabia du CHA, Quebec City, QC, Canada.
| | | | | | | | | |
Collapse
|