Fatigue patterns in Chinese patients receiving chemotherapy

Fatigue, Physical and Functional Mobility, and Obesity in Pediatric Cancer Survivors

BACKGROUND

Survivors of childhood cancer are prone to an increased risk of chronic issues such as cardiovascular disease, fatigue, weight-related problems, and emotional disturbances.

OBJECTIVE

This study utilized the biopsychosocial model to examine the hypothesis that greater depression and lower mobility would be significantly associated with greater fatigue and higher body mass index in survivors of childhood cancer.

METHODS

Data were analyzed for 144 children treated and followed up for an oncology condition at a southeastern academic medical center. Voluntarily, children completed the Patient-Reported Outcomes Measurement Information System 1.0, and parents completed the Family Symptom Inventory as part of a brief annual psychosocial screening battery. Height and weight were collected by a clinic nurse prior to questionnaire completion.

RESULTS

Hierarchical linear regression showed that shorter time since diagnosis (β = -.154, P < .05), greater child-reported depression (β = .396, P < .01), and lower mobility (β = .427, P < .01) significantly predicted greater fatigue (adjusted R = 0.54). Older age (β = .262, P < .01) and not receiving chemotherapy (β = -.209, P < .05) significantly predicted higher body mass index (adjusted R = 0.051).

CONCLUSIONS

Findings showed that fatigue tends to improve over time after treatment but may be predicted by greater depression symptoms and lower mobility in recent survivors of childhood cancer.

IMPLICATIONS FOR PRACTICE

For survivors of childhood cancer with higher levels of fatigue, treating symptoms of depression and maximizing physical and mobility may be of clinical value. With the impact of psychological and social factors not yet understood in pediatric cancer survivors, weight status in recent survivors of childhood cancer is likely a complex interaction between biological and treatment factors.

The Experience of Fatigue Across Long-Term Conditions: A Qualitative Meta-Synthesis

CONTEXT

Fatigue is a common and debilitating symptom associated with many long-term conditions and is reported to cause significant levels of distress for those individuals. There is a substantial body of literature related to the nature of fatigue; however, this has not been drawn together and compared across conditions.

OBJECTIVES

The aim of this review was to synthesize data on the nature of fatigue across long-term conditions.

METHODS

The review was designed as a qualitative meta-synthesis and followed the Joanna Briggs Institute guidelines for synthesizing qualitative research. The following databases were searched for the period January 1980 to January 2016, Ovid (Medline, Embase, CINAHL, and PsycINFO) and manual searching from the reference lists from articles identified by electronic search. Fifty-seven studies were included in the review, and findings related to the nature of fatigue were extracted and findings meta-synthesized.

RESULTS

The perceived nature of fatigue across long-term conditions was encompassed in one synthesis; the fatigue experience is without precedent, with four categories: a different fatigue to any experienced before, the intensity of fatigue is overwhelming, the trajectory of fatigue, and impact on sleep and sleep disturbance. Just over half of the participants in the included studies were diagnosed with cancer. Patterns in the experience of fatigue by condition were found for cancer-related fatigue and post-stroke fatigue where data were able to be synthesized.

CONCLUSION

Although similarities in the nature of the fatigue experienced were found across conditions, differences were also evident and could be mapped for cancer-related fatigue and post-stroke fatigue. Further qualitative research on the experience of fatigue across a wide range of chronic conditions would further contribute to understanding similarities and differences across conditions and inform both research and practice in relation to assessment and management.

Effect of pretreatment distress on daily fatigue after chemotherapy for breast cancer

PURPOSE

Fatigue is one of the most frequently reported and adverse effects of cancer chemotherapy. The present study tested the hypothesis that women's levels of emotional distress at the time of their initial outpatient chemotherapy treatment would predict the severity of their postinfusion fatigue.

METHODS

Sixty stage I (32.6%) and II (67.4%) patients with breast cancer (mean age, 44.5 years) who were receiving standard outpatient chemotherapy participated. The independent variable, emotional distress, was assessed for "last night," "this morning," and "right now" with a visual analog scale (0 to 100). The dependent variable, post-treatment fatigue (PTF), was assessed (0 to 100) over each of the subsequent 6 days using end-of-day diaries, which also included assessments of distress and nausea (0 to 100). For the statistical analyses, post-treatment fatigue was divided into three phases with means calculated for days 1 through 2 (phase 1), 3 to 4 (phase 2), and 5 to 6 (phase 3).

RESULTS

Consistent with the study hypothesis, patients' pretreatment distress level in the clinic was a significant (P < .001) predictor of PTF. There was also a significant (P < .025) interaction with phase, with distress becoming a predictor of PTF after phase 1. Multivariate analysis indicated that prior levels of distress were not independent predictors of PTF.

CONCLUSIONS

This study is the first to demonstrate time-specific effects of pretreatment distress on PTF. Possible mechanisms of these effects now warrant investigation, as do possible benefits of brief interventions to reduce patient distress immediately before treatment.

The Experience of Fatigue in Turkish Patients Receiving Chemotherapy

PURPOSE/OBJECTIVES

To determine the experience of fatigue in Turkish patients receiving chemotherapy.

DESIGN

Descriptive.

SETTING

Outpatient unit in a large university hospital in Ankara, Turkey.

SAMPLE

100 patients randomly chosen from those who were undergoing chemotherapy at the outpatient unit.

METHODS

Data were collected using a personal information form developed by the investigator and a visual analog scale for fatigue.

MAIN RESEARCH VARIABLES

Measures taken by patients to cope with fatigue, fatigue experienced by individuals affecting their daily activities, age and gender, disease and treatment factors, and symptoms related to the chemotherapy.

FINDINGS

The majority of patients (86%) experienced fatigue, and 73% stated that they coped with fatigue by decreasing their activities and resting more. Age was not a statistically significant factor affecting the level of fatigue, but gender was found to have an effect. Length of illness, number of chemotherapy courses, and the patients' symptoms affected level of fatigue.

CONCLUSIONS

The majority of patients experienced fatigue, and most of the measures used to cope with fatigue were not effective. Fatigue affected patients' daily activities.

IMPLICATIONS FOR NURSING

A need exists for more and better interventions to help patients cope with chemotherapy-related fatigue.

The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial

BACKGROUND

Cancer-related fatigue after chemotherapy is a difficult symptom to manage in practice and the most disruptive symptom in patients' lives. Acupuncture is a popular complementary therapy among cancer patients and some evidence exists that it could potentially alleviate fatigue by stimulating 'energy' points in the body. Hence, this study was carried out to assess the effects of acupuncture and acupressure in managing cancer-related fatigue and the feasibility of running a randomised trial with these two complementary therapies in preparation for a large trial.

METHODS

This study was a randomised controlled trial. Forty-seven patients with cancer who experienced moderate to severe fatigue were randomised either to an acupuncture group (n=15), an acupressure group (n=16) or a sham acupressure group (n=16). The acupuncture group received six 20-min sessions over 2 weeks, while the patients in the two acupressure groups were taught to massage/press the points and did so daily thereafter for 2 weeks on their own. Patients completed the Multidimensional Fatigue Inventory before randomisation, at the end of the 2-week intervention and again about 2 weeks after the end of the intervention.

RESULTS

Significant improvements were found with regards to General fatigue (P<0.001), Physical fatigue (P=0.016), Activity (p=0.004) and Motivation (P=0.024). At the end of the intervention, there was a 36% improvement in fatigue levels in the acupuncture group, while the acupressure group improved by 19% and the sham acupressure by 0.6%. Improvements were observed even 2 weeks after treatments, although they were lower (22%, 15%, 7%, respectively). Acupuncture was a more effective method than acupressure or sham acupressure. Subjects needed a longer treatment period to have more sustained results. The trial was methodologically feasible.

CONCLUSION

Acupuncture shows great potential in the management of cancer-related fatigue. As a randomised trial with acupuncture is feasible and preliminary data shows significant improvements, it should be tested further using a large sample and a multicentre design.

Course of Fatigue Between Two Cycles of Adjuvant Chemotherapy in Breast Cancer Patients

The purpose of this study was to determine the course of fatigue in patients with breast cancer between 2 cycles of adjuvant chemotherapy, from the day of administration until the day of the next infusion. In a prospective cohort study, a sample of 151 patients with breast cancer receiving adjuvant chemotherapy was recruited from 6 hospitals in mainly the south of the Netherlands. Patients reported their experience of fatigue in a diary, the Shortened Fatigue Questionnaire, on a daily basis between the third and fourth treatment with adjuvant chemotherapy. Patients were treated with either a doxorubicin containing schedule or with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF, 28 days). In the 28-day regimens, infusions were given on day 1 and day 8. The days after completion of the third and the start of the fourth treatment with chemotherapy were statistically analyzed. We tested the hypothesis that the maximum fatigue score occurs in the first 4 days after treatment. The mean age of the sample was 47.2 years (SD = 8.8). Most women (84%) were married or lived together with a partner. The majority (80%) of all patients had been diagnosed with stage II breast cancer. The division between mastectomies (47%) and lumpectomies (52%) was approximately equal. Sixty percent of the patients received radiotherapy before the third treatment with chemotherapy and/or in the period they kept the diary. A chaotic pattern of fatigue between the 2 cycles of chemotherapy emerged. Smooth (splines) curves showed an average highest level of fatigue on day 3 from the start. For the 28-day regimens, another distinct peak was seen around day 11. A relatively larger number of patients experienced peak fatigue levels before day 5. The course of fatigue in the CMF group was significantly different compared with the doxorubicin regimens. The fatigue peak in the CMF group was lower. Women taking cyclophosphamide orally experienced the peak level of fatigue significantly later. Influences of other variables were not observed in any chemotherapy group. Cancer-related fatigue has a chaotic nature. The first days after treatment with chemotherapy are the worst. The type of chemotherapy has a significant impact on the course of fatigue. Improved understanding of the nature and course of fatigue could equip healthcare providers better for informing patients about what they may expect. Future research should include interventions aimed at reducing or coping with fatigue.

A study to assess the existence of the symptom cluster of breathlessness, fatigue and anxiety in patients with advanced lung cancer

The purpose of this small-scale study was to assess the existence of a symptom cluster involving breathlessness, fatigue and anxiety in patients with advanced lung cancer undergoing palliative radiation. A convenience sample of 27 patients were asked to complete a set of 100mm horizontal visual analogue scales (VAS) measuring the intensity of anxiety, breathlessness and fatigue at 3 points in time: 1 day prior to palliative radiotherapy (RT) (baseline, T0), and at week 3 (T1) and week 6 (T2) after the commencement of the RT. The prevalence of the 3 symptoms ranged from 59% to 96%. At baseline the median intensity of symptoms was mild, becoming progressively worse at T1 and T2. The correlations between the 3 symptoms were moderately strong at T1 and T2 (r=0.49-0.75). The proposed symptom cluster had high internal consistency across T0-T2. These data support the notion that the symptoms--breathlessness, fatigue, and anxiety--may be viewed as a symptom cluster. The high prevalence and moderate intensity of the symptom cluster demonstrates a need for an intervention to manage these symptoms simultaneously.

Fatigue patterns in Chinese patients receiving radiotherapy

Fatigue has been reported as the most frequently occurring symptom in cancer patients receiving chemoradiotherapy. The purpose of the current descriptive study was to explore the pattern, associated factors, and experience of fatigue in Chinese cancer patients receiving radiotherapy. Twenty-seven subjects from an out patient clinic of a university hospital in Hong Kong participated in the study. They were asked to complete three times daily (morning, afternoon and evening) a diary over a period of two weeks from the beginning of their therapy. The diary incorporated a 10-cm horizontal visual analogue scale (VAS) for measuring fatigue intensity. Further, the Chinese version of the fatigue subscale of the Profile of Mood States was completed before the radiotherapy, at the end of the first week post-treatment, and at the end of the second week. Most patients (44-80.8%) undergoing radiotherapy in this study experienced fatigue at some point during their treatment. The pattern of fatigue was that of repeated curves, with higher levels observed in the afternoons and evenings, and at the end of the first week or the end of the second week. Qualitative data indicated the universal sensations of fatigue and also some culturally specific descriptors. A variety of methods were used by the patients to cope with their fatigue but the effects of such methods were not always positive. It is important for clinical practice to assess the individual patterns and perceptions of fatigue, identify those patients at risk for developing fatigue and initiate interventions to combat fatigue.

Factors predicting fatigue in breast cancer patients

A prospective study was designed to investigate the factors predicting fatigue in breast cancer patients using the Cancer Fatigue Scale (CFS) in addition to the Hospital Anxiety and Depression Scale (HADS) and a questionnaire containing items on demographic and clinical data, and measures of patients' physical symptoms. The CFS measures total fatigue score ranging from 0 (lowest level) to 60 (highest level) and contains three subscales namely: physical, affective and cognitive fatigue. The questionnaires were administered to a consecutive sample of breast cancer patients attending the Iranian Center for Breast Cancer either for their treatment or follow-up examination. In all, 112 patients were studied. The mean age of the respondents was 45.7 years (SD11.0). Most had stage II breast cancer (67%) and had completed their initial treatment (45%). The mean total fatigue score of the patients was 18.7 (SD 13.5) and overall 49% reported experiencing fatigue to some degree (from quite a bit to very much). Severe anxiety and depression was reported by 16% and 32%, respectively. The regression analysis revealed that fatigue was predicted by depression ( P=0.003), pain ( P=0.005), current tamoxifen use ( P=0.001), undergoing mastectomy ( P=0.03) and anxiety ( P=0.04). The other variables studied did not emerge as significant predictors of fatigue in the regression analysis. The study findings suggest that in comparison to treatment factors, physical and psychological symptoms have a more important role in cancer-related fatigue and that fatigue should be recognized and managed even before commencing breast cancer treatment.