Prevalence and predictors of fatigue in haemo-oncological patients

Impact of anxiety and chemotherapy side effects on quality of life in patients with malignant lymphoma

PURPOSE

There are no reports on the side effects of chemotherapy on the quality of life (QOL) of patients with malignant lymphoma or on the intensity of anxiety affecting these side effects. We conducted a prospective observational study to evaluate the association between anxiety, chemotherapy side effects, and QOL in patients with malignant lymphoma undergoing their first cancer chemotherapy treatment.

METHODS

We studied anxiety intensity, side effects, and QOL changes in 60 patients with malignant lymphoma who received their first course of initial chemotherapy at Gifu Municipal Hospital (Japan) between January 2021 and December 2022. Questionnaires were administered before and after the first chemotherapy course. The questionnaires included patient information and the STAI-JYZ, EQ-5D-5L, and EORTC QLQ-C30. EQ-5D-5L utility values and EORTC QLQ-C30 item scores were compared before and after the first chemotherapy course. The proportion of patients with issues with the five EORTC QLQ-C30 items was compared before and after the first chemotherapy. QOL was compared based on side effects and severity. QOL based on anxiety intensity was also compared.

RESULTS

The number of patients reporting problems with their usual activities significantly increased after the first chemotherapy course. Emotional functioning on the EORTC QLQ-C30 significantly increased after the first chemotherapy course. Patients' anxiety, depression, and pain decreased after the first course of chemotherapy. Patients with anorexia had lower utility values and EORTC QLQ-C30 Global health status. The utility values of the anxiety group increased significantly after chemotherapy.

CONCLUSION

Chemotherapy reduced activity but improved mental and psychological status. Anorexia negatively affects QOL and improves the QOL of patients with anxiety undergoing chemotherapy. This study clarified the relationship between anxiety, side effects, and QOL associated with cancer chemotherapy in patients with malignant lymphoma.

An Antagonist Antibody That Inhibits Cancer Cell Growth In Vitro through RACK1

BACKGROUND/OBJECTIVES

Our research introduces a novel screening method to identify antibodies that can suppress cell proliferation and induce apoptosis.

METHODS

By using an autocrine signaling system with lentivirus, we developed an antibody screening method based on FACS sorting assays and cell cycle analysis to inhibit tumor growth in vitro. This approach is particularly well suited for studying tumor suppressors. Inducing the G0 phase in tumor cells with specific antibodies may arrest their growth permanently or trigger apoptosis. The cell cycle is composed of tightly regulated phases for cell growth and division, with tumorigenesis or apoptosis occurring when these regulatory mechanisms fail.

RESULTS

In our study, we identified RACK1 as a key regulator of cancer cell growth. The H9 antibody against RACK1 selected from a human antibody library effectively suppressed cell proliferation by inhibiting RACK1 function.

CONCLUSIONS

These findings suggest that RACK1 plays a crucial role in tumor cell cycling and could represent a novel therapeutic target for cancer treatment. Although RACK1 is recognized as a significant target protein in various tumors, no commercial therapeutic agents currently exist. Our results suggest that the H9 antibody could be a promising candidate for the development of novel cancer therapies.

Influencing factors of cancer-related fatigue in acute leukemia patients: A cross-sectional study

Purpose

To investigate influencing factors of cancer-related fatigue (CRF) in adult patients with acute leukemia (AL).

Methods

A total of 288 adult patients diagnosed with acute leukemia in West China Hospital were included in this study. A cross-sectional survey, including the Clinical Information Questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HAD), was provided to the patients. Hierarchical multiple linear regression analyses were conducted to evaluate the associations of the variable factors and the AL patients' CRF.

Results

The CRF score of AL patients was 33.25 ± 10.35. Gender, age, albumin level, depression, anxiety status of the patients and treatment cycles were identified as influencing factors of CRF in AL patients (P < 0.05). The CRF level of acute leukemia patients in the complete remission group was lower than that of patients who were not achieving complete remission. Depression, anxiety, age, employment, albumin, and sleep disturbance were independent influencing factors for CRF in patients who were not achieving complete remission.

Conclusions

Acute leukemia patients who are female, older, hypoalbuminemia，or in the induction therapy have a higher risk of developing a high degree of CRF. Clinical staff should pay more attention to the CRF of patients who were not achieving complete remission. Early screening and aggressive intervention could be adopted in caring for these patients.

Coping Skills Interventions for Fatigue in Adults with Hematologic Malignancies: A Systematic Review

Background: Persons with hematologic malignancies have a high symptom burden throughout the illness journey. Coping skills interventions effectively reduce fatigue for other cancer patients. The purpose of this systematic review is to identify if coping interventions can reduce fatigue in patients with hematologic malignancies. Methods: A search of PubMed, Embase, CINAHL, APA Psych INFO, Scopus, Cochrane, and non-traditional publications was performed in June 2021 for studies introducing coping interventions for adults with hematological cancers within the past 20 years. The Transactional Model of Stress and Coping was used as a framework with fatigue as the primary outcome. The Johns Hopkins Nursing Evidence Based Practice Appraisal tool was used for quality appraisal. Results: Twelve interventional studies met criteria for inclusion. Four studies significantly reduced fatigue, with an additional 3 showing a reduction in fatigue. Interventions that utilized both problem and emotion-focused coping were more effective at reducing fatigue compared to interventions that only used emotion or problem-focused coping. Conclusion: This systematic review found moderate-strength evidence to support that coping interventions can reduce fatigue, with mixed, but mostly beneficial results. Clinicians caring for patients with hematologic malignancies should consider using coping interventions to reduce fatigue.

Prospective observational study of palliative care in hematological malignancies: Report of one year of practice

INTRODUCTION

Palliative care is an approach that improves the quality of life of patients with advanced disease.

OBJECTIVE

The aim of this study is to evaluate the process of palliative care in patients with hematologic malignancies.

METHODS

In this prospective observational study, we included patients with hematologic malignancies who received palliative care over a 12 month period from June 1, 2019, to May 31, 2020 at the day care hospital of the hematology department in University Hospital of Sfax, Tunisia. Blood transfusion was used to relieve symptoms of anemia and bleeding.

RESULTS

Fifty-five patients were included. The median age was 68 years. Forty-three percent of patients were diagnosed with acute leukemia and 41.8% with myelodysplastic syndrome. Red cell and platelet transfusions were indicated in 94.5% and 36.3% of cases respectively. Patients reported improvement after blood transfusion in 50% of cases. Twenty-five transfusion reactions (45%) were noted. Fever was noted in 33 patients (60%), with documented sites of infection in 84.8% of them. Pulmonary infection was frequently noted (50%). Antimicrobial treatment was prescribed in all febrile cases. Pain was reported in 22 patients and in 77.5% of these cases, it was nociceptive. Patients who received analgesics showed clinical improvement in pain in 81% of cases. Anorexia with malnutrition was reported in 23% of cases which was treated with enteral nutrition in 75% of cases. Sleep disturbance (20 patients), anxiety (7 patients), and depression (4 patients) were mentioned respectively.

CONCLUSION

Palliative care in hematology should be a multidisciplinary care approach with a global management of the various physical, psychological and sociological complications.

Fatigue in chronic myeloid leukemia patients on tyrosine kinase inhibitor therapy: predictors and the relationship with physical activity

Fatigue is a common side effect of tyrosine kinase inhibitor (TKI) therapy in patients with chronic myeloid leukemia (CML). However, the prevalence of TKI-induced fatigue remains uncertain and little is known about predictors of fatigue and its relationship with physical activity. In this study, 220 CML patients receiving TKI therapy and 110 genderand age-matched controls completed an online questionnaire to assess fatigue severity and fatigue predictors (Part 1). In addition, physical activity levels were objectively assessed for 7 consecutive days in 138 severely fatigued and non-fatigued CML patients using an activity monitor (Part 2). We demonstrated that the prevalence of severe fatigue was 55.5% in CML patients and 10.9% in controls (P<0.001). We identified five predictors of fatigue in our CML population: age (odds ratio [OR] 0.96, 95% confidence interval [95% CI]: 0.93-0.99), female gender (OR 1.76, 95% CI: 0.92-3.34), Charlson Comorbidity Index (OR 1.91, 95% CI: 1.16-3.13), the use of comedication known to cause fatigue (OR 3.43, 95% CI: 1.58-7.44), and physical inactivity (OR of moderately active, vigorously active and very vigorously active compared to inactive 0.43 (95% CI: 0.12-1.52), 0.22 (95% CI: 0.06-0.74), and 0.08 (95% CI: 0.02-0.26), respectively). Objective monitoring of activity patterns confirmed that fatigued CML patients performed less physical activity of both light (P=0.017) and moderate to vigorous intensity (P=0.009). In fact, compared to the non-fatigued patients, fatigued CML patients performed 1 hour less of physical activity per day and took 2,000 fewer steps per day. Our findings facilitate the identification of patients at risk of severe fatigue and highlight the importance of setting reduction of fatigue as a treatment goal in CML care. This study was registered at The Netherlands Trial Registry, NTR7308 (Part 1) and NTR7309 (Part 2).

Clinically Significant Fatigue in Adult Leukemia Patients: Prevalence, Predictors, and Impact on Quality of Life

Background

Cancer-related fatigue (CRF) is a common distressing symptom in leukemia patients. CRF becomes clinically significant fatigue (CSF) when adversely affects health-related quality of life (HRQoL) and warrants further workup, referrals, and treatment. Objective: To assess the prevalence and predictors of CSF and assesses its impact on HRQoL in adult leukemia patients.

Method

Analysis was performed on 168 leukemia patients. The primary study outcomes were CSF (score ≥4) as measured by the fatigue numerical rating scale and HRQoL using a validated Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) scale.

Result

The prevalence of CSF was 89 (53%), with a mean score of 6.66±2.02. About 106 (63.1%) of leukemia patients had poor Health-related quality of life (HRQoL) (102.61±23.50). Overall, FACT-Leu mean score indicated that study participants had poor HRQoL (114.70±29.67). There was a statistically significant difference in HRQoL between the patients with CSF 104.89±28.82 and Non-CSF 125.76±26.71, p<0.001. Poor appetite (odd ratio: 3.02 [95% CI: 1.33-6.85]) was statistically significant predictors (p<0.010) of CSF. Dependence on caregiver (odd ratio: 3.31 [95% CI: 0.41-0.75]) and having non-CSF (odd ratio: 5.22 [95% CI: 2.44-11.19]) were found statistically significant predictors of good HRQoL.

Conclusion

CSF is prevalent among leukemia patients, and adversely affects their HRQoL. Holistic assessment and supportive care are needed to reduce the burden of CSF and improve leukemia patients HRQoL.

Prevalence and risk factors of cancer-related fatigue: A systematic review and meta-analysis

BACKGROUND

Cancer-related fatigue, one of the most frequent side-effects of cancer treatment, affects the well-being of patients. Despite the fact that the estimated prevalence and risk factors of cancer-related fatigue are widely reported, these results have not been synthesized.

OBJECTIVES

To systematically assess the prevalence of cancer-related fatigue, including stratification by fatigue degree, sex, age, therapeutic method, cancer-related fatigue scales, countries, and risk factors for cancer-related fatigue.

DESIGN

Systematic literature review and meta-analysis.

DATA SOURCES

PubMed, Cochrane Library, Web of Science, CINAHL Plus, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP) were comprehensively searched for observational studies investigating the prevalence and risk factors of cancer-related fatigue from inception to March 31st, 2019.

REVIEW METHODS

Original journal articles were included which met the inclusion criteria. The quality of the included studies was evaluated independently by two investigators. Meta-analysis was conducted using Stata 12.0 software package, with estimates of cancer-related fatigue from pooled using a random-effects model.

RESULTS

In total, 2641 articles were screened and data from 84 studies involving 144,813 subjects were used in meta-analysis. The prevalence of cancer-related fatigue in individual studies varied from 14.03% to 100%. The pooled prevalence of cancer-related fatigue was 52% (95% confidence interval, CI: 48% to 56%, I2 = 99.7%, P < 0.0001). After controlling for confounding variables, the following risk factors were associated with cancer-related fatigue: poor performance status (odds ratio, OR = 6.58, 95% CI: 2.60 to 16.67, I2 = 75.2%, P < 0.0001), chemoradiotherapy (OR = 2.25, 95% CI: 1.90 to 2.67, I2 =0%, P<0.0001), female sex (OR = 2.07, 95% CI: 1.51 to 2.84, I2 = 41.2%, P<0.0001), insomnia (OR = 2.83, 95% CI: 1.22 to 6.57, I2 = 98.3%, P = 0.015), neuroticism (OR = 1.23, 95% CI: 1.05 to 1.43, I2 = 88.9%, P = 0.01), pain (OR = 2.64, 95% CI: 1.20 to 5.80, I2 = 95.3%, P = 0.016), and depression (OR = 2.23, 95% CI: 1.70 to 2.93, I2 = 98.1%, P < 0.0001).

CONCLUSION

The current analysis indicates an overall pooled prevalence of cancer-related fatigue of 52%. Poor performance status, chemoradiotherapy, female sex, insomnia, neuroticism, pain, and depression were identified as risk factors for cancer-related fatigue. Understanding the risk factors of cancer-related fatigue can provide the healthcare personnel with the theoretical basis for the management and treatment of the patients.

Evaluation of Distress and Religious Coping Among Cancer Patients in Turkey

The purpose of this study was to determine distress levels and religious coping styles of cancer patients and the relationship between religious coping styles and distress. This study was conducted as descriptive design. It was determined that 60.7% of the patients experienced distress related to the disease. The field of problem from which the patients mostly experienced distress was physical problems. It was observed that positive coping scores of the patients were higher. There was a negative correlation between their mean scores for positive religious styles and distress total scores.

Patient-reported fatigue prior to treatment is prognostic of survival in patients with acute myeloid leukemia

Acute myeloid leukemia (AML) is associated with poor survival. While clinical prognostic factors of survival have been identified, the contribution of patient-reported symptoms has only received marginal attention. Fatigue is one of the most commonly reported symptoms of AML. There is some evidence that fatigue is associated with shorter survival in hematological malignancies. However, the prognostic effects of fatigue in a homogenous cohort of patients with untreated AML has not been tested. We here report results of a prospective study on the prognostic value of patient-reported fatigue prior to onset of treatment, for 2-year survival in 94 AML patients. Cox regression models controlling for demographic and clinical factors showed that those with severe fatigue (22%) had decreased survival rates (Hr = 2.255, 95% CI = 1.16-5.60, p = 0.019). Further exploration showed that fatigue was associated with increased plasma concentrations of IL-6 and TNF-α, but not with demographic or disease-related factors. In conclusion, we here show for the first time that the experience of severe fatigue prior to remission induction chemotherapy (IC) is prognostic for shorter survival in patients with AML of all ages. These findings point to the importance of interventions aimed at relieving fatigue especially before or in the early phases of treatment in order to improve survival.

Palliative care in patients with haematological neoplasms: An integrative systematic review

BACKGROUND

Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological malignancies.

AIM

To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments.

DESIGN

Integrative systematic review with data extraction and narrative synthesis (PROSPERO #: CRD42016036240).

DATA SOURCES

PubMed, CINAHL, Cochrane, Scopus and Web-of-Science were searched for articles published through 30 June 2015. Study inclusion criteria were as follows: (1) published in English or Spanish and (2) containing data on palliative care interventions in adults with haematological malignancies.

RESULTS

The search yielded 418 articles; 99 met the inclusion criteria. Six themes were identified: (1) end-of-life care, (2) the relationship between onco-haematology and palliative care departments and referral characteristics, (3) clinical characteristics, (4) experience of patients/families, (5) home care and (6) other themes grouped together as 'miscellany'. Our findings indicate that palliative care is often limited to the end-of-life phase, with late referral to palliative care. The symptom burden in haematological malignancies patients is more than the burden in non-haematological neoplasms patients. Patients and families are generally satisfied with palliative care. Home care is seldom used. Tools to predict survival in this patient population are lacking.

CONCLUSION

Despite a growing interest in palliative care for haematological malignancies patients, the evidence base needs to be strengthened to expand our knowledge about palliative care in this patient group. The results of this review support the need to develop closer cooperation and communication between the palliative care and onco-haematology departments to improve patient care.

Prevalence and determinants of fatigue in patients with moderate to severe chronic GvHD

Although fatigue is common after allogeneic hematopoietic cell transplantation, little is known about fatigue in patients with chronic GvHD (cGvHD). The aim of this study was to explore factors associated with fatigue in cGvHD. Data were drawn from a sequentially recruited, cross-sectional study of adults with moderate or severe cGvHD (n=263). Respondents were classified as fatigued or not fatigued based on their response to a single item regarding loss of energy from the Lee cGvHD Symptom Scale. In univariate analysis, factors significantly associated with fatigue included performance status, number of prior cGvHD therapies, cGvHD symptom bother, self-assessed physical and mental health, nutritional status, walk velocity and self-reported physical activity. There were no significant associations between fatigue and disease-related cGvHD variables. Multivariable logistic regression demonstrated that being less active and having pulmonary and/or muscle/joint symptoms were independently associated with fatigue. In conclusion, clinically significant fatigue was prevalent in more than one-third of subjects with cGvHD, and was disabling. Absence of association with measures of cGvHD severity underscores the need to elucidate the pathogenesis of fatigue and its relationship with inflammatory activity. Pulmonary and muscle/joint symptoms and physical inactivity represent potential targets for intervention in clinical studies.