Management of Fatigue in Patients with Advanced Cancer

OPINION STATEMENT

Fatigue is a common and distressing symptom experienced by patients with cancer. It is most common in patients with locally advanced or metastatic incurable disease. It can have profound effects on quality-of-life and physical functioning. In addition to general supportive measures (directed at tackling contributory conditions and comorbidities), a variety of specific interventions have been developed which can be broadly categorised as physical therapies, psychological therapies or medication. There is some evidence that each of these approaches can have benefits in patients with earlier stage disease, those undergoing active treatment and in cancer survivors. The best evidence is for aerobic exercise, yoga, cognitive-behavioural therapy (CBT) and psycho-educational interventions. Less strong evidence supports the use of medications such as methylphenidate or ginseng. In patients with advanced disease, it is likely that the mechanisms of fatigue or the factors contributing to fatigue maintenance may be different. Relatively fewer studies have been undertaken in this group and the evidence is correspondingly weaker. The authors recommend the cautious use of aerobic exercise (e.g. walking) in those who are still mobile. The authors advise considering the use of psycho-educational approaches or CBT in those patients who are able to engage in such forms of therapy. In patients near the end-of-life, the authors advise use of dexamethasone (short-term use) and other pharmacological treatments only on the basis of a clinical trial.

Type-specific prevalence of Human Papillomavirus infection among women in the Northwest Territories, Canada

BACKGROUND

Certain types of Human Papillomavirus (HPV) are highly associated with cervical cancer and precursor lesions (dysplasia), but the distribution of HPVs in Northern Canada is largely unknown. This study determined the prevalences of HPV infection due to different virus types and the association of different virus types with cervical dysplasia in the Northwest Territories (NWT).

METHODS

Between April 2008 and March 2009, women who underwent routine Pap testing in the NWT were included in the study. An in-house Luminex assay detected type-specific HPV infections. The HPV prevalence rates and population attributable risk fractions were calculated.

RESULTS

In 5725 bio-samples, the overall HPV prevalence was 24.2%, and of the HPV-positive samples, 76.6% harbored high-risk types, 35.2% harbored multi-type infections, and 21.6% harbored HPV16 or 18 infections. The HPV prevalence was approximately 50% higher among Aboriginal than non-Aboriginal women. The age-specific HPV prevalence exhibited a U-shape distribution in the Aboriginal group. The prevalence of HPV16 or 18 infections found in high-grade lesions was 34.1%. Among this study population, 89.5% of the cases with cervical dysplasia were attributable to HPV infection, with 27.1% attributable to HPV16/18.

CONCLUSION

The high prevalence of high-risk HPV in this population, particularly in the Aboriginal group, will require further studies to identify specific predictors of infection.

Benchmarks for health expenditures, services and outcomes in Africa during the 1990s

There is limited information on national health expenditures, services, and outcomes in African countries during the 1990s. We intend to make statistical information available for national level comparisons. National level data were collected from numerous international databases, and supplemented by national household surveys and World Bank expenditure reviews. The results were tabulated and analysed in an exploratory fashion to provide benchmarks for groupings of African countries and individual country comparison. There is wide variation in scale and outcome of health care spending between African countries, with poorer countries tending to do worse than wealthier ones. From 1990-96, the median annual per capita government expenditure on health was nearly US$ 6, but averaged US$ 3 in the lowest-income countries, compared to US$ 72 in middle-income countries. Similar trends were found for health services and outcomes. Results from individual countries (particularly Ethiopia, Ghana, Côte d'Ivoire and Gabon) are used to indicate how the data can be used to identify areas of improvement in health system performance. Serious gaps in data, particularly concerning private sector delivery and financing, health service utilization, equity and efficiency measures, hinder more effective health management. Nonetheless, the data are useful for providing benchmarks for performance and for crudely identifying problem areas in health systems for individual countries.