The impact of hemoglobin levels on fatigue and quality of life in cancer patients.

BACKGROUND: Although fatigue is a commonly reported symptom in cancer patients its etiology is still poorly understood. The objective of the present study was to investigate the relationship between hemoglobin (Hb) levels and the subjective experience of fatigue and quality of life in cancer patients with mild or no anemia undergoing chemotherapy. PATIENTS AND METHODS: Sixty-eight cancer patients (25 colorectal, 26 lung and 17 ovarian cancer) presently undergoing chemotherapy participated in the study. Fatigue was measured with the Multidimesional Fatigue Inventory (MFI-20), quality of life with The European Organization for Research and Treatment of Cancer QLQ-C30. In order to provide normative data for fatigue levels, the MFI-20 was also completed by a sex- and age-matched sample of 120 healthy controls. RESULTS: Compared with healthy subjects, cancer patients experienced significantly higher levels of subjective fatigue. Correlations between Hb values and subscales of the MFI-20 were moderate with a tendency to increase during chemotherapy. Hb values alone, however, do not fully account for the observed fatigue. Other symptoms, especially pain, dyspnea and sleep disturbances, also showed an association with perceived fatigue. CONCLUSIONS: Despite significant correlations, these results indicate that Hb values only partially explain subjectively experienced fatigue and quality of life in cancer patients. It is suggested therefore that the treatment of fatigue must be multidimensional and involve all areas which contribute to the syndrome.     

肺癌患者癌因性疲乏的影响因素及其与生活质量关系的研究

目的调查肺癌患者癌因性疲乏的发生率及程度,研究癌因性疲乏的相关症状及影响因素,初步探讨癌因性疲乏的治疗,研究肺癌患者癌因性疲乏与生存质量的相互关系,为肺癌患者的姑息性治疗提供一定的依据。方法采用收集病史与问卷调查相结合的办法,测试者本人填写附表。将调查表发给72例肺癌患者由患者自愿填写,填写后收回。其中接受放疗的肺癌患者于放疗第15天再次接受疲乏数字等级量评估疲乏程度并记录。所得数据采用SPSS13.0统计软件分析。结果乏力发生率为80.6%,以中重度疲乏为主占81.3%,乏力评分为4.65±2.87;疼痛和睡眠障碍是乏力最常见的相关症状,抑郁是癌症患者常见的情绪障碍且与癌因性疲乏相关,食欲与患者情感疲乏呈负相关;血红蛋白、血清白蛋白、白细胞及中性粒细胞计数与乏力程度有显著相关性;放疗影响患者的疲乏程度;肺癌患者对自身生存质量评价不满意者占51.4%,癌因性疲乏与生存质量呈负相关。结论肺癌患者中疲乏的发生率高,程度较重,在很大程度上影响患者的生活质量。改善患者的合并症如疼痛、睡眠障碍、抑郁、贫血、白细胞低下、低蛋白血症等,能在一定程度上降低疲乏的程度,提高患者的生活质量。     

癌痛治疗与癌痛患者生活质量的关系研究

目的探讨恶性肿瘤生存者癌痛治疗与生存质量的关系。方法对入选患者给予三阶梯止痛治疗,应用数字评分疼痛分级法及EORTC QLQ-C30问卷调查表分别对止痛治疗前后患者进行疼痛测定及生活质量测定,对结果进行比较分析。结果 （1）使用三阶梯止痛治疗后,中度疼痛缓解率为95.3%,重度疼痛缓解率为85.3%,疼痛总缓解率为88.4%;不良反应主要表现为恶心、呕吐、便秘等。（2）按照三阶梯止痛疗法疼痛治疗后患者生活质量较好,中、重度癌痛患者社会功能、情绪功能、躯体功能、失眠、整体质量均明显改善（P〈0.01）;中度疼痛患者生活质量得分为65.49±8.54,重度疼痛患者生活质量得分33.38±10.67,与治疗前比较差异均有统计学意义（P〈0.01）。结论三阶梯止痛疗法能明显缓解癌性疼痛,有效地提高恶性肿瘤生存者的生活质量。     

Development of a fatigue and functional impact scale in anemic cancer patients receiving chemotherapy

BACKGROUND.: This study was conducted to develop a brief measure of fatigue and functional impact in cancer patients with anemia. METHODS.: Data were obtained from a multisite, phase 2 study of darbepoetin-alpha (n = 1558). Eligible patients were >/=18 years with nonmyeloid malignancies and anemia (hemoglobin 相似文献   

Changes in exercise capacity,quality of life and fatigue in cancer patients during an intervention

The study explored the interdependence of changes in oxygen uptake, quality of life and cancer‐related side‐effect fatigue during a 4‐month exercise intervention. Participants were during adjuvant (curative) or palliative therapy and post‐adjuvant therapy (finished within the previous 12 months). Aerobic exercise capacity (VO₂peak), quality of life and fatigue symptom (EORTC QLQ‐C30) were obtained in 101 cancer patients (30–77 years). After initial examination, patients participated in supervised and/or home‐based training interventions. Patients were re‐examined after 16–20 weeks and stratified into 3 subgroups (terciles) with respect to the absolute change in VO₂peak. The ANCOVA, with significant covariate effect for pretest fatigue score (F_(5,101) = 8.150, P < 0.001), indicated significant differences between groups in outcome measures (P < 0.001). Based on the absolute change of VO₂peak (1.9 ± 1.7; 1.8 ± 0.8; 5.7 ± 2.8 ml/kg/min) there were significant differences in the quality of life improvement (17.2 ± 15.1 vs. 4.8 ± 22.0 points, P < 0.05) and cancer‐related fatigue reduction (?6.1 ± 30.7; ?11.5 ± 20.9; ?21.2 ± 21.4 points) between upper and lower tercile. The findings point towards a relationship of exercise capacity enhancement, quality of life improvement and fatigue symptom reduction during and shortly after cancer treatment.     

The relationship between pain,fatigue, sleep disorders and quality of life in adult patients with acute leukaemia: During the first year after diagnosis

The aim of this study was to investigate the relationship between pain, fatigue, sleep disorders and quality of life and assess the most powerful predictor of quality of life in patients with acute leukaemia. In this cross‐sectional multicentre study, 406 patients were recruited. Data were collected using the Iranian Short‐Form 36‐item Health Survey, the Pittsburgh Sleep Quality Index, and the Numeric Rating Scale for Pain and Fatigue Intensity. It was found that pain and fatigue had direct relationship with sleep disorders. Statistically significant relationships were reported between pain, fatigue, sleep disorders and QoL. Also, a statistically significant relationship was found between pain and QoL (p < .001). Pain, fatigue and sleep disorders in total had the predictive power for quality of life (R² = 36%). The most powerful predictor of quality of life was pain. It is suggested that healthcare professionals note the importance of patients' symptoms in clinical investigations and take appropriate measures for their management. The assessment of pain as the most powerful predictor of quality of life can be considered a basis for the improvement of quality of life, fatigue and sleep quality in patients with acute leukaemia.     

自我效能干预对肺癌患者癌性疲乏和生活质量的影响

目的探讨自我效能干预对肺癌患者癌性疲乏和生活质量的影响。方法对80例有癌性疲乏的肺癌患者在常规治疗和护理的基础上增加自我效能干预措施,比较干预前后患者疲乏程度和生活质量的差异。结果自我效能干预后患者的癌性疲乏程度显著改善,生活质量得到提高,与干预前比较,差异均有统计学意义(均P<0.05)。结论自我效能干预可以改善肺癌患者的癌性疲乏程度,提高生活质量。     

Quality of life and/or symptom control in randomized clinical trials for patients with advanced cancer.

BACKGROUND: Measures reflecting quality of life (QoL) or symptom control should be included as major endpoints in most phase III trials for patients with advanced cancer. Here we review the use of such endpoints. METHODS: We evaluated methodological aspects relating to QoL or symptom control in randomized controlled trials (RCTs) that included >or=150 patients, published from 1994 to 2004, using a 10-point checklist. RESULTS: Of 112 RCTs that met our criteria, few were rated as high quality: 22% defined QoL or symptom control as a primary endpoint; 19% established an a priori hypothesis relevant to palliation and 21% defined minimal differences in QoL or symptom scores that were clinically meaningful. Most trials (81%) analyzed differences between mean or median scores across groups and only 21% defined the proportion of individual patients who met criteria for palliative response. Only 15% of the studies met more than 5/10 criteria from our checklist. There was improvement over time in methodology and reporting. CONCLUSIONS: Current standards for analyzing QoL and symptom control in RCTs are poor. Definition of a palliative endpoint, with an a priori hypothesis, is essential; defining the proportion of patients with palliative response is preferred. The proposed checklist could raise standards of reporting in future RCTs.     

Assessment of quality of life in advanced breast cancer. An overview of randomized phase III trials

Background

Health-related quality of life (HRQOL) parameters are often used as end points in phase III trials in advanced breast cancer. The frequency and correlates of significant gains in HRQOL have not been assessed.

Methods

To evaluate the contemporary role for HRQOL assessment in advanced breast cancer, we searched PubMed for the main and companion papers reporting the results of phase III trials on systemic antineoplastic therapies published between 1/98 and 7/09 in 11 leading journals.

Results

The search yielded 87 trials that enrolled a total of 33,669 patients. HRQOL was mentioned/reported in the main paper in 34 trials, reported in a companion paper in one (a total of 35/87 = 40%), and mentioned in the abstract of the main paper in 19/34 cases (56%). There was no temporal trend for reporting on HRQOL in the two 6-year periods. Although formal statistical comparisons were reported in 31/35 cases (89%), a significant difference was found in only 4/31 (13%) trials, always favoring the experimental arm. Given the small number of studies with a significant HRQOL finding, we could not assess correlates of gain in HRQOL.

Conclusions

HRQOL is one of the key indicators of treatment benefit in advanced breast cancer, but contemporary systemic therapies in this setting do not appear to affect HRQOL differentially.     

Once-weekly epoetin-beta improves hemoglobin levels in cancer patients with chemotherapy-induced anemia: A randomized, double-blind, dose-finding study

OBJECTIVE: To determine a recommended dose of once-weekly epoetin-beta administration for anemic cancer patients receiving myelosuppressive chemotherapy, we conducted a multicenter, randomized, double-blind trial. METHODS: A total of 86 patients with malignant lymphoma or lung cancer who received chemotherapy containing platinum, taxanes or anthracyclines were enrolled in the study. Patients were randomly assigned into groups that received three dose levels of epoetin-beta (9000, 18,000 or 36,000 IU) administered subcutaneously once a week for 12 weeks. The primary endpoint was change in hemoglobin, while the secondary endpoints were quality of life (QOL) assessed by Functional Assessment of Cancer Therapy-Anemia (FACT-An) questionnaire and transfusion requirements. RESULTS: Among the 69 patients (per protocol set population) assessable for efficacy, hemoglobin level change in the 36,000 IU group was significantly greater than that in the 9000 IU group (1.75 +/- 2.15 versus 0.04 +/- 1.98 g/dl; P = 0.009), and a significant dose-response relationship was observed for the change in hemoglobin level (P = 0.003). Although changes in FACT-An Total Fatigue subscale (Fatigue subscale) scores were similar for the three dosage groups, there was a statistically significant correlation (r = 0.435, P < 0.001) between the change in hemoglobin levels and the change in Fatigue subscale scores. The proportion of transfused patients was significantly smaller in the 36 000 IU group compared with that in the 9000 IU group (P = 0.022, not adjusted for pre-study transfusions). The incidence of adverse events was similar in the three dosage groups. CONCLUSIONS: Once-weekly epoetin-beta 36,000 IU for 12 weeks was well tolerated and significantly increased hemoglobin levels in anemic cancer patients receiving chemotherapy.     

Effects of exercise on angiogenesis and apoptosis‐related molecules,quality of life,fatigue and depression in breast cancer patients

The aim of this study was to explore the effects of exercise on angiogenesis and apoptosis‐related molecules, quality of life, fatigue and depression in patients who completed breast cancer treatment. Sixty breast cancer patients were randomised into three groups, as supervised exercise group, home exercise group and education group. Angiogenesis and apoptosis‐related cytokine levels and quality of life (EORTC QOL‐C30: European Organisation for Research and Treatment of Cancer Quality of Life C30), fatigue (Brief Fatigue Inventory) and depression (BDI: Beck Depression Inventory) scores were compared before and after a 12‐week exercise programme. After the exercise programme, statistically significant decreases were found in interleukin‐8 and neutrophil activating protein‐78 levels in the home exercise group (P < 0.05). The education group showed a statistically significant increase in monocyte chemoattractant protein‐1 level (P < 0.05). Functional score and global health score of EORTC QOL‐C30 in the supervised exercise group and functional score of EORTC QOL‐C30 in the home exercise group increased significantly after exercise programme (P < 0.05). BDI score was significantly lower in the supervised exercise group after the exercise programme (P < 0.05). Changes in angiogenesis and apoptosis‐related molecules in the study groups suggest a possible effect of exercise on these parameters. Exercise programmes are safe and effective on quality of life and depression in breast cancer patients whose treatments are complete.     

放疗前患者癌痛和生活质量状况调查

目的：了解放疗前患者癌痛的发生率及其对生活质量的影响。方法采用欧洲癌症研究和治疗组织的生命质量核心问卷（the Europe Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30,EORTC QLQ-C30）对门诊行CT定位的100例患者进行问卷调查。结果100例准备行放疗的患者中,疼痛患者42例,其中轻度疼痛33例,中度疼痛7例,重度疼痛2例。与无疼痛患者比较,疼痛患者在躯体功能、角色功能、情绪功能和认知功能方面得分均较低,差异均具有统计学意义（均P＜0．05）,而在总体健康状况方面得分高于无疼痛患者,差异具有统计学意义（P＜0．01）。多元线性回归分析显示,24 h最重的以及平均疼痛对生活质量的影响比较明显,需要药物止痛的患者认知功能得分较低,女性及文化程度高的患者社会功能得分较低（均P＜0．05）。结论疼痛在多个方面影响癌症患者的生活质量,尤其对躯体功能、角色功能及社会功能的影响较为突出。     

Resistance training improves fatigue and quality of life in previously sedentary breast cancer survivors: a randomised controlled trial

The primary aim of this study was to evaluate the benefits of resistance training (RT) on quality of life (QOL) and fatigue in breast cancer survivors as an adjunct to usual care. We recruited 39 women who had survived breast cancer [mean age (y) 51.9 ± 8.8; time since diagnosis (m) 11.6 ± 13.2]. Primary outcomes were fatigue as assessed by the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT) scale and QOL as assessed by the Functional Assessment of Cancer Therapy – General (FACT‐G) scale. ANCOVA was used to assess the change in the primary outcomes while controlling for baseline values, with effect sizes (ES) displayed as partial Eta squared. The experimental group received supervised RT 3 days per week in a university clinic for 16 weeks. Perceptions of fatigue improved significantly in the RT group compared to controls [mean (SD) 6.7 (7.5) points vs. 1.5 (3.7) points], (P = 0.006, ES = 0.20) as did QOL [6.9 (8.5) points vs. 1.6 (4.4) points], (P = 0.015, ES = 0.16). We demonstrated both statistically and clinically important improvements in fatigue and QOL in response to RT in breast cancer survivors.     

Health-related quality of life and distress in cancer patients: results from a large randomised study

To compare the effectiveness of individual support, group rehabilitation and a combination of the two in improving health-related quality of life (HRQOL) and psychological well-being in cancer patients during 24 months after diagnosis, as compared with standard care (SC). Furthermore, to compare the study sample and a random sample of the Swedish population with regard to HRQOL. A total of 481 consecutive patients, newly diagnosed with cancer, were randomly assigned to one of the four alternatives. Data on HRQOL and psychological well-being were collected at baseline and after 3, 6, 12 and 24 months. The interventions did not improve HRQOL or psychological well-being, as compared with SC. At 3 months, the study sample reported an HRQOL comparable with the normal population. Many cancer patients are able to manage their cancer-related concerns with the support available from SC. However, it is reasonable to assume that the findings suffer from a lack of data from especially vulnerable patients and a possible Hawthorne effect. It cannot be concluded that cancer patients have no need for additional psychosocial interventions. Future projects should include screening and target interventions for those at risk for significant and prolonged psychological distress.