Fatigue in advanced cancer patients attending an outpatient palliative radiotherapy clinic as screened by the Edmonton Symptom Assessment System

Introduction

Advanced cancer patients present with a variety of physical and psychological symptoms. Fatigue is one such symptom which reduces overall quality of life and is difficult to manage. The purpose of this study was to report the presence, severity, and correlating factors of fatigue in advanced cancer patients attending an outpatient palliative radiotherapy clinic.

Materials/methods

Patients referred to the Rapid Response Radiotherapy Program between January 1999 and October 2009 completed the Edmonton Symptom Assessment System (ESAS) prior to consultation. Demographic information including age, Karnofsky Performance Status (KPS), gender, and primary cancer sites were collected. Ordinal logistic regression analysis was conducted to determine relationships between demographic information, other ESAS items, and levels of fatigue. Multivariate ordinal logistic regression analysis was used to determine the most significant predictors of fatigue. A p value of <0.05 was considered statistically significant.

Results

A total of 1,397 patients completed the ESAS prior to consultation. Median age was 68?years (range, 21–95), median KPS was 60 (range, 10–100), and slightly more males completed the ESAS (53.0%). Common primary cancers were of the lung (35.8%), breast (20.7%), and prostate (17.7%). Only 179 (12.8%) patients reported no fatigue; the majority of patients reported moderate (31.8%) or severe (34.4%) fatigue. A low KPS (p?<?0.0001), being female (p?=?0.0056), or being referred for bone metastases (p?=?0.0185) significantly correlated with higher levels of fatigue. Patients with a genitourinary primary cancer (p?=?0.0078) and/or referred for malignant spinal cord compression (p?=?0.0004) reported less fatigue. All other ESAS items were significantly related to fatigue. The most significant predictors of fatigue were pain (p?<?0.0001, odds ratio (OR)?=?1.07), nausea (p?=?0.0010, OR?=?1.10), depression (p?<?0.0001, OR?=?1.10), drowsiness (p?<?0.0001, OR?=?1.33), dyspnea (p?=?0.0003, OR?=?1.08), and overall well-being (p?<?0.0001, OR?=?1.19).

Conclusion

Moderate fatigue was reported in over 66% of our advanced cancer patients prior to radiotherapy. Since radiotherapy inherently causes fatigue, proactive and multidisciplinary management is required for these patients. Similar rates of fatigue severity, in lengthier, fatigue-specific tools, suggest that the ESAS may be a good tool for screening the advanced cancer population.     

Changes in nutritional status, body composition, quality of life, and physical activity levels of cancer patients undergoing autologous peripheral blood stem cell transplantation

Purpose

This pilot exploratory study aimed to describe the changes in nutritional status, body composition, quality of life (QoL), and physical activity levels (PAL) of cancer patients undergoing high-dose conditioning and autologous peripheral blood stem cell transplantation (PBSCT) at pre-admission, hospital discharge, and at 100 days post-transplantation, and to examine if changes in these parameters are interrelated.

Methods

Twenty-four patients (56.2?±?12.9 years; 7 females, 17 males) were recruited from an Australian transplant center. Assessment was prospectively conducted at pre-admission, hospital discharge, and 100 days post-transplantation using the scored patient-generated subjective global assessment, air displacement plethysmography, EORTC QLQ-C30 (version 3), and the international physical activity questionnaire.

Results

At discharge, nutritional status deteriorated (patient-generated subjective global assessment (PG-SGA) median, +8.0; interquartile range, 6.0–13.0; p?<?0.001) and the number of malnourished patients increased (n?=?8/23; p?=?0.023). Patients experienced significant loss of lean body mass (LBM; ?2.2 kg, CI 95 % ?3.0, ?1.4; p?<?0.001), and decrease in QoL (?10.6, CI 95 % ?24.1, 2.9; p?=?0.117); the proportion of patients with high PAL decreased (p?=?0.012). By 100 days post-transplantation, all patients were well-nourished; however, LBM remained lower ?1.0 kg (CI 95 % ?1.9, ?0.1; p?=?0.028). Change in nutritional status (PG-SGA score) was associated with weight (r?=??0.46; p?=?0.039) and fat mass (r?=??0.57; p?=?0.013). Change in QoL was associated with nutritional reservoir (i.e., fat; r?=?0.54; p?=?0.024); QoL was consistently higher for patients with high PAL.

Conclusions

High-dose conditioning and autologous PBSCT is associated with deterioration in nutritional status, QoL and PAL, with LBM remaining below baseline levels at 100 days post-transplantation. A nutrition and exercise intervention program post-hospital discharge may be beneficial for these patients.     

Fatigue scores in patients with brain metastases receiving whole brain radiotherapy

Purpose

Whole brain radiotherapy (WBRT) is a treatment strategy used commonly to relieve burdensome symptoms and improve quality of life (QOL) in patients with multiple brain metastases. The purpose of this study is to determine changes in fatigue score following WBRT as it is a common symptom experienced in this population.

Methods

Fatigue and overall QOL scores were collected prospectively in patients for up to 3 months post-WBRT by several questionnaires at different times including the following: Edmonton Symptom Assessment System (ESAS), Brain Symptom and Impact Questionnaire (BASIQ), Spitzer Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), EORTC brain module (EORTC QLQ-BN20?+?2), EORTC QLQ-C15-PAL, and Functional Assessment of Cancer Therapy—General (FACT-G). Questionnaires were grouped for analysis by Wilcoxon Signed Rank test according to the scale of ranking into 0–10, 1–4, and 0–4.

Results

Thirty-six patients were interviewed with the ESAS or BASIQ. The median age was 65 years old, and median Karnofsky Performance Status (KPS) was 70. There was a significant increase in fatigue score from baseline to month 1 (p?=?0.02), and months 2 and 3 had no significant change. There was a significant correlation between fatigue and overall QOL score at baseline and month 1 (p?=?0.01, p?<?0.0001), respectively. Two hundred and twenty-eight patients were surveyed with Spitzer, C15-PAL, BN20?+?2, QLQ-C30, or FACT-G. Median age was 64 years old and median KPS was 80. Compared to baseline, fatigue score was significantly higher at month 1 (p?<?0.0001) and month 2 (p?=?0.001), with no significant change at month 3. Significant correlation was found between fatigue and overall QOL at baseline, months 1, 2 (p?<?0.0001), and 3 (p?=?0.0009). For all groups, there was no significant change in fatigue score between patients with or without dexamethasone (Dx), except for the fatigue changed score of the group with scale 0–4.

Conclusions

Fatigue was significantly increased from baseline to month 1 in all patients, and most patients experienced no difference in fatigue if they were receiving Dx. Increased fatigue was significantly related with decreased overall QOL.     

A systematic review and meta-analysis on the use of traditional Chinese medicine compound kushen injection for bone cancer pain

Purpose

Bone cancer pain presents a clinical challenge with limitations of current treatments. Compound kushen injection (CKI) is a well-known traditional Chinese medicine (TCM) formulation in treatment of patients with bone cancer pain. The objective of this study is to assess the efficacy and safety of CKI for bone cancer pain.

Methods

A systematic literature search was conducted in nine databases until December 2012 to identify randomized controlled trials (RCTs) of CKI versus current western therapies for bone cancer pain. The primary outcome was total pain relief rate. The secondary outcomes were the quality of life and adverse events at the end of treatment course. The methodological quality of RCTs was assessed independently using six-item criteria according to the Cochrane Collaboration, and the level of evidence was assessed by the GRADE approach. All data were analyzed using Review Manager 5.1.0.

Results

Seven RCTs with 521 patients from 2010 to 2012 were identified. Compared with radiotherapy or bisphosphonates, seven RCTs showed significant effects of CKI for improving pain relief in patients with bone cancer pain (n?=?521, risk ratio (RR)?=?1.25, 95 % CI (95 % confidence intervals (CI)), 1.13 to 1.38, p?<?0.0001)), three RCTs for improving Karnofsky scoring (KPS) increase rate (n?=?305, RR?=?1.62, 95 % CI, 1.32 to 1.99, p?<?0.00001), 1 RCT for increasing KPS scores (n?=?78, mean difference (MD)?=?10.43, 95 % CI 4.76 to 16.10, p?=?0.0003). 4 RCTs reported adverse effects in both the treatment and control groups. The patients treated with CKI achieved statistically significant reductions of incidences of leukopenia (n?=?276, RR?=?0.32, 95 % CI, 0.21 to 0.47, p?<?0.00001) and nausea (n?=?78, RR?=?0.15, 95 % CI, 0.06 to 0.34, p?<?0.00001). No severe adverse events were found and no treatment was stopped because of adverse events of CKI in the treatment groups. However, the studies were deemed to have a high risk of bias.

Conclusion

This systematic review showed positive but weak evidence of CKI for bone cancer pain because of the poor methodological quality and the small quantity of the included trials. Future rigorously designed RCTs are required.     

Falls and functional impairments in cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN): a University of Rochester CCOP study

Purpose

This study was conducted in order to characterize the prevalence of falls and functional impairments (FIs) and their association with chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors.

Methods

We analyzed baseline assessments from a phase III RCT in cancer survivors with self-reported CIPN scores of >4 out of 10. Patients completed the EORTC QLQ-CIPN-20 for neuropathy and reported falls in the previous 3 months. FIs were defined using the Activities of Daily Living subsection of the Vulnerable Elder’s Scale. Associations of baseline characteristics and CIPN with falls and FIs were examined using logistic regression.

Results

Of 421 patients, 11.9 % experienced recent falls and 26.6 % reported FIs. Motor neuropathy was the only factor associated with falls (OR?=?1.127, p?=?0.01). Factors associated with FIs included non-white race (OR?=?0.335 white relative to non-white, 0.781, p?=?0.01) and greater motor neuropathy scores (OR?=?1.262, p?<?0.0001).

Conclusion

CIPN, primarily motor, is associated with falls and FIs. Future prospective research should investigate the ability of motor neuropathy severity to predict falls.     

Health-related quality of life and inflammatory markers in malignant pleural mesothelioma

Purpose

Malignant pleural mesothelioma (MPM) is a highly aggressive and symptomatic disease. We examined the relationship between health-related quality of life (HRQoL) and inflammatory markers, and the prognostic role of HRQoL in MPM patients.

Methods

MPM patients from two parallel phase II studies (thalidomide alone or thalidomide with chemotherapy) were included. HRQoL was assessed at baseline using the modified Lung Cancer Symptom Scale (LCSS). Baseline inflammatory markers and cytokines were measured. Spearman correlation was used to examine the relationship between inflammatory markers and HRQoL measures. The prognostic value of the HRQoL domains was examined using Cox proportional hazard model.

Results

Sixty-three patients were included: median age 61 years (range 44–79); 82 % male; 77 % Eastern Cooperative Oncology Group (ECOG) performance status 0–1; 44 % epithelial histology subtype. Baseline systemic symptoms of anorexia and fatigue, the summation symptoms of overall symptomatic distress, interference with normal activity and global QoL and the aggregate score of total LCSS score were all associated with elevated neutrophil-to-lymphocyte ratio, C-reactive protein and vascular endothelial growth factor levels at baseline (rho?≥?0.25; p?<?0.05). Baseline anorexia, fatigue, cough, dyspnoea, pain, overall symptomatic distress, interference with normal activity, global QoL and total LCSS score were all significantly related to survival (p?<?0.05) after adjusting for established prognostic factors (age, gender, histological subtype and performance status) and treatment effect.

Conclusions

In conclusion, HRQoL seems to relate to a patient's systemic inflammatory status and is associated with survival in MPM patients.     

Testing the ‘teachable moment’ premise: does physical activity increase in the early survivorship phase?

Purpose

Little is known about objectively measured physical activity during the early survivorship period. This study measured physical activity, fatigue, and quality of life (QOL) in breast cancer patients over the first year after completion of chemotherapy and compared results to a matched non-cancer group.

Methods

Data was obtained from 24 breast cancer subjects (mean ± SD) 50.9?±?12.8 years at time points of 6 weeks, 6 months and 1 year after completion of adjuvant chemotherapy and from 20 matched women. The following variables were assessed, physical activity (RT3 accelerometer and International Physical Activity Questionnaire), quality-of-life (EORTC QLQ C-30) and fatigue (Brief Fatigue Inventory).

Results

At 6 weeks after completion of chemotherapy, high levels of sedentary behaviour were found (6.8?±?1.9 h sedentary per day), which did not improve, and was no different to the comparison group (6.5?±?1.4 h). Less light activity was performed in the cancer cohort compared to the comparison group (p?=?0.003). Body mass index (BMI) increased significantly in the cancer cohort (p?=?0.015) and 1 year after chemotherapy finished only 13 % (n?=?3) had a BMI <25, while the comparable value was 45 % (n?=?9) in the non-cancer group. The QOL domain of cognitive function improved over the first 6 months (p?=?0.034) but physical functioning declined (p?=?0.008) over this time period. Fatigue did not change, and at the 1-year time point, 38 % of the cancer patients (n?=?11) reported high levels of fatigue.

Conclusion

This study highlighted the unchanging sedentary behaviour and weight gain of breast cancer survivors during the first year after completion of chemotherapy, which may inform rehabilitation models in this population.     

Multimodal exercise training during myeloablative chemotherapy: a prospective randomized pilot trial

Purpose

Cancer and its treatment-related side effects induce loss of physical performance. This study evaluated the effects of multimodal aerobic and strength exercises on physical performance in hospitalized cancer patients while receiving myeloablative chemotherapy.

Methods

In this prospective pilot study, 48 evaluable patients were randomly assigned to a training (TG, n?=?24) or control (CG, n?=?24) group. The TG performed an individually supervised exercise program five times a week with ergometer training and strength exercises for 20 min each during the hospitalization period for chemotherapy. The CG received standard physiotherapy. Physical performance was evaluated using spiroergometry, lung function, and muscle strength testing. Treatment-related side effects were assessed by daily interviews, quality of life by EORTC-QLQ-C30, and fatigue using the Modified Fatigue Impact Scale (MFIS) questionnaire.

Results

Physical performance significantly increased in the TG (8.96?±?24 W) and decreased in the CG (?7.24?±?20 W, p?=?0.02). At 2-mmol/ml blood lactate concentration, the TG achieved significantly increased oxygen consumption (p?=?0.03) and expiratory minute ventilation (p?=?0.04) compared to the CG. Furthermore, physical functioning increased significantly in the TG (p?=?0.04). Patients in the TG required less antiemetics (p?=?0.01) and experienced significantly less fatigue (p?=?0.04), although MFIS analysis was not able to detect this beneficial effect. Patients of the CG displayed higher impairments of cognitive (p?=?0.02) and psychosocial function (p?=?0.03) after chemotherapy. No adverse events due to the study intervention were observed.

Conclusions

Multimodal exercise has beneficial effects on physical performance, physical functioning, and treatment-related symptoms even during myeloablative chemotherapy. We suggest an enhanced physical activity intervention program during hospitalization of cancer patients.     

Analysis of ECOG performance status in head and neck squamous cell carcinoma patients: association with sociodemographical and clinical factors, and overall survival

Purpose

In the present study, we analyzed sociodemographical and clinical factors, and the Eastern Cooperative Oncology Group performance status (ECOG-PS) scale in head and neck squamous cell carcinoma (HNSCC) patients. We evaluated the impact of a range of variables on overall survival.

Methods

We investigated a sample of HNSCC patients (n?=?671), using sociodemographical and clinical information, and survival data collected from a review of epidemiological, clinical, and treatment reports. Statistical associations were analyzed by bivariate and multivariate statistical tests. Statistical significance was set at p?<?0.05.

Results

Of patients 85.4% recorded good ECOG-PS scores. Poor ECOG-PS scores were associated with the covariates indicative of dysphagia [odd ratios (OR)?=?2.660, CI 95%?=?1.661–4.260, p?=?0.000] and large-size malignant disease (T3–T4; OR?=?5.337, CI 95%?=?2.251–12.652, p?=?0.000). Overall survival analysis revealed that ECOG-PS scores (OR?=?1.879, CI 95%?=?1.162–3.038, p?=?0.010), tumor size (OR?=?1.665, CI 95%?=?1.035–2.680, p?=?0.036), and the presence of cervical metastasis (OR?=?3.145, CI 95%?=?2.008–4.926, p?=?0.000) were independent predictors.

Conclusion

Evaluation of physical consumption in head and neck cancer patients at diagnosis may indicate a more aggressive type of malignant disease. Thus, the ECOG-PS scale may help to identify HNSCC patients in need of rapid referral, who may benefit from specific therapeutic and rehabilitative interventions.     

Testosterone replacement for fatigue in hypogonadal ambulatory males with advanced cancer: a preliminary double-blind placebo-controlled trial

Background

Uncontrolled studies show fatigue, anorexia, depression, and mortality are associated with low testosterone in men with cancer. Testosterone replacement improves quality of life and diminishes fatigue in patients with non-cancer conditions. The primary objective was to evaluate the effect of testosterone replacement on fatigue in hypogonadal males with advanced cancer, by the Functional Assessment of Chronic Illness Therapy-Fatigue subscale (FACIT-Fatigue) at day 29.

Methods

This is a randomized, double-blinded placebo-controlled trial. Outpatients with advanced cancer, bioavailable testosterone (BT) <70 ng/dL and fatigue score >3/10 on the Edmonton Symptom Assessment Scale were eligible. Intra-muscular testosterone or sesame seed oil placebo was administered every 14 days to achieve BT levels 70–270 ng/dL.

Results

Sixteen placebo and 13 testosterone-treated subjects were evaluable. No statistically significant difference was found for FACIT-fatigue scores between arms (?2?±?12 for placebo, 4?±?8 for testosterone, p?=?0.11). Sexual Desire Inventory score (p?=?0.054) and performance status (p?=?0.02) improved in the testosterone group. Fatigue subscale scores were significantly better (p?=?0.03) in those treated with testosterone by day 72.

Conclusions

Four weeks of intramuscular testosterone replacement in hypogonadal male patients with advanced cancer did not significantly improve quality of life. Larger studies of longer duration are warranted.     

Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy

Purpose

Peak oxygen consumption (VO_2peak) is an important predictive factor for long-term prognosis in patients with non-small cell lung cancer (NSCLC). The purpose of this study was to investigate whether 8 weeks of exercise training improves exercise capacity, as assessed by VO_2peak, and other related factors in patients with NSCLC receiving targeted therapy.

Methods

A total of 24 participants with adenocarcinoma were randomly assigned to either the control group (n?=?11) or the exercise group (n?=?13). Subjects in the exercise group participated in individualized, high-intensity aerobic interval training of exercise. The outcome measures assessed at baseline and after 8?weeks were as follows: VO_2peak and the percentage of predicted VO_2peak (%predVO_2peak), muscle strength and endurance of the right quadriceps, muscle oxygenation during exercise, insulin resistance as calculated by the homeostasis model, high-sensitivity C-reactive protein, and quality of life (QoL) questionnaire inventory.

Results

No exercise-related adverse events were reported. After exercise training, VO_2peak and %predVO_2peak increased by 1.6?mL?kg^?1?min^?1 and 5.3% (p?<?0.005), respectively; these changes were associated with improvements in circulatory, respiratory, and muscular functions at peak exercise (all p?=?0.001). The exercise group also had less dyspnea (p?=?0.01) and favorably lower fatigue (p?=?0.05) than baseline.

Conclusions

Patients with NSCLC receiving targeted therapy have quite a low exercise capacity, even with a relatively high QoL. Exercise training appears to improve exercise capacity and alleviate some cancer-related symptoms.     

Determinants of quality of life in advanced cancer patients with bone metastases undergoing palliative radiation treatment

Purpose

Assessment of health-related quality of life (HRQOL) is critical to effective delivery of palliative care in patients with advanced cancer. The current study analyzes relationships between baseline social determinants of health and medical factors, and self-reported HRQOL in patients with bone metastases receiving palliative radiotherapy.

Methods and materials

Advanced cancer patients referred for radiotherapy treatment of bone metastases completed the EORTC QLQ-C30 questionnaire in multiple outpatient clinics internationally. Demographics and social determinants were collected as baseline information. Univariate and Bonferroni-adjusted multivariate linear regression analyses were used to detect significant correlations between baseline determinants and different HRQOL domains.

Results

Karnofsky Performance Status (KPS) was correlated with better physical (p?=?0.0002), role (p?<?0.0001), emotional (p?<?0.0001), and social (p?<?0.0001) functioning, and global health scores (p?=?0.0015) and predicted lower symptom scores for fatigue (p?<?0.0001), pain (p?<?0.0001), appetite loss (p?<?0.0001), and constipation (p?<?0.0001). Increased age was predictive of better social functioning (p?<?0.0001) and less insomnia (p?=?0.0036), higher education correlated with better global health status (p?=?0.0043), and patients who were employed or retired had improved physical functioning (p?=?0.0004 and p?=?0.0030, respectively) and less financial challenges compared to patients who were unemployed (p?=?0.0005).

Conclusions

Baseline KPS had the greatest influence on EORTC QLQ-C30 domain scores. Age, education level, and employment status had significant impacts, although on fewer domains. Further studies that investigate baseline determinants are worthwhile to clarify relationships in order to care for patients more effectively at the end of life.     

Relationship between weakness and phase angle in advanced cancer patients with fatigue

Objective

This study aims to determine the relationship between weakness and bioimpedance analysis (BIA)-derived phase angle in a population of untreated cancer patients with fatigue.

Methods

We prospectively evaluated 41 treatment-naive cancer patients of several origins that presented with performance status 1–2, weight loss >5 % in the last 6 months, and Fatigue Numeral Scale score >4. Weakness was considered a physical component of the multidimensional fatigue syndrome and was evaluated through several parameters utilizing hand grip strength technique by dinamometry. The same assessment was also performed on a healthy control population (n?=?20). BIA-derived phase angle was also determined by BIA.

Results

Compared to healthy controls, cancer patients exhibited significant differences in all the parameters: median fatigue was 6 (range 5–9), evaluated maximal strength mean was 27?±?10.71 vs. 42?±?10.74 kg (p?<?0.0001 for patients vs. control, respectively), and muscle strength difference (max–min muscle strength) was also statistically different (p?<?0.0001). We also determined parameter associations within the patient population. We found statistical significant correlations between median phase angle score and endurance muscle with percentage of weight loss (r?=?0.43, p?=?0.03) for head and neck cancer patients, and in non-small cell lung cancer patients, grip work correlated significantly with normal or decreased phase angle (r?=?0.85), p?=?0.006 (Spearman Rank Correlation).

Conclusions

Weakness could be correlated with normal or decreased phase angle in a population with ambulatory advanced cancer with fatigue naive of treatment. We also found a significant relationship between median phase angle score and endurance muscle with percentage of weight loss in the subpopulation of patients with head and neck carcinoma.     

The impact of radiotherapy on quality of life for cancer patients: a longitudinal study

Purpose

The aim of this study was to assess for changes in quality of life (QOL) among cancer patients who undergo radiotherapy (RT) and to identify factors that influence QOL in this group.

Materials and methods

Three hundred sixty-seven cancer patients who received curative RT were investigated using the EORTC QLQ-C30 questionnaire at the start of RT, end of RT, and 1 and 6 months post-RT.

Results

The patients were 49 % women, 51 % men, and median age at diagnosis was 57 years (range, 16–86 years). Compared to pre-RT, at the end of RT, the global health status score (p?<?0.001), nausea/vomiting (p?<?0.001), and apetite loss scores (p?<?0.001) were significantly poorer. Compared to the end of RT, at 1 and 6 months post-RT, global health status, all functional, and all symptom scores were significantly improved (p?<?0.001). Patient sex influenced scores for pain (p?=?0.036), appetite loss (p?=?0.027), and financial difficulty (p?=?0.003). Performance status influenced scores for global health status (p?=?0.006), physical functioning (p?<?0.001), cognitive functioning (p?=?0.001), and role functioning (p?=?0.021). Comorbidity influenced fatigue score (p?<?0.001). Cancer stage influenced scores for physical functioning (p?=?0.001), role functioning (p?=?0.010), and fatigue (p?<?0.001). Treatment modality (chemoRT vs. RT alone) influenced scores for physical functioning (p?=?0.016), fatigue (p?<?0.001), nausea/vomiting (p?=?0.009), and appetite loss (p?<?0.001); and RT field influenced scores for nausea/vomiting (p?=?0.001), appetite loss (p?=?0.003), and diarrhea (p?=?0.037). Radiotherapy dose functioning (p?<?0.001), cognitive functioning (p?<?0.001), social functioning (p?<?0.001), fatigue (p?<?0.001), and pain (<60 vs ≥60 Gy) had an effect on scores for physical functioning (p?<?0.001), role functioning (p?<?0.001), emotional (p?<?0.001), insomnia (p?<?0.001), constipation (p?<?0.001).

Conclusion

While RT negatively affects cancer patients’ QOL, restoration tends to be rapid and patients report significant improvement by 1 month post-RT. Various patient- and disease-specific factors and RT modality affect QOL in this patient group. We advocate measuring cancer patients’ QOL regularly as part of routine patient management.     

Parental sleep experiences on the pediatric oncology ward

Purpose

Parents of pediatric oncology patients are encouraged to sleep on the ward with their child to provide additional care throughout the night. The purpose of this study was to provide the first prevalence estimates of self-reported sleep quantity and quality among parents accommodated on the pediatric oncology ward, compared to parents of age-matched controls.

Methods

Parents of children receiving in-patient cancer treatment and parents of healthy, age-matched children completed a self-report questionnaire, including validated measures of parental sleep and psychological distress, demographic, and clinical characteristics.

Results

In total, 114 parents participated (52 parents of children with cancer; 62 control parents; over all response rate 70 %). Parents on the pediatric oncology ward reported sleeping 5.7 h (SD?=?1.8) on average, in comparison to control parents who reported sleeping 7.0 h at home (SD?=?1.4; t?=?4.3, p?<?0.001). Parents reported waking an average of 4.6 times (SD?=?0.3) per night on the ward, compared to control parents who reported 2.0 (SD?=?0.2) nighttime awakenings (t?=?7.69, p?<?0.001). Parents of children with cancer were significantly more likely to report that they had slept “badly” (67.3 versus 21.0 %; χ²?=?21.9, p?<?0.001). Significant predictors of sleep duration included anxiety (p?=?0.013) and caffeine consumption (p?=?0.017). Parents who slept on the ward attributed poor sleep to feelings of anxiety, environmental noise, and child-related factors.

Conclusions

Parents who sleep on the pediatric oncology ward experience poor sleep outcomes, including inadequate duration and frequent interruptions. The detrimental effects of sleep deprivation on parents' ability to cope during this challenging time require further investigation and intervention.     

Effects of a 12-week home-based exercise program on the level of physical activity, insulin, and cytokines in colorectal cancer survivors: a pilot study

Purpose

The purposes of this study are to examine (1) the feasibility and efficacy of two different home-based exercise protocols on the level of physical activity (PA), and (2) the effect of increased PA via home-based exercise program on biomarkers of colorectal cancer.

Methods

Seventeen patients (age 55.18 ± 13.3 years) with stage II–III colorectal cancer completed the 12-week home-based exercise program. Subjects were randomized into either casually intervened home-based exercise group (CIHE) or intensely intervened home-based exercise group (IIHE). The primary outcome was the level of PA. Furthermore, insulin, homeostasis model assessment of insulin resistance, insulin-like growth factor axis, and adipocytokines were measured.

Results

Both CIHE and IIHE program significantly increased the level of PA at 12 weeks compared to its level at baseline (CIHE, 10.00?±?8.49 vs. 46.07?±?45.59; IIHE, 12.08?±?11.04 vs. 35.42?±?27.42 MET hours per week). Since there was no difference in PA change between groups (p?=?0.511), the data was combined in analyzing the effects of increased PA on biomarkers. Increase in PA significantly reduced insulin (6.66?±?4.58 vs. 4.86?±?3.48 μU/ml, p?=?0.006), HOMA-IR (1.66?±?1.23 vs. 1.25?±?1.04, p?=?0.017), and tumor necrosis alpha-α (TNF-α 4.85?±?7.88 vs. 2.95?±?5.38 pg/ml, p?=?0.004), and significantly increased IGF-1 (135.39?±?60.15 vs. 159.53 ng/ml, p?=?0.007), IGF binding protein (IGFBP)-3 (2.67?±?1.48 vs. 3.48?±?1.00 ng/ml, p?=?0.013), and adiponectin (6.73?±?3.07 vs. 7.54?±?3.96 μg/ml, p?=?0.015).

Conclusion

CIHE program was as effective as IIHE program in increasing the level of PA, and the increase in PA resulted in significant change in HOMA-IR, IGF-1 axis, TNF-α, and adiponectin levels in stage II–III colorectal cancer survivors.     

The impact of bone mineral density testing,fracture assessment,and osteoporosis education in men treated by androgen deprivation for prostate cancer: a pilot study

Purpose

Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and engage in few healthy bone behaviors (HBBs). A multicomponent intervention was piloted in this population. Changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated.

Methods

A pre-post pilot study was performed in a convenience sample of men recruited from the Princess Margaret Cancer Centre. Men were sent personalized letters explaining their dual x-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t tests and McNemar’s test were used to assess changes in outcomes.

Results

A total of 148 men completed the study. There was an increase in OP knowledge (9.7?±?4.3 to 11.4?±?3.3, p?<?0.0001) and feelings of susceptibility (16.5?±?4.3 to 17.4?±?4.7, p?=?0.015), but a decrease in total self-efficacy (86.3?±?22.9 to 81.0?±?27.6, p?=?0.007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p?≤?0.001), and there was uptake of vitamin D supplementation from 44 % (n?=?65) to 68 % (n?=?99) (p?<?0.0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9?±?4.3 vs. ?0.22?±?4.2, p?=?0.005) compared to men with normal bone density.

Conclusions

Our results provide preliminary evidence that a multicomponent intervention such as the one described can lead to increased knowledge and feelings of susceptibility regarding OP and can enhance uptake of some HBBs.     

The early discontinuation of palliative chemotherapy in older patients with cancer

Purpose

Older patients with cancer may have an increased risk of early discontinuation of active treatment (ED), which results in poor outcome in curative or adjuvant settings. We aimed to determine the association between survival and ED and to identify predictors of ED in palliative setting.

Methods

Ninety-eight patients older than 65 years of age who received a comprehensive geriatric assessment (CGA) before palliative first-line chemotherapy were analyzed. Clinical information and CGA results were retrieved from electronic medical record. CGA included Charlson’s co-morbidity index, activities of daily living (ADL), instrumental ADL (IADL), Mini-Mental Status Examination, short-form of the geriatric depression scale, timed-get-up-and-go test (TGUG), and mini-nutritional assessment (MNA). ED was defined as no active cancer treatment (radiotherapy and/or chemotherapy) beyond palliative first-line chemotherapy. Predictors of ED were identified using clinical parameters and CGA.

Results

Active treatment was discontinued after first-line chemotherapy in 30 patients during median follow-up period of 15.1 months. ED after first-line chemotherapy was associated with shorter overall survival (OS; median OS?=?3.1 vs. 14.7 months in patients with ED compared with patients without ED, p?<?0.001). Eastern Cooperative Oncology Group performance status, living alone, ADL, IADL, MNA, and TGUG were associated with ED (p?=?0.001, p?=?0.048, p?=?0.001, p?<?0.001, p?<?0.001, p?=?0.002, respectively). In multivariable analysis, malnutrition and dependent IADL were the independent predictive factors for ED (odds ratio?=?5.03; 95 % confidence interval?=?1.50–16.87: odds ratio?=?3.06; confidence interval?=?1.03–9.12, respectively).

Conclusions

ED was associated with shorter OS in older patients with cancer. Malnutrition and dependent IADL were identified as independent predictive factors for ED.     

Overall survival and self-reported fatigue in patients with esophageal cancer

Purpose

A prospective cohort study was conducted to analyze whether self-reported fatigue predicts overall survival in patients with esophageal cancer.

Methods

Patients enrolled in the Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry between September 2001 and January 2009 who completed a baseline quality of life instrument were eligible for evaluation. The fatigue component was scored on a 0–10 scale, with 0 as extreme fatigue. Patients were categorized as having a decreased energy level if they reported a score of ≤5. Fatigue scores ≥6 reflect normal levels of energy.

Results

Data from a total of 659 enrolled patients were analyzed. A total of 392 (59 %) and 267 (41 %) patients reported decreased and normal energy, respectively. Univariate analysis indicates patients with normal energy had improved 5-year survival compared to patients with decreased energy (37 vs 28 %, hazard ratio (HR) 0.74, p?=?0.006). Among the patients with locally advanced disease, the same relationship was seen (28 vs 17 %, HR?=?0.67, p?=?0.003); this remained significant on multivariate analysis (HR?=?0.71, p?=?0.015).

Conclusions

A decreased energy level is associated with poor survival in patients with esophageal cancer. Thus, patients with high levels of fatigue should be referred for psychological support and be considered for therapy aimed at amelioration of fatigue symptoms.     

Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients

Purpose

Oral mucositis (OM) is a side effect of intensive chemotherapy and radiation and has been reported to affect 75–100 % of hematopoietic stem cell transplantation (HSCT) recipients. The purpose of this study was to compare the incidence of OM in patients conditioned with myeloablative conditioning (MAC) to reduced-intensity conditioning (RIC) and to determine the effect of a new oral care protocol.

Methods

The study involved 171 HSCT recipients, with hematological malignancies transplanted between 2007 and 2011. Median age of the patients was 50 years (range 12–71). Ninety-nine (58 %) received RIC and 72 received MAC. Clinical features of OM were recorded from day ?3 before to day +25 after HSCT using the World Health Organization (WHO) scoring system and the oral mucositis assessment score (OMAS).

Results

Overall, 87 % of the patients developed OM of any severity, which peaked on days 10–11. The mean WHO score was 1.7. In multivariate analysis, the severity of OM was associated with MAC (relative hazard (RH) 1.57, 95 % confidence interval (CI) 1.37–1.80, p?<?0.001), all donor-recipient gender combinations except female-to-male (RH?=?1.26, 95 % CI 1.10–1.4, p?=?0.001), and early year of HSCT (RH?=?0.84, 95%CI 0.7–0.96, p?=?0.013). There was a correlation between long hospitalization and OM (day 15, r?=?0.31, p?<?0.001). There was a good correlation between the WHO and OMAS scoring systems for OM (r?=?0.74, p?<?0.001).

Conclusions

Oral mucositis was reduced in patients treated with RIC and in patients treated during recent years, when oral care was intensified. Increased scores of OM prolonged hospitalization.