Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-19T12:40:30.082Z Has data issue: false hasContentIssue false
  • English
  • Français

Fatigue in patients on oral targeted or chemotherapy for cancer and associations with anxiety, depression, and quality of life

Published online by Cambridge University Press:  19 September 2019

Hanneke Poort Open the ORCID record for Hanneke Poort [Opens in a new window] ,
Jamie M. Jacobs ,
William F. Pirl ,
Jennifer S. Temel  and
Joseph A. Greer
Hanneke Poort
Affiliation:
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
Jamie M. Jacobs
Affiliation:
Massachusetts General Hospital Cancer Center, Boston, MA
William F. Pirl
Affiliation:
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
Jennifer S. Temel
Affiliation:
Massachusetts General Hospital Cancer Center, Boston, MA
Joseph A. Greer*
Affiliation:
Massachusetts General Hospital Cancer Center, Boston, MA
*
Author for correspondence: Dr. Joseph Greer, Massachusetts General Hospital Cancer Center & Harvard Medical School, Yawkey Center, Suite 10B, 55 Fruit Street, Boston, MA02114. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Oral treatment (targeted or chemotherapy) for cancer is being increasingly used. While fatigue is a known side effect of intravenous chemotherapy, the rate of fatigue and the impact of fatigue on other patient-reported outcomes are not well described.

Method

At Massachusetts General Hospital Cancer Center, 180 adult patients prescribed oral targeted or chemotherapy for various malignancies enrolled in a randomized controlled trial of adherence and symptom management. Patients completed baseline self-reported measures of fatigue (Brief Fatigue Inventory; BFI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale; HADS), and quality of life, including subscales for physical, social, emotional, and functional well-being ([QOL] Functional Assessment of Cancer Therapy — General; FACT-G). We examined clinically relevant fatigue using a validated cut-off score for moderate-severe fatigue (BFI global fatigue ≥4) and tested the associations with anxiety symptoms, depressive symptoms, and QOL with independent samples t-tests.

Results

At baseline, 45 of 180 participants (25.0%) reported moderate-severe fatigue. Fatigued patients experienced more anxiety symptoms (mean diff. 3.73, P < 0.001), more depressive symptoms (mean diff. 4.14, P < 0.001), and worse QOL on the total FACT-G score (mean diff. −19.58, P < 0.001) and all subscales of the FACT-G compared to patients without moderate-severe fatigue.

Significance of results

One in four patients on oral treatment for cancer experienced clinically relevant fatigue that is associated with greater anxiety and depressive symptoms and worse QOL.

Keywords

CancerFatigueOral chemotherapyQuality of lifeTargeted therapy
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 2 , April 2020 , pp. 141 - 147
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aisner, J (2007) Overview of the changing paradigm in cancer treatment: Oral chemotherapy. American Journal of Health-System Pharmacy 64(9_Supplement_5), S4–S7.CrossRefGoogle ScholarPubMed
Anderson, KO, Getto, CJ, Mendoza, TR, et al. (2003) Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults. Journal of Pain and Symptom Management 25(4), 307–318.CrossRefGoogle ScholarPubMed
Andrykowski, MA, Donovan, KA and Jacobsen, PB (2009) Magnitude and correlates of response shift in fatigue ratings in women undergoing adjuvant therapy for breast cancer. Journal of Pain and Symptom Management 37(3), 341–351.CrossRefGoogle ScholarPubMed
Basch, E, Deal, AM, Kris, MG, et al. (2016) Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. Journal of Clinical Oncology 34(6), 557–565.CrossRefGoogle ScholarPubMed
Bjelland, I, Dahl, AA, Haug, TT, et al. (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research 52(2), 69–77.CrossRefGoogle ScholarPubMed
Brucker, PS, Yost, K, Cashy, J, et al. (2005) General population and cancer patient norms for the Functional Assessment of Cancer Therapy-General (FACT-G). Evaluation & the Health Professions 28(2), 192–211.CrossRefGoogle Scholar
Butt, Z, Rosenbloom, SK, Abernethy, AP, et al. (2008) Fatigue is the most important symptom for advanced cancer patients who have had chemotherapy. Journal of the National Comprehensive Cancer Network 6(5), 448–455.CrossRefGoogle ScholarPubMed
Cella, DF, Tulsky, DS, Gray, G, et al. (1993) The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology 11(3), 570–579.CrossRefGoogle ScholarPubMed
Colomer, R, Alba, E, Gonzalez-Martin, A, et al. (2010) Treatment of cancer with oral drugs: A position statement by the Spanish Society of Medical Oncology (SEOM). Annals of Oncology 21(2), 195–198.CrossRefGoogle Scholar
Derogatis, LR (1982) Psychopharmacologic applications to cancer. An overview. Cancer 50(9 Suppl), 1962–1967.3.0.CO;2-C>CrossRefGoogle ScholarPubMed
Efficace, F, Baccarani, M, Breccia, M, et al. (2013) Chronic fatigue is the most important factor limiting health-related quality of life of chronic myeloid leukemia patients treated with imatinib. Leukemia 27(7), 1511–1519.CrossRefGoogle ScholarPubMed
Fallowfield, L (2002) Quality of life: A new perspective for cancer patients. Nature Reviews Cancer 2(11), 873–879.CrossRefGoogle ScholarPubMed
Given, BA, Spoelstra, SL and Grant, M (2011) The challenges of oral agents as antineoplastic treatments. Seminars in Oncology Nursing 27(2), 93–103.CrossRefGoogle ScholarPubMed
Hartigan, K (2003) Patient education: The cornerstone of successful oral chemotherapy treatment. Clinical Journal of Oncology Nursing 7(6 Suppl), 21–24.CrossRefGoogle ScholarPubMed
Hauser, K, Walsh, D, Rybicki, LA, et al. (2008) Fatigue in advanced cancer: A prospective study. The American Journal of Hospice & Palliative Care 25(5), 372–378.CrossRefGoogle ScholarPubMed
Hofman, M, Ryan, JL, Figueroa-Moseley, CD, et al. (2007) Cancer-related fatigue: The scale of the problem. The Oncologist 12(suppl_1), 4–10.CrossRefGoogle Scholar
Holzner, B, Kemmler, G, Cella, D, et al. (2004) Acta Oncologica Normative data for functional assessment of cancer therapy. General scale and its use for the interpretation of quality of life scores in cancer survivors) Normative data for functional assessment of cancer therapy. General scale and its use for the interpretation of quality of life scores in cancer survivors. Acta Oncologica 43(2), 153–160.CrossRefGoogle ScholarPubMed
Irvine, D, Vincent, L, Graydon, JE, et al. (1994) The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals. Cancer Nursing 17(5), 367–378.CrossRefGoogle ScholarPubMed
Mendoza, TR, Wang, XS, Cleeland, CS, et al. (1999) The rapid assessment of fatigue severity in cancer patients: Use of the Brief Fatigue Inventory. Cancer 85(5), 1186–1196.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
National Comprehensive Cancer Network (2018) Clinical Practice Guidelines in Oncology (NCCN Guidelines). Cancer-Related Fatigue, Version 2.2018. Available at: https://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf (accessed 2 April 2018).Google Scholar
Neuss, MN, Polovich, M, McNiff, K, et al. (2013) 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. Journal of Oncology Practice 9(2 Suppl), 5s–13s.CrossRefGoogle Scholar
O'Neill, VJ and Twelves, CJ (2002) Oral cancer treatment: Developments in chemotherapy and beyond. British Journal of Cancer 87(9), 933–937.CrossRefGoogle ScholarPubMed
Peters, MEWJ, Goedendorp, MM, Verhagen, CAHHVM, et al. (2014) Severe fatigue during the palliative treatment phase of cancer. Cancer Nursing 37(2), 139–145.CrossRefGoogle ScholarPubMed
Peterson, LG, Leipman, M and Bongar, B (1987) Psychotropic medications in patients with cancer. General Hospital Psychiatry 9(5), 313–323.CrossRefGoogle ScholarPubMed
Poort, H, van der Graaf, WTA, Tielen, R, et al. (2016) Prevalence, impact, and correlates of severe fatigue in patients with gastrointestinal stromal tumors. Journal of Pain and Symptom Management 52(2), 272–283.CrossRefGoogle ScholarPubMed
Servaes, P, Verhagen, S and Bleijenberg, G (2002) Determinants of chronic fatigue in disease-free breast cancer patients: A cross-sectional study. Annals of Oncology: Official Journal of the European Society for Medical Oncology 13(4), 589–598.CrossRefGoogle ScholarPubMed
Sikorskii, A, Given, CW, Given, BA, et al. (2018) An automated intervention did not improve adherence to oral oncolytic agents while managing symptoms: Results from a two-arm randomized controlled trial. Journal of Pain and Symptom Management 56(5), 727–735.CrossRefGoogle Scholar
Sprangers, MA, Van Dam, FS, Broersen, J, et al. (1999) Revealing response shift in longitudinal research on fatigue—the use of the then test approach. Acta Oncologica 38(6), 709–718.Google Scholar
Stiefel, FC, Kornblith, AB and Holland, JC (1990) Changes in the prescription patterns of psychotropic drugs for cancer patients during a 10-year period. Cancer 65(4), 1048–1053.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Susanne, K, Michael, F, Thomas, S, et al. (2019) Predictors of fatigue in cancer patients: A longitudinal study. Supportive Care in Cancer 27(9), 3463–3471.CrossRefGoogle ScholarPubMed
Tanaka, K, Akechi, T, Okuyama, T, et al. (2002) Impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer. Journal of Pain and Symptom Management 23(5), 417–423.CrossRefGoogle ScholarPubMed
van Muijen, P, Duijts, SFA, Bonefaas-Groenewoud, K, et al. (2017) Predictors of fatigue and work ability in cancer survivors. Occupational Medicine 67(9), 703–711.CrossRefGoogle ScholarPubMed
Vardy, JL, Dhillon, HM, Pond, GR, et al. (2016) Fatigue in people with localized colorectal cancer who do and do not receive chemotherapy: A longitudinal prospective study. Annals of Oncology 27(9), 1761–1767.CrossRefGoogle Scholar
Wang, H-L, Ji, M, Visovsky, C, et al. (2016) Clinically relevant four-level cancer-related fatigue among patients with various types of cancer. Journal of the Advanced Practitioner in Oncology 7(1), 23–37.Google ScholarPubMed
Zigmond, AS and Snaith, RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67(6), 361–370.CrossRefGoogle ScholarPubMed