BACKGROUNDPatients often describe fatigue as the most distressing of the symptoms they experienced during their cancer treatment. Fatigue may increase from initial levels experienced during cancer treatment with the addition of radiotherapy (RT).METHODSThree hundred seventy‐two patients completed a Symptom Inventory at the initiation of RT and weekly for 4 weeks thereafter. Descriptive statistics were used to evaluate differences in fatigue at baseline by demographics and diagnosis. Changes over the course of treatment were evaluated by repeated‐measures analysis of variance and Student t tests for paired data. The effect of diagnosis, age, gender, and previous treatment on fatigue was investigated by linear and hierarchical regression.RESULTSFifty‐seven percent of patients reported some degree of fatigue at the initiation of RT. The proportion increased to 76% by Week 3 and then to 78% at Week 5. Eighty‐four percent of patients with initial fatigue remained fatigued throughout the 5‐week course. Of the 160 patients without initial fatigue, 70% subsequently developed it. By Week 5, only 13% of patients had never reported any fatigue. Severity was found to be related to diagnosis, with patients with prostate carcinoma reporting the least severe fatigue and patients with lung, alimentary, and head and neck carcinoma reporting the most severe fatigue. Neither gender, age, nor total dose of RT predicted significant variance in severity.CONCLUSIONSFatigue was a common adverse effect of RT for cancer, reported by more than three‐fourths of patients by the third to fifth weeks of treatment. Cancer diagnosis was the only factor found to be significantly related to variation in fatigue severity. Additional studies should be devised to identify other underlying causes of RT‐related fatigue. Cancer 2005. © 2005 American Cancer Society.

Although negative affect is a common precipitant of alcohol relapse, there are few interventions for alcohol dependence that specifically target negative affect. In this Stage 1a/1b treatment development study, several affect regulation strategies (e.g., mindfulness, prolonged exposure, distress tolerance) were combined to create a new treatment supplement called Affect Regulation Training (ART), which could be added to enhance Cognitive-Behavioral Therapy (CBT) for alcohol dependence. A draft therapy manual was given to therapists and treatment experts before being administered to several patients who also provided input. After two rounds of manual development (Stage 1a), a pilot randomized clinical trial (N = 77) of alcohol-dependent outpatients who reported drinking often in negative affect situations was conducted (Stage 1b). Participants received 12-weekly, 90-minute sessions of either CBT for alcohol dependence plus ART (CBT + ART) or CBT plus a healthy lifestyles control condition (CBT + HLS). Baseline, end-of-treatment, and 3- and 6-month posttreatment interviews were conducted. For both treatment conditions, participant ratings of treatment satisfaction were high, with CBT + ART rated significantly higher. Drinking outcome results indicated greater reductions in alcohol use for CBT + ART when compared to CBT + HLS, with moderate effect sizes for percent days abstinent, drinks per day, drinks per drinking day, and percent heavy drinking days. Overall, findings support further research on affect regulation interventions for negative affect drinkers.

Difficulties regulating emotions have implications for the development, maintenance, and recovery from alcohol problems. One construct thought to impede the regulation of emotion is alexithymia. Alexithymia is characterized by difficulties identifying, differentiating and expressing feelings, a limited imagination and fantasy life, and an externally-oriented thinking style (e.g., prefer talking about daily activities rather than feelings). Given that poor emotion regulation skills have been found to predict posttreatment levels of alcohol use, and that several defining characteristics of alexithymia bear similarity to deficits in emotion regulation skills, it is possible that alexithymia may predict poorer alcohol treatment outcomes. Thus, the present study first examined the relationship of alexithymia to several other emotion regulation measures and then investigated the impact of alexithymia on attrition and alcohol treatment outcomes in men and women (N = 77) enrolled in a 12-week cognitive-behavioral intervention for alcohol dependence. At baseline, higher scores on alexithymia were associated poorer emotion regulation skills, fewer percent days abstinent, greater alcohol dependence severity, and several high-risk drinking situations. Alexithymia was unrelated to attrition and to level of alcohol consumption at posttreatment. Overall, the construct of alexithymia is shown to be related to several theoretically-related constructs (e.g., emotion regulation, mindfulness) but demonstrated a limited relationship to drinking outcomes in those seeking treatment for alcohol dependence.

SummaryBackground-Despite widespread use of short-acting antagonists for the 5-hydroxytryptamine (5-HT) receptor, about 50% of patients given moderately emetogenic chemotherapy have delayed nausea. We aimed to assess whether a 5-HT-receptor antagonist was more effective than was prochlorperazine for control of delayed nausea and delayed vomiting caused by doxorubicin.

Purpose: Cancer patients often report cognitive impairment, manifested as problems with concentration and memory, following cancer therapy. As part of a large multicenter survey of cancer patients undergoing treatment, we investigated the frequency and severity of self-reported problems with memory and concentration over time.Methods: A total of 595 patients undergoing treatment for solid tumors self-rated problems with memory and concentration, using an 11-point Likert scale (0 ϭ "not present" to 10 ϭ "as bad as you can imagine") at baseline before treatment began (T1), at their worst during treatment (T2), and at 6 months following treatment (T3). Any symptom level Ն 7 was classified as "severe." Paired or independent t tests (as appropriate) with a Bonferroni correction were used to examine differences in symptoms over time and between patients treated with chemotherapy, radiation therapy, or both.Results: Concentration problems were reported by 48% of the 595 participants at T1 (5% severe), 67% at T2 (18% severe), and 58% (8% severe) at T3. Problems with memory were reported by 53% at T1 (4% severe), 67% (18% severe) at T2, and 68% (11% severe) at T3. The average frequency and severity of both symptoms in patients receiving chemotherapy, with or without radiation, increased significantly between T1 and T2 (P Ͻ .001). Both symptoms were less severe in patients receiving radiation alone at all three measurements than in either of the chemotherapy groups (all P values Ͻ .001). Symptoms at T3 were significantly higher than T1 for all groups (P Ͻ .001). Conclusion:A significant proportion of patients undergoing cancer therapy self-report problems with memory and concentration. Cognitive problems get worse during treatment and are still in evidence 6 months following the conclusion of treatments.

Cancer patients report exercising and appear amenable to attempting exercise during and within 6 months after treatment. Research is needed to assess (1) the frequency, intensity, duration, and mode of exercise; (2) randomized controlled trials with exercise and its influence on treatments and side effects; and (3) physician-patient communication regarding exercise during cancer treatment.

Objectives-While risk factors for tooth loss in adults have been identified, limited studies describing factors associated with incident tooth loss in postmenopausal women exist. This study assessed both clinical and non-clinical risk factors for incident tooth loss.Methods-Postmenopausal women (N= 1,341) were recruited between 1997-2000 from 1847 eligible Observational Study participants of the Buffalo, NY center of the Women's Health Initiative who had complete dental examinations to assess alveolar bone height, soft tissue attachment and general oral health, and completed questionnaires concerning demographics, general health, lifestyle and oral health (72.6% participation rate). Five years later (2002)(2003)(2004)(2005), 1021 women (76.1%) repeated these examinations and questionnaires. Incident tooth loss was determined by oral examination Results-After an average 5.1 years of follow-up (SD, 0.38), a total of 323 teeth were lost in 293 women, resulting in 28.7% of women with incident loss of at least one tooth. In multivariable models, diabetes history, gum disease history, smoking, previous tooth loss, BMI and plaque index, baseline clinical measures including alveolar crestal height (ACH) (OR=1.22 per mm loss, 95% CI 1.11, 1.35), clinical attachment loss (CAL) (OR=1.13 per mm loss, 95% CI 1.05, 1.23) and pocket depth (PD) (OR=1.26 per mm loss, 95% CI 1.13, 1.41) were significant risk factors of incident tooth loss. In a community model that included no clinical measures, diabetes history (OR=2.45, 95% CI 1.26, 4.77), prior gum disease (OR=1.97, 95% CI 1.43, 2.70), ever smoking (OR=1.42, 95% CI 1,06, 1.89), number of teeth lost at baseline (OR=1.05 per tooth, 95% CI 1.02, 1.08) and BMI (OR=1.15 per 5 km/m 2 increase, 95% CI 1.01, 1.33) were associated with an increased risk of incident tooth loss.Conclusions-Clinical and questionnaire based models were found to provide similar risk estimates for incident tooth loss in postmenopausal women. These models identified high risk postmenopausal women where preventive strategies may be targeted.

Pretreatment changes in alcohol use challenges the assumption that the major portion of the change process occurs after treatment entry. Greater understanding of the behavior change process prior to treatment has the potential to improve our understanding of behavioral changes during treatment. In this study, participants (N = 45) were recruited for a clinical trial examining multiple mechanisms of change in cognitive-behavioral treatment for alcohol dependence. Using data from both baseline and end of treatment assessments, several pretreatment intervals were created (e.g., a two-week pre-phone call interval, phone call to baseline assessment, baseline assessment to first treatment). To examine pretreatment changes in drinking, percent days abstinent and drinks per drinking day were analyzed using multi-level growth curve modeling and repeated measures ANOVAs. Initial examination of the data revealed significant increases in percent days abstinent and decreases in drinks per drinking day during the pretreatment intervals. Follow-up analyses also suggested that the majority of change in drinking occurs between the phone call and baseline assessment. Further examination of the data revealed two distinct patterns of pretreatment change: a) rapid changers who maintained changes during the course of treatment, and b) gradual changers who changed more gradually during the course of treatment. Analyses revealed that rapid changers had significantly higher rates of abstinence and lower drinks per drinking day at 90 days post-treatment compared to gradual changers. Overall, the data suggest that a more systematic investigation of pretreatment changes in alcohol use is warranted. Future studies may yield insights resulting in more efficient treatment delivery and adaptations to treatment based on an individual’s pretreatment change status.