Background:Fatigue is disabling and continuous phenomenon in cancer patients during and after various anticancer treatments which can continue for many years after treatment and definitely it has profound effect on Quality of Life (QOL). However, determining its severity is still underestimated among the cancer patients and also very few studies in the literature exist reporting on Cancer-Related Fatigue (CRF) among Indian population.Aims:To find out the prevalence of rate of fatigue in cancer patient receiving various anti cancer therapies. To find out the relative impact of fatigue on QOL.Materials and Methods:This cross-sectional observational study included a total 121 cancer patients receiving radiotherapy, chemotherapy, and concurrent chemo-radiation with the age group of above 15 years who fulfilled the inclusion and exclusion criteria. All the patients were assessed for severity of fatigue using Brief Fatigue Inventory (BFI) and for QOL using FACT-G scale while they were receiving the anticancer therapies as an in-patient in the regional cancer centers in Madhya Pradesh, India.Results:The severe fatigue was more prevalent in chemotherapy [58/59 (98.30%)], and concurrent chemo-radiation (33/42 (78.57%)) as compared to radiotherapy (Moderate-9/20 (45%) and Severe-9/20 (45%)). Moderate correlations were exhibited between fatigue due to radiotherapy and QOL (r = -0.71, P < 0.01), whereas weak correlation was found between fatigue due to chemotherapy and concurrent chemo-radiation (r = -0.361, P < 0.01 and r = -0.453, P < 0.01, respectively).Conclusion:Severity of fatigue was found more after chemotherapy and concurrent chemo-radiation therapy while impact on QOL was more after the radiotherapy.
Rehabilitation in relation to cancer can be preventative, restorative, supportive, and palliative. It is recognized that patients may have rehabilitation needs throughout their care pathway. The role of physiotherapy in the cancer rehabilitation is less understood and particularly in the head and neck cancer (HNC) patients. This results in various residual deformities and dysfunctions for the patients with HNC. The objective of this review is to provide detailed information regarding the problems faced after the cancer treatments and rehabilitation of patients who suffered with HNC. The fact that cancer patients are facing several months of chemotherapy and/or radiotherapy and usually major surgery, as well as the direct effect of immobility due to pain, means that muscle wasting, joint stiffness, as well as de-conditioning and fatigue are inevitable. The absence of physiotherapy intervention would be detrimental to patient care and the ability of the patient/family to cope with the effects of the disease or its treatment on their functional capacity and quality of life. Following any treatment for HNC, physical therapy may play an essential role in preventing various complications and helping patients to mitigate impairments, and restoring function of the shoulder joint, neck, and face.
For intensity‐modulated radiation therapy, evaluation of the measured dose against the treatment planning calculated dose is essential in the context of patient‐specific quality assurance. The complexity of volumetric arc radiotherapy delivery attributed to its dynamic and synchronization nature require new methods and potentially new tools for the quality assurance of such techniques. In the present study, we evaluated and compared the dosimetric performance of EDR2 film and three other commercially available quality assurance devices: IBA I'MatriXX array, PTW Seven29 array and the Delta 4 array. The evaluation of these dosimetric systems was performed for RapidArc and IMRT deliveries using a Varian NovalisTX linear accelerator. The plans were generated using the Varian Eclipse treatment planning system. Our results showed that all four QA techniques yield equivalent results. All patient QAs passed our institutional clinical criteria of gamma index based on a 3% dose difference and 3 mm distance to agreement. In addition, the Bland‐Altman analysis was performed which showed that all the calculated gamma values of all three QA devices were within 5% from those of the film. The results showed that the four QA systems used in this patient‐specific IMRT QA analysis are equivalent. We concluded that the dosimetric systems under investigation can be used interchangeably for routine patient specific QA.PACS numbers: 87.55.Qr, 87.56.Fc
Intensity‐modulated radiotherapy treatment demands stringent quality assurance and accurate dose determination for delivery of highly conformal dose to the patients. Generally 3D dose distributions obtained from a treatment planning system have to be verified by dosimetric methods. Mainly, a comparison of two‐dimensional calculated and measured data in several coplanar planes is performed. In principle, there are many possibilities to measure two‐dimensional dose distributions such as films, flat‐panel electronic portal imaging devices (EPID), ion chambers and ionization chamber arrays, and radiographic and radiochromic films. The flat‐panel EPIDs show a good resolution and offer a possibility for real‐time measurements: however to convert the signal into dose, a separate commercial algorithm is required. The 2D ion chamber array system offers the real‐time measurements. In this study, dosimetric characteristics of 2D ion chamber array matrix were analyzed for verification of radiotherapy treatments. The dose linearity and dose rate effect of the I'matriXX device was studied using 6 MV, 18 MV photons and 12 MeV electrons. The output factor was estimated using I'matriXX device and compared with ion chamber measurements. The ion chamber array system was found to be linear in the dose range of 2–500 cGy and the response of the detector was found to be independent of dose rate between 100 MU/min to 600 MU/min. The estimated relative output factor with I'matriXX was found to match very well with the ion chamber measurements. To check the final dose delivered during IMRT planning, dose distribution patterns such as field‐in‐field, pyramidal, and chair tests were generated with the treatment planning system (TPS) and the same was executed in the accelerator and measured with the I'matriXX device. The dose distribution pattern measured by the matrix device for field‐in‐field, pyramidal, and chair test were found to be in good agreement with the calculated dose distribution by TPS both for 6 and 18 MV photons (γ ≤ 1: 96%, criteria 3%, 3 mm). Two 7‐field IMRT plans (one prostate, one head and neck) dose distribution patterns were also measured with I'matriXX device and compared with film dosimetry. The measurements and evaluation proves that I'matriXX can be used for quantifying absolute dose. Moreover, using I'matriXX as absolute dosimeter in IMRT field verification, avoids the time‐consuming procedure of making ionometric measurement for absolute dose estimation and film for dose distribution verification. The I'matriXX can also used for routine quality assurance checks like flatness, symmetry, field width, and penumbra of the linear accelerator beam.PACS number: 87.55.ne and 87.56.Fc
The translated and adapted versions are comparable with the original English instrument in terms of content and accuracy and it is suitable to assess the current physiotherapy practice pattern in cancer rehabilitation settings.
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