Fatigue is a frequent side effect in patients undergoing cancer chemotherapy. Patients may experience insomnia and pain, which are risk factors for fatigue, and have more severe fatigue after the introduction of chemotherapy. The present prospective cohort study included 59 patients who had been newly introduced to chemotherapy. We investigated the incidence of the severe fatigue and the influencing factors after the introduction of chemotherapy in patients with insomnia or pain prior to the introduction of chemotherapy. Patients with Visual Analog Scale (VAS) scores of < 20 mm and ≥ 20 mm were categorized into the "-group" and "+ group," respectively. A VAS score of ≥ 80 mm was considered to indicate severe fatigue, which was the primary endpoint of this study. Statistical analyses were performed using the log-rank test and the Cox proportional hazards model. The incidence of severe fatigue in the + group was always high (P = 0.011). Four factors: insomnia (adjusted HR = 17.721; P < 0.0001), cigarette smoking (adjusted HR = 31.602; P < 0.0001), alcohol use (adjusted HR = 0.119; P = 0.002), sleep-inducing drug use (adjusted HR = 0.054; P = 0.016) have been identified as risk factors contributing to the occurrence of severe fatigue. The results of the present study suggest the possibility that severe fatigue in cancer patients can be prevented by evaluating and treating symptoms such as insomnia, etc., which are risk factors for severe fatigue, prior to the introduction of chemotherapy.
Background: Over the past decade, the outcome of treatment with chemotherapy for metastatic colorectal cancer (mCRC) is substantially better, with proven increases survival. However, many patients still suffer significant toxicities, such as peripheral neuropathy. In advanced countries, where most patients with mCRC are older, maintenance therapy is under study with the goal of reducing severe side effects and maintaining quality of life (QOL). Continuation of cytotoxic chemotherapy in the setting of accumulated toxicities is often not feasible, so less toxic drugs are needed over the long-term. Bevacizumab is one option that has low side effects and proven benefit when combined with chemotherapy. This report describes our experience in giving bevacizumab maintenance therapy to 11 older patients with mCRC and reviews maintenance therapy for mCRC. Materials and Methods:Baseline clinical characteristics, pre-specified bevacizumab-related adverse events, and efficacy data were collected from the local patient registry. Approval was provided by the Juntendo University Hospital Institutional Review Board. Results: Eleven patients received maintenance therapy after FOLFOX and/or FOLFIRI regimens for an average of 476 days. Maintenance therapy was instituted due to several side effects from oxaliplatin-based chemotherapy.Side effect included such as peripheral neuropathy and fatigue could reduce during maintenance therapy and get QOL until end stage.Conclusions: Our experience with these 11 patients, demonstrates both prolonged survival as well as maintained QOL. Bevacizumab based maintenance therapy may be considered in elderly patients with mCRC.
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