Previous Chemotherapy Influences the Symptom Experience and Quality of Life of Women With Breast Cancer Prior to Radiation Therapy

Biological Research For Nursing

Dunn

Mastick

et al. 2016

Self Cite

Moderate to severe fatigue occurs in 14% to 96% of oncology patients undergoing active treatment. Current interventions for fatigue are not efficacious. A major impediment to the development of effective treatments is a lack of understanding of the fundamental mechanisms underlying fatigue. In the current study, differences in phenotypic characteristics and gene expression profiles were evaluated in a sample of breast cancer patients undergoing chemotherapy (CTX) who reported low (n=19) and high (n=25) levels of evening fatigue. Compared to the low group, patients in the high evening fatigue group reported lower functional status scores, higher comorbidity scores, and fewer prior cancer treatments. One gene was identified as up-regulated and eleven genes were identified to be down-regulated in the high evening fatigue group. Gene set analysis found 24 down-regulated and 94 simultaneously up and down perturbed pathways between the two fatigue groups. Transcript Origin Analysis found that differential expression originated primarily from monocytes and dendritic cell types. Query of public data sources found 18 gene expression experiments with similar differential expression profiles. Our analyses revealed that inflammation, neurotransmitter regulation, and energy metabolism are likely mechanisms associated with evening fatigue severity; that CTX may contribute to fatigue seen in oncology patients; and that the patterns of gene expression may be shared with other models of fatigue (e.g., physical exercise, pathogen-induced sickness behavior). These results suggest that the mechanisms that underlie fatigue in oncology patients are multi-factorial.

Section: Discussionsupporting

confidence: 90%

Gene Expression Profiling of Evening Fatigue in Women Undergoing Chemotherapy for Breast Cancer

Biological Research For Nursing

Dunn

Mastick

et al. 2016

Self Cite

“…Consistent with previous reports, patients in both the higher morning and evening fatigue classes reported a poorer functional status [12,39] and a more severe comorbidity profile [40]. Compared to the Moderate Evening Fatigue class, decrements in functional status reported by patients in the High and Very High Evening Fatigue classes represent not only statistically significant but clinically meaningful differences in KPS scores (d=0.39, d=0.52, respectively) [41,42].…”

Section: Discussionsupporting

confidence: 87%

Subgroups of chemotherapy patients with distinct morning and evening fatigue trajectories

Cooper

Paul

et al. 2015

Support Care Cancer

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Purpose Purposes of this study were to: identify subgroups of patients with distinct trajectories for morning and evening fatigue; evaluate for differences in demographic and clinical characteristics among these subgroups; and compare and contrast the predictors of subgroup membership for morning and evening fatigue. Methods Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n=582) completed questionnaires a total of six times over two cycles of CTX. Morning and evening fatigue severity were evaluated using the Lee Fatigue Scale. Latent profile analysis (LPA) was used to identify distinct subgroups. Results Three latent classes were identified for morning fatigue (i.e., Low (31.8%), High (51.4%), and Very High (16.8%)) and for evening evening fatigue (i.e., Moderate (20.0%), High (21.8%), and Very High (58.2%)). Most of the disease and treatment characteristics did not distinguish among the morning and evening fatigue classes. Compared to the Low class, patients in the High and Very High morning fatigue class were younger, had a lower functional status and higher level of comorbidity. Compared to the Moderate class, patients in the Very High evening fatigue class were younger, more likely to be female, had child care responsibilities, had a lower functional status, and a higher level of comorbidity. Conclusion LPA allows for the identification of risk factors for more severe fatigue. Since an overlap was not observed across the morning and evening fatigue classes and unique predictors for morning and evening fatigue were identified, these findings suggest that morning and evening fatigue may have distinct underlying mechanisms.

“…In the older age group, the patients’ KPS (i.e., 4.8%) and SCQ (i.e., 6.7%) scores uniquely explained relatively similar amounts of variance. While previous studies found positive associations between both poorer functional status (Dhruva, et al, 2013; Hofso, Miaskowski, Bjordal, Cooper, & Rustoen, 2012) and higher levels of comorbidity (Berger, Gerber, & Mayer, 2012) and more severe fatigue, findings from our study suggest differential age effects for these two characteristics. In the older patients, research is warranted to determine which comorbidities and/or associated treatments contribute to higher levels of both morning and evening fatigue.…”

Section: Discussioncontrasting

confidence: 98%

Age differences in fatigue, decrements in energy, and sleep disturbance in oncology patients receiving chemotherapy

Bischel

Ritchie

European Journal of Oncology Nursing

et al. 2016

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Objective The number of older adults with cancer is increasing. Given the limited amount of research and the inconsistent findings regarding age differences in common physical symptoms associated with cancer and its treatments, the purposes of this study, in a sample of oncology outpatients receiving chemotherapy (CTX), were to evaluate for age differences in demographic and clinical characteristics, as well as in occurrence rates of and severity ratings for fatigue, decrements in energy, and sleep disturbance. In addition, using regression analysis techniques, within and across age groups, demographic and clinical characteristics associated with the severity of each symptom were evaluated. Methods Patients (n=1343) were dichotomized into younger (<65 years) and older (≥65 years) age groups. Patients completed self-report questionnaires prior to their next dose of CTX. Results Overall, our findings suggest that compared to younger patients, older adults experience a lower or similar level of fatigue, decrements in energy, and sleep disturbance. However, it should be noted that both age groups experienced high occurrence rates and moderate to severe levels of all three symptoms. Conclusions Clinicians need to assess all oncology patients receiving CTX for these three symptoms. Future research needs to determine the biopsychosocial reasons that underlie these age-related differences in fatigue, decrements in energy, and sleep disturbance.