Risk factors for fatigue severity in primary brain tumor patients

Armstrong, Terri S.; Cron, Stanley G.; Bolanos, Elizabeth Vera; Gilbert, Mark R.; Kang, Duck Hee

doi:10.1002/cncr.25018

Cited by 86 publications

(58 citation statements)

References 41 publications

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“…They are not ‘brute mechanical' [[10], p. 103]. Edith's fatigue may demonstrate this point: fatigue is a frequent, highly disabling consequence of a range of neurological conditions, including brain tumors [21]. It usually presents in a complex clinical picture, resulting from an interaction of physiological, psychological and psychosocial factors, such as the brain lesion, stress, medical treatment, cognitive dysfunctions, mood, sleep disturbances, lack of social support, etc.…”

Section: Are Brain Disorders Just Inside the Brain?mentioning

confidence: 99%

Are Mental Disorders Brain Diseases, and What Does This Mean? A Clinical-Neuropsychological Perspective

Frisch

2016

Psychopathology

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Neuroscientific research has substantially increased our knowledge about mental disorders in recent years. Along with these benefits, radical postulates have been articulated according to which understanding and treatment of mental disorders should generally be based on biological terms, such as neurons/brain areas, transmitters, genes etc. Proponents of such a ‘biological psychiatry' claim that mental disorders are analogous to neurological disorders and refer to neurology and neuropsychology to corroborate their claims. The present article argues that, from a clinical-neuropsychological perspective, ‘biological psychiatry' is based on a mechanistic, ‘cerebrocentric' framework of brain (dys-)function which has its roots in experimental neuroscience but runs up against narrow limits in clinical neurology and neuropsychology. In fact, understanding and treating neurological disorders generally demands a systems perspective including brain, organism and environment as intrinsically entangled. In this way, ‘biological' characterizes a ‘holistic', nonreductionist level of explanation, according to which the significance of particular mechanisms can only be estimated in the context of the organism (or person). This is evident in the common observation that local brain damage does not just lead to an isolated loss of function, but to multiple attempts of reorganization and readaptation; it initiates new developments. Furthermore, treating brain disorders necessarily includes aspects of individuality and subjectivity, a conclusion that contradicts the purely ‘objectivist', third-person stance put forward by some proponents of biological psychiatry. In sum, understanding and treating brain damage sequelae in the clinical neurosciences demands a biopsychosocial perspective, for both conceptual and historical reasons. The same may hold for psychiatry when adopting a brain-based view on mental disorders. In such a perspective, biological psychiatry seems an interesting project but falls short of its original claims.

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Section: Are Brain Disorders Just Inside the Brain?mentioning

confidence: 99%

Are Mental Disorders Brain Diseases, and What Does This Mean? A Clinical-Neuropsychological Perspective

Frisch

2016

Psychopathology

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“…In several prior studies, a significant difference in symptom burden and interference has been demonstrated in patients with KPS of 80 compared with those with KPS of !90. 25,[33][34][35] Independent sample tests were used to compare dyads with poor KPS versus those with good KPS, as well as dyads categorized as having impaired versus unimpaired NCF. In addition, known group validity was assessed for caregivers and patients separately, using KPS and NCF.…”

Section: Testing For Group Differencesmentioning

confidence: 99%

Congruence of primary brain tumor patient and caregiver symptom report

Armstrong

Wefel

Gning

et al. 2012

Cancer

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BACKGROUND: Evaluating the severity of symptoms in patients with primary brain tumors (PBTs) is important in clinical care and research but may be difficult due to patient neurocognitive (NC) impairment. This study was conducted to evaluate the congruence of symptom reporting in patient and caregiver dyads, examining potential impact of NC impairment and Karnofsky performance status (KPS). METHODS: PBT patients undergoing NC testing and their caregivers were included in this study. These dyads (paired patient and caregiver group) completed the MD Anderson Symptom Inventory-Brain Tumor Module prior to testing, and impairment was categorized based on NC test scores. Concordance and equivalency was then assessed using Bland-Altman analysis and 2 onesided techniques. RESULTS: A total of 115 dyads participated. Median patient and caregiver age was 49 and 51 years, respectively, and 63% of patients were male (73% female caregivers). Most patients had a good KPS (!90, 66%) but were classified as NC impaired (58%). Caregiver's report of patient symptoms are congruent to the self-report of the patient. Equivalency between patient and caregiver report were found using prespecified confidence intervals. KPS group (good, !90; poor, 80) comparisons of equivalency indicated no significant differences in symptoms and interference reporting between dyads (good ¼ 0.49, P >.05; and poor ¼ 0.3, P >.05) overall, but there was a tendency for higher report by caregivers if the patients had a poor KPS. CONCLUSIONS: Caregivers of PBT patients have similar assessments of symptom severity (highly congruent) with patient self-report regardless of NC function or KPS. These findings suggest that caregivers may serve as proxy report of symptoms for primary brain tumor patients.

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“…[38] In brain tumor patients, fatigue severity and risk factors for fatigue have been studied; female sex, poor KPS, disease status, use of opioids and AEDs are predictors of fatigue. [39] Other symptoms associated with fatigue are sleep disturbance, weakness, pain, and psychiatric distress. [39] Fatigue, with its broad associations and causations, remains an important marker of QoL in brain tumor patients and now a predictor of survival in the recurrent HGG population.…”

Section: Discussionmentioning

confidence: 99%

“…[39] Other symptoms associated with fatigue are sleep disturbance, weakness, pain, and psychiatric distress. [39] Fatigue, with its broad associations and causations, remains an important marker of QoL in brain tumor patients and now a predictor of survival in the recurrent HGG population.…”

Section: Discussionmentioning

confidence: 99%

Impact of health-related quality of life and fatigue on survival of recurrent high-grade glioma patients

et al. 2014

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Background Quality of life (QoL) impairment and fatigue are frequently experienced during treatment for recurrent high-grade glioma (HGG). Fatigue and QoL impairments can be due to primary neurological dysfunction, cytotoxic treatments, mood disturbances, and supportive medications. We now seek to understand how QoL and fatigue impacts survival in recurrent HGG. Patients and Methods Using a prospective observational design, 237 patients with recurrent HGG and KPS≥70 completed a self-administered questionnaire that evaluated QoL and fatigue. QoL was assessed with Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-Brain (FACT-Br) scales while fatigue was assessed using Functional Assessment of Chronic Illness Therapy (FACIT-F) scale. Cox proportional hazard models were utilized to evaluate the association between QoL and fatigue and survival. Results Seventy-three (31%) subjects had recurrent WHO grade III gliomas and 164 (69%) had recurrent WHO grade IV gliomas. Median follow-up analysis was 27.60 months. In univariate Cox analyses, the FACT-Br specific subscale (HR=0.88; CI 95%, 0.77-1; p=0.048) and FACIT-F (HR=0.82; CI 95%, 0.68-0.99; p=0.045) were both significant predictors of survival. Fatigue added prognostic information beyond that provided by KPS, age, sex, tumor grade, and number of prior progressions (HR=0.80; CI 95%, 0.68-0.9; p=0.031). A greater degree of fatigue was associated with poorer survival in recurrent HGG patients. Conclusion In multivariable analyses, FACT-G and FACT-Br are not independent predictors of prognosis. Fatigue is a strong independent predictor of survival that provides incremental prognostic value to the traditional markers of prognosis in recurrent HGG. Pharmacological or non-pharmacological strategies to treat fatigue warrant investigation.

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Risk factors for fatigue severity in primary brain tumor patients

Cited by 86 publications

References 41 publications

Are Mental Disorders Brain Diseases, and What Does This Mean? A Clinical-Neuropsychological Perspective

Are Mental Disorders Brain Diseases, and What Does This Mean? A Clinical-Neuropsychological Perspective

Congruence of primary brain tumor patient and caregiver symptom report

Impact of health-related quality of life and fatigue on survival of recurrent high-grade glioma patients

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