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Fatigue and Other Variables During Adjuvant Chemotherapy for Colon and Rectal Cancer
Purpose/Objectives: To examine patterns of fatigue and other variables (sleep quality, sleep-wake variables, activity and rest, circadian rhythms, quality of life [QOL], blood counts, and demographic and medical variables) during colon and rectal cancer adjuvant chemotherapy, as well as feasibility of the study.
Design: Longitudinal, descriptive feasibility study.
Setting: Two oncology clinics in the midwestern region of the United States.
Sample: From April 2006-December 2008, 27% of screened subjects (n = 21) enrolled and 14 completed the study. Participants were middle aged, partnered, and employed and had postsecondary education.
Methods: Measurements completed during the first week of three two-week cycles (chemotherapy 1-3) and at six weeks (before chemotherapy 4) were the Piper Fatigue Scale, Pittsburgh Sleep Quality Index, wrist actigraphy, Functional Assessment of Cancer Therapy-Colon, blood counts, and demographic and medical data form. Analysis included descriptive statistics and repeated-measures analysis of variance.
Main Research Variables: Fatigue, sleep quality, sleep-wake variables, activity-rest, circadian activity rhythms, and QOL.
Findings: Fatigue was mild at baseline and rose to moderate levels during chemotherapy 1-3. Sleep quality was poor the months prior to chemotherapy 1 and chemotherapy 4. Actigraphy data revealed disturbed sleep, low daytime activity, and impaired circadian activity rhythms during the first week after chemotherapy 1-3. QOL ratings were similar to those in other cancer populations. Fatigue increased, and white blood cell counts decreased significantly over time.
Conclusions: During adjuvant chemotherapy, patients reported moderate fatigue and poor sleep quality; actigraphs confirmed problems with sleep maintenance as well as low daytime activity and disturbed circadian rhythms. Multiple barriers were encountered during the study.
Implications for Nursing: Clinicians should screen for fatigue and sleep-wake variables and use guidelines to select interventions.
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References
American Cancer Society. (2010). Cancer facts and figures 2010. Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf
Aprile, G., Ramoni, M., Keefe, D., & Sonis, S. (2008). Application of distance matrices to define associations between acute toxicities in colorectal cancer patients receiving chemotherapy. Cancer, 112, 284-292. dx.doi.org/10.1002/cncr.23182
Arraras Urdaniz, J. I., Arias de la Vega, F., Vera García, R., Manterola Burgaleta, A., Martínez Aguillo, M., Villafranca Iturre, E., & Salgado Pascual, E. (2006). Quality-of-life assessment through the EORTC questionnaires of locally advanced rectal cancer patients treated with preoperative chemo-radiotherapy. Clinical and Translational Oncology, 8, 423-429.
Arraras Urdaniz, J. I., Vera García, R., Martínez Aguillo, M., Manterola Burgaleta, A., Arias de la Vega, F., & Salgado Pascual, E. (2006). Quality-of-life assessment through the EORTC questionnaires of colorectal cancer patients in advanced disease stages. Clinical and Translational Oncology, 8, 664-671.
Berge r, A. M., Parker, K. P., Young-McCaughan, S., Mallory, G. A., Barsevick, A. M., Beck, S. L., … Hall, M. (2005). Sleep wake disturbances in people with cancer and their caregivers: State of the science. Oncology Nursing Forum, 32, E98 E126. dx.doi.org/10.1188/04.ONF.E98-E126
Berge r, A. M., Wielgus, K. K., Young-McCaughan, S., Fischer, P., Farr, L., & Lee, K. A. (2008). Methodological challenges when using actigraphy in clinical populations. Journal of Pain and Symptom Management, 36, 191-199. dx.doi.org/10.1016/j.jpainsymman.2007.10.008
Brown, A. C., Smolensky, M. H., D'Alonzo, G. E., & Redman, D. P. (1990). Actigraphy: A means of assessing circadian patterns in human activity. Chronobiology International, 7, 125-133.
Butt, Z., Rosenbloom, S. K., Abernethy, A. P., Beaumont, J. L., Paul, D., Hampton, D., … Cella, D. (2008). Fatigue is the most important symptom for advanced cancer patients who have had chemotherapy. Journal of the National Comprehensive Cancer Network, 6, 448-455.
Buysse, D. J., Reynolds, C. F., III, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193-213. dx.doi.org/10.1016/0165-1781(89)90047-4
Buysse, D. J., Reynolds, C. F., III, Monk, T. H., Hoch, C. C., Yeager, A. L., & Kupfer, D. J. (1991). Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep, 14, 331-338.
Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., … Brannon, J. (1993). The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology, 11, 570-579.
Cera, S. M., & Wexner, S. D. (2005). Minimally invasive treatment of colon cancer. Cancer Journal, 11(1), 26-35.
Chevalier, V., Mormont, M. C., Cure, H., & Chollet, P. (2003). Assessment of circadian rhythms by actimetry in healthy subjects and patients with advanced colorectal cancer. Oncology Reports, 10, 733-737.
Courneya, K. S., Vallance, J. K., McNeely, M. L., Karvinen, K. H., Peddle, C. J., & Mackey, J. R. (2004). Exercise issues in older cancer survivors. Critical Reviews in Oncology/ Hematology, 51, 249-261. dx.doi.org/10.1016/j.critrevonc.2004.05.001
Dutta, C. (1997). Significance of sarcopenia in the elderly. Journal of Nutrition, 127(5, Suppl.), 992S 993S.
Eaton, L. H., & Tipton, J. M. (2009). Putting Evidence Into Practice: Improving oncology patient outcomes. Pittsburgh, PA: Oncology Nursing Society.
Engstrom, P. F., Arnoletti, J. P., Benson, A. B., III, Chen, Y. J., Choti, M. A., Cooper, H. S., … Willett, C. (2009a). NCCN Clinical Practice Guidelines in Oncology™: Colon cancer. Journal of the National Comprehensive Cancer Network, 7, 778-831.
Engstrom, P. F., Arnoletti, J. P., Benson, A. B., III, Chen, Y. J., Choti, M. A., Cooper, H. S., … Willett, C. (2009b). NCCN Clinical Practice Guidelines in Oncology™: Rectal cancer. Journal of the National Comprehensive Cancer Network, 7, 838-881.
Evans, B. D., & Rogers, A. E. (1994). 24-hour sleep/wake patterns in healthy elderly persons. Applied Nursing Research, 7, 75-83.
Farr, L., & Boen, L. (1996). Comparison of rectal and axillary temperature rhythms with activity. NASA Space Grant Consortium Symposium [Abstract]. Proceedings of the Nebraska Academy of Science (p.29). Lincoln, NB: Nebraska Academy of Sciences.
Grenon, N. N., & Chan, J. (2009). Managing toxicities associated with colorectal cancer chemotherapy and targeted therapy: A new guide for nurses. Clinical Journal of Oncology Nursing, 13, 285-296. dx.doi.org/10.1188/09.CJON.285-296
Hauri, P. J., & Wisbey, J. (1992). Wrist actigraphy in insomnia. Sleep, 15, 293-301.
Houldin, A., & Lewis, F. M. (2006). Salvaging their normal lives: A qualitative study of patients with recently diagnosed advanced colorectal cancer. Oncology Nursing Forum, 33, 719-725. dx.doi.org/10.1188/06.ONF.719-725
Hurley, B. F., & Roth, S. M. (2000). Strength training in the elderly: Effects on risk factors for age-related diseases. Sports Medicine, 30, 249-268. dx.doi.org/10.0000/135475097231670
Kripke, D. F., Mullaney, D. J., Messin, S., & Wyborney, V. G. (1978). Wrist actigraphic measures of sleep and rhythms. Electroencephalograph y and Clinical Neurophysiology, 44, 674-676.
Lentz, M. J. (1990). Time-series analysis Cosinor analysis: A special case. Western Journal of Nursing Research, 12, 408-412.
Levin, R. D., Daehler, M. A., Grutsch, J. F., Quiton, J., Lis, C. G., Peterson, C., … Hrushesky, W. J. (2005). Circadian function in patients with advanced non-small cell lung cancer. British Journal of Cancer, 93, 1202-1208. dx.doi.org/10.1038/sj.bjc.6602859
Lichstein, K. L., Stone, K. C., Donaldson, J., Nau, S. D., Soeffing, J. P., Murray, D., … Aguillard, R. N. (2006). Actigraphy validation with insomnia. Sleep, 29, 232-239.
Littner, M., Kushida, C. A., Anderson, W. M., Bailey, D., Berry, R. B., Davila, D. G., … Johnson, S. F. (2003). Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: An update for 2002. Sleep, 26, 337-341.
Morin, C. (1993). Insomnia: Psychological assessment and management. New York, NY: Guilford Press.
Mormont, M. C., Langouet, A. M., Claustrat, B., Bogdan, A., Marion, S., Waterhouse, J., … Levi, F. (2002). Marker rhythms of circadian system function: A study of patients with metastatic colorectal cancer and good performance status. Chronobiology International, 19, 141-155.
Mormont, M. C., Waterhouse, J., Bleuzen, P., Giacchetti, S., Jami, A., Bogdan, A., … Levi, F. (2000). Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. Clinical Cancer Research, 6, 3038-3045. Retrieved from http://clincancerres.aacrjournals.org/content/6/8/3038.long http://clincancerres.aacrjournals.org/content/6/8/3038.long
Morse, M. A. (2006). Supportive care in the management of colon cancer. Supportive Cancer Therapy, 3, 158-170. dx.doi.org/10.3816/SCT.2006.n.014
National Comprehensive Cancer Network. (2010). NCCN Clinical Practice Guidelines in Oncology™: Cancer-related fatigue [v.1.2010]. Retrieved from http://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf
Ohayon, M. M., Carskadon, M. A., Guilleminault, C., & Vitiello, M. V. (2004). Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: Developing normative sleep values across the human lifespan. Sleep, 27, 1255-1273.
Osoba, D., Hsu, M. A., Copley-Merriman, C., Coombs, J., Johnson, F. R., Hauber, B., … Pyles, A. (2006). Stated preferences of patients with cancer for health-related quality-of-life (HRQOL) domains during treatment. Quality of Life Research, 15, 273-283. dx.doi.org/10.1007/s11136-005-0580-5
Piper, B. F., Dibble, S. L., Dodd, M. J., Weiss, M. C., Slaughter, R. E., & Paul, S. M. (1998). The revised Piper Fatigue Scale: Psychometric evaluation in women with breast cancer. Oncology Nursing Forum, 25, 677-684.
Piper, B. F., Lindsey, A. M., & Dodd, M. J. (1987). Fatigue mechanisms in cancer patients: Developing nursing theory. Oncology Nursing Forum, 14(6), 17-23.
Rich, T., Innominato, P. F., Boerner, J., Mormont, M. C., Iacobelli, S., Baron, B., … Levi, F. (2005). Elevated serum cytokines correlated with altered behavior, serum cortisol rhythm, and dampened 24-hour rest-activity patterns in patients with metastatic colorectal cancer. Clinical Cancer Research, 11, 1757-1764. Retrieved from http://clincancerres.aacrjournals.org/content/11/5/1757.long http://clincancerres.aacrjournals.org/content/11/5/1757.long
Saltz, L. B., Clarke, S., Díaz-Rubio, E., Scheithauer, W., Figer, A., Wong, R., … Cassidy, J. (2008). Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: A randomized phase III study. Journal of Clinical Oncology, 26, 2013-2019. dx.doi.org/10.1200/JCO.2007.14.9930
Schmitz, K. H., Holtzman, J., Courneya, K. S., Masse, L. C., Duval, S., & Kane, R. (2005). Controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Cancer Epidemiology, Biomarkers and Prevention, 14, 1588-1595. Retrieved from http://cebp.aacrjournals.org/content/14/7/1588.long http://cebp.aacrjournals.org/content/14/7/1588.long
Shelt on, B. K. (2002). Introduction to colorectal cancer. Seminars in Oncology Nursing, 18(2, Suppl. 2), 2-12. dx.doi.org/10.1016/S0749-2081(02)80099-7
Suh, T. T., & Lyles, K. W. (2003). Osteoporosis considerations in the frail elderly. Current Opinion in Rheumatology, 15, 481-486.
Vena, C., Parker, K., Cunningham, M., Clark, J., & McMillan, S. (2004). Sleep-wake disturbances in people with cancer part I: An overview of sleep, sleep regulation, and effects of disease and treatment. Oncology Nursing Forum, 31, 735-746. dx.doi.org/10.1188/04.ONF.735-746
Ward, W. L., Hahn, E. A., Mo, F., Hernandez, L., Tulsky, D. S., & Cella, D. (1999). Reliability and validity of the Functional Assessment of Cancer Therapy Colorectal (FACT-C) quality of life instrument. Quality of Life Research, 8, 181-195. dx.doi.org/1023/A:1008821826499
Yoon, I. Y., Kripke, D. F., Youngstedt, S. D., & Elliott, J. A. (2003). Actigraphy suggests age-related differences in napping and nocturnal sleep. Journal of Sleep Research, 12, 87-93. dx.doi.org/10.1046/j.1365-2869.2003.00345.x
Yost, K. J., Hahn, E. A., Zaslavsky, A. M., Ayanian, J. Z., & West, D. W. (2008). Predictors of health-related quality of life in patients with colorectal cancer. Health and Quality of Life Outcomes, 6, 66. dx.doi.org/10.1186/1477-7525-6-66