Nutritional, Functional, and Emotional Characteristics Related to Fatigue in Patients During and After Biochemotherapy
Purpose/Objectives: To test Winningham's psychobiologic entropy hypothesis in patients receiving biochemotherapy for melanoma.
Design: Descriptive, correlational, cross-sectional study.
Setting: Midwest cancer center.
Sample: 25 male and female patients who were receiving biochemo-therapy or who had completed treatment 6-12 months prior.
Methods: Data were collected using a series of questionnaires and diet recall.
Main Research Variables: Fatigue, anxiety, depression, distressing symptoms, nutritional intake, and weight.
Findings: Moderate fatigue was significantly related to physiologic and psychological symptoms but not to nutrient intake. The sample was overweight, and a significant number of participants were obese. High caloric intakes were evident. Depression was a significant problem.
Conclusions: Fatigue was not as severe as expected, but problems with responses to the fatigue scale may explain this. Nutritional status and nutrient intake were not correlated to fatigue in this sample. Activity levels were related to fatigue, and treatment reduced activity. On average, activity returned to pretreatment levels 6-12 months after treatment. Winningham's hypothesis held and will be useful for understanding fatigue in this population.
Implications for Nursing: Depression needs to be assessed and treated as a side effect of biotherapy. Assessing the impact of nutrition when patients are overweight or obese is difficult. A scale specifically designed to test Winningham's hypothesis is needed.
Jump to a section
References
Balducci, L., & Extermann, M. (2000). Management of the frail person with advanced cancer. Critical Reviews in Oncology/Hematology, 33, 143-148.
Beach, P., Siebeneck, B., Buderer, N.F., & Ferner, T. (2001). Relationship between fatigue and nutritional status in patients receiving radiation therapy to treat lung cancer. Oncology Nursing Forum, 28, 1027-1031.
Bingham, S.A., Gill, C., Welch, A., Day, K., Cassidy, A., Khaw, K.T., et al. (1994). Comparison of dietary assessment methods in nutritional epidemiology: Weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. British Journal of Nutrition, 72, 619-643.
Courneya, K.S., & Friedenreich, C.M. (1997). Relationship between exercise during treatment and current quality of life among survivors of breast cancer. Journal of Psychosocial Oncology, 15(3/4), 35-57.
Courneya, K.S., & Friedenreich, C.M. (1999). Physical exercise and quality of life following cancer diagnosis: A literature review. Annals of Behavioral Medicine, 21, 171-179.
Cuaron, L., &, Thompson, J. (1995). The interferons. In P.T. Rieger (Ed.), Biotherapy: A comprehensive overview (pp. 125-194). Sudbury, MA: Jones and Bartlett.
Dean, G.E., Spears, L., Ferrell, B.R., Quan, W.D., Groshon, S., & Mitchell, M.S. (1995). Fatigue in patients with cancer receiving interferon alpha. Cancer Practice, 3, 164-172.
Donnelly, S. (1998). Patient management strategies for interferon alfa-2b as adjuvant therapy of high-risk melanoma. Oncology Nursing Forum, 25, 921-927.
Figlin, R.A., Belldegrun, A., Moldawer, N., Zeffren, J., & deKernion, J. (1992). Concomitant administration of recombinant human interleukin-2 and recombinant interferon alpha-2A: An active outpatient regimen in metastatic renal cell carcinoma. Journal of Clinical Oncology, 10, 414-421.
Fleming, G.F., Schilsky, R.L., Schumm, L.P., Meyerson, A., Hong, A.M., Vogelzang, N.J., et al. (2003). Phase I and pharmacokinetic study of 24-hour infusion 5-fluorouracil and leucovorin in patients with organ dysfunction. Annals of Oncology, 14, 1142-1147.
Fu, M.R., Anderson, C.M., McDaniel, R., & Armer, J. (2002). Patients' perceptions of fatigue in response to biochemotherapy for metastatic melanoma: A preliminary study. Oncology Nursing Forum, 29, 961-966.
Godin, G., & Bouillon, J. (1986). Assessment of leisure time exercise behavior by self-report: A concurrent validity study. Canadian Journal of Public Health, 77, 359-362.
Godin, G., & Shephard, R.J. (1985). A simple method to assess exercise behavior in the community. Canadian Journal of Applied Sport Sciences, 10, 141-146.
Graham, K. Y., & Longman, A.J. (1987). Quality of life and persons with melanoma: Preliminary model testing. Cancer Nursing, 10, 338-346.
Grieco, A., & Long, C.L. (1984). Investigation of the Karnofsky Performance Status as a measure of quality of life. Health Psychology 3, 129-142.
Hirsh, M., Lipton, A., Harvey, H., Givant, E., Hopper, K., Jones, G., et al. (1990). Phase I study of interleukin-2 and interferon alpha-2a as outpatient therapy for patients with advanced malignancy. Journal of Clinical Oncology, 8, 1657-1663.
Kaasa, T., Loomis, J., Gillis, K., Bruera, E., & Hanson, J. (1997). The Edmonton Functional Assessment Tool: Preliminary development and evaluation for use in palliative care. Journal of Pain and Symptom Management, 13, 10-19.
Karnofsky, D.A., Abelmann, W.H., Craver, L.F., & Burchenal, J.H. (1948). The use of nitrogen mustard in the palliative treatment of cancer. Cancer, 1, 634-656.
Kirkwood, J.M., Bender, C., Agarwala, S., Tarhini, A., Shipe-Spotloe, J., Smelko, B., et al. (2002). Mechanisms and management of toxicities associated with high-dose interferon alfa-2b therapy. Journal of Clinical Oncology, 20, 3703-3718.
Mahich, E., & Fefer, A. (Eds.). (1983). Biological response modifiers: Subcommittee report [Monograph 63]. Washington, DC: National Cancer Institute.
Orr, S. T., & Aisner, J. (1986). Performance status assessment among oncology patients: A review. Cancer Treatment Reports, 70, 1423-1429.
Parkinson, D.R. (1989). The role of interleukin-2 in the biotherapy of cancer. Oncology Nursing Forum, 16(Suppl. 6), 16-20.
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.
Porock, D., & Juenger, J. (2004). Just go with the flow: A qualitative study of fatigue in biotherapy. European Journal of Cancer Care, 13, 356-361.
Quesada, J.R., Talpaz, M., Rios, A., Kuzrock, R., & Gutterman, J.U. (1986). Clinical toxicity of interferons in cancer patients: A review. Journal of Clinical Oncology, 4, 234-243.
Rieger, P.H. (1997). Biotherapy. In S.E. Otto (Ed.), Oncology nursing (3rd ed., pp. 573-613). St. Louis, MO: Mosby.
Rhodes, V., McDaniel, R.W., Homan, S.S., Johnson, M., & Madsen, R. (2000). An instrument to measure symptom experience. Cancer Nursing, 23, 49-54.
Schwartz, A.L. (1998). Patterns of exercise and fatigue in physically active cancer survivors. Oncology Nursing Forum, 25, 485-491.
Schwartz, A.L., Thompson, J.A., & Masood, N. (2002). Interferon-induced fatigue in patients with melanoma: A pilot study of exercise and methylphenidate [Online exclusive]. Oncology Nursing Forum, 29, E85-E90. Retrieved February 28, 2005, from http://www.ons.org/publications/journals/ONF/Volume29/Issue7/pdf/85.pdf
Skalla, K.A., & Reiger, P.T. (1995). Fatigue. In P.T. Reiger (Ed.), Biotherapy: A comprehensive overview (pp. 221-242). Sudbury, MA: Jones and Bartlett.
Smets, E.M., Garssen, B., Schuster-Uitterhoeve, A.L., & de Haes, J.C. (1993). Fatigue in cancer patients. British Journal of Cancer, 68, 220-224.
Stasi, R., Abriani, L., Beccaglia, P., Terzoli, E., & Amadori, S. (2003). Cancer-related fatigue: Evolving concepts in evaluation and treatment. Cancer, 98, 1786-1801.
Wheeler, V.S. (1997). Biotherapy. In S.L. Groenwald, M. Frogge, M. Goodman, & C.H. Yarbro (Eds.), Cancer nursing: Principles and practice (4th ed., pp. 426-458). Sudbury, MA: Jones and Bartlett.
Whitney, E.N., Cataldo, C.B., & Rolfes, S.R. (2002). Understanding normal and clinical nutrition (Computer software: Diet Analysis Plus 6.0) (6th ed.). Belmont, CA: Wadsworth.
Winningham, M.L. (1992). The role of exercise in cancer therapy. In R.R. Watson & M. Eisinger (Eds.), Exercise and disease (pp. 64-70). Boca Raton. FL: CRC Press.
Zigmond, A.S., & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361-370.