The Trajectory of Fatigue in Adult Patients With Breast and Ovarian Cancer Receiving Chemotherapy

ONF 2007, 29(9), 1334-1340. DOI: 10.1188/02.ONF.1334-1340

Purpose/Objectives: To describe the trajectory of fatigue and determine the feasibility of exploring physiologic mechanisms of fatigue in adult patients receiving chemotherapy for breast and ovarian cancer.

Design: Descriptive, longitudinal, repeated measures.

Setting: Outpatient ambulatory cancer centers within two large, academic, teaching hospitals with overnight hospital stays in general clinical research centers.

Sample: Seventeen adult participants with either early-stage breast or ovarian cancer receiving chemotherapy for the first time.

Methods: Demographic questionnaire; Piper Fatigue Scale (PFS); hemoglobin, bilirubin, melatonin, and weight change were measured at baseline, three months, and approximately six months. PFS also was collected at three additional two-week nadir, post-treatment, measurement points. Descriptive statistics and repeated analysis of variance measures were used to analyze data.

Main Research Variables: Fatigue, hemoglobin, bilirubin, melatonin, and presence of other comorbid disease.

Findings: Subjective fatigue was experienced by the majority of patients receiving chemotherapy. It was irregular over time, intensified at three months, and continued after treatment ended. The physiologic trajectory of fatigue from baseline to three months indicated a significant change over time in hemoglobin in the breast cancer group (p = 0.02) and in nighttime melatonin levels for both breast and ovarian cancer groups (p = 0.03). Although not significant, daytime melatonin levels changed over time from baseline to six months.

Conclusions: Fatigue fluctuates during the course of chemotherapy treatment and does not cease after treatment ends. Preliminary findings suggest that fatigue mechanisms may have an undetermined physiologic basis.

Implications for Nursing: Assessment of cancer treatment-related fatigue must be ongoing, even after treatment ends. Findings suggest an awareness of the importance of understanding fatigue mechanisms to enable future testing of research-based interventions.

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    References

    Atkinson, A., Barsevick, A., Cella, D., Cimprich, B., Cleeland, C., Donnelly, J., et al. (2000). NCCN practice guidelines for cancer-related fatigue. Oncology, 14, 151-161.
    Atkinson, H. (1985). Women and fatigue. New York: G.P. Publishing.
    Axelrod, L., Halter, J.B., Cooper, D.S., Aoki, T.T., Roussell, A.M., & Bagshaw, S.L. (1983). Hormone levels and fuel flow in patients with weight loss and lung cancer. Evidence for excessive metabolic expenditure and for an adaptive response mediated by a reduced level of 3, 5, 3'- triiodothyronine. Metabolism, 32, 924-937.
    Barofsky, I., & Legro, M.W. (1991). Definition and measurement of fatigue. Review of Infectious Disease, 13(Suppl. 1), S94-S97.
    Bartley, S. (1976). What do we call fatigue? In E. Simonson & P. Weiser (Eds.), Psychological aspects and physiological correlates of work and fatigue (pp. 409-414). Springfield, IL: Charles C. Thomas.
    Beare, P.G., & Myers, J.M. (Eds.). (1998). Adult health nursing (3rd ed.). St. Louis, MO: Mosby.
    Berger, A.M. (1998). Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncology Nursing Forum, 25, 51-62.
    Berger, A.M., & Higginbotham, P. (2000). Correlates of fatigue during and following adjuvant breast cancer chemotherapy: A pilot study. Oncology Nursing Forum, 27, 1443-1448.
    Birdsell, T.C. (1996). The biological effects and clinical uses of the pineal hormone melatonin. Alternative Medicine Review, 1, 94-102.
    Broeckel, J.A., Jacobsen, P.B., Horton, J., Balducci, L., & Lyman, G.H. (1998). Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 16, 1689-1696.
    Cella, D. (1998). Factors influencing quality of life in cancer patients: Anemia and fatigue. Seminars in Oncology, 25(3 Suppl. 7), 43-46.
    Cupp, M. (1997). Melatonin. American Family Physician, 56, 1421-1425.
    Del Mastro, L., Venturini, M., Lionetto, R., Garrone, O., Melioli, G., Pasquetti, W., et al. (1997). Randomized phase III trial evaluating the role of erythropoietin in the prevention of chemotherapy-induced anemia. Journal of Clinical Oncology, 15, 2715-2721.
    Demetri, G.D., Kris, M., Wade, J., Degos, L., & Cella, D. (1998). Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: Results from a prospective community oncology study. Journal of Clinical Oncology, 16, 3412-3425.
    Edwards, R. (1981). Human muscle function and fatigue. Ciba Foundation Symposium, 82, 1-18.
    Edwards, R.H., Harris, R.C., Hultman, E., Kaijser, L., Koh, D., & Nordesjo, L.O. (1972). Effect of temperature on muscle energy metabolism and endurance during successive isometric contractions, sustained to fatigue, of the quadriceps muscle in man. Journal of Physiology, 220, 335-352.
    Ferrell, B.R., Grant, M., Dean, G.E., Funk, B., & Ly, J. (1996). "Bone tired": The experience of fatigue and its impact on quality of life. Oncology Nursing Forum, 23, 1539-1547.
    Glaspy, J., Bukowski, R., Steinberg, D., Taylor, C., Tchekmedyian, S., & Vadhan-Raj, S. (1997). Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. Journal of Clinical Oncology, 15, 1218-1234.
    Glaus, A. (1993). Assessment of fatigue in cancer and non-cancer patients and in healthy individuals. Supportive Care in Cancer, 1, 305-315.
    Grandjean, E.P. (1970). Fatigue. American Industrial Hygiene Association Journal, 31, 401-411.
    Greene, D., Nail, L.M., Fieler, V.K., Dudgeon, D., & Jones, L.S. (1994). A comparison of patient-reported side effects among three chemotherapy regimens for breast cancer. Cancer Practice, 2, 57-62.
    Haylock, P.J., & Hart, L.K. (1979). Fatigue in patients receiving localized radiation. Cancer Nursing, 2, 461-467.
    Holmes, H.N. (Ed.). (2001). Clinical laboratory tests: Values and implications (3rd ed.). Springhouse, PA: Springhouse.
    Irvine, D., Vincent, L., Graydon, J.E., Bubela, N., & Thompson, L. (1994). The prevalence of correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals. Cancer Nursing, 17, 367-378.
    Irvine, D.M., Vincent, L., Bubela, N., Thompson, L., & Graydon, J. (1991). A critical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nursing, 14, 188-199.
    Jacobsen, P.B., Hann, D.M., Azzarello, L.M., Horton, J., Balducci, L., & Lyman, G.H. (1999). Fatigue in women receiving adjuvant chemotherapy for breast cancer: Characteristics, course, and correlates. Journal of Pain and Symptom Management, 18, 233-242.
    Karlsson, J., Sjodin, B., Jacobs, I., & Kaiser, P. (1981). Relevance of muscle fiber type of fatigue in short intense and prolonged exercise in man. Ciba Foundation Symposium, 82, 59-74.
    Meek, P.M., Nail, L.M., Barsevick, A., Schwartz, A.L., Stephen, S., Whitmer, K., et al. (2000). Psychometric testing of fatigue instruments for use with cancer patients. Nursing Research, 49, 181-190.
    Nail, L.M. (1996). Differentiating between fatigue and depression in cancer patients. In C.M. Hogan & R. Wickham (Eds.), Issues in managing the oncology patient (pp. 482-496). New York: Phillips Healthcare Communications.
    Norris, C. (1982). Tiredness and fatigue. In C. Norris (Ed.), Concept clarification in nursing (pp. 321-326). Rockville, MD: Aspen.
    Pickard-Holley, S. (1991). Fatigue in cancer patients: A descriptive study. Cancer Nursing, 14, 13-19.
    Piper, B. (1997). Measuring fatigue. In M. Frank-Stromborg & S. Olsen (Eds.), Instruments for clinical health-care research (pp. 482-496). Boston: Jones and Bartlett.
    Piper, B., 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. (1987). Fatigue mechanisms in cancer patients: Developing nursing theory. Oncology Nursing Forum, 14(6), 17-23.
    Puccio, M., & Nathanson, L. (1997). The cancer cachexia syndrome. Seminars in Oncology, 24, 277-287.
    Reiter, R. (1995). Melatonin. New York: Bantam.
    Richardson, A. (1995). Fatigue in cancer patients: A review of the literature. European Journal of Cancer Care, 4(1), 20-32.
    Richardson, A., Ream, E., & Wilson-Barnett, M. (1998). Fatigue in patients receiving chemotherapy: Patterns of change. Cancer Nursing, 21, 17-30.
    Richardson, A., & Ream, E.K. (1997). Self-care behaviours initiated by chemotherapy patients in response to fatigue. International Journal of Nursing Studies, 34(1), 35-43.
    Ryden, M.B. (1977). A crucial consideration in the nursing process. Nursing Forum, 1, 71-82.
    Spiekerman, A.M. (1993). Proteins used in nutritional assessment. Clinics in Laboratory Medicine, 13, 353-369.
    St. Pierre, B.A., Kasper, C.E., & Lindsey, A.M. (1992). Fatigue mechanisms in patients with cancer: Effects of tumor necrosis factor and exercise on skeletal muscle. Oncology Nursing Forum, 19, 419-425.
    Straus, S.E., Tosato, G., Armstrong, G., Lawley, T., Preble, O.T., Henle, W., et al. (1985). Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection. Annals of Internal Medicine, 102, 7-16.
    Tisdale, M.J. (1997). Biology of cachexia. Journal of the National Cancer Institute, 89, 1763-1773.
    Valdini, A., Steinhardt, S., & Feldman, E. (1989). Usefulness of a standard battery of laboratory tests in investigating chronic fatigue in adults. Family Practice, 6, 286-291.
    Vogelzang, N.J., Breitbart, W., Cella, D., Curt, G.A., Groopman, J.E., Horning, S.J., et al. (1997). Patient, caregiver, and oncologist perceptions of cancer-related fatigue: Results of a tripart assessment survey. Seminars in Hematology, 34(3 Suppl. 2), 4-12.
    Wilkes, G. (2000). Nutrition: The forgotten ingredient in cancer care. American Journal of Nursing, 100(4), 46-51.
    Winningham, M., & Barton-Burke, M. (2000). Fatigue in cancer: A multidimensional approach. Boston: Jones and Bartlett.
    Winningham, M.L., Nail, L.M., Burke, M.B., Brophy, L., Cimprich, B., Jones, L.S., et al. (1994). Fatigue and the cancer experience: The state of the knowledge. Oncology Nursing Forum, 21, 23-36.