Fatigue in women with breast cancer receiving radiation therapy.

Fatigue is a common complaint of individuals receiving treatment for cancer. There is a dearth of rigorous research investigating the clinical course and prognosis of fatigue over the course of radiation therapy. Seventy six patients with breast cancer receiving external radiation therapy were followed longitudinally from the onset of treatment to 6 months post-treatment. Fatigue significantly increased over the course of treatment, was highest at the last week of treatment, and returned to pretreatment levels by 3 months after treatment. Fatigue was not influenced by the patient's age, stage of disease, time since surgery, weight, and length of time since diagnosis. Fatigue was significantly related to symptom distress, psychologic distress, and self-reported fatigue relief strategies. The most frequently reported self-relief strategies were "sit" and "sleep." Fatigue had a negative impact on the patient's quality of life. Impairment in quality of life was evident by the end of treatment, with improvement by 3 and 6 months after treatment. The second week through to the last week of radiation therapy are critical times to target interventions for the management of fatigue. The amelioration of concomitant symptoms is a supportive approach that might be helpful. Self-help strategies focusing on the cessation of activity and increasing rest were reported as successful by patients.

Discharge information needs and symptom distress after abdominal aortic surgery.

The purpose of this study was to describe the discharge information needs and symptom distress of people after abdominal aortic reconstructive surgery. Interviews (N = 51) were conducted prior to, and 4 weeks after, hospital discharge. People indicated that the most important information to help them manage their care after discharge related to the recognition, prevention and management of complications. Broken sleep and incisional pain were the most distressful of symptoms prior to hospital discharge, whereas fatigue and broken sleep were most distressful once home. These results may assist nurses to understand the discharge information needs and symptom distress of people recovering from aortic reconstructive surgery and the importance of discharge education to help people to manage their care once home.

Symptom distress, anxiety, depression, and discharge information needs after peripheral arterial bypass.

The purpose of this study was to describe the symptom distress, anxiety, depression, and discharge information needs of patients after peripheral arterial bypass surgery. Patients (n = 38) were interviewed before and after hospital discharge. The symptoms of incisional pain and broken sleep, as measured by Visual Analogue Scales, were the most distressing symptoms experienced before and after discharge. Patients reported low levels of anxiety and depression as measured by the Profile of Mood States. A moderate amount of information, assessed by the Patient Learning Need Scale, was perceived by patients to be important to help manage their care after discharge. The most important information related to the recognition, prevention, and management of complications. The findings contribute to an understanding of discharge information needs after peripheral arterial bypass and emphasizes the importance of patient education to facilitate transition to the home.

Fatigue-reducing strategies used by patients receiving treatment for cancer.

In order to determine which strategies are most effective in relieving fatigue of women undergoing treatment for cancer, women receiving either chemotherapy (n = 45) or radiation therapy (n = 54) were interviewed twice to determine their level of fatigue and the effectiveness of the strategies they used to relieve their fatigue. The subjects were interviewed either at the start and mid-point of any cycle of chemotherapy, or at the beginning and end of a 5- or 6-week course of radiation therapy. At each interview, the subjects completed the Pearson Byars Fatigue Feeling Checklist and the Fatigue Relief Scale. At the second interview, the patients were significantly more fatigued than they had been at the first interview (p < 0.0001). The more effective the fatigue-relieving strategies at the second interview, the less fatigue experienced by the women (p < 0.0001). At both interviews, subjects used similar strategies to relieve their fatigue. Sleep and exercise were among the most effective strategies. However, there was a wide range of scores for each strategy used, indicating variability among subjects as to the effectiveness of the strategy. The results of the study provide nurses with some guidance as to strategies they might suggest to patients who experience fatigue.

The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals.

Fatigue can be a prevalent and serious problem for the individual with cancer and can negatively impact on the individual's quality of life. Little is known about the prevalence of clinical fatigue among patients with cancer and how the fatigue cancer patient's experience compares with the fatigue people experience as a function of their normal daily activities. This study, which utilized a control group, investigated the prevalence of fatigue among patients receiving treatment with radiotherapy (n = 54) and chemotherapy (n =47) over two measurement points. The level of fatigue experienced by cancer patients was compared with the level of fatigue experienced by apparently healthy auxiliary staff (n = 53) working at three cancer treatment facilities. There were no differences in the mean level of fatigue experienced by cancer patients and the mean level experienced by healthy controls before the start of cancer treatment. However, cancer patients experienced a significant increase in fatigue over a 5- or 6-week course of radiotherapy and 14 days after treatment with chemotherapy, and these increases were significantly greater than the fatigue reported by healthy control subjects. The midpoint of the Pearson Byars Fatigue Feeling Checklist was accepted as a crude measure of clinical fatigue and was found to be significantly different from the mean level of fatigue reported by healthy controls. The prevalence of fatigue among patients after undergoing cancer treatment was determined to be 61%. Fatigue in cancer patients was found to covary with weight, symptom distress, mood disturbance, and alterations in usual functional activities. The best predictors of fatigue in the patient sample were their symptom distress and mood disturbance. Symptom distress and fatigue were significant predictors of impairment in functional activities related to illness. Implications for practice and future research are discussed.

A critical appraisal of the research literature investigating fatigue in the individual with cancer.

Fatigue is a commonly experienced symptom, which may be a component of virtually any disease and can have a psychological, physical, or mixed origin. Nurses need to understand the onset, duration, and progression of fatigue to intervene successfully with the cancer patient adapting to diagnosis and treatment. While the literature is an important source of information, results of research studies must be critically interpreted before proceeding with practice guidelines based on research findings. A critical appraisal of the research literature investigating the problem of fatigue in individuals with cancer was conducted. There is strong evidence to suggest that fatigue is a prevalent problem among cancer patients receiving chemotherapy and radiation therapy. However past research has been limited by methodological problems. Typically, studies fail to include a control group, do not control for possible confounding variables, and have restricted measurement to unidimensional scales with limited reliability and validity. While several correlates of fatigue have been postulated, research to date has found no consistent relationships among such correlates as weight loss, anemia, or psychological distress. This article reviews what is currently known about fatigue in the cancer patient and how future research could be designed to improve on past measurement and sampling problems.

The Patient Learning Needs Scale: reliability and validity.

The article describes the development and initial psychometric evaluation of an instrument to measure patients' perceptions of learning needs at time of discharge from hospital to home. Evaluation of the Patient Learning Needs Scale was based on responses of 301 adults hospitalized with a medical or surgical illness. Factor analysis isolated seven subscales: medications, activities of living, feelings related to condition, community and follow-up, treatment and complications, enhancing quality of life and skin care. These seven factors accounted for 56.1% of the variance. Cronbach's alpha for the 50-item scale was 0.95.

Factors influencing patients' informational needs at time of hospital discharge.

The relationship between patients' perceived informational needs and selected sociodemographic and illness-related variables were examined in a sample of 301 adult medical and surgical patients preparing for discharge from an acute care setting. Marital status, living arrangements and chronicity of illness had no influence on the importance of informational needs as measured by the Patient Learning Need Scale (PLNS). More informational needs were identified by females than males, and those with malignant as opposed to benign disease. Length of time spent in the hospital, number of discharge medications, and patient perception of the influence of the illness on life were positively correlated with informational needs at the time of discharge.