Relationship of hemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy.

The aim of this study was to examine the relationship of changes in hemoglobin levels to changes in fatigue and cognitive functioning in cancer patients undergoing chemotherapy treatment. Seventy-seven (77) patients completed a self-administered measure of fatigue and a battery of psychometrician-administered measures of cognitive performance before the start of chemotherapy and again before the start of the fourth treatment cycle. Hemoglobin levels were measured at corresponding timepoints. Findings partially supported the hypothesis that greater declines in hemoglobin over the course of repeated chemotherapy administrations would be accompanied by greater increases in fatigue and greater declines in cognitive performance over the same interval. Among the subset of 49 patients who demonstrated a decline in hemoglobin to a final value < or =12 g/dL, greater declines in hemoglobin were significantly (P<0.05) related to greater increases in fatigue duration and disruptiveness and more negative changes in performance on three cognitive tasks. These findings suggest that, in addition to previously reported relationships with fatigue, declines in hemoglobin levels during chemotherapy treatment are associated with adverse changes in cognitive functioning.

Relationship of catastrophizing to fatigue among women receiving treatment for breast cancer.

This study examined the relationship of catastrophizing to fatigue in 80 women receiving chemotherapy (CT) or radiotherapy (RT) for treatment of early stage breast cancer. Findings revealed expected relationships between catastrophizing and fatigue among women receiving RT but not CT. Among RT patients, those high in catastrophizing reported significantly greater fatigue than was reported by those low in catastrophizing; among CT patients, differences in fatigue based on level of catastrophizing were not significant. Likewise, catastrophizing was found to account for significant variability in subsequent reports of fatigue among RT patients but not CT patients. These findings extend research on catastrophizing beyond previously studied relationships with pain and are consistent with the view that, as the inherent symptom-producing potential of treatment decreases, psychological factors play a greater role in patients' experience of symptoms.

Fatigue in the radiation therapy patient: current management and investigations.

Fatigue is one of the most common and distressing symptoms experienced by cancer patients. Research conducted over the past few years has documented that initiation of radiation therapy typically results in significant increases in fatigue severity. Preliminary evidence suggests that, among disease-free patients, this heightened fatigue remits to levels approaching those reported before initiation of treatment in the weeks or months after treatment completion. Potential sources of fatigue are varied and may include anemia, cytokine activation, psychological distress, concomitant symptoms and side effects, and concurrent medications. Efforts to manage fatigue in cancer patients should focus on correcting potential etiologies and relieving symptoms. For patients experiencing fatigue related to anemia, treatment with an erythropoietic agent should be considered. Preliminary evidence suggests that moderate exercise during radiation therapy may also be helpful in relieving fatigue. Additional research is needed to evaluate the effectiveness of these therapies as well as other intervention strategies, such as the use of antidepressant and psychostimulant medications.

Sexual functioning in long-term breast cancer survivors treated with adjuvant chemotherapy.

BACKGROUND: Previous reports suggest that problems in sexual functioning may be common among long-term (> 5 years) breast cancer survivors. To investigate this issue further, we examined the characteristics and correlates of sexual functioning in women diagnosed with breast cancer at least 5 years previously and treated with adjuvant chemotherapy and in an age-matched comparison group of women with no history of cancer. PATIENTS AND METHODS: Participants were 58 women initially diagnosed with breast cancer at an average of 7.65 years previously and 61 women with no history of cancer. All participants completed standardized self-report measures of sexual functioning, marital functioning, depression, fatigue, and menopausal symptoms. RESULTS: Compared with women with no history of cancer, long-term breast cancer survivors reported worse sexual functioning (P < or = 0.01), characterized by greater lack of sexual interest, inability to relax and enjoy sex, difficulty becoming aroused, and difficulty achieving an orgasm. Additional analyses indicated that severity of vaginal dryness was significantly (P < or = 0.05) related to poorer sexual functioning among long-term breast cancer survivors and mediated the relationship between group membership (breast cancer survivor v.s. noncancer comparison subject) and sexual functioning. CONCLUSIONS: These findings confirm and extend previous reports of impaired sexual functioning among long-term breast cancer survivors. Results further suggest that relief of vaginal dryness should be an essential component of efforts to improve sexual functioning among long-term breast cancer survivors.