Fatigue, the most common and distressing side effect reported by patients
receiving chemotherapy, has long been accepted by health professionals
and patients alike as a side effect of treatment. But researchers say the
problem, which may continue after treatment, has long been ignored because
of the perception that no effective treatments are available.
Fatigue is widespread in this population, affecting between 70 to 95
percent of patients undergoing chemotherapy for breast cancer. Even after
chemotherapy treatments end, between 30 and 50 percent of patients say
their fatigue remains at least six months or doesnt ever go away, said
Ann Berger, Ph.D, associate professor of nursing at the University of Nebraska
Medical Center College of Nursing.
Dr. Berger is principal investigator of a $1.5 million, five-year grant
to test new approaches for reducing fatigue in patients undergoing breast
cancer treatment. The study is funded by the National Institute of Nursing
Research, a division of the National Institutes of Health.
The study is the first of this magnitude to test a nursing intervention
designed to reduce fatigue during and after chemotherapy without using
drugs. Sleep interventions have proven successful in patients with chronic
sleep problems and with chronic pain, but no one has tested these interventions
in people with cancer.
We usually talk about fatigue intensity level on a zero to 10 scale,
she said. By the time somebody reports having a seven, eight, nine or
10 intensity of fatigue, their life is probably completely on hold. Theyre
not going to work, theyre not managing their family and theyre not feeling
well enough to socialize.
She said when nurses look for advice for managing fatigue, they find
few interventions that have been tested and found to be effective. More
attention now is being given because of its prevalence. Scientifically
rigorous intervention studies are needed to determine the best ways to
modify fatigue during chemotherapy and to prevent chronic fatigue after
treatment, Dr. Berger said.
Although the exact cause of fatigue is not known, it is thought to be
due to a combination of factors, including chemotherapy or radiation, both
of which cause damage and cell death, and/or altered sleep/wake patterns,
changes in nutrition, activity/exercise patterns, nausea and psychological
stress.
In the past, we have advised patients to get more rest if they experience
fatigue. Theres been a lot of encouragement to reduce activity take
leave from work, shorten your work day, get your family to do household
chores and prepare meals. For some, this is a bad idea. They really needed
to remain active, said Dr. Berger, who has done several studies related
to fatigue in cancer patients over the past 10 years.
Dr. Berger said women with early stage breast cancer have been found
to experience less fatigue when they remain more active, but that alone
is not enough.
For the study, researchers are recruiting 220 study participants, ages
19 and older, with stages I, II or IIIA breast cancer receiving chemotherapy,
through the Nebraska Health System and other metro-area oncology clinics.
In 2002, an estimated 1,250 women living in Nebraska were diagnosed with
breast cancer; 80 percent were diagnosed at stage I, II, or IIIA disease.
Participants will be randomly assigned to sleep or healthy eating intervention
groups.
During the study, both groups will keep diaries, complete questionnaires,
and wear wrist actigraphs (designed to measure sleep and activity patterns)
during various treatment intervals. Study participants will receive modest
stipends following successful study completion. The study, which combines
activity monitoring with either a sleep or healthy eating intervention,
will compare results before, during and after chemotherapy treatments.
Dr. Bergers interest in helping cancer patients comes from the fact
that her mother died from leukemia at age 53. With five children ages 14
to 25 in her family at the time of the diagnosis, she saw the impact of
cancer. I want to help any individual or family better tolerate treatment
and as a family, survive the experience, she said.
Others involved in the study at UNMC include: Julie Chamberlain, MS,
RN, project director; Mary Pat Roh and Trish Fischer, research nurses;
Susanna Von Essen, M.D., Brett Kuhn, Ph.D., Lynne Farr, Ph.D., Barbara
F. Piper, D.N.Sc. James Lynch, Ph.D., and Sangeeta Agrawal, M.Sc., co-investigators;
and Tom Davis, Pharm.D., and Anne Kessinger, M.D.; consultants. Kathryn
Lee, Ph.D., professor, University of California, San Francisco, is serving
as the studys outside consultant.