Assessment of Cancer-Related Fatigue on the Lives of Patients


Doctoral Thesis / Dissertation, 2017
58 Pages, Grade: A

Excerpt

Table of Contents

ABSTRACT

INTRODUCTION

MATERIALS AND METHODS

RESULTS

1. Socio-demographic Characteristics of The Respondents

2. Cancer & Cancer Treatment Related Informations of Respondents

3. Patients' Physical Wellbeing Related Informations

4. Patients' Family/Social/Financial Wellbeing Related Informations

5. Patients' Emotional Wellbeing Related Informations

6. Patients' Functional Wellbeing Related Informations

7. Assessment of Fatigue Level Using FACT-F SCALE

8. Association between Fatigue level and Sex group of the Respondents

9. Association between Fatigue level and Education of the Respondents

10. Association between Fatigue level and Income of the Respondents

11. Association between Fatigue level and Duration of Illness

12. Association between Fatigue level and Duration of Treatment

13. Association between Fatigue level and Cancer Stage of the Patients

14. Association between Fatigue level and Anaemia Stage of the Patients

15. Association between Fatigue level and Different Modalities of Anti-Neoplastic Treatment

DISCUSSION

CONCLUSION

ACKNOWLEDGEMENT

REFERENCES

ABSTRACT

A cross-sectional study entitled "Assessment of Cancer-Related Fatigue on the lives of patients" conducted at National Institute of Cancer Research & Hospital, Mohakhali, Dhaka, Ahsania Mission Cancer & General Hospital, Mirpur 13, Dhaka, and Kurmitola General Hospital, Dhaka among 267 cancer patients, has assessed the level of Cancer-Related Fatigue (CRF), using The Functional Assessment of Cancer Therapy Fatigue Scale (FACT-F), version 4, evaluates the socioeconomic impact and explores the distressing symptom on patients' functioning and Quality of Life. Data was collected by face to face interview using a Pre-tested Semi-structured questionnaire. Among 267 patients, 55.8% were male & 44.2% female. The majority (40.1%) cancer patients were in 36-55 age group. The mean age was 46.11 (SD ± 16.548) years, with minimum age 16 & maximum 83 years. Most of the respondents (19.5%) were Graduate, 10.1% Post-Graduate & 13.1% illiterate. Majority (34.5%) were house-wives, 11.6% students, 7.9% retired person & rest were businessmen, service holder & day laborer. The majority (52.1%) income were within 25000 taka. Larger part of the patients (15.7%) were affected by Gastro-intestinal cancer, 15% breast cancer, 14.2% lung cancer, 12.4% Ca head-neck, 10.5% Soft tissue Sarcoma, 10.1% Gynaecological cancer, 7.9% Genitourinary cancer, 7.9% Haematological cancer, & rest were suffering from Ca Brain-PNS-Spinal cord, Ca Melanoma & Skin, Carcinoma of Unknown Primary Site (CUP). Majority (87.3%) were suffering from cancer for 1-12 months & rest for 13-48 months. Greater part of the patients (47.6%) were belonging to the cancer stage II, 35.2% in stage III, 12.7% stage IV, & 4.5% in stage I. Majority (49.4%) were moderately anaemic, 26.6% severely anaemic, 24.0% mildly anaemic. Most of the patients (37.1%) were receiving chemotherapy, 21.3% surgery & chemotherapy, 15.4% concurrent chemo-radiation therapy, 9.0% only radiotherapy, 7.1% surgical treatment. The better part (76.4%) were receiving treatment regularly & 23.6% were irregular. Fatigue was present in 79.4% of the patients, where 4.5% were severely fatigued, 28.5% moderately fatigued & 46.4% weary with mild fatigue. Physical wellbeing was Good among 18.7%, Fair in 36%, Average 34.1% & Bad in 11.2%. The Greater part (53.2%) patients' family- social life & financial condition was seriously hampered. The majority (65.2%) were facing extreme financial difficulties due to their physical condition & medical treatment. Mental condition was vulnerable in 43.8%. Functional wellbeing was bad in 15.7% patients, 34.8% were completely unable to work outside & to perform strenous activities. Fatigue level was found to be associated with Sex (χ2 test value = 16.667, P <0.05), Income (χ2 test value = 8.561, P < 0.05), and Cancer stage of the respondents (χ2 test value = 12.457, P < 0.05). This research presents & evaluates measures that have been used to assess the socio-economic aspects of fatigue in cancer patients, will yield positive outcomes in them with different diagnosis undergoing different modalities of anti-neoplastic treatments along with strategies to facilitate reliable assessment of symptoms of Cancer-Related Fatigue.

INTRODUCTION

Fatigue is the most prevalent symptom of individuals with cancer who receive radiation therapy, cytotoxic chemotherapy, or biological response modifiers (Stone P, Robinson KD, 2000). It was accepted by the International Classification of Disease (10th Revision, Clinical modification in 1999).

Cancer-related fatigue (CRF), defined by the National Comprehensive Cancer Network, NCCN) as "a distressing persistent subjective sense of physical, emotional or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity & interferes with usual functioning" (www.nccn.org/fatigue/pdf, 26 April 2009).

Cella & Colleagues defines CRF as "a subjective state of overwhelming & sustained exhaustion & decreased capacity for physical & mental work that is not relieved by rest".

The European Association of Palliative Care (EAPC) defines fatigue as" a subjective feeling of tiredness, weakness or loss of energy".

In healthy individuals, fatigue generally serves as a protective or pleasant response to physical or psychological stress. For patients with a chronic disease, however, it can become a distressing symptom (Glaus A, 1998), which negatively affects daily functioning & quality of life (Curt G, Breitbart W, 2000). It arises over a continuum, ranging from tiredness to exhaustion. But, by contrast, with the tiredness sometimes felt by a healthy individual, CRF is perceived as being of greater magnitude, disproportionate to activity or exertion, & not completely relieved by rest, leaving the patient with an overwhelming & sustained sense of exhaustion.(GlausA, Crow R, 1996). It impairs daily functioning, profoundly affects the quality of life, self- care capabilities and desire to continue treatment. In some cases, fatigue is the most significant barrier to functional recovery in cancer patients. It is a debilitating, multi-faceted biopsychosocial symptom, which begins after diagnosis and persists long after treatments end, even when the cancer is in remission. The etiological pathopsychophysiology underlying this is multifactorial and not well deliniated. Mechanisms may include- effects of anti-neoplastic therapy on CNS, sleep, circadian rhythm, inflammatory and stress mediators, immune system activation, hormonal alterations related the effects on hypothalamus pituitary axis, early menopause, androgen deprivation in men, abnormal accumulations of muscle metabolites, dysregulation of homeostatic status of cytokines, irregularities in neuromuscular function, abnormal gene expression, inadequate ATP synthesis, serotonin dysregulation, abnormal vagal afferent nerve activation, an array of psychosocial mechanisms, including self-efficacy, causal attributions, expectancy, coping and social support.

Fatigue is an umbrella term used to describe various sensations or feelings, & a variety of expressions of reduced capacity at physical, mental, emotional & social levels (Glaus A,1996). How CRF is related to indicators of tiredness, such as reduced energy expenditure, sleep disturbance, attention deficits, decreased endurance, & weakness, is unclear (Winningham M, Nail L, 2000). Fatigue affects the whole person- their body & mind & is a complex symptom with physical, emotional & mental effects. Patients have variously described themselves as feeling listless, sluggish, faint, despondent, apathetic, tired, slack, indifferent& having paralysing fatigue (Magnusson K, Moller A, 1999). CRF is the most frequently reported symptoms by cancer patients or its treatment & is almost universal in patients undergoing chemotherapy, radiation therapy , HSCT or treatment with biological response modifiers (Hofman M, Ryan JL, 2005). As the use of multi-modal treatments & dose-dense, intensity-dense treatment protocol has increased, so has the burden of CRF (NCCN).

Fatigue is also recognized as a common state in palliative care & patients with advanced cancer experience it as the most distressing symptom affecting their quality of life. The patients feel lack of energy & enthusiasm. Problems with this symptom is experienced from many months to years following completion of the treatment.

CRF include a feeling of debilitating tiredness, weakness, lethargy & malaise, where the exhaustion felt is disproportionate to the level of physical exertion & not relieved by sleep (Gutstein HB, Jean-Pierre P, 2001). CRF has a substantial negative impact (Hofman M, Ryan JL, 2007).

CRF is particularly high during & after chemotherapy treatment (Hartvig P, Bower JE, 2006). Fatigue typically rises its maximum over the first few days following chemotherapy infusions & then declines (Berger AM, Molassiotis A, 2010). Emotional distress is one of the potential contributor to post-treatment fatigue (PTF), which is particularly high among patients before chemotherapy (Montgomery GH, Watson M, 1996).

CRF is a complex multidimensional problem characterized by reduced energy & increased need for rest unrelated to recent sleep or activity that affects adversely by reducing mental & physical functioning, disturbing mood & interfering with usual activities (Butt Z, Scott JA, 2008). CRF is also emerging as a dose-limiting toxicity associated with established & newer therapies including targeted agents ,such as tyrosine kinase inhibitors, that can ultimately limit the effectiveness of treatment (Cornelison M, Jabbour EJ, 2010).

CRF is not always easily differentiated from everyday fatigue without careful diagnostic evaluation. Proposed International Classification of Disease -10 (ICD 10) criteria for diagnosis of CRF are as follows:

A. 6 or more of the following present everyday or nearly everyday during same 2 weeks in the past month; at least 1 symptom is significant fatigue (#1)

1. Significant fatigue, diminished energy, increased need to rest disproportionate to any recent change in activity level
2. Generalized weakness, limb heaviness
3. Diminished concentration, attention
4. Decreased motivation, interest in usual activities
5. Insomnia or hypersomnia
6. Sleep unrefreshing or nonrestorative
7. Struggle to overcome inactivity
8. Emotional reactivity to feeling fatigued (sadness, frustration, irritability)
9. Difficulty with completing daily tasks attributed to fatigue
10. Perceived short-term memory problems
11. Postexertional malaise lasting several hours

B. Symptoms causing clinically significant distress or impairment in social, occupational, or other important areas of functioning

C. Evidence from history, physical examination, or laboratory findings that symptoms are consequence of cancer or cancer therapy

D. Symptoms not primarily consequence of co-morbid psychiatric disorders such as major depression, somatization or somatoform disorder, or delirium.

MATERIALS AND METHODS

The study was conducted as per following methodology

Study design: This study was a Descriptive cross- sectional study

Study place: The study was conducted at

1. National Institute of Cancer Research & Hospital (NICRH),Mohakhali, Dhaka.
2. Ahsania Mission Cancer & General Hospital, Mirpur 13, Dhaka.
3. Kurmitola General Hospital, Dhaka.

Study period:

The total study period was 1 year, from January - December 2016. A work schedule was prepared including all the tasks in a sequence. The first 4 months were applied for literature review and strategy finalization. The subsequent months were passed for questionnaire development, pretesting, data collection, compilaton and analysis, report writing, printing and submission of thesis. Literature review was simultaneously going on till final report was submitted. The daily work schedule appended as Annexure D.

Study population:

The patients with Cancer receiving different methods of anti- neoplastic therapy

Inclusion criteria

1. Confirmed tissue diagnosis of cancer
2. Age: > 15 years
3. Gender: Male and female
4. Patients receiving radiotherapy, chemotherapy and concurrent chemo-radiotherapy, surgical treatment and palliative care.

Exclusion criteria

1. Patients who are unwilling to participate
2. Patients who are seriously ill

Sample size: To determine the sample size, following formula was used:

n= z²pq/d²

here, Z= at 95% confidence limit, the value of Z is 1.96

n= required sample size

p= estimated prevalence =50%

q= 1-p

d= margin of error at 5% (Standard value of 0.05)

so, n= {(1.96)² X 0.5X (1-0.5)}/(0.05)²

=3.8416 X 0.5 X0.5)/0.0025

=0.9604/0.0025

=384

The calculated sample size was 384.

Sampling technique: Purposive sampling technique

Research title approval: Research proposal was presented in front of the honorable faculty members, necessary modifications were done based on their comments and suggestions and then submitted for ethical clearance to ethical review committee of the National Institute of Preventive & Social Medicine (NIPSOM). Before commencement of data collection, a request letter signed by the Director, NIPSOM and Head of the Department of Community Medicine, NIPSOM was taken for appropriate authority. Identification of the researcher and purpose of data collection were explained to the respondent and informed consent was taken before data collection. After collecting the data, a brief counseling was given to the respondents.

Research Instruments

- Pre- tested semi- structured questionnaire
- The Functional Assessment of Cancer Therapy Fatigue Scale (FACT-F)

The FACT-F Scale,Version 4 consists of the 28 items of the FACT general, to assess the health related quality of life, and an additional 13 items to assess fatigue. The FACT-F has high internal consistency (ovarall α = 0.95, for fatigue subscale α = 0.93-0.95)

Developer:Suzanne B. Yellen, David Cella

Items of the Scale: 41 items

Domains/ Categories of the Scale:

5 domains: Physical wellbeing

Family/ Social/ Financial wellbeing

Emotional wellbeing

Functional wellbeing

Fatigue

Level of Fatigue

In 0-10 scale,

- 0 indicates an absence of fatigue
- a score of 1-3 indicates the presence of mild fatigue, that does not require clinical intervention
- scores of 4-6 indicate moderate fatigue, require further evaluation
- scores 7-10 indicate severe fatigue, need clinical intervention

Data collection technique: Data was collected by-

1.Record Review
2.Face to face interview using the questionnaire

Initially verbal consent was obtained from each respondents following introducing and informing about the purpose, objectives and procedures of the study. Data was collected by face to face interview ensuring the privacy and confidentiality of data. Data were also collected by reviewing relevant medical records. Time required for data collection from each individuals was about 30-40 minutes. Data were collected from 10 am to 4 pm. On an average, 10 respondents were interviewed daily.

Data processing, analysis & presentation:

Data processing

Data processing involves

- Categorization of the data
- Coding
- Summarizing the data
- Categorizing to detect the errors and to maintain consistency and validity
- Then these were entered into SPSS software in a computer for analysis

Data Analysis

The data was collected, verified and checked to exclude any error. Further validation checks for accuracy and consistency were carried out afterwards. Finally data analyzed by computer through Statistical Package for Social Science (SPSS) program (version 23) according to the variables to fulfill the objectives of this study. Described statistics were computed for socio-demographic variables. Distribution of data was checked. Data were presented in tables and graphs. Qualitative and quantitative were analyzed through proper methods.

Data presentation

Data was presented by tables, charts, figures, statistical inferences.

RESULTS

1. Socio-demographic Characteristics of The Respondents:

1.1 Distribution of The Respondents by Age Group:

Table 1: Distribution of The Respondents by Age Group

Abbildung in dieser Leseprobe nicht enthalten

Table 1 demonstrates that, Among all of the respondents (267), the majority 107 (40.1%) were in the age group 36-55 years, followed by 78 (29.2%) belong to the age group 16-35 years, 77 (28.8%) incorporate in the age group 56-75 years and remaining 5 respondents (1.9%) encompass above 75 years. The mean age of the respondent was 46.11(±16.548 years), with minimum age 16 and maximum age was 83 years.

1.2 Distribution of The Respondents by Sex:

Figure 1: Distribution of The Respondent by Sex

Figure 1 shows that, Out of all 267 respondents, 149 respondents (55.8%) were male and 118 (44.2%) were female.

Abbildung in dieser Leseprobe nicht enthalten

1.3 Distribution of The Respondents by Religion

Figure 2: Distribution of The Respondents by Religion

Abbildung in dieser Leseprobe nicht enthalten

Figure 2 shows that, Among 267 respondents, the majority 252 respondents (94.4%) were Muslim and remaining 15 (5.6%) were Hindu.

1.4 Distribution of The Respondents by Marital Status:

Figure 3: Distribution of The Respondents by Marital Status

Abbildung in dieser Leseprobe nicht enthalten

Married Unmarried Widow

Figure 3 demonstrates that, Among all 267 respondents, 179 respondents (67%) were married, 48(18%) were unmarried and 40 respondents (15%) were widowed.

1.5 Distribution of The Respondents by Educational Qualifications

Table 2: Distribution of The Respondents by Educational Qualification

Abbildung in dieser Leseprobe nicht enthalten

Table 2 illustrates that, Among 267 respondents, the majority 52 respondents (19.5%) were Graduate, followed by 42 (15.7%) were in the Class I-V group, 37 (13.9%) were SSC passed, 35 ( 13.1%) were HSC passed, 35 (13.1%) were illiterate, 27 (10.1%) were Post-graduate, 21(7.9%) can put sign only, and remaining 18 respondents (6.7%) were in the class VI-X group.

1.6 Distribution of The Respondents by Occupation

Table 3: Distribution of The Respondents by Occupation

Abbildung in dieser Leseprobe nicht enthalten

Table 4 shows that, Among all 267 respondents, the majority 92 respondents (34.5%) were house-wife, followed by 40 respondents (15%) were service holder, 31 (11.6%) were businessmen, 31(11.6%) were students, 26(9.7%) were day-laborer, 26(9.7%) were farmers, and remaining 21 (7.9%) were retired person.

1.7 Distribution of The Respondents by Monthly Income

Table 4: Distribution of Respondents by Monthly Income

Abbildung in dieser Leseprobe nicht enthalten

Table 4 shows that, Among 267 respondents, the majority 139 respondents (52.1%) monthly income were in 2000-25000 taka income group, followed by 75 respondents (28.1%) income were in 25001-50000 taka group, 40(15%) income in 50001-100000 group, 5 (1.9%) income were in 100001-150000 group, 4 respondents(1.5%) income were in 150001-200000 taka income group, and the remaining 4 respondents (1.5%) monthly income were above 200000 taka. The mean monthly income was 42333.33 (±73082.283 )taka, with minimum income 2000 & maximum monthly income was 700000 taka.

1.8 Distribution of The Respondents by Family Type

Figure 4: Distribution of The Respondents by Family Type

Abbildung in dieser Leseprobe nicht enthalten

Nuclear Joint Extended

In Figure 4, Among 267 respondents, 148 respondents (55.4%) belong to nuclear family, 113 (42.3%) incorporate in joint family and remaining 6 respondents (2.2%) encompass in extended family.

1.9 Distribution of the Respondents by Family Size:

Table 5: Distribution of The Respondents by Family Size

Abbildung in dieser Leseprobe nicht enthalten

Table 5 illustrates that, Among 267 respondents, 160 respondents (59.9%) family consist of 1-5 members, followed by 100 respondents (37.5%) family consist 6-10 members and remaining 7 respondents (2.6%) family have 11-15 members. The mean family size 5.47 (±2.189), with mimimum family member 2 and maximum 14.

2. Cancer & Cancer Treatment Related Informations of Respondents:

2.1 Distribution of Patients According to Duration of Illness

Table 6: Distribution of Patients according to Duration of Illness

Abbildung in dieser Leseprobe nicht enthalten

Table 6 shows that, Among 267 patients, the majority 233 patients (87.3%) are suffering from cancer for 1-12 months, followed by 25(9.4%) suffering for 13-24 months, 7 (2.6%) suffering for 25-36 months and remaining 2 patients(0.7%) suffering for 37-48 months, which has shown in Table - 6. The mean duration of illness is 9.42 (± 8.173) months, with minimum duration 1 month & maximum duration is 48 months.

2.2 Distribution of the Respondents Belonging to the Cancer Stage

Table 7: Distribution of Patients Belonging to Cancer Stage

Abbildung in dieser Leseprobe nicht enthalten

Table 7 demonstrates that, Among 267 patients, the majority 127 patients (47.6%) belonging to the 2nd stage, 94(35.2%) belong to the 3rd stage, 34 patients (12.7%) belong to 4th stage, and remaining 12 patients 94.5%) belong to the 1st stage.

2.3 Distribution of Patients According to Organ Involvement

Table 8: Distribution of Patients According to Organ Involvement

Abbildung in dieser Leseprobe nicht enthalten

Table 8 shows that, Among all 267 patients, the highest 42 patients (15.7%) are affected by Gastro-intestinal Cancer, 40(15%) are suffering from breast cancer, 38(14.2%) affected by lung cancer, 33(12.4%) by Ca head-neck, 28(10.5%) affected by Soft Tissue Sarcoma, 27(10.1%) suffering from Gynaecological cancer, 21(7.9%) affected by Genito-urinary cancer, 21(7.9%) affected by Haematological cancer, 7 patients(2.6%) are suffering from Ca Brain-PNS-Spinal cord, 5 (1.9%) affected by Melanoma & Skin cancer, and remaining 5 patients(1.9%) are suffering from CUP.

2.4 Distribution of Patients Belonging to the Anaemia Stage

Table 9: Distribution of Patients Belonging to Anaemia Stage

Abbildung in dieser Leseprobe nicht enthalten

Among 267 patients, 132 (49.4%) are moderately anaemic, followed by 71 (26.6%) are severely anaemic, and remaining 64 patients (24.0%) are mildly anaemic, which have shown in Table- 9.

2.5 Distribution of Patients by Receiving Treatment Types

Table 10: Distribution of Patients Receiving Treatment Type

Abbildung in dieser Leseprobe nicht enthalten

Among 267 patients, The highest 99 patients (37.1%) receiving Chemotherapy, followed by 57 patients (21.3%) receiving Surgery & Chemotherapy, 41(15.4%) receiving concurrent Chemo-radiation therapy, 24(9.0%) receiving only Radiotherapy, 19(7.1%) receiving surgical treatment, 13 patients (4.9%) receiving Surgery-Chemo-radiation therapy, 11(4.1%) receiving Surgery & Radiotherapy, 2 patients (0.7%) receiving oral anti-neoplastic drugs, and remaining 1 patient(0.4%) receiving Surgical treatment & Oral anti-cancer drugs, which have shown in Table- 10.

[...]

Excerpt out of 58 pages

Details

Title
Assessment of Cancer-Related Fatigue on the Lives of Patients
Course
mph
Grade
A
Author
Year
2017
Pages
58
Catalog Number
V353056
ISBN (eBook)
9783668395640
ISBN (Book)
9783668395657
File size
1991 KB
Language
English
Tags
assessment, cancer-related, fatigue
Quote paper
Ishrat Eshita (Author), 2017, Assessment of Cancer-Related Fatigue on the Lives of Patients, Munich, GRIN Verlag, https://www.grin.com/document/353056

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