Annemie Courtens

Fatigue in patients with breast cancer receiving adjuvant chemotherapy: A review of the literature

The aim of this literature review was to evaluate the prevalence and course of fatigue in patients with breast cancer undergoing adjuvant chemotherapy and to examine factors relating to fatigue. Fatigue is one of the most common side effects of chemotherapy. High and fluctuating prevalence rates of fatigue have been found not only during but also after adjuvant chemotherapy. The intensity of fatigue seems to be stable throughout the treatment cycles, despite the common perception that more chemotherapy treatments lead to greater fatigue. The first two days after a chemotherapy treatment seem to be the worst period. The influence of factors such as pain, impaired quality of sleep, and depression are be highly consistent across several studies, although it is often not clear whether it is the symptoms that cause the fatigue or vice versa. The outcomes of the studies indicate that several symptoms are interrelated in a network of symptoms. Factors such as changes in weight, menopausal symptoms, coping, social support, and biochemical changes have been mentioned in the literature as potentially contributing to fatigue. Results have been conflicting and need further study.

Course of fatigue between two cycles of adjuvant chemotherapy in breast cancer patients.

The purpose of this study was to determine the course of fatigue in patients with breast cancer between 2 cycles of adjuvant chemotherapy, from the day of administration until the day of the next infusion. In a prospective cohort study, a sample of 151 patients with breast cancer receiving adjuvant chemotherapy was recruited from 6 hospitals in mainly the south of the Netherlands. Patients reported their experience of fatigue in a diary, the Shortened Fatigue Questionnaire, on a daily basis between the third and fourth treatment with adjuvant chemotherapy. Patients were treated with either a doxorubicin containing schedule or with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF, 28 days). In the 28-day regimens, infusions were given on day 1 and day 8. The days after completion of the third and the start of the fourth treatment with chemotherapy were statistically analyzed. We tested the hypothesis that the maximum fatigue score occurs in the first 4 days after treatment. The mean age of the sample was 47.2 years (SD = 8.8). Most women (84%) were married or lived together with a partner. The majority (80%) of all patients had been diagnosed with stage II breast cancer. The division between mastectomies (47%) and lumpectomies (52%) was approximately equal. Sixty percent of the patients received radiotherapy before the third treatment with chemotherapy and/or in the period they kept the diary. A chaotic pattern of fatigue between the 2 cycles of chemotherapy emerged. Smooth (splines) curves showed an average highest level of fatigue on day 3 from the start. For the 28-day regimens, another distinct peak was seen around day 11. A relatively larger number of patients experienced peak fatigue levels before day 5. The course of fatigue in the CMF group was significantly different compared with the doxorubicin regimens. The fatigue peak in the CMF group was lower. Women taking cyclophosphamide orally experienced the peak level of fatigue significantly later. Influences of other variables were not observed in any chemotherapy group. Cancer-related fatigue has a chaotic nature. The first days after treatment with chemotherapy are the worst. The type of chemotherapy has a significant impact on the course of fatigue. Improved understanding of the nature and course of fatigue could equip healthcare providers better for informing patients about what they may expect. Future research should include interventions aimed at reducing or coping with fatigue.

Evidence-based palliative care across the life span

In providing its well-balanced overview of the evidence base in palliative care, this book considers a good range of research, offers balance between the perceptions of patients and carers, and provides objective measurements of effectiveness, that is what works.

De MITTZ : Het meten van tevredenheid met het (in)formele zorgproces van terminale patiënten en hun naasten. (Wetenschappelijk artikel)

Abstract Summary The MITTZ. Measuring satisfaction with the (in)formal care process of terminally ill patients and their beloved ones.In this study a measurement instrument (MITTZ) has been developed, which can be used to evaluate the satisfaction with the care delivered in the palliative terminal phase from the perspectives of patients and their beloved ones. A proxyversion has been also developed. The MITTZ has been tested in 43 terminally ill patients and 39 informal caregivers. The content validity, clinical utility and feasibility appeared to be good. With the information from the MITTZ the quality of care for terminally ill patients can be improved. In addition, the MITTZ can be used as outcome measure in studies into the field of palliative care.SamenvattingIn deze studie is een meetinstrument (MITTZ) ontwikkeld waarmee de tevredenheid met de zorg in de palliatieve terminale fase geëvalueerd kan worden vanuit het perspectief van patiënten en naasten. Tevens is een proxy-versie van de MITTZ ontwikkeld. De MITTZ is bij 43 terminale patiënten en 39 mantelzorgers getest. De inhoudsvaliditeit, klinische bruikbaarheid en haalbaarheid bleken goed te zijn. Met behulp van de informatie uit de MITTZ kan de kwaliteit van zorg voor terminale patiënten geoptimaliseerd worden. Tevens kan de MITTZ dienen als uitkomstmaat bij onderzoek in het veld van de palliatieve zorg.Sleutelwoorden: palliatieve terminale zorg, meetinstrument, tevredenheid, kwaliteit van zorg.