Eileen Danaher Hacker

Fatigue and physical activity in patients undergoing hematopoietic stem cell transplant

PURPOSE/OBJECTIVES To examine the patterns of fatigue, physical activity, health status, and quality of life before and after high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT) and to examine the feasibility of obtaining real-time fatigue and physical activity data. DESIGN Prospective, repeated measures. SETTING Two midwestern academic medical centers. SAMPLE Convenience sample of autologous or allogeneic patients undergoing HSCT (N = 20 baseline, N = 17 post-transplant). METHODS Subjects were assessed over a five-day period before and after HSCT for a total of 10 days. Subjects rated fatigue intensity three times daily and wore a wrist actigraph to measure physical activity. At the end of both five-day periods, subjects completed measures of perceived health status (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30) and life satisfaction Quality of Life Index). MAIN RESEARCH VARIABLES Fatigue, physical activity, perceived health status, and quality of life. FINDINGS Study results indicate that fatigue significantly increased and physical activity decreased following high-dose chemotherapy and HSCT. The decline coincided with diminished physical, emotional, role, and cognitive functioning. The symptoms that patients experienced (i.e., fatigue, pain, nausea and vomiting, sleep disturbances, appetite loss, and diarrhea) increased during the acute post-transplant period. No significant changes in life satisfaction were found. CONCLUSIONS The study findings suggest that patients receiving high-dose chemotherapy followed by HSCT experience increased fatigue, reduced physical activity, diminished functioning, and poorer quality of life immediately after transplant. Findings demonstrate that real-time fatigue and physical activity data can feasibly be collected in acutely ill patients. IMPLICATIONS FOR NURSING Patients undergoing HSCT require considerable supportive nursing care immediately following transplant. Clinicians and researchers need to strive for effective symptom management to improve the likelihood of successful outcomes.

Strength training following hematopoietic stem cell transplantation

Background: Patients receiving high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT) experience considerable reductions in physical activity and deterioration of their health status. Objective: The purpose of this pilot study was to test the effects of strength training compared with usual activity on physical activity, muscle strength, fatigue, health status perceptions, and quality of life following HSCT. Methods: Nineteen subjects were randomized to the exercise or control group. Moderate-intensity strength training began following discharge from the hospital. Dependent variables included physical activity, muscle strength, fatigue, health status perceptions, and quality of life. Variables were measured prior to admission to the hospital for HSCT, day 8 following HSCT, and 6 weeks following discharge from the hospital. Results: Significant time effects were noted for many variables with anticipated declines in physical activity, muscle strength, fatigue, and health status perceptions immediately after HSCT with subsequent improvements 6 weeks following hospital discharge. One group effect was noted with subjects in the exercise group reporting less fatigue than subjects in the control group. Although no significant interactions were detected, the trends suggest that the exercise group may be more physically active following the intervention compared with the usual-activity group. Conclusions: This study demonstrates the potential positive effects of strength training on physical activity, fatigue, and quality of life in people receiving high-dose chemotherapy and HSCT. Implications for Practice: Preliminary evidence is provided for using strength training to enhance early recovery following HSCT. Elastic resistance bands are easy to use and relatively inexpensive.

Quality of life immediately after peripheral blood stem cell transplantation.

This prospective, longitudinal study investigated the quality of life among patients immediately after undergoing peripheral blood stem cell transplantation. The patients were assessed before transplantation (n = 16), immediately before hospital discharge (n = 10), 2 weeks after hospital discharge (n = 10), and 6 weeks after hospital discharge (n = 8). Patients completed the European Organization for Research and Training Quality of Life Questionnaire-Core 30 and the Ferrans and Powers Quality of Life Index at each assessment point. A brief telephone interview was conducted 6 weeks after hospitalization (n = 7). The study results indicate that patients undergoing peripheral blood stem cell transplantation experience significant appetite loss (P < .01), diarrhea (P < .05), nausea and vomiting (P < .05), and sleep disturbances (P < .01) during the acute posttransplantation period. Other clinically important changes also were identified, so that a general pattern of recovery emerged. These patients reported diminished functional ability, increased symptoms, and poorer quality of life immediately before hospital discharge, with a return to pretransplantation levels by 6 weeks after hospitalization. In contrast, life satisfaction continued to decline 2 weeks after hospitalization, but did improve by 6 weeks. The qualitative data provide further support for this trend.

Quantitative Measurement of Quality of Life in Adult Patients Undergoing Bone Marrow Transplant or Peripheral Blood Stem Cell Transplant: A Decade in Review

PURPOSE/OBJECTIVES To critically evaluate a decade of quantitative quality-of-life (QOL) measurement in adult patients undergoing bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT). DATA SOURCES Quantitative research articles published between January 1990 and January 2000 in the nursing and medical literature. DATA SYNTHESIS QOL measures reported in BMT and PBSCT literature support the multidimensional nature of the construct. The majority of studies used a single instrument to assess QOL. Variations in measurement included use of a single versus multiple instruments to assess QOL, theoretical underpinnings of instruments, and output (overall score, domain scores) provided by the instruments. CONCLUSIONS A studys purpose, conceptual approach, patient burden, and resources available to the researcher should guide decisions regarding QOL instrumentation. No gold standard exists for assessing QOL in research or clinical practice. IMPLICATIONS FOR NURSING Nurses can select from a variety of tools to measure QOL in the BMT and PBSCT patient populations. Clinicians must consider the clinical meaningfulness of changes in QOL before implementing changes in their practice.

Fatigue in Women With Type 2 Diabetes

Purpose The purpose of this study was to explore the relationship between fatigue and physiological, psychological, and lifestyle phenomena in women with type 2 diabetes (T2DM) in order to establish the magnitude and correlates of fatigue in women with T2DM and explore the interrelationships between fatigue and specific diabetes-related factors that may be associated with increased levels of fatigue. These factors included physiological factors (glucose control, diabetes symptoms), psychological factors (diabetes emotional distress, depressive symptoms in general), and lifestyle factors (body mass index, physical activity). Methods A cross-sectional, descriptive design was used. Women who reported conditions known to cause fatigue were excluded. Physiological measures included fasting blood glucose (FBG), hemoglobin A1C (A1C), glucose variability, and body mass index (BMI). Women completed questionnaires about health, fatigue levels, diabetes symptoms, diabetes emotional distress, depressive symptoms, physical activity, and current diabetes self-care practices. A subset of the women wore a Medtronic Gold CGM sensor for 3 days for assessment of glucose variability. Results Eighty-three women aged 40 to 65 years with T2DM completed the study. Fatigue was significantly related to diabetes symptoms, diabetes emotional distress, depressive symptoms, higher BMI, and reduced physical activity. There was no relationship between fatigue and FBG or A1C. The strongest explanatory factors for fatigue were diabetes symptoms, depressive symptoms, and BMI, which accounted for 48% of the variance in fatigue scores. Glucose variability was not significantly associated with fatigue in these women. Conclusions Fatigue is a persistent clinical complaint among women with T2DM and may signal the presence of physiological, psychological, and lifestyle-related phenomena that could undermine diabetes health outcomes.

Measurement of Quality of Life in Men With Prostate Cancer

Prostate cancer continues to be one of the most common cancers diagnosed in men. In light of the excellent survival rates for prostate cancer, quality of life is a primary concern during and following prostate cancer treatment. Quality of life is defined and determined in multiple ways. This article explores quality of life in men with prostate cancer. Quality-of-life dimensions, measurement tools, and implications of quality of life with prostate cancer on clinical practice for oncology nurses will be presented.

Exercise and Quality of Life: Strengthening the Connections

Exercise improves quality of life (QOL) in people with cancer. Most oncology healthcare providers recognize the statement to be true because the research literature provides strong support for the physical and psychological benefits of exercise. Because the terms exercise, QOL, and people with cancer have different meanings, the contextual connections in which they are used are important to understanding the relationship between exercise and QOL in people with cancer. This article explores the links between exercise and QOL in people with cancer and examines issues that impact the development, implementation, and evaluation of exercise programs for people with cancer. Issues related to exercise goal development, exercise prescription, exercise testing, exercise adherence, and methods to evaluate the efficacy of exercise in relation to QOL are discussed.

Fatigue in Women Receiving Intraperitoneal Chemotherapy for Ovarian Cancer A Review of Contributing Factors

Women diagnosed with stage III or IV ovarian cancer typically are treated with surgery followed by chemotherapy. Intraperitoneal (IP) chemotherapy, the direct administration of chemotherapy into the IP cavity, has been explored as a viable treatment option for some women with advanced ovarian cancer. Fatigue may occur as a result of the disease process, treatment, or a wide variety of physical, psychological, or situational factors. Fatigue is one of the most common and distressing side effects associated with chemotherapy and it may be intensified in women receiving IP chemotherapy. The purpose of this article is to examine fatigue in women receiving IP chemotherapy for advanced ovarian cancer and to examine what aspects of IP chemotherapy may contribute to fatigue development. Factors reviewed include surgery for debulking the tumor and placement of the IP catheter, administration of IV chemotherapy in addition to IP chemotherapy, pain, anemia, sleep disturbances, gastrointestinal disturbances, and emotional distress. Oncology nurses who are knowledgeable about the factors that contribute to fatigue in women receiving IP chemotherapy will be better prepared to conduct a comprehensive assessment and develop effective treatment strategies.

Regional body composition: cross-calibration of DXA scanners-QDR4500W and Discovery Wi.

Differences exist in body composition assessed by dual‐energy X‐ray absorptiometers (DXAs) between devices produced by different manufacturers and different models from the same manufacturer. Cross‐calibration is needed to allow body composition results to be compared in multicenter trials or when scanners are replaced. The aim was to determine reproducibility and extent of agreement between two fan‐beam DXA scanners (QDR4500W, Discovery Wi) for body composition of regional sites. The sample was: 39 women 50.6 ± 9.6 years old with BMI 26.8 ± 5.5 kg/m2, body fat 33 ± 7%. Four whole body scans (two on each device) were performed over 3 weeks. Major variables were fat mass, nonosseous lean mass, and bone mineral content (BMC) for the truncal and appendicular regions. Extent of agreement was assessed using Bland and Altman plots. Both devices demonstrated good precision with mean test–retest differences close to zero for fat mass, nonosseous lean mass, and BMC of the truncal and appendicular regions. Evaluation of interdevice agreement revealed significant differences for truncal and appendicular BMC, nonosseous lean mass, and fat mass. The greatest interdevice difference was for truncal fat mass (0.69 ± 0.60 kg). Differences in truncal and appendicular fat mass increased in magnitude at higher mean values. Furthermore, differences in truncal and appendicular fat mass were strongly related to BMI (R = −0.61, R = −0.55, respectively). In conclusion, in vivo cross‐calibration is important to ensure comparability of regional body composition data between scanners, especially for truncal fat mass and for subjects with higher BMI.

Importance of cross-calibration when replacing DXA scanners: QDR4500W and Discovery Wi.

The aim of the study was to determine reproducibility and extent of agreement between 2 dual-energy X-ray absorptiometers (Hologic QDR4500W, Discovery Wi). The average age of the sample (n = 42) was 50.4 (SD = 9.9) years old and 27.1 (SD = 6.1) kg/m2 body mass index. Four scans were performed with each subject (2 on each device) over ∼3 weeks. Whole body, proximal femur, and spine scans were performed at each visit. Major variables were whole body bone mineral content (BMC), fat mass, and nonosseous lean mass, and bone mineral density (BMD) of total proximal femur, femoral neck, total spine. Bland and Altman plots assessed the extent of the agreement. Regression analysis was used to develop correction equations if indicated. Both devices demonstrated good precision for whole body composition and BMD of central sites (<1% different). Interdevice agreement was acceptable for BMD of central sites (<1% different), but there were systematic differences for whole body composition between the 2 devices. It was concluded that when replacing an existing scanner with a new model, in vivo cross-calibration is important to ensure comparability of scan data, especially for whole body composition.