Posttreatment Considerations
This posttreatment section has been especially prepared for those individuals
with cancer who have been off all antineoplastic therapy for at least
6 months. The rationale for creating a separate section is twofold. First,
the etiology of problems is different for individuals receiving treatment
versus those who are no longer receiving therapy. Second, intervention
strategies and information can be better tailored so that there will be a
greater likelihood of meeting the needs of these two distinct populations.
Fatigue is a separate and distinct problem for individuals after treatment is
completed. Many theories have been proposed to explain the etiology of fatigue
in the patient undergoing treatment and to explain the impact of that treatment
on quality of life. Many of these theories, however, do not apply to the posttreatment population. Nonetheless, fatigue continues to be a major issue for
individuals who are no longer receiving therapy and who are considered to be
disease free.
There is evidence that fatigue significantly affects the quality of life of
cancer survivors. The experience of fatigue in cancer survivors is quite
similar to the experience of patients with chronic fatigue syndrome in the
general medical setting.[1] Few studies have been done that indicate the
impact of fatigue on quality of life, but some examples follow:
- In cancer survivors who had bone marrow transplants, 50% of 29 survivors
reported moderate-to-severe fatigue more than 1 year after transplant.
Fatigue was one of the three most negative items studied and had an impact
on quality of life more than any other physical problem.[2]
- In patients who had bone marrow transplants, 56% of 125 patients reported
ongoing fatigue 6 to 18 years after transplant.[3]
- Of 687 posttreatment survivors of various forms of cancer evaluated for
quality-of-life issues, fatigue was one of the three most negative items
affecting quality of life.[4]
- Of 90 patients with a diagnosis of Hodgkin lymphoma or non-Hodgkin
lymphoma, 30 reported a lack of energy at a median of 32 months after
diagnosis.[5]
- Of 403 individuals with Hodgkin lymphoma, 37% reported their energy levels
had not returned to levels that satisfied them even after a median of 9
years posttreatment.[6]
- In Hodgkin lymphoma survivors, 26% had persistent fatigue 6 months after
treatment with 50% associated with psychological distress. Increasing age and
no prior psychological symptoms predicted fatigue “caseness.”[7]
- Of 162 women treated with radiation for breast cancer and 173 women treated
with chemotherapy for breast cancer, 75% and 61% respectively
described decreased stamina 2 to 10 years after the completion of
treatment.[8] In a separate cross-sectional survey of women who completed therapy for breast cancer by a mean of 29 months prior to the survey, 38% had severe fatigue compared with only 11% of matched controls.[9]
- Fatigue has been reported in women survivors of autologous bone marrow
transplantation and high-dose chemotherapy treatment for lymphomas 4
to 10 years posttreatment.[10]
Although many studies document the incidence of fatigue in those who are no
longer receiving cancer treatment, the specific mechanism of fatigue remains
unknown. Because fatigue is a multifaceted problem, determining its etiology
is difficult.
The information available regarding fatigue in survivors of childhood cancer is
from the literature describing the physiologic and cognitive effects following
treatment. In one study, cognitive outcomes were evaluated in children 3 to 4
years after diagnosis of brain tumors. Fatigue was a factor in poor school
performance.[11]
In another study, survivors of acute lymphoblastic leukemia who were evaluated
for cognitive deficits after treatment were noted to have a typical fatigue
effect. This was thought to be a factor in the variability of their test
scores.[12] Anecdotally, individuals who have received chest and total-body
irradiation complain of fatigue, with an increased sleep requirement.
People who are successfully treated for cancer are at risk for a variety of
organ-specific complications that are secondary to their treatment.[13] Fatigue in
the posttreatment population underscores the importance of follow-up care.
The persistence of fatigue following cancer treatment requires a thorough
evaluation to rule out contributing physiologic conditions.
References
-
Servaes P, van der Werf S, Prins J, et al.: Fatigue in disease-free cancer patients compared with fatigue in patients with chronic fatigue syndrome. Support Care Cancer 9 (1): 11-7, 2001.
[PUBMED Abstract]
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Whedon M, Stearns D, Mills LE: Quality of life of long-term adult survivors of autologous bone marrow transplantation. Oncol Nurs Forum 22 (10): 1527-35; discussion 1535-7, 1995 Nov-Dec.
[PUBMED Abstract]
-
Bush NE, Haberman M, Donaldson G, et al.: Quality of life of 125 adults surviving 6-18 years after bone marrow transplantation. Soc Sci Med 40 (4): 479-90, 1995.
[PUBMED Abstract]
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Ferrell BR, Grant M, Dean GE, et al.: Bone tired: the experience of fatigue and its impact on quality of life. Oncol Nurs Forum 23 (10): 1539-47, 1996.
-
Devlen J, Maguire P, Phillips P, et al.: Psychological problems associated with diagnosis and treatment of lymphomas. II: Prospective study. Br Med J (Clin Res Ed) 295 (6604): 955-7, 1987.
[PUBMED Abstract]
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Fobair P, Hoppe RT, Bloom J, et al.: Psychosocial problems among survivors of Hodgkin's disease. J Clin Oncol 4 (5): 805-14, 1986.
[PUBMED Abstract]
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Loge JH, Abrahamsen AF, Ekeberg, et al.: Fatigue and psychiatric morbidity among Hodgkin's disease survivors. J Pain Symptom Manage 19 (2): 91-9, 2000.
[PUBMED Abstract]
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Berglund G, Bolund C, Fornander T, et al.: Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. Eur J Cancer 27 (9): 1075-81, 1991.
[PUBMED Abstract]
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Servaes P, Verhagen S, Bleijenberg G: Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol 13 (4): 589-98, 2002.
[PUBMED Abstract]
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Knobel H, Loge JH, Nordøy T, et al.: High level of fatigue in lymphoma patients treated with high dose therapy. J Pain Symptom Manage 19 (6): 446-56, 2000.
[PUBMED Abstract]
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Radcliffe J, Packer RJ, Atkins TE, et al.: Three- and four-year cognitive outcome in children with noncortical brain tumors treated with whole-brain radiotherapy. Ann Neurol 32 (4): 551-4, 1992.
[PUBMED Abstract]
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Brouwers P: Neuropsychological abilities of long-term survivors of childhood leukemia. In: Aaronsen NK, Beckmann J, eds.: The Quality of Life of Cancer Patients. New York: Raven Press, 1987, pp 153-65.
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Baker F, Denniston M, Smith T, et al.: Adult cancer survivors: how are they faring? Cancer 104 (11 Suppl): 2565-76, 2005.
[PUBMED Abstract]
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