Purpose/Objectives: To evaluate how patients diagnosed with uterine cancer experience fatigue, psychological distress, coping resources, and functional status before, during, and after treatment with radiation therapy and to study whether significant correlations exist among these variables.
Design: Longitudinal, descriptive, and correlational.
Setting: The Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Sample: 60 women diagnosed with uterine cancer who were receiving curative external radiation therapy. Typical participants were 64 years old, married, and on sick leave or retired from work.
Methods: Data were collected through self-report instruments. Demographic and clinical data were extracted from the patients' records.
Main Research Variables: Cancer-related fatigue, psychological distress, coping resources, and functional status.
Findings: Patients' fatigue scores increased significantly during and after completion of radiotherapy. The participants reported normal levels of anxiety and depression, and their coping resources changed over time. After completing therapy, all dimensions of function had decreased; for social function, the decrease was significant. The correlation over time was significant among fatigue and physical function, role function, and cognitive function. The variation of the change in fatigue after therapy was completed was explained only by the level of fatigue experienced at baseline.
Conclusions:Fatigue is a symptom that increases in connection with radiotherapy. Functional status is influenced by the variation in fatigue levels. Fatigue level before treatment may be an important variable when trying to find a risk factor for the development of fatigue over the course of treatment.
Implications for Nursing:Nurses must inform patients receiving radiotherapy about the expected changes in fatigue and functional status. Pretreatment screening for fatigue is needed to identify patients at risk for developing fatigue.
Aaronson, N.K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N.J., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365-376.
Ahlberg, K., Ekman, T., Gaston-Johansson, F., & Mock, V. (2003). Assessment and management of cancer-related fatigue in adults. Lancet, 362, 640-650.
Antonovsky, A. (1979). Health, stress, and coping. San Francisco, CA: Jossey-Bass.
Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay well. San Francisco, CA: Jossey-Bass.
Antonovsky, A. (1993). The structure and properties of the Sense of Coherence Scale. Social Science and Medicine, 36, 725-733.
Armstrong, T.S. (2003). Symptoms experience: A concept analysis.Oncology Nursing Forum, 30, 601-606.
Blom, G. (1958). Statistical estimates and transformed beta variables. New York: John Wiley.
Bower, J.E., Ganz, P.A., Desmond, K.A., Rowland, J.H., Meyerowitz, B.E., & Belin, T.R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18, 743-753.
Broeckel, J.A., Jacobsen, P.B., Horton, J., Balducci, L., & Lyman, G.H. (1998). Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 16, 1689-1696.
Cella, D. (1997). The Functional Assessment of Cancer Therapy Anemia (FACT-An) Scale: A new tool for the assessment of outcomes in cancer anemia and fatigue. Seminars in Hematology, 34(3, Suppl. 2), 13-19.
Cella, D., Lai, J.S., Chang, C.H., Peterman, A., & Slavin, M. (2002). Fatigue in cancer patients compared with fatigue in the general United States population. Cancer, 94, 528-538.
Cella, D., Peterman, A., Passik, S., Jacobsen, P., & Breitbart, W. (1998). Progress toward guidelines for the management of fatigue. Oncology, 12, 369-377.
Creasman, W.T., Odicino, F., Maisonneuve, P., Beller, U., Benedet, J.L., Henttz, A.P.M., et al. (2001). Carcinoma of the corpus uteri. Journal of Epidemiology and Biostatistics, 6(1), 45-86.
Curt, G.A. (2000). Impact of fatigue on quality of life in oncology patients. Seminars in Hematology, 37(4, Suppl. 6), 14-17.
Dodd, M.J., Miaskowski, C., & Paul, S.M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology-Nursing Forum, 28, 465-470.
Faithfull, S. (1998). Fatigue in patients receiving radiotherapy. Professional Nurse, 13, 459-461.
Fayers, P.M., Aaronson, N.K., Bjordal, K., & Sullivan, M. (1995). EORTC QLQ-C30 scoring manual. Brussels, Belgium: European Organisation for Research and Treatment of Cancer.
Flechtner, H., & Bottomley, A. (2003). Fatigue and quality of life: Lessons from the real world. Oncologist, 8(Suppl. 1), 5-9.
Forsberg, C., & Bjorvell, H. (1996). Living with cancer: Perceptions of well-being. Scandinavian Journal of Caring Science, 10, 109-115.
Furst, C.J., & Ahsberg, E. (2001). Dimensions of fatigue during radiotherapy. An application of the Multidimensional Fatigue Inventory. Supportive Care in Cancer, 9, 355-360.
Gaston-Johansson, F., Fall-Dickson, J.M., Bakos, A.B., & Kennedy, M.J. (1999). Fatigue, pain, and depression in pre-autotransplant breast cancer patients. Cancer Practice, 7, 240-247.
Given, B., Given, C., Azzouz, F., & Stommel, M. (2001). Physical functioning of elderly cancer patients prior to diagnosis and following initial treatment. Nursing Research, 50, 222-232.
Given, C.W., Given, B., Azzouz, F., Kozachik, S., & Stommel, M. (2001). Predictors of pain and fatigue in the year following diagnosis among elderly cancer patients. Journal of Pain and Symptom Management, 21, 456-466.
Graydon, J.E. (1994). Women with breast cancer: Their quality of life following a course of radiation therapy. Journal of Advanced Nursing, 19, 617-622.
Grimm, P. (1997). Measuring anxiety. In M. Frank-Stromborg & S. Olsen (Eds.), Instruments for clinical health-care research (pp. 329-341). Sudbury, MA: Jones and Bartlett.
Gutstein, H.B. (2001). The biologic basis of fatigue. Cancer, 92(6, Suppl.), 1678-1683.
Harrison, L., Shasha, D., Shiaova, L., White, C., Ramdeen, B., & Portenoy, R. (2001). Prevalence of anemia in cancer patients undergoing radiation therapy. Seminars in Oncology, 28(2, Suppl. 8), 54-59.
Hickok, J.T., Morrow, G.R., McDonald, S., & Bellg, A.J. (1996). Frequency and correlates of fatigue in lung cancer patients receiving radiation therapy: Implications for management. Journal of Pain and Symptom Management, 11, 370-377.
Irvine, D.M., Vincent, L., Graydon, J.E., & Bubela, N. (1998). Fatigue in women with breast cancer receiving radiation therapy. Cancer Nursing, 21, 127-135.
Jacobsen, P.B., Hann, D.M., Azzarello, L.M., Horton, J., Balducci, L., & Lyman, G.H. (1999). Fatigue in women receiving adjuvant chemotherapy for breast cancer: Characteristics, course, and correlates. Journal of Pain and Symptom Management, 18, 233-242.
Janda, M., Gerstner, N., Obermair, A., Fuerst, A., Wachter, S., Dieckmann, K., et al. (2000). Quality of life changes during conformal radiation therapy for prostate carcinoma. Cancer, 89, 1322-1328.
Klee, M., & Machin, D. (2001). Health-related quality of life of patients with endometrial cancer who are disease-free following external irradiation. Acta Oncologica, 40, 816-824.
Klee, M., Thranov, I., & Machin, D. (2000). The patients' perspective on physical symptoms after radiotherapy for cervical cancer. Gynecologic Oncology, 76, 14-23.
Langius, A., Bjorvell, H., & Antonovsky, A. (1992). The sense of coherence concept and its relation to personality traits in Swedish samples. Scandinavian Journal of Caring Sciences, 6(3), 165-171.
Lazarus, R.S. (1999). Stress and emotion: A new synthesis. New York: Springer.
Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Leidy, N.K. (1994). Functional status and the forward progress of merry-go-rounds: Toward a coherent analytical framework. Nursing Research, 43, 196-202.
Loge, J.H., Abrahamsen, A.F., Ekeberg, O., & Kaasa, S. (2000). Fatigue and psychiatric morbidity among Hodgkin's disease survivors. Journal of Pain and Symptom Management, 19, 91-99.
Lundman, B., & Norberg, A. (1993). The significance of a sense of coherence for subjective health in persons with insulin-dependent diabetes. Journal of Advanced Nursing, 18, 381-386.
Maher, K. (2000). Radiation therapy: Toxicities and management. In C.H. Yarbro, M. Frogge, M. Goodman, & S. Groenwald (Eds.), Cancer nursing: Principles and practice (pp. 323-351). Sudbury, MA: Jones and Bartlett.
Marty, M., Bedairia, N., Laurence, V., Espie, M., & Cottu, H. (2001). Factors related to fatigue in cancer patients: The key to specific therapeutic approaches. In M. Marty & S. Pecorelli (Eds.), European school of oncology. Scientific updates, 5 (pp. 33-44). Amsterdam, the Netherlands: Elsevier.
McDaniel, J.S., Musselman, D.L., Porter, M.R., Reed, D.A., & Nemeroff, C.B. (1995). Depression in patients with cancer. Diagnosis, biology, and treatment. Archives of General Psychiatry, 52, 89-99.
Mock, V., Atkinson, A., Barsevick, A., Cella, D., Cimprich, B., Cleeland, C., et al. (2000). NCCN practice guidelines for cancer-related fatigue. Oncology, 14, 151-161.
Molassiotis, A., van den Akker, O.B., Milligan, D.W., Goldman, J.M., Boughton, B.J., Holmes, J.A., et al. (1996). Quality of life in long-term survivors of marrow transplantation: Comparison with a matched group receiving maintenance chemotherapy. Bone Marrow Transplantation, 17, 249-258.
Morrow, G.R, Andrews, P.L, Hickok, J.T., Roscoe, J.A., & Matteson, S. (2002). Fatigue associated with cancer and its treatment. Supportive Care in Cancer, 10, 389-398.
Nail, L.M. (2002). Fatigue in patients with cancer. Oncology Nursing Forum, 29, 537.
Pasacreta, J. (1997). Measuring depression. In M. Frank-Stromborg, & S. Olsen (Eds.), Instruments for clinical health-care research (pp. 342-360). Sudbury, MA: Jones and Bartlett.
Pearman, T. (2003). Quality of life and psychosocial adjustment in gynecologic cancer survivors. Health and Quality of Life Outcomes, 1(1), 33.
Portenoy, R.K., & Itri, L.M. (1999). Cancer-related fatigue: Guidelines for evaluation and management. Oncologist, 4(1), 1-10.
Redeker, N.S., Lev, E.L., & Ruggiero, J. (2000). Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Scholarly Inquiry for Nursing Practice, 14, 275-290.
Schnyder, U., Buchi, S., Sensky, T., & Klaghofer, R. (2000). Antonovsky's sense of coherence: Trait or state? Psychotherapy and Psychosomatics, 69, 296-302.
Schwartz, A.L., Nail, L.M., Chen, S., Meek, P., Barsevick, A.M., King, M.E., et al. (2000). Fatigue patterns observed in patients receiving chemotherapy and radiotherapy. Cancer Investigation, 18, 11-19.
Sivesind, D., & Baile, W.F. (2001). The psychologic distress in patients with cancer. Nursing Clinics of North America, 36, 809-825.
Smets, E.M., Garssen, B., Bonke, B., & de Haes, J.C. (1995). The Multidimensional Fatigue Inventory (MFI). Psychometric qualities of an instrument to assess fatigue. Journal of Psychosomatic Research, 39, 315-325.
Smets, E.M., Garssen, B., Cull, A., & de Haes, J.C. (1996). Application of the Multidimensional Fatigue Inventory (MFI-20) in cancer patients receiving radiotherapy. British Journal of Cancer, 73, 241-245.
Smets, E.M., Visser, M.R., Willems-Groot, A.F., Garssen, B., Oldenburger, F., van Tienhoven, G., et al. (1998). Fatigue and radiotherapy: Experience in patients undergoing treatment. British Journal of Cancer, 78, 899-906.
Stone, P., Richards, M., A'Hern, R., & Hardy, J. (2000). A study to investigate the prevalence, severity and correlates of fatigue among patients with cancer in comparison with a control group of volunteers without cancer. Annals of Oncology, 11, 561-567.
Stone, P., Richards, M., A'Hern, R., & Hardy, J. (2001). Fatigue in patients with cancers of the breast or prostate undergoing radical radiotherapy. Journal of Pain and Symptom Management, 22, 1007-1015.
Tchekmedyian, N.S., Kallich, J., McDermott, A., Fayers, P., & Erder, M.H. (2003). The relationship between psychologic distress and cancer-related fatigue. Cancer, 98, 198-203.
University of California, San Francisco, School of Nursing Symptom Management Faculty Group. (1994). A model for symptom management. Image: Journal of Nursing Scholarship, 26, 272-276.
Visser, M.R., & Smets, E.M. (1998). Fatigue, depression and quality of life in cancer patients: How are they related? Supportive Care in Cancer, 6, 101-108.
Vogelzang, N.J., Breitbart, W., Cella, D., Curt, G.A., Groopman, J.E., Horning, S.J., et al. (1997). Patient, caregiver, and oncologist perceptions of cancer-related fatigue: Results of a tripart assessment survey. Seminars in Hematology, 34(3, Suppl. 2), 4-12.
White, R.W. (1985). Strategies of adaptation: An attempt at systematic description. In A. Monat & R. Lazarus (Eds), Stress and coping, an anthology (2nd ed., pp. 121-143). New York: Colombia University Press.
Winningham, M.L., & Barton-Burke, M. (2000). Fatigue in cancer: A multidimensional approach. Sudbury, MA: Jones and Bartlett.
Winningham, M.L., Nail, L.M., Barton-Burke, M., Brophy, L., Cimprich, B., Jones, L., et al. (1994). Fatigue and the cancer experience: The state of the knowledge. Oncology Nursing Forum, 21, 23-36.
Woo, B., Dibble, S.L., Piper, B.F., Keating, S.B., & Weiss, M.C. (1998). Differences in fatigue by treatment methods in women with breast cancer. Oncology Nursing Forum, 25, 915-920.
Yellen, S.B., Cella, D.F., Webster, K., Blendowski, C., & Kaplan, E. (1997). Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. Journal of Pain and Symptom Management, 13, 63-74.
Zigmond, A.S., & Snaith, R.P. (1983). The hospital and anxiety and depression scale. Acta Psychiatrica Scandinavia, 67, 367-370.