Fatigue and Physical Activity in Patients Undergoing Hematopoietic Stem Cell Transplant

Eileen D. Hacker

Carol E. Ferrans

Ellen Verlen

Farhad Ravandi

Koen van Besien

Julie Gelms

Natalie Dieterle

ONF 2007, 33(3), 614-624. DOI: 10.1188/06.ONF.614-624

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.

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    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.
    Aaronson, N.K., Cull, A.N., Kaasa, S., & Sprangers, M.A. (1996). The European Organization for Research and Treatment of Cancer (EORTC) modular approach to quality of life assessment in oncology: An update. In B. Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (2nd ed., pp. 179-189). Philadelphia: Lipponcott-Raven.
    Aistars, J. (1987). Fatigue in the cancer patient: A conceptual approach to a clinical problem. Oncology Nursing Forum, 14(6), 25-30.
    Anderson, J.S., & Ferrans, C.E. (1997). The quality of life of persons with chronic fatigue syndrome. Journal of Nervous and Mental Disease, 185, 359-367.
    Barbui, T., Finazzi, G., Grassi, A., & Marchioli, R. (1996). Thrombosis in cancer patients treated with hematopoietic growth factors—A meta-analysis. On behalf of the Subcommittee on Haemostasis and Malignancy of the Scientific and Standardization Committee of the ISTH. Thrombosis and Haemostasis, 75, 368-371.
    Beck-Sague, C., Banerjee, S., & Jarvis, W.R. (1993). Infectious diseases and mortality among US nursing home residents. American Journal of Public Health, 83, 1739-1742.
    Belec, R.H. (1992). Quality of life: Perceptions of long-term survivors of bone marrow transplantation. Oncology Nursing Forum, 19, 31-37.
    Bellm, L.A., Epstein, J.B., Rose-Ped, A., Martin, P., & Fuchs, H.J. (2000). Patient reports of complications of bone marrow transplantation. Supportive Care in Cancer, 8, 33-39.
    Berger, A.M. (1998). Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncology Nursing Forum, 25, 51-62.
    Berger, A.M., Berry, D.L., Christopher, K.A., Greene, A.L., Maliski, S., Swenson, K.K., et al. (2005). Oncology Nursing Scoiety year 2004 research priorities survey. Oncology Nursing Forum, 32, 281-290.
    Berger, A.M., & Higginbotham, P. (2000). Correlates of fatigue during and following adjuvant breast cancer chemotherapy: A pilot study. Oncology Nursing Forum, 27, 1443-1448.
    Bjordal, K., & Kaasa, S. (1992). Psychometric validation of the EORTC Core Quality of Life Questionnaire, 30-item version and a diagnosis-specific module for head and neck cancer patients. Acta Oncologica, 31, 311-321.
    Bliley, A.V., & Ferrans, C.E. (1993). Quality of life after coronary angioplasty. Heart and Lung, 22, 193-199.
    Cowan, M., Young-Graham, K., & Cochrane, B. (1992). Comparison of a theory of quality of life between myocardial infarction and malignant melanoma: A pilot study. Progress in Cardiovascular Nursing, 7, 18-28.
    El-Banna, M.M., Berger, A.M., Farr, L., Foxall, M.J., Friesth, B., & Schreiner, E. (2004). Fatigue and depression in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation. Oncology Nursing Forum, 31, 937-944.
    Ferrando, A.A., Stuart, C.A., Brunder, D.G., & Hillman, G.R. (1995). Magnetic resonance imaging quantitation of changes in muscle volume during 7 days of strict bed rest. Aviation, Space, and Environmental Medicine, 66, 976-981.
    Ferrans, C.E. (1990). Development of a quality of life index for patients with cancer. Oncology Nursing Forum, 17(3, Suppl.), 15-19.
    Ferrans, C.E., & Powers, M.J. (1985). Quality of Life Index: Development and psychometric properties. Advances in Nursing Science, 8, 15-24.
    Ferrans, C.E., & Powers, M.J. (1992). Psychometric assessment of the Quality of Life Index. Research in Nursing and Health, 15, 29-38.
    Glaus, A. (1993). Assessment of fatigue in cancer and non-cancer patients and in healthy individuals. Supportive Care in Cancer, 1, 305-315.
    Grap, M.J., Borchers, C.T., Munro, C.L., Elswick, R.K., Jr., & Sessler, C.N. (2005). Actigraphy in the critically ill: Correlation with activity, agitation, and sedation. American Journal of Critical Care, 14, 52-60.
    Gruber, U., Fegg, M., Buchmann, M., Kolb, H.J., & Hiddemann, W. (2003). The long-term psychosocial effects of haematopoetic stem cell transplantation. European Journal of Cancer Care, 12, 249-256.
    Hacker, E.D. (2003). Quantitative measurement of quality of life in adult patients undergoing bone marrow transplant or peripheral blood stem cell transplant: A decade in review. Oncology Nursing Forum, 30, 613-629.
    Hacker, E.D., & Ferrans, C.E. (2003). Quality of life immediately after peripheral blood stem cell transplantation. Cancer Nursing, 26, 312-322.
    Hann, D.M., Garovoy, N., Finkelstein, B., Jacobsen, P.B., Azzarello, L.M., & Fields, K.K. (1999). Fatigue and quality of life in breast cancer patients undergoing autologous stem cell transplantation: A longitudinal comparative study. Journal of Pain and Symptom Management, 17, 311-319.
    Hathaway, D., Hartwig, M., Milstead, J., Elmer, D., Evans, S., & Graber, A. (1994). A prospective study of changes in quality of life reported by diabetic recipients of kidney-only and pancreas-kidney allografts. Journal of Transplant Coordination, 4, 12-17.
    Holley, S. (2000). Cancer-related fatigue. Suffering a different fatigue. Cancer Practice, 8, 87-95.
    Hughes, K.K. (1993). Psychosocial and functional status of breast cancer patients: The influence of diagnosis and treatment choice. Cancer Nursing, 16, 222-229.
    Illman, A., Stiller, K., & Williams, M. (2000). The prevalence of orthostatic hypotension during physiotherapy treatment in patients with an acute spinal cord injury. Spinal Cord, 38, 741-747.
    Irvine, D., Vincent, L., Graydon, J.E., Bubela, N., & Thompson, L. (1994). The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy: A comparison with the fatigue experienced by healthy individuals. Cancer Nursing, 17, 367-378.
    Ishizaki, Y., Fukuoka, H., Ishizaki, T., Katsura, T., Nishimura, Y., Haruna, M., et al. (1997). Psychological stress induced by 20 days bed rest. Journal of Gravitational Physiology, 4(1), S95-S98.
    Jacobsen, P.B., & Stein, K. (1999). Is fatigue a long-term side effect of breast cancer treatment? Cancer Control, 6, 256-263.
    Johnson, C.D., Wicks, M.N., Milstead, J., Hartwig, M., & Hathaway, D.K. (1998). Racial and gender differences in quality of life following kidney transplantation. Image—Journal of Nursing Scholarship, 30, 125-130.
    Katsume, H., Furukawa, K., Azuma, A., Nakamura, T., Matsubara, K., Ohnishi, K., et al. (1992). Disuse atrophy of the left ventricle in chronically bedridden elderly people. Japanese Circulation Journal, 56, 201-206.
    Kim, S., & Rew, L. (1994). Ethnic identity, role integration, quality of life, and depression in Korean-American women. Archives of Psychiatric Nursing, 8, 348-356.
    King, M.T. (1996). The interpretation of scores from the EORTC Quality of Life Questionnaire QLQ-C30. Quality of Life Research, 5, 555-567.
    King, R.B. (1996). Quality of life after stroke. Stroke, 27, 1467-1472.
    Knobel, H., Loge, J.H., Brenne, E., Fayers, P., Hjermstad, M.J., & Kaasa, S. (2003). The validity of EORTC QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors. Palliative Medicine, 17, 664-672.
    Knobel, H., Loge, J.H., Nordoy, T., Kolstad, A.L., Espevik, T., Kvaloy, S., et al. (2000). High level of fatigue in lymphoma patients treated with high dose therapy. Journal of Pain and Symptom Management, 19, 446-456.
    Lovely, M.P., Miaskowski, C., & Dodd, M. (1999). Relationship between fatigue and quality of life in patients with glioblastoma multiformae. Oncology Nursing Forum, 26, 921-925.
    Macquart-Moulin, G., Viens, P., Palangie, T., Bouscary, M.L., Delozier, T., Roche, H., et al. (2000). High-dose sequential chemotherapy with recombinant granulocyte colony-stimulating factor and repeated stem-cell support for inflammatory breast cancer patients: Does impact on quality of life jeopardize feasibility and acceptability of treatment? Journal of Clinical Oncology, 18, 754-764.
    Maron, B.J., Pelliccia, A., Spataro, A., & Granata, M. (1993). Reduction in left ventricular wall thickness after deconditioning in highly trained Olympic athletes. British Heart Journal, 69, 125-128.
    Miaskowski, C., & Lee, K.A. (1999). Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: A pilot study. Journal of Pain and Symptom Management, 17, 320-332.
    Mock, V. (2001). Fatigue management: Evidence and guidelines for practice. Cancer, 92(6, Suppl.), 1699-1707.
    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., & Morris, P.J. (1999). Quality of life in patients with chronic myeloid leukemia after unrelated donor bone marrow transplantation. Cancer Nursing, 22, 340-349.
    National Comprehensive Cancer Network. (2005). The NCCN cancer-related fatigue guidelines (version 2.2005). In The complete library of NCCN clinical practice guidelines in oncology [CD-ROM]. Jenkintown, PA: Author.
    Nishimura, Y., Fukuoka, H., Kiriyama, M., Suzuki, Y., Oyama, K., Ikawa, S., et al. (1994). Bone turnover and calcium metabolism during 20 days bed rest in young healthy males and females. Acta Physiologica Scandinavica, Supplementum, 616, 27-35.
    Osoba, D., Aaronson, N., Zee, B., Sprangers, M., & te Velde, A. (1997). Modification of the EORTC QLQ-C30 (version 2.0) based on content validity and reliability testing in large samples of patients with cancer. The Study Group on Quality of Life of the EORTC and the Symptom Control and Quality of Life Committees of the NCI of Canada Clinical Trials Group. Quality of Life Research, 6, 103-108.
    Osoba, D., Rodrigues, G., Myles, J., Zee, B., & Pater, J. (1998). Interpreting the significance of changes in health-related quality-of-life scores. Journal of Clinical Oncology, 16, 139-144.
    Osoba, D., Zee, B., Pater, J., Warr, D., Kaizer, L., & Latreille, J. (1994). Psychometric properties and responsiveness of the EORTC Quality of Life Questionnaire (QLQ-C30) in patients with breast, ovarian and lung cancer. Quality of Life Research, 3, 353-364.
    Papadantonaki, A., Stotts, N.A., & Paul, S.M. (1994). Comparison of quality of life before and after coronary artery bypass surgery and percutaneous transluminal angioplasty. Heart and Lung, 23, 45-52.
    Portenoy, R.K., & Itri, L.M. (1999). Cancer-related fatigue: Guidelines for evaluation and management. Oncologist, 4, 1-10.
    Prou, E., & Marini, J.F. (1997). Muscle research in space—Increased muscle susceptibility to exercise-induced damage after a prolonged bedrest. International Journal of Sports Medicine, 18(Suppl. 4), S317-S320.
    Sarna, L., & Conde, F. (2001). Physical activity and fatigue during radiation therapy: A pilot study using actigraph monitors. Oncology Nursing Forum, 28, 1043-1046.
    Stone, A.A., Shiffman, S., Schwartz, J.E., Broderick, J.E., & Hufford, M.R. (2002). Patient non-compliance with paper diaries. BMJ, 324, 1193-1194.
    Stuifbergen, A.K. (1995). Health-promoting behaviors and quality of life among individuals with multiple sclerosis. Scholarly Inquiry for Nursing Practice, 9, 31-50.
    Suzuki, Y., Murakami, T., Haruna, Y., Kawakubo, K., Goto, S., Makita, Y., et al. (1994). Effects of 10 and 20 days bed rest on leg muscle mass and strength in young subjects. Acta Physiologica Scandinavica, Supplementum, 616, 5-18.
    Wilson, I.B., & Cleary, P.D. (1995). Linking clinical variables with healthrelated quality of life. A conceptual model of patient outcomes. JAMA, 273, 59-65.
    Winer, E.P., Lindley, C., Hardees, M., Sawyer, W.T., Brunatti, C., Borstelmann, N.A., et al. (1999). Quality of life in patients surviving at least 12 months following high dose chemotherapy with autologous bone marrow support. Psycho-Oncology, 8, 167-176.
    Winningham, M.L., Nail, L.M., Burke, M.B., Brophy, L., Cimprich, B., Jones, L.S., et al. (1994). Fatigue and the cancer experience: The state of the knowledge. Oncology Nursing Forum, 21, 23-36.
    Zittoun, R., Achard, S., & Ruszniewski, M. (1999). Assessment of quality of life during intensive chemotherapy or bone marrow transplantation. Psycho-Oncology, 8, 64-73.