The Relationship of Sick Leave Benefits, Employment Patterns, and Individual Characteristics to Radiation Therapy-Related Fatigue

Patricia Poirier

ONF 2007, 33(3), 593-601. DOI: 10.1188/06.ONF.593-601

Purpose/Objectives: To examine the relationship among sick leave benefits, employment patterns, individual characteristics, and fatigue in patients receiving radiation therapy.

Design: Prospective, longitudinal design.

Setting: A community hospital radiation oncology department.

Sample: 77 patients receiving radiation therapy to the breast, chest, head and neck, pelvis, or prostate. All were employed at the time of diagnosis.

Methods: The Piper Integrated Fatigue Model guided the study. The Revised Piper Fatigue Scale (PFS), Brief Fatigue Inventory, and a single-item scale were used to measure five dimensions of subjective fatigue. Sick leave, employment, individual characteristics, and fatigue were measured at baseline, weekly during treatment, and at one month post-treatment.

Main Research Variables: Employment patterns, availability of sick leave benefits, and fatigue.

Findings: Mean total fatigue scores on the PFS ranged from 0-4.77 at baseline (¯X = 0.46, SD = 0.93), 0-8.77 at the completion of treatment (¯X = 2.84, SD = 2.40), and 0-4.82 at one month post-treatment (¯X= 0.77, SD = 1.20). Side effects, education, living situation, age, treatment site, and work were associated with fatigue along the trajectory of radiation therapy. Study participants who were working at the end of radiation had lower fatigue scores than those who were not. Availability of sick leave benefits was associated with employment patterns during treatment.

Conclusions: Work may have benefits during radiation therapy but may be affected by radiation therapy-related fatigue.

Implications for Nursing: Management of treatment side effects, including fatigue, may help patients remain in the workforce during radiation.

Jump to a section

    References

    Akechi, T., Kugaya, A., Okamura, H., Yamawaki, S., & Uchitomi, Y. (1999). Fatigue and its associated factors in ambulatory cancer patients: A preliminary study. Journal of Pain and Symptom Management, 17, 42-48.
    American Cancer Society. (2006). Cancer facts and figures 2006. Retrieved April 3, 2006, from http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf
    Anderson, K.O., Getto, C.J., Mendoza, T.R., Palmer, S.N., Wang, X.S., Reyes-Gibby, C.C., et al. (2003). Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults. Journal of Pain and Symptom Management, 25, 307-318.
    Bansal, M., Mohanti, B.K., Shah, N., Chaudhry, R., Bahadur, S., & Shukla, N.K. (2004). Radiation related morbidities and their impact on quality of life in head and neck cancer patients receiving radical radiotherapy. Quality of Life Research, 13, 481-488.
    Barsevick, A.M., Whitmer, K., Sweeney, C., & Nail, L.M. (2002). A pilot study examining energy conservation for cancer treatment-related fatigue. Cancer Nursing, 25, 333-341.
    Berger, A., & Walker, S.N. (2001). An explanatory model of fatigue in women receiving adjuvant breast cancer chemotherapy. Nursing Research, 50, 42-52.
    Berger, A.M., Berry, D.L., Christopher, K.A., Greene, A.L., Maliski, S., Swenson, K.K., et al. (2005). Oncology Nursing Society year 2004 research priorities survey. Oncology Nursing Forum, 32, 281-290.
    Berger, A.M., Von Essen, S., Kuhn, B.R., Piper, B.F., Agrawal, S., Lynch, J.C., et al. (2003). Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: Results of a feasibility intervention study. Oncology Nursing Forum, 30, 513-522.
    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.
    Burnie, C. (2000). Breast cancer: A study of the psychosocial issues faced by women undergoing radiation therapy. Canadian Journal of Medical Radiation Technology, 31, 119-128.
    Burns, N., & Grove, S.K. (2001). The practice of nursing research: Conduct, critique and utilization (4th ed.). Philadelphia: Saunders.
    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.
    Center for Survey Research. (2002). Boston area survey. Boston: Author.
    Chan, C.W., Molassiotis, A., Yam, B.M., Chan, S.J., & Lam, C.S. (2001). Traveling through the cancer trajectory: Social support perceived by women with gynecological cancer in Hong Kong. Cancer Nursing, 5, 387-394.
    Cimprich, B. (1998). Age and extent of surgery affect attention in women treated for breast cancer. Research in Nursing and Health, 21, 229-238.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
    Curt, G., & Johnston, P.G. (2003). Cancer fatigue: The way forward. Oncologist, 8(Suppl. 1), 27-30.
    Curt, G.A., Breitbart, W., Cella, D., Groopman, J.E., Horning, S.J., Itri, L.M., et al. (2000). Impact of cancer-related fatigue on the lives of patients: New findings from the Fatigue Coalition. Oncologist, 5, 353-360.
    Der, G., & Everitt, B. (2002). A handbook of statistical analyses using SAS (2nd ed.). Boca Raton, FL: Chapman and Hall.
    Dillon, E., & Kelly, J. (2003). The status of cancer fatigue on the island of Ireland: AIFC professional and interim patient surveys. Oncologist, 8(Suppl. 1), 22-26.
    Donovan, K.A., Jacobsen, P.B., Andrykowski, M.A., Winters, E.M., Balducci, L., Malik, U., et al. (2004). Course of fatigue in women receiving chemotherapy and/or radiotherapy for early stage breast cancer. Journal of Pain and Symptom Management, 28, 373-380.
    Geinitz, H., Zimmermann, F.B., Stoll, P., Thamm, R., Kaffenberger, W., Ansorg, K., et al. (2001). Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer. International Journal of Radiation Oncology, Biology, Physics, 51, 691-698.
    Gift, A.G., Stommel, M., Jablonski, A., & Given, W. (2003). A cluster of symptoms over time in patients with lung cancer. Nursing Research, 52, 393-400.
    Greenberg, D., Sawicka, J., Eisenthal, S., & Ross, D. (1992). Fatigue syndrome due to localized radiation. Journal of Pain and Symptom Management, 7, 38-45.
    Hamilton, J., Butler, L., Wagenaar, H., Sveinson, T., Ward, K.A., McLean, L., et al. (2001). The impact and management of cancer-related fatigue on patients and families. Canadian Oncology Nursing Journal, 11, 192-198.
    Haylock, P.J., & Hart, L.K. (1979). Fatigue in patients receiving localized radiation. Cancer Nursing, 2, 461-467.
    Hilderly, L. (1997). Principles of teletherapy. In K.H. Dow, J.D. Bucholtz, R. Iwamoto, V. Fieler, & L. Hilderly (Eds.), Nursing care in radiation oncology (2nd ed., pp. 6-20). Philadelphia: Saunders.
    Hwang, S.S., Chang, V.T., Rue, M., & Kasimis, B. (2003). Multidimensional independent predictors of cancer-related fatigue. Journal of Pain and Symptom Management, 26, 604-614.
    Irvine, D., Vincent, L., Graydon, J., & Bubela, N. (1998). Fatigue in women with breast cancer receiving radiation therapy. Cancer Nursing, 21, 127-135.
    King, K.B., Nail, L.M., Kreamer, K., Strohl, R.A., & Johnson, J.E. (1985). Patients' descriptions of the experience of receiving radiation therapy. Oncology Nursing Forum, 12, 55-61.
    Magnan, M.A., & Mood, D.W. (2003). The effects of health state, hemoglobin, global symptom distress, mood disturbance, and treatment site on fatigue onset, duration, and distress in patients receiving radiation therapy. [Online exclusive]. Oncology Nursing Forum, 30, E33-E39. Retrieved March 29, 2006, from http://www.ons.org/publications/journals/ONF/Volume30/Issue2/pdf/222.pdf
    Mock, V., Pickett, M., Ropka, M.E., Muscari, E.L., Stewart, K.J., Rhodes, V.A., et al. (2001). Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Practice, 9, 119-127.
    Moore-Higgs, G.J., Watkins-Bruner, D., Balmer, L., Johnson-Doneski, J., Komarny, P., Mautner, B., et al. (2003). The role of licensed nursing personnel in radiation oncology part A: Results of a descriptive study. Oncology Nursing Forum, 30, 51-58.
    Munro, A.J., & Potter, S. (1996). A quantitative approach to the distress caused by symptoms in patients treated with radical radiotherapy. British Journal of Cancer, 74, 640-647.
    National Cancer Institute. (2003). Common terminology criteria for adverse events v3.0. Retrieved March 29, 2006, from http://ctep.cancer.gov/forms/CTCAEv3.pdf
    National Comprehensive Cancer Network. (2003). Cancer-related fatigue. Retrieved September 28, 2003, from http://www.ncn.org/professionals/physician_gls/PDF/fatigue.pdf
    National Institutes of Health State-of-the-Science Panel. (2003). National Institutes of Health state-of-the-science conference statement: Symptom management in cancer: Pain, depression, and fatigue, July 15-27, 2002. Journal of the National Cancer Institute, 95, 1110-1117.
    Oberst, M.T., Hughes, S.H., Chang, A.S., & McCubbin, M.A. (1991). Self-care burden, stress appraisal, and mood among persons receiving radiotherapy. Cancer Nursing, 14, 71-78.
    Oncology Nursing Society. (2005). Measuring oncology nursing-sensitive patient outcomes: Evidence-based summary: Fatigue. Retrieved February 17, 2005, from http://onsopcontent.ons.org/toolkits/evidence/Clinical/pdf/FatigueSummary.pdf
    Passik, S.D., Kirsh, L.L., Donaghy, K., Holtsclaw, E., Theobald, D., Cella, D., et al. (2002). Patient-related barriers to fatigue communication: Initial validation of the fatigue management barriers questionnaire. Journal of Pain and Symptom Management, 24, 481-493.
    Piper, B.F., Dibble, S.L., Dodd, M.J., Weiss, M.C., Slaughter, R.E., & Paul, S.M. (1998). The revised Piper Fatigue Scale: Psychometric evaluation in women with breast cancer. Oncology Nursing Forum, 25, 677-684.
    Piper, B.F., Lindsey, A.M., & Dodd, M.J. (1987). Fatigue mechanisms in cancer patients: Developing nursing theory. Oncology Nursing Forum, 14(6), 17-23.
    Schwartz, A.H. (2002). Validity of cancer-related fatigue instruments. Pharmacotherapy, 22, 1433-1441.
    Schwartz, A.L. (1998). Patterns of exercise and fatigue in physically active cancer survivors. Oncology Nursing Forum, 25, 485-491.
    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 Investigations, 18, 11-19.
    Shi, L. (1997). Health services research methods. Albany, NY: Delmar.
    Sitton, E. (1997). Managing side effects of skin changes and fatigue. In K.H. Dow, J.D. Bucholtz, R. Iwamoto, V. Fieler, & L. Hilderly (Eds.), Nursing care in radiation oncology (2nd ed., pp. 79-100). Philadelphia: W.B. Saunders.
    Social Security Administration. (2005). Temporary disability insurance. In Social security programs in the United States (pp. 44-50). Retrieved April 3, 2006, from http://www.ssa.gov/policy/docs/progdesc/sspus/tempdib.pdf
    Stone, P., Hardy, J., Huddart, R., A'Hern, R., & Richards, M. (2000). Fatigue in patients with prostate cancer receiving hormone therapy. European Journal of Cancer, 36, 1134-1141.
    Stone, P., Ream, E., Richardson, A., Thomas, H., Andrews, P., Campbell, P., et al. (2003). Cancer-related fatigue—A difference of opinion? Results of a multicentre survey of healthcare professionals, patients, and caregivers. European Journal of Cancer Care, 12, 20-27.
    Stricker, C.T., Drake, D., Hoyer, K., & Mock, V. (2004). Evidence-based practice for fatigue management in adults with cancer: Exercise as an intervention. Oncology Nursing Forum, 31, 963-976.
    Wang, X.S., Janjan, N.A., Guo, H., Johnson, B.A., Engstrom, M.C., Crane, C.H., et al. (2001). Fatigue during preoperative chemoradiation for resectable rectal cancer. Cancer, 92(6, Suppl.), 1725-1732.
    Wengstrom, Y., Haggmark, C., & Forsberg, C. (2001). Coping with radiation therapy: Strategies used by women with breast cancer. Cancer Nursing, 24, 264-271.
    Williams, P.D., Ducey, K.A., Sears, A.M., Williams, A.R., Tobin-Rumelhart, S.E., & Bunde, P. (2001). Treatment type and symptom severity among oncology patients by self-report. International Journal of Nursing Studies, 38, 359-367.
    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.
    Wu, H., & McSweeney, M. (2001). Measurement of fatigue in people with cancer. Oncology Nursing Forum, 28, 1371-1384.