Supportive Care in Cancer

, Volume 15, Issue 10, pp 1169–1176 | Cite as

Prospective evaluation of fatigue during a course of curative radiotherapy for localised prostate cancer

Original Article

Abstract

Purpose

To prospectively evaluate radiation-induced fatigue among patients undergoing curative radiotherapy at the Toronto Sunnybrook Regional Cancer Centre using two different instruments.

Materials and methods

Consecutive consenting English speaking men receiving curative radiotherapy for localised prostate cancer were enrolled in a prospective ethics board approved study. We used an 11 questions fatigue questionnaire (FQ) based on a modified FACT-AN questionnaire and the 2 questions of the fatigue pictogram (FP) to record patients’ responses weekly during treatment. The 11 FQ items were summed to calculate a fatigue scale (FS). The proportion and 95% confidence interval for each FQ and FP item and mean FS was calculated at baseline, week 3 and week 6. Chi-squared tests or analysis of variance f-tests were used to compare treatment groups and paired t-tests to compare baseline to week 6. A linear mixed model was used to compare the mean FS for treatment groups across time.

Results

From June 2000 to June 2003, we enrolled 130 patients. Fifty-one received conformal radiotherapy to the prostate (CRT), 46 received whole pelvis and prostate boost radiotherapy (WP+PB) and 33 received post prostatectomy radiotherapy to the prostate bed (PBRT). At baseline, 39% (30–47%) reported some fatigue for the FQ and 60% (52–68%) for the FP tiredness item. As treatment progressed, the mean fatigue increased significantly. The FP tiredness item best differentiated between treatment groups (p = 0.04 at week 6) compared to the FQ tiredness item or FS. Those receiving irradiation to smaller volumes (CRT or PBRT) reported lower FS scores than those treated to larger volumes (WP+PB) across time.

Conclusions

The pictogram was better than the questionnaire in differentiating between treatment groups. The pictogram could be used to screen and monitor patients with baseline fatigue for interventional studies in a busy clinic.

Keywords

Fatigue Prostate cancer Radiotherapy Pictogram FACT-AN 

References

  1. 1.
    Vogelzang NJ, Breitbart W, Cella D, Curt GA, Groopman JE, Horning SJ, Itri LM, Johnson DH, Scherr SL, Portenoy RK (1997) Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 34(3 Suppl 2):4–12PubMedGoogle Scholar
  2. 2.
    Akechi T, Kugaya A, Okamura H, Yamawaki S, Uchitomi Y (1999) Fatigue and its associated factors in ambulatory cancer patients: a preliminary study. J Pain Symptom Manage 17(1):42–48PubMedCrossRefGoogle Scholar
  3. 3.
    Cella D, Peterman A, Passik S, Jacobsen P, Breitbart W (1998) Progress toward guidelines for the management of fatigue. Oncology (Williston Park) 12(11A):369–377Google Scholar
  4. 4.
    Lilleby W, Fossa SD, Waehre HR, Olsen DR (1999) Long-term morbidity and quality of life in patients with localized prostate cancer undergoing definitive radiotherapy or radical prostatectomy. Int J Radiat Oncol Biol Phys 43(4):735–743PubMedCrossRefGoogle Scholar
  5. 5.
    Janda M, Gerstner N, Obermair A, Fuerst A, Wachter S, Dieckmann K, Potter R (2000) Quality of life changes during conformal radiation therapy for prostate carcinoma. Cancer 89(6):1322–1328PubMedCrossRefGoogle Scholar
  6. 6.
    Stone P, Richards M, A’Hern R, Hardy J (2001) Fatigue in patients with cancers of the breast or prostate undergoing radical radiotherapy. J Pain Symptom Manage 22(6):1007–1015PubMedCrossRefGoogle Scholar
  7. 7.
    Monga U, Kerrigan AJ, Thornby J, Monga TN (1999) Prospective study of fatigue in localized prostate cancer patients undergoing radiotherapy. Radiat Oncol Investig 7(3):178–185PubMedCrossRefGoogle Scholar
  8. 8.
    Monga U, Kerrigan AJ, Thornby J, Monga TN, Zimmermann KP (2005) Longitudinal study of quality of life in patients with localized prostate cancer undergoing radiotherapy. J Rehabil Res Dev 42(3):391–399PubMedCrossRefGoogle Scholar
  9. 9.
    Truong PT, Berthelet E, Lee JC, Petersen R, Lim JTW, Gaul CA, Pai H, Blood P, Ludgate CM (2006) Prospective evaluation of the prevalence and severity of fatigue in patients with prostate cancer undergoing radical external beam radiotherapy and neoadjuvant hormone therapy. Can J Urol 13(3):3139–3146PubMedGoogle Scholar
  10. 10.
  11. 11.
    Lukka H, Warde P, Pickles T, Morton G, Brundage M, Souhami L; Canadian GU Radiation Oncologist Group (2001) Controversies in prostate cancer radiotherapy: consensus development. Can J Urol 8(4):1314–1322PubMedGoogle Scholar
  12. 12.
    Lukka H (2002) Prostate cancer: risk categories and role of hormones and radiotherapy. Can J Urol 9(Suppl 1):26–29PubMedGoogle Scholar
  13. 13.
    Smets EM, Garssen B, Bonke B, De Haes JC (1995) The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39(3):315–325PubMedCrossRefGoogle Scholar
  14. 14.
    Glaus A (1998) Fatigue in patients with cancer. Analysis and assessment. Recent Results Cancer Res 145(I–XI):1–172Google Scholar
  15. 15.
    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. Semin Hematol 34(3 Suppl):13–19PubMedGoogle Scholar
  16. 16.
    Schwartz AL (1998) The Schwartz Cancer Fatigue Scale: testing reliability and validity. Oncol Nurs Forum 5(4):711–717Google Scholar
  17. 17.
    Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM (1998) The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum 25(4):677–684PubMedGoogle Scholar
  18. 18.
    Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, Wallace EP (1993) Development of fatigue scale. J Psychosom Res 37(2):147–153PubMedCrossRefGoogle Scholar
  19. 19.
    Glaus A (1993) Assessment of fatigue in cancer and non-cancer patients and in healthy individuals. Support Care Cancer 1(6):285–286CrossRefGoogle Scholar
  20. 20.
    Fitch MI, Bunston T, Mings D, Sevean P, Bakker D (2003) Evaluating a new clinical assessment tool: the fatigue pictogram. Support Care Cancer 11(6):403Google Scholar
  21. 21.
    Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 13(2):63–74PubMedCrossRefGoogle Scholar
  22. 22.
    Hickok JT, Roscoe JA, Morrow GR, Mustian K, Okunieff P, Bole CW (2005) Frequency, severity, clinical course, and correlates of fatigue in 372 patients during 5 weeks of radiotherapy for cancer. Cancer 104(8):1772–1778PubMedCrossRefGoogle Scholar
  23. 23.
    Irvine D, Vincent L, Graydon JE, 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 Nurs 17(5):367–378PubMedCrossRefGoogle Scholar
  24. 24.
    Monga U, Kerrigan AJ, Thornby J, Monga TN (1999) Prospective study of fatigue in localized prostate cancer patients undergoing radiotherapy. Radiat Oncol Investig 7(3):178–185PubMedCrossRefGoogle Scholar
  25. 25.
    Greenberg DB, Sawicka J, Eisenthal S, Ross D (1992) Fatigue syndrome due to localized radiation. J Pain Symptom Manage 7(1):38–45PubMedCrossRefGoogle Scholar
  26. 26.
    King KB, Nail LM, Kreamer K, Strohl RA, Johnson JE (1985) Patients’ descriptions of the experience of receiving radiation therapy. Oncol Nurs Forum 12(4):55–61PubMedGoogle Scholar
  27. 27.
    Rodrigues G, Bezjak A, Osoba D, Catton P, Tsuji D, Taylor D, Warde P (2004) The relationship of changes in EORTC QLQ-C30 scores to ratings on the Subjective Significance Questionnaire in men with localized prostate cancer. Qual Life Res 13(7):1235–1246PubMedCrossRefGoogle Scholar
  28. 28.
    Fitch MI, Bunston T, Mings D (2001) The fatigue pictogram: a new clinical assessment tool. 6th Oncology Nursing Research Conference, Florida, FebruaryGoogle Scholar
  29. 29.
    Fitch MI Bunston T, Sevean P, Bakker D (2003) Evaluating a new clinical assessment tool: the fatigue pictogram. 15th International Conference of the Multinational Association of Supportive Care in Cancer, Berlin, JuneGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Radiation OncologistToronto Sunnybrook Regional Cancer CentreTorontoCanada
  2. 2.Clinical Trials and EpidemiologyToronto Sunnybrook Regional Cancer CentreTorontoCanada
  3. 3.Nursing DepartmentToronto Sunnybrook Regional Cancer CentreTorontoCanada

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