Abstract
Asthenia is a very common symptom of patients with advanced cancer, but its investigation is hindered by a lack of suitable validated measuring instruments. The goal of the present study was to construct and validate a questionnaire for the study of asthenia in cancer patients, as well as to establish correlations with other symptoms and physiological and biochemical parameters. A group of 31 patients with advanced cancer and a control group of 30 healthy volunteers were examined. The proposed questionnaire, based on visual analogue scales, questions with categorical anwers and on the hospital anxiety and depression scale was validated by comparing results of the patient and control groups, by the test/retest method and by comparison with the evaluation of an observer. Correlation with various physiological and biochemical parameters was performed. The questionnaire distinguished well among the patients and control groups. VAS of asthenia proved quite stable over a period of 5 days. Correlations of asthenia with lack of appetite, the hospital anxienty and depression scale, weight, heart rate and serum cortisol levels could be established. No significant correlation between asthenia and various serum markers of inflammation and cytokines, including C-reactive protein, tumour necrosis factor, interleukin-1, and interleukin-2 receptors, could be found. The proposed questionnaire for evaluation of asthenia could be validated in a patient sample of limited size and a simplified questionnaire based on visual analogue scales is being developed for further investigations.
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References
Adams F, Quesada JR, Gutterman JU (1984) Neuropsychiatric manifestations of human leucocyte interferon therapy in patients with cancer. JAMA 252:938–941
Aylard PR, Gooding JH, McKenna PJ, Snaith RP (1987) A validation study of the anxiety and depression self-assessment scales. J Psychosom Res 31:261–268
Beutler B, Cerami A (1987) Cachectin: more than a tumor necrosis factor. N Engl J Med 316:379–385
Bruera E, MacDonald RN (1988) Asthenia in patients with advanced cancer. J Pain Symptom Manage 3:9–14
Bruera E, Brenneis C, Michaud M, et al (1989) Association between asthenia and nutritional status, lean body mass, anemia, psychological status and tumor mass in patients with advanced breast cancer. J Pain Symptom Manage 4:59–63
Foa R, Guarini A, Francia de Celle P, Trentin L, Gillio Tos A, et al (1992) Constitutive production of tumor necrosis factor-alpha in hairy cell leukemia: possible role in the pathogenesis of the cytopenias and effect of treatment with interferonalpha. J Clin Oncol 10:954–959
Herrmann C, Scholz KH, Kreuzer H (1991) Psychologisches Screening von Patienten einer kardiologischen Akutklinik mit einer deutschen Fassung der “Hospital Anxiety und Depression” (HAD) Skala. Psychother Psychosom Med Psychol 41:83–92
Holroyde CP, Axelrod RS, Skutches CL, et al (1979) Lactate metabolism in patients with metastatic colorectal cancer. Cancer Res 39:4900–4904
Lindemann A, Ludwig WD, Oster E, et al (1989) High-level secretion of tumor necrosis factor-alpha contributes to hematopoietic failure in hairy-cell leukemia. Blood 73:880–883
Moldawer LL, Drott C, Lundholm K (1988) Monocytic production and plasma bioactivity of interleukin-1 and tumour necrosis factor in human cancer. Eur J Clin Invest 18:486–492
Morant R (1991) Asthenia, a double-edged defense against tumors. J Palliative Care 7:22–24
Ochoa JB, Curti B, Peitzman AB, Simmons RL, Billiar TR, et al (1992) Increased circulating nitrogen oxides after human tumor immunotherapy: correlation with hemodynamic changes. J NCI 84:864–867
Rohatiner AZS, Prior PF, Burton AC, et al (1983) Central nervous systemic toxicity of interferon. Br J Cancer 47:418–422
Saunders C (1989) The management of terminal malignant disease, 2nd edn. Arnold, London Melbourne Auckland
Simonson E (1971) Physiology of work capacity and fatigue. Thomas, Springfield, III, pp 5–6
Stiefel F, Breitbart W, Kornblith A, Holland J (1990) Psychiatric distrurbances in cancer patients receiving high dose corticosteroids (poster abstract). 2nd International Symposium of Supportive Care in Cancer, St Gallen 1990
Stiefel F, Morant R, Senn HJ (1992) Asthenie bei Tumorkranken-eine Übersicht. Dtsch Med Wochenschr 117:107–111
Theologides A (1986) Anorexins, asthenins, and cachectins in cancer. Am J Med 81:696–698
Tracey KJ, Wei H, Manogue KR, et al (1988) Cachectin/tumor necrosis factor induces cachexia, anemia and inflammation. J Exp Med 167:1211–1227
Waterhouse C (1974) Lactate metabolism in patients with cancer. Cancer 33:66–71
WHO (1990) Cancer pain relief and palliative care. WHO Tech Rep Ser 804:41
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 7:61–370
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Morant, R., Stiefel, F., Berchtold, W. et al. Preliminary results of a study assessing asthenia and related psychological and biological phenomena in patients with advanced cancer. Support Care Cancer 1, 101–107 (1993). https://doi.org/10.1007/BF00366904
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DOI: https://doi.org/10.1007/BF00366904