The determinants of long-term blood pressure stability: control of trough blood pressure during sleep

Little is known regarding the prevalence and course of fatigue in cancer patients after treatment has ended and no recurrence found. The present study examines fatigue in disease-free cancer patients after being treated with radiotherapy (n = 154). The following questions are addressed. First, how do patients describe their fatigue 9 months after radiotherapy and is this different from fatigue in a nonselective sample from the general population (n = 139)? Secondly, to what degree is fatigue in patients associated with sociodemographic, medical, physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue 9 months after radiotherapy? Results indicated that fatigue in disease-free cancer patients did not differ significantly from fatigue in the general population. However, for 34% of the patients, fatigue following treatment was worse than anticipated, 39% listed fatigue as one of the three symptoms causing them most distress, 26% of patients worried about their fatigue and patients' overall quality of life was negatively related to fatigue (r = -0.46). Fatigue in disease-free patients was significantly associated with: gender, physical distress, pain rating, sleep quality, functional disability, psychological distress and depression, but not with medical (diagnosis, prognosis, co-morbidity) or treatment-related (target area, total radiation dose, fractionation) variables. The degree of fatigue, functional disability and pain before radiotherapy were the best predictors of fatigue at 9-month follow-up, explaining 30%, 3% and 4% of the variance respectively. These findings are in line with the associations found with fatigue during treatment as reported in the preceding paper in this issue. The significant associations between fatigue and both psychological and physical variables demonstrate the complex aetiology of this symptom in patients and point out the necessity of a multidisciplinary approach for its treatment.     

Fatigue following traumatic brain injury: Frequency, characteristics, and associated factors.

Objectives: To document the frequency, characteristics, and factors associated with fatigue following traumatic brain injury (TBI). Design: Survey methodology and multivariate statistical design. Setting: Rehabilitation center and community. Participants: 452 participants aged 16 years and over with minor to severe TBI who answered a questionnaire measuring diverse aspects of fatigue as well as different dimensions of psychological distress, pain, and sleep quality. Measures: Proportion of participants reporting being significantly fatigued. Validated measures of fatigue, sleep quality, and psychological distress. Results of a logistic regression analysis. Results: Significant fatigue was reported by 68.5% of participants. Mental fatigue was the most prominent type of fatigue, followed by physical fatigue. Fatigue was present even several years following the accident and had many perceived impacts on day-to-day function. Factors associated with fatigue were a shorter time since injury; being on long-term disability leave; and higher levels of sleep problems, cognitive disturbances, and anxiety. Conclusion: Fatigue is a prevalent problem after TBI that requires more clinical and scientific attention because it probably has important repercussions on the quality of rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fatigue in cancer and HIV/AIDS

Fatigue is a common and troubling symptom in patients with cancer or HIV/AIDS, resulting in significant disability and adverse effects on quality of life. Its etiology remains complex and is most likely multifactorial. Despite its impact and prevalence, fatigue is often overlooked and undertreated in these patient populations. The general perceptions of fatigue are that its etiology cannot be determined, it is an inevitable manifestation that must be endured, and few interventions are available. Efforts are ongoing to better understand the etiology, characteristics, and consequences of fatigue in patients with cancer or HIV/AIDS. New practical methods of assessing it in cancer patients are now available. In order to improve the quality of life in these patients, physicians need to reassess their perceptions of fatigue and their approach to its diagnosis and management. There are recognizable causes and correlates for which interventions can be beneficial. These include anemia, pain, infection/fever, hormonal or nutritional deficiencies, depression/anxiety, sleep disturbances, and excessive inactivity or rest. Physicians should fully evaluate patients to identify the factors amenable to management. Fatigue is also seldom discussed by patients and their physicians. Improved communication with and counseling of patients and their caregivers can play an important role in the effective assessment and management of fatigue in patients with cancer or HIV/AIDS. Many patients may benefit from wider implementation of recent advances in the understanding and treatment of fatigue in these oncologic and infectious conditions.     

Pebbling of the skin: a marker of Hunter''s syndrome

Cancer patients typically experience fatigue while undergoing treatment for their disease. This study was an effort to identify a reliable and economical measure of fatigue. In particular, scores on the five subscales of the Multidimensional Fatigue Inventory (MFI-20) were analyzed for internal consistency and then correlated with scores on the Rhoten Fatigue Inventory to establish a measure of validity. Moderate-to-high Cronbach alphas coefficients were established for the General Fatigue subscale of the MFI-20 using a sample of 97 rural oncology outpatients (1). Partial associations with the Rhoten Fatigue Scale lend evidence to the validity of the MFI-20 measures.     

Psychologic and neuropsychologic functioning of patients with limited small-cell lung cancer treated with chemotherapy and radiation therapy with or without warfarin: a study by the Cancer and Leukemia Group B

PURPOSE: The current study assessed the psychologic and neuropsychologic functioning of patients with small-cell lung cancer who were randomized in a large clinical trial to receive intensive doxorubicin, cyclophosphamide, etoposide (ACE)/cisplatin, cyclophosphamide, etoposide (PCE) chemotherapy and radiation therapy (RT) to the primary tumor and prophylactic whole-brain irradiation with (regimen I) or without (regimen II) warfarin. PATIENTS AND METHODS: Patients' emotional states and cognitive functioning were assessed using the Profile of Mood States (POMS) and Trail Making B Test (Trails B), respectively. Two hundred ninety-five patients completed the POMS and Trails B at pretreatment, 224 patients after the completion of the ACE course of chemotherapy (week 9), and 177 patients after the completion of the PCE chemotherapy and RT (week 17). RESULTS: No differences on the POMS or Trails B measures were found between the two treatment arms as predicted, given that the only difference between the two treatment arms was the presence or absence of warfarin. Analysis of the POMS revealed that, overall, mean scores remained stable over the course of treatment; however, women showed a trend toward higher mean scores, which indicated a higher level of distress, compared with men at the pretreatment assessment. Examination of cognitive functioning, measured by the Trails B, revealed improved performance from baseline to post-ACE chemotherapy, which is consistent with a practice effect, but a significant worsening of Trails B scores post-RT compared with the pre-RT assessments, which is consistent with impaired cognitive functioning because of treatment (P < .0001). CONCLUSION: Emotional state, measured by the POMS, did not differ between the groups or change significantly over time in this study of small-cell lung cancer patients treated with a combination of chemotherapy and RT plus or minus warfarin. However, the pattern of relatively stable POMS scores and poorer Trails B performance post-RT suggested that this combination of chemotherapy and RT had a negative impact on cognitive functioning.     

A quantitative approach to the distress caused by symptoms in patients treated with radical radiotherapy

A computerised self-assessment instrument was used to capture data on the distress caused by symptoms in 110 patients treated with radical radiotherapy. Patients selected symptoms from a list of 34 problems and then quantified the distress associated with each problem using a linear Analogue self assessment (LASA)-type scale. The test instrument was feasible: 90% of assessments were completed in under 14 min. There was a significant increase in tiredness and significant decrease in anxiety and worries about the family, during treatment. Menopausal symptoms and post-surgical problems were important causes of distress in the patients with breast cancer. When the area under the curve method was used to quantify distress in the patients with breast cancer, difficulty concentrating, pain and sleep disturbances emerged as significantly troublesome problems. Computerised self-assessment may have a useful role in quantifying the distress caused by treatment with radiotherapy.     

Parental involvement, psychological distress, and sleep: A preliminary examination in sleep-disturbed adolescents with a history of substance abuse.

The relationships between family environment and psychological distress and between psychological distress and sleep disturbance in adolescents are well established. However, less is known about the influence of family environment on sleep disturbance. The authors' goal is to examine the effects of parental involvement on psychological distress and sleep disturbance in 34 adolescents with a history of substance abuse. Linear regression techniques and confidence intervals were used to test the significance of mediation analyses. Lower levels of parental involvement were associated with higher levels of psychological distress, and higher levels of psychological distress were associated with lower sleep efficiency and more time spent in bed. Follow-up analyses found that higher levels of parental involvement were associated with earlier morning arising times, when controlling for psychological distress. These data indicate that psychological distress is important to consider when examining the relationship between parental involvement and sleep in adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-awareness, distress, and postacute rehabilitation outcome.

Objective: To examine changes in impaired self-awareness (ISA) and distress with participation in a brain injury comprehensive day treatment program (CDTP) and their relationship to treatment outcomes at program end and 1-year follow-up. Study Design and Participants: Ratings of ISA and distress by rehabilitation staff and their relationship to other outcome measures were examined for 62 consecutive program graduates. Measures: Ratings of ISA and distress from the Mayo-Portland Adaptability Inventory (MPAI); outcome measures included Rasch-transformed MPAI score, goal attainment scaling T score, the Vocational Independence Scale, and the Independent Living Scale. Results: Nonparametric analyses of change scores showed that ISA and distress diminished after program participation. Nonparametric correlational analysis indicated that reduced ISA did not correlate with increased distress at program end. Linear and logistic regression analyses revealed that lower ISA and distress correlated with more positive outcomes on most measures (i.e., independent living, goal attainment scaling, and other ratings of disability on the MPAI) but did not predict vocational outcome. Conclusions: Participation in a CDTP reduces ISA and distress. Lower ISA and distress are associated with positive behavioral changes and more independent living but are neither necessary nor sufficient conditions for employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer

PURPOSE: Clinical reports suggest that many breast cancer patients experience persistent fatigue as a long-term side effect of adjuvant chemotherapy treatment. To investigate this issue further, we examined the characteristics and correlates of fatigue in women who had completed adjuvant chemotherapy for breast cancer and in a comparison group of women with no history of cancer. PATIENTS AND METHODS: Participants were 61 women with breast cancer who had completed chemotherapy an average of 471 days previously and 59 women with no history of cancer. All participants completed standardized self-report measures of fatigue, sleep quality, menopausal symptoms, and coping and were administered a structured clinical interview to identify current and past psychiatric disorder. RESULTS: Compared with women with no history of cancer, former adjuvant chemotherapy patients reported more severe fatigue (P < .01) and worse quality of life because of fatigue (P < .05). More severe fatigue among patients was significantly (P < .05) related to poorer sleep quality, more menopausal symptoms, greater use of catastrophizing as a coping strategy, and current presence of a psychiatric disorder. CONCLUSION: These findings support the view that many breast cancer patients experienced heightened fatigue after completion of adjuvant chemotherapy treatment. Results yield a profile of women who are at increased risk for heightened fatigue after chemotherapy and suggest ways to intervene clinically to prevent or reduce fatigue in this patient population.     

Frontal networks play a role in fatigue perception in multiple sclerosis.

Fatigue, an overwhelming lack of physical or mental energy, is a common complaint in patients affected by multiple sclerosis (MS). Although different mechanisms have been proposed to explain MS-related fatigue, injury of distinct anatomical networks seems to be relevant in fatigue etiology. Particularly, theories point to fronto-striatal network pathological changes as a possible neural basis of fatigue. To investigate the role of fronto-striatal white matter structural alterations in fatigue perception we prospectively recruited 40 relapsing remitting patients with MS and 15 healthy controls. In patients with MS, fatigue was assessed using a validated measure, the Modified Fatigue Impact Scale (MFIS; Kos et al., 2005). Brain MRI scans were acquired for each subject enrolled with diffusion tensor imaging. Diffusion tensor data were correlated with MFIS scores using voxel-wise analysis of fractional anisotropy maps and fiber tractography algorithms. A significant cluster of voxels correlating with fatigue scores located in the deep left frontal white matter was identified. Fiber tractography revealed the cluster to be included in a complex fronto-frontal, fronto-striatal, fronto-occipital, and fronto-limbic network. Structural properties of the traced white matter fiber bundles correlated with fatigue perception and patients with clinically relevant fatigue were found to present reduced white matter integrity in the aforementioned tracts compared to those with lower levels of fatigue. Our observations show a significant involvement of different frontal networks in the pathophysiology of fatigue, thus accounting for the multifaceted nature of this disabling symptom. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

5- to 18-year follow-up study of cemented total knee arthroplasty for patients 55 years old or younger

BACKGROUND: Although both expectant mothers and expectant fathers complain of fatigue during the last trimester of pregnancy, studies have focused exclusively on mothers. This pilot study examined parents' levels of morning or evening fatigue, number of uninterrupted sleep periods and length of sleep during the last trimester of pregnancy; and the relationship of sleep to parents' reports of fatigue. METHODS: Data were collected from 24 midwestern, nulliparous couples, who completed the Visual Analog Scale for Fatigue each morning and each evening on 4 consecutive days during the last trimester. Concurrently, the couples recorded sleep and wake periods in an activity diary. RESULTS: Expectant mothers but not expectant fathers reported increasing levels of fatigue, especially morning fatigue, as the pregnancy progressed. Expectant fathers and mothers did not differ either in the night-time mean number of minutes of sleep obtained, or in the mean number of night-time uninterrupted 90-minute sleep cycles obtained. Fatigue and sleep were not significantly related for either mothers or fathers. CONCLUSIONS: These findings support the multidimensional nature of fatigue and indicate a need for perinatal health caregivers to develop individualized interventions for mothers during the last trimester of pregnancy. Fathers should also participate in future research of factors influencing the prenatal and postpartum experience.     

Reduction in disability in a randomized controlled trial of telephone-administered cognitive-behavioral therapy.

Objective: The authors examined the efficacy of telephone-administered cognitive-behavioral therapy (T-CBT) and telephone-administered supportive emotion-focused therapy (T-SEFT) in reducing disability among disabled patients with multiple sclerosis and depression. Telephone administration of therapy allowed care to be delivered to a more disabled population. This is a secondary analysis of a randomized controlled trial; the primary outcome results for depression are reported in D. C. Mohr, S. L. Hart, L. Julian, C. Catledge, L. Honos-Webb, L. Vella, et al. (2005). Design: A randomized controlled trial, comparing 16 weeks of T-CBT with T-SEFT. Main Outcome Measures: Disability was measured using Guy's Neurological Disability Scale; fatigue was measured using the Fatigue Impact Scale; depression was measured using the Hamilton Depression Rating Scale and the Beck Depression Inventory-II. Results: Patients in both treatments showed significant improvements in disability and fatigue. These improvements were related to reductions in depression. T-CBT produced significantly greater decreases in disability and fatigue, compared with T-SEFT, even after controlling for depression. The greater benefit of T-CBT on disability was mediated by physical fatigue. Conclusion: These findings support the hypothesis that significant reductions in disability can be achieved by reducing depression in patients with multiple sclerosis. There was also evidence that further reductions could be achieved through CBT-specific interventions that include a focus on symptoms such as fatigue management. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronobiologic features in a 12-hour working day

A review of investigations into the effects of 12-hour workdays indicates that the extended workday is frequently related to decrement of performance efficiency, alertness and safety, and to increased subjective fatigue during work. Fatigue is increased even more during night shift work. As sleep duration after the night shift is also reduced, combined effects of fatigue and sleep debt can increase the risk of accidents, especially when workers work more nights in a row. In spite of the increased feeling of fatigue the workers prefer longer working hours to an eight-hour working schedule, because they have more free time to use for restitution, leisure and other domestic and second job activities.     

Fatigue in women with myocardial infarction

This study measured fatigue in women 6 weeks after myocardial infarction. Fatigue was experienced by the women as chronic, generalized, intermittent, and longstanding. More than one third of the women attributed their fatigue directly to the heart attack or hospitalization. Significant relations were found between fatigue and the physiological dimension of the Sickness Impact Sale (SIP), the Perceived Health Assessment and Risk Protection Survey (PHARPS), and the site of infarction, as well as with the psychological dimension of the SIP. There was an inverse significant relation between fatigue scores and the Psychological General Well-Being (PGWB) Index. Although not reaching statistical significance, fatigue scores for women 65 and older were higher than for younger women.     

Rapid recovery of spermatogenesis after mitoxantrone, vincristine, vinblastine, and prednisone chemotherapy for Hodgkin's disease

PURPOSE: Because the effects of mitoxantrone on human male fertility were unknown, we determined prospectively the effects of three courses of mitoxantrone (Novantrone), vincristine (Oncovin), vinblastine, prednisone (NOVP) chemotherapy on the potential for fertility of men with Hodgkin's disease (HD). PATIENTS AND METHODS: Semen analyses were performed on 58 patients with stages I-III HD before, during, and after chemotherapy and after the sperm count recovered from the effects of abdominal radiotherapy that was given after chemotherapy. RESULTS: Before the initiation of treatment, 84% of the patients were normospermic. Sperm counts declined significantly within 1 month after the start of NOVP chemotherapy. In the month after chemotherapy, 38% of patients were azoospermic, 52% had counts < 1 million/ mL, and 10% had counts between 1 and 3 million/mL. Between 2.6 and 4.5 months after the completion of chemotherapy, sperm counts recovered rapidly to normospermic levels in 63% of patients. In the remaining patients who were followed up for at least 1 year after standard upper abdominal radiotherapy, counts also recovered to normospermic levels. CONCLUSION: NOVP chemotherapy, like most other regimens, produced marked temporary effects or spermatogenesis. However, sperm production recovered very rapidly, within 3 to 4 months after the end of NOVP chemotherapy. This pattern was caused by killing differentiating spermatogenic cells, but there was little cytotoxicity or inhibition of stem cells from mitoxantrone or the other drugs. After the combination of NOVP plus abdominal radiotherapy, sperm counts and motility were restored in most patients to pretreatment levels, which were compatible with normal fertility.     

Correlates of fatigue in older women with heart failure

OBJECTIVE: To examine the relative contribution of psychologic factors and physical symptoms to the variance in fatigue in older women with heart failure. METHODS: Eighty women who had been hospitalized in the previous 12 months for heart failure were interviewed. Fifty-seven women completed second interviews 18 months after the first interview. RESULTS: Fatigue was the most frequently occurring physical symptom at both measurement times, and it significantly increased with time. Other physical symptoms contributed uniquely to the variance in fatigue at both measurement times, but psychologic factors did not. At time 1, sleep difficulties, chest pain, and weakness each explained unique variance in fatigue. At time 2, dyspnea was the only variable that explained unique variance in fatigue (9%). Dyspnea also explained a significant portion of the variance (7%) in time 2 fatigue, when time 1 fatigue was controlled. CONCLUSIONS: Fatigue in older women with heart failure is related more to other physical symptoms than psychologic factors.     

Quality of life in adults with cystic fibrosis

BACKGROUND: Cystic fibrosis is an inherited condition with a high mortality and morbidity. The aims of this study were to assess quality of life in a population of adults with cystic fibrosis, to compare quality of life with published scores from a healthy population and other patient groups, and to examine the relation between quality of life and other measured clinical variables. METHODS: Patients over 16 years of age attending an adult cystic fibrosis outpatient clinic were surveyed at a time when they were clinically stable. A self-complete questionnaire was administered which comprised the Nottingham Health Profile (NHP) together with six additional questions related to cystic fibrosis. RESULTS: Completed questionnaires were obtained from 240 subjects (100 women) of median age 26 years (range 16-56). Mean (SD) forced expiratory volume in one second (FEV1) was 49 (26)% predicted, forced vital capacity (FVC) was 68 (26)% predicted, and the FEV1:FVC ratio was 59 (16)%. In this cross sectional study different patterns of perceived quality of life were seen in men and women. In part 1 of the NHP there was an age related trend compared with norms in men, with more distress/disability in the dimensions of emotion, sleep, and social isolation in the older age groups. In women there was no age related trend in the degree of distress/disability compared with norms. The mean score was different from norms in the dimensions of pain, emotion and sleep. For the patients with cystic fibrosis as a whole the scores in part 1 were comparable with published scores of patients with minor non-acute conditions. Scores in part 2 of the NHP for men were different from norms in six of the seven areas of daily living (all except home life). For women the scores were different from norms in the areas of looking after the home, social life, hobbies, and holidays. There were correlations between several of the quality of life dimensions and other measured variables such as FEV1, breathlessness score, and the time spent on home treatment. CONCLUSIONS: Men and women with cystic fibrosis have different patterns of perceived quality of life, and there is an age related trend of perceived quality of life in men in some dimensions. Quality of life scores in this group, as assessed by the NHP, are similar to those reported in subjects with minor non-acute conditions.     

A new assessment of quality of life (QOL) for cancer patients

A new assessment of quality of life (QOL) was made for cancer patients. The QOL assessment consists of 12 items: pain; nausea; constipation; general fatigue; sleep; eating; activity; a daily life pattern; conversation; treatment acceptability; satisfaction at the present status and family exhaustion. Ranges of scores are one (best) to five (worst). For visual expression of QOL, the author made an original method called "QOL diagram", drawn with a circle which has 12 diverging lines marked five points indicating the score for each item. QOL changes after cancer pain control with either oral or intravenous morphine were examined in 22 adult cancer patients by the QOL assessment. Laxatives and anti-nausea drugs were mostly prescribed at the same time in order to avoid side effects of morphine. QOL was evaluated and recorded by the author through an individual interview with each patient. It was observed that the psychological factors were improved along with pain relief. Although items such as general fatigue, nausea, constipation, sleep and eating did not change considerably at first, they improved well with time in the oral morphine group. On the other hand, there was no marked time-dependent change in the intravenous morphine group. Items such as activity, a daily life pattern and conversation were rather negative than positive. These items seem to be more important to improve QOL of the cancer patients, in particular, whose general status is relatively good. In conclusion, the QOL diagram helped us to follow subtle changes of status and needs of cancer patients. And it enables us to easily assess risks and benefits of the treatment plans including palliative care and home supportive programs. It is designed for both patients and medical staffs to use easily and repeatedly. However, the further evaluation and refinement will be needed to verify validity and reliability of the QOL diagram before a routine clinical application.     

Sleepiness and the reinforcing and subjective effects of methylphenidate.

On 4 days, 6 volunteers received 10mg methylphenidate or placebo at 0900 after 4 or 8 hr time in bed (TIB) and then on 4 days after 4 or 8 hr TIB chose their preferred capsule. On sampling days, 4 hr TIB increased multiple sleep latency test (MSLT) scores and Fatigue scale scores on the Profile of Mood States (POMS). In both TIBs, the drug increased the MSLT and POMS Vigor and Tension scale scores. It reduced POMS Fatigue scores and improved divided attention performance to a greater extent after 4 versus 8 hr. Drug was chosen on 88% of days after 4 hr, but only 29% of days after 8 hr. Preference for the drug depends on sleepiness and is mediated by performance-enhancing and fatigue-altering effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)