Cancer-related fatigue, depressive symptoms, and functional status: a mediation model. Quality of life in long-term survivors of ovarian germ cell tumors: a Gynecologic Oncology Group study. Fatigue states after cancer treatment occur both in association with, and independent of, mood disorder: a longitudinal study Impact of Age on Quality of Life in Patients with Rectal Cancer A longitudinal investigation of psychological morbidity in patients with ovarian cancer Fatigue, menopausal symptoms, and cognitive function in women after adjuvant chemotherapy for breast cancer: 1- and 2-year follow-up of a prospective controlled study. An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early‐stage cervical cancer Doctor-Patient Communication: Results of a Four-Year Prospective Study in Rectal Cancer Patients Tamoxifen effects on subjective and psychosexual well-being, in a randomised breast cancer study comparing high-dose and standard-dose chemotherapy Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation. The Health of Older-Adult, Long-term Cancer Survivors Utility of a cognitive-behavioral model to predict fatigue following breast cancer treatment. Fatigue and relating factors in high-risk breast cancer patients treated with adjuvant standard or high-dose chemotherapy: a longitudinal study. Does neoadjuvant hormone therapy for early prostate cancer affect cognition? Results from a pilot study. Patient-reported lower urinary tract symptoms, urinary incontinence, and quality of life after external beam radiotherapy for localized prostate cancer – 15 years’ follow-up. A comparison with age-matched controls Altered cognitive function in men treated for prostate cancer with luteinizing hormone‐releasing hormone analogues and cyproterone acetate: a randomized controlled trial Social support, anxiety and depression after chemotherapy for ovarian cancer: a prospective study. A longitudinal prospective study of health-related quality of life in breast cancer patients following high-dose chemotherapy with autologous blood stem cell transplantation Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study. Axilla Surgery Severely Affects Quality of Life: Results of a 5-Year Prospective Study in Breast Cancer Patients Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy. Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study. Psychosocial adjustment in gynecologic cancer survivors: a longitudinal study on risk factors for maladjustment. Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer. Early self-reported impairments in arm functioning of primary breast cancer patients predict late side effects of axillary lymph node dissection: results from a population-based cohort study The cognitive sequelae of standard‐dose adjuvant chemotherapy in women with breast carcinoma Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Gender Differences in Quality of Life of Patients with Rectal Cancer. A Five-Year Prospective Study Phantom breast sensations and phantom breast pain: A 2‐year prospective study and a methodological analysis of literature Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients. Course of mental fatigue and motivation in breast cancer patients receiving adjuvant chemotherapy. Prospective study of long-term impact of adjuvant high-dose and conventional-dose chemotherapy on health-related quality of life.
BACKGROUND Patients with cancer grapple with a confusing array of disease- and treatment-related symptoms while trying to maintain functioning in usual roles and daily activities . Research is needed to sort out and identify symptom clusters as a basis for a rational approach to symptom management . OBJECTIVE The aim of this study was to test , through secondary analysis , a mediation hypothesis about the direct and indirect relationships between fatigue and depressive symptoms through a pathway involving functional status . METHODS Data from the experimental and control groups of a r and omized clinical intervention trial for fatigue management , collected after the second chemotherapy treatment or during the last week of radiotherapy  , were analyzed . The mediation pathway from fatigue to depressive symptoms through functional status was tested separately for groups receiving either an energy conservation intervention or a control intervention , equating for time and attention . RESULTS For the control group , the results indicate support for partial mediation . The previously significant relationship between fatigue and depressive symptoms was reduced after functional status was controlled , accounting for 43 % of the total mediated effect . The mediation hypothesis was not supported in the energy conservation group , indicating that the intervention may have changed the role of functional status in mediating the effect of fatigue on depressive symptoms . DISCUSSION In the control group , when routine activities became more difficult because of fatigue , individuals had more depressive symptoms . The results suggest that functional status is an important factor to consider in symptom management for fatigue . An appropriate intervention for fatigue would have two targets : the fatigue and strategies to reduce the likelihood of impaired functioning that could result in elevated depressive symptoms PURPOSE This report describes the strength and significance of the association between antecedent and mediating variables across four categories of quality of life ( QOL ) outcomes in 132 disease free women with ovarian germ cell survivors . METHODS Survivors ( n=132 ) participated in a mailed question naire and computer-assisted telephone survey .  Participants in four prospect i ve GOG protocol s were contacted their treating physician for verbal consent to be approached by investigators at the Indiana University Cancer Center about a quality of life study . Similar patients treated at the MD And erson Cancer Center were also included . If women verbally consented after being contacted by investigators at Indiana University , an informed consent and question naire packet was sent via mail . After return of the written informed consent and background question naire , a trained research assistant scheduled a computer-assisted interview to complete data collection . RESULTS Median follow-up from diagnosis was 10.2 years . Mediating variables of self-efficacy or social support played a significant role ( p=0.05 to p=0.001 ) in all four QOL categories : physical functioning , psychological functioning , sexual functioning , and spiritual functioning . Being a younger age at diagnosis and married were positively related to sexual functioning ( p=0.05 ) . Menstrual and gynecological symptoms were inversely related . IMPLICATION S Results indicate that clinicians may want to be especially sensitive to identifying a survivor 's social support and confidence ( self efficacy ) in h and ling issues evolving from treatment since these skills may be related to overall quality of life outcomes Background Persistent fatigue is recognised as one of the most common , ongoing symptoms reported by patients following cancer treatment and may have profound effects on the quality of life . However , recent cross-sectional studies also highlight the close relationship between cancer related fatigue ( CRF ) and diagnoses of depression or anxiety disorder . There is currently limited information about the relationships between these conditions over time . We sought to examine the longitudinal relationships between fatigue and mood disorder in women treated with adjuvant therapy for early stage breast cancer . Methods Women who had recently completed adjuvant therapy for Stage I or II breast cancer ( n = 212 ) were sent a question naire with established case thresholds for clinical ly-significant fatigue and psychological disorder , as well as a question naire assessing disability . Potentially relevant variables linked to fatigue states , including age , treatment modality , menopausal status , and hematological indices were recorded . The illness outcomes were assessed over 48 months of follow-up . Results The 176 women who responded to the question naire ( 84 % ) had a mean age of 55 ( range 24–83 ) years and had completed adjuvant treatment on average 10 ( range 4.7 – 16.3 ) months previously .  Radiotherapy had been administered , either alone ( 50 % of women ) or in combination with chemotherapy ( 36 % ) . Responses from 87 women ( 48 % ) indicated a significant fatigue state ( termed here post-cancer fatigue ; PCF ) , and from 59 women ( 33 % ) responses indicated significant psychological distress . Thirty-four women ( 19 % ) were cases of fatigue alone ( i.e. unaccompanied by psychological disorder ) , whereas 52 ( 30 % ) were cases of both disorders . Multivariate analysis did not reveal any association between demographic , clinical or laboratory variables , and caseness for PCF . Self-reported functional disability was significantly associated with fatigue . Follow-up at 24 , 36 and 48 months revealed high rates of ongoing PCF in conjunction with psychological distress , despite falling rates of psychological distress alone and fatigue alone . Conclusion Post-cancer fatigue was prevalent and sustained on follow-up . Concurrent psychological disorder was evident in the majority , but not all , cases of PCF and tended to be sustained over time . Further prospect i ve cohort studies to define the longitudinal co-morbid relationships between fatigue , mood disorder , and ongoing disability after cancer treatment are indicated Some studies indicate that age at the time of surgery has a general effect on outcomes . The impact of age on the quality of life ( QOL ) of patients with rectal cancer , however , has not been investigated . The present study was conducted to address this issue . Over a 5-year period the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C-30 and a tumor-specific module were prospect ively administered to patients before surgery , at discharge , and at 3 , 6 , 12 , and 24 months postoperatively . Comparisons were made between age groups . A total of 519 patients participated in the study . QOL data were available for 253 patients . Significant differences were observed only between patients aged 69 years and younger ( ≤69 years ) ( 169/253 ) and those aged 70 years and older ( ≥70 years ) ( 85/253 ) . Physical and role functioning was better for patients ≤69 years ; patients ≥70 years suffered from increased pain and fatigue . Younger patients had more difficulty with sexual enjoyment , and over time sexual strain was worse for patients aged ≥70 years during the early postoperative period but improved , whereas patients aged ≤69 years had increasing levels of strain over time . The findings in this study confirmed that QOL is dynamic over time and that age has an impact on QOL and sexuality . Patients aged ≥70 years are affected by impaired physical functioning , global health , and fatigue , whereas increased treatment strain during the early postoperative period improves over time . Patients aged ≤69 years experience increased strain because of impaired sexual function Ovarian cancer patients may experience  psychological disorders  due to the aggressive nature of the illness and treatment . We investigated the presence of psychological disorders longitudinally in women with a new diagnosis of ovarian cancer and the factors that predicted development and maintenance of these disorders . Patients were assessed in a prospect i ve longitudinal study at the beginning of chemotherapy treatment , mid-treatment , end of treatment and 3 months follow-up for depression , anxiety , perceived social support , neuroticism and cognitive strategies to control unwanted thoughts .  A total of 121 patients were recruited and 85 patients were assessed at all four time points . Three different longitudinal profiles of anxiety and depression caseness were found : non-cases ( never cases ) , occasional cases ( cases on at least one but not all four occasions ) and stable cases ( cases on all four occasions ) . Most of the women were occasional cases of anxiety ( 52 % , 44 ) , whereas for depression , the majority of women were non-cases ( 55 % , 47 ) . A subset of patients were stable cases of anxiety ( 22 % , 19 ) . Neuroticism and marital status were significant independent predictors of anxiety caseness profile . Neuroticism and use of anti-depressants  were independent predictors of depression caseness profile . Social support was not related to psychological morbidity PURPOSE We previously evaluated fatigue , menopausal symptoms , and cognitive dysfunction in patients receiving adjuvant therapy for breast cancer and matched healthy women . Here we report assessment of these women 1 and 2 years later . PATIENTS AND METHODS Patients without relapse and controls were evaluated by the Functional Assessment of Cancer Treatment-General Quality of Life question naire , with subscales for fatigue and endocrine symptoms , and by the High Sensitivity Cognitive Screen . RESULTS There were 104 , 91 , and 83 patients and 102 , 81 , and 81 controls assessed at baseline and at 1 and 2 years , respectively . Median Functional Assessment of Cancer Treatment-Fatigue scores ( range , 0 to 52 ) for patients improved from 31 ( on chemotherapy ) to 43 and 45 at 1 and 2 years , respectively , but were stable in controls ( 46 to 48 ) . Median Functional Assessment of Cancer Treatment-Endocrine Symptoms scores ( range , 0 to 72 ) for patients improved from 57 ( on chemotherapy ) to 59 and 61 at 1 and 2 years , respectively , and were stable in controls ( 64 to 65 ) . Differences between patients and controls remained significant for these scales . The incidence of moderate-severe cognitive dysfunction by the High Sensitivity Cognitive Screen  decreased in patients from 16 % ( on chemotherapy ) to 4.4 % and 3.8 % and in controls from 5 % to 3.6 % and 0 % at 1 and 2 years , respectively . There were minimal differences between estrogen receptor-positive patients who started hormonal therapy ( mainly tamoxifen ) after chemotherapy and estrogen receptor-negative patients who did not . Differences in quality of life between patients and controls were significant only at baseline . CONCLUSION Fatigue , menopausal symptoms , and cognitive dysfunction are important adverse effects of chemotherapy that improve in most patients . Hormonal treatment has minimal impact on them The objective of this study was to evaluate the problems with miction , defecation , and sexuality after a  radical hysterectomy with or without adjuvant radiotherapy  for the treatment of cervical cancer stage I – IIA . This study included an observational longitudinal study of self-reported bladder , defecation , and sexual problems with a baseline score . Ninety-four women were included in the study . An age-matched control group consisted of 224 women . The patients showed significantly more negative effects on sexual function compared with both the controls and their situation before the treatment throughout 24 months of follow-up . The problems included less lubrication , a narrow and short vagina , senseless areas around the labia , dyspareunia , and sexual dissatisfaction . Up to 12 months after the treatment , the patients complained significantly more of little or no urge to urinate and diarrhea as compared with the controls . Adjuvant radiotherapy did not increase the risk of bladder dysfunction , colorectal motility disorders , and sexual functions . We conclude that a radical hysterectomy for the treatment of early-stage cervical carcinoma is associated with adverse effects mainly on sexual functioning PURPOSE The purpose of the study was to examine the effect of communication on rectal cancer patients ’  quality of life over four years . Previous studies have either used short follow-up periods or examined only certain aspects of quality of life , such as anxiety and depression . METHODS In a prospect i ve , observational study , rectal cancer patients , recruited by clinicians over a two-year period , were sent question naires over four years . The clinical details of these patients were recorded by the Munich Cancer Registry . The psychological scores from the European Organization for Research and Treatment of Cancer QLQ-C30 and CR38 were the main outcome variables . RESULTS Thirty-nine percent of the sample reported that some aspect of the communication  they received was unclear ( incomprehensible or too little ) . More than 60 percent wished to speak more with their physician . Younger patients and those in larger hospitals were more likely to report unclear communication ( P < 0.05 ) . Analyses of covariance , controlled for age , gender , adjuvant therapy , stoma , education , clinic , and comorbidity , demonstrated that role , emotional , and social functioning scores were consistently lower in patients reporting unclear communication . Additionally , these patients experienced more problems sleeping , poorer body image , more financial worries , and a worse future perspective . Repeated measures analyses indicated that sleeping problems and emotional and social functioning difficulties persisted for at least three years . CONCLUSION Reports of unclear communication were associated with poorer quality of life in rectal cancer patients without disease progression To evaluate the impact of tamoxifen on subjective and psychosexual well-being in breast cancer patients in relation to type of prior chemotherapy and menopausal status . Longitudinal interview study in breast cancer patients during and after adjuvant tamoxifen use . Menopausal status was defined by last menstrual period and serum oestradiol and FSH levels . Gynaecology outpatient clinic , Tertiary Referral Hospital , January 1995 to September 1999 . Breast cancer patients < 56 years of age , participating in a r and omised trial comparing adjuvant high-dose ( n=45 ) and st and ard-dose ( n=53 ) chemotherapy , followed by radiotherapy and tamoxifen .  Relative incidence and correlation of subjective and psychosexual symptoms during and after tamoxifen . During tamoxifen the most frequent complaints were hot flushes ( 85 % ) , disturbed sleep ( 55 % ) , vaginal dryness and /or dyspareunia ( 47 % ) , decreased sexual desire ( 44 % ) and musculo-skeletal symptoms ( 43 % ) . Disturbed sleep correlated with hot flushes ( P<0.0005 ) and concentration problems ( P<0.05 ) . Decreased sexual interest correlated with vaginal dryness ( P<0.0005 ) and /or dyspareunia ( P<0.0005 ) . In the high-dose group more patients became postmenopausal ( 95 % vs 33 % ) and more patients reported symptoms than in the st and ard-dose group ( P<0.05 ) . After discontinuation of tamoxifen , symptoms decreased significantly . However , hot flushes , disturbed sleep and vaginal dryness persisted more often in patients who remained postmenopausal after high-dose chemotherapy ( P<0.05 ) . Overall , during tamoxifen patients reported many symptoms . More patients become postmenopausal after high-dose chemotherapy , and they remain often symptomatic after tamoxifen OBJECTIVE To describe the impairments of upper body and limbs , activity limitations and participation restrictions 6 and 12 months after operation for breast cancer and to examine the impact of impairments on activity limitations . DESIGN A prospect i ve survey 6 and 12 months after operation . PATIENTS Ninety-six breast cancer patients . METHODS A question naire for assessing the impairments , activity limitations and participation restrictions was developed . RESULTS The most common impairments 6 months after operation were breast and axilla scar tightness , axilla oedema and neck-shoulder pain . At 12-month follow-up the breast scar tightness ( p=0.008 ) and axilla oedema ( p=0.023 ) decreased , and limb ache ( p=0.005 ) increased significantly . The most limiting impairments were axilla oedema and limb numbness 6 months after operation , and at 12-month follow-up axilla oedema . Lifting , carrying and reaching out caused worsening of impairments to more than half of the respondents at 6-month follow-up . Regression analysis showed that many impairments together were determinants of activity limitations and sleep impairment . Participation restrictions were constant . Respondents had not given up participation in activities in the home , but some had ab and oned leisure activities and felt that their work ability had decreased . CONCLUSION Impairments and their impact on activities were frequent and constant . There is an urgent need for developing rehabilitation protocol s for breast cancer patients Research indicates that cancer-related health problems persist for decades among survivors . The combination of late effects of cancer or its treatment and age-related health problems may add to the vulnerability of older survivors . This research reports on the health and functioning of a sample of long-term ( 5+years ) , older-adult ( > 60 years ) survivors of breast , prostate , and colorectal cancer . Data were derived from 321 in-person interviews with a sample r and omly selected from a tumor registry at a comprehensive cancer center . Descriptive data analyzed comorbid health conditions and continued cancer symptoms reported by survivors . Correlational analysis examined the association among demographic cancer-related factors and a range of health quality -of-life outcomes , including functioning and illness impact . Nearly 40 % of respondents have at least 1 symptom attributed to cancer/treatment .  Pain was the most commonly reported symptom , with 21 % attributing it to cancer . More than 40 % of breast cancer survivors and nearly 20 % of prostate cancer survivors reported pain . Being African American or female was significantly associated with more current symptoms and greater functional difficulty .  Survivors who had chemotherapy and survivors with more types of treatment  reported significantly more symptoms both during treatment and currently . Many older-adult survivors are more vulnerable due to both cancer-related symptoms and comorbid health conditions . Women and African Americans are at special risk . This combined vulnerability is an important factor for clinicians treating long-term survivors The objective of the current study was twofold : ( a ) to determine whether subgroups of breast cancer patients could be identified on the basis of their distinct trajectory or pattern of fatigue following treatment for early stage cancer using growth mixture modeling and ( b ) to examine whether the subgroups could be distinguished on the basis of a cognitive-behavioral model . Growth mixture modeling and a prospect i ve longitudinal design were used to examine the course of fatigue after treatment for early stage breast cancer . Women ( n = 261 ; mean age = 55.2 years ) provided fatigue ratings for 6 months following treatment . A low-fatigue group ( n = 85 ) and a high-fatigue group ( n = 176 ) were extracted . Women who were not married , had a lower income , had a higher body mass index , engaged in greater fatigue catastrophizing , and were lower in exercise participation were more likely to be in the high-fatigue group . Only body mass index and catastrophizing remained significant predictors in multivariate analysis . Findings suggest considerable heterogeneity in the experience of fatigue following treatment and support the utility of a cognitive-behavioral model in predicting the course of posttreatment fatigue PURPOSE Determine whether st and ard or high-dose chemotherapy leads to changes in fatigue , hemoglobin ( Hb ) , mental health , muscle and joint pain , and menopausal status from pre- to post-treatment and to evaluate whether fatigue is associated with these factors in disease-free breast cancer patients . PATIENTS AND METHODS Eight hundred eighty-five patients were r and omly assigned between two chemotherapy regimens both followed by radiotherapy and tamoxifen .  Fatigue was assessed using vitality scale ( score < or = 46 defined as fatigue ) , poor mental health using mental health scale ( score < or = 56 defined as poor mental health ) both of Short-Form 36 , muscle and joint pain with Rotterdam Symptom Checklist , and Hb levels were assessed before and 1 , 2 , and 3 years after chemotherapy . RESULTS Fatigue was reported in 20 % of 430 assessable patients ( 202 st and ard-dose , 228 high-dose ) with at least a 3-year follow-up , without change over time or difference between treatment arms . Mean Hb levels were lower following high-dose chemotherapy . Only 5 % of patients experienced fatigue and anemia . Mental health score was the strongest fatigue predictor at all assessment moments . Menopausal status had no effect on fatigue . Linear mixed effect models showed that the higher the Hb level ( P = .0006 ) and mental health score ( P < .0001 ) , the less fatigue was experienced . Joint ( P < .0001 ) and muscle pain ( P = .0283 ) were associated with more fatigue . CONCLUSION In 3 years after treatment , no significant differences in fatigue were found between st and ard and high-dose chemotherapy .  Fatigue did not change over time . The strongest fatigue predictor was poor mental health OBJECTIVE To examine , in a prospect i ve study , the influence that temporary reversible medical castration for localized prostate cancer has on cognition , by assessing whether temporary 3 - 5 month treatment with a luteinizing-hormone releasing hormone ( LHRH ) agonist before radical radiotherapy had a short- or long-term affect on cognitive function . PATIENTS , SUBJECTS AND METHODS Thirty-two patients with localized prostate cancer had  cognitive assessment  s at baseline ( T1 ) before the start of drug treatment , at 3 months ( T2 ) or on completing drug treatment but before radiotherapy , and 9 months later ( T3 ) . Eighteen men with no prostate cancer ( controls subjects ) completed the  cognitive tests  at the same times . In addition , psychological functioning and quality of life were assessed at the same times , together with serum free and bound testosterone , beta-oestradiol and sex hormone-binding globulin levels . RESULTS There was a significant cognitive decline ( on at least one cognitive task ) at T2 in 15 ( 47 % ) patients vs three ( 17 % ) of controls ( odds ratio 4.412 , P = 0.033 ) . Most patients ( nine of 15 ) who had a change in performance declined on tasks of spatial memory and ability . At T3 there was significant cognitive decline in 11 ( 34 % ) patients and five ( 28 % ) control subjects ( odds ratio 1.37 , P = 0.631 ) . CONCLUSION This pilot study suggests that short-term LHRH therapy for early-stage prostate cancer has modest short-term consequences on men 's cognitive functioning ; a larger prospect i ve study is warranted Background . To prospect ively examine the urinary toxicity and quality of life ( QOL ) in patients 15 years after external beam radiotherapy ( EBRT ) for localized prostate cancer ( LPC ) and compare the outcomes with results for age-matched controls . Material and methods . Urinary symptoms were assessed using the symptom-specific Prostate Cancer Symptom Scale ( PCSS )  question naire , and QOL was assessed with the European Organization for Research and Treatment of Cancer ( EORTC ) 's Quality of Life Question naire ( QLQ-C30 ) . Both question naires were sent to the surviving 41 patients ( 25 % ) and the PCSS question naire was sent to 69 age-matched controls for comparison . Results . The response rate was 71 % in the patient group and 59 % in the control group . Two patients and four controls were excluded due to other cancer diagnoses , result ing in a total of 27 patients and 37 controls for inclusion in the analyses . The mean age in both groups was 78 years . In the patient group , incontinence had increased between the 8-year ( mean=0.6 ) and the 15-year follow-up ( mean=2.1 ; p=0.038 ) . No other differences in urinary problems were seen between these two follow-ups . Increased incontinence , stress incontinence , and pain while urinating were reported by the patients in comparison with the controls at 15 years . Role function was worse in the patient group ( mean=67.3 ) compared with the controls ( mean=82.4 ; p=0.046 ) . The patients also reported more appetite loss , diarrhea , nausea/vomiting , and pain than the controls . Conclusion . EBRT for LPC has divergent effects on urinary symptoms and QOL in comparison with age-matched controls . In our patient population , urinary incontinence increased between 8 and 15 years of follow-up . Otherwise , no differences in urinary symptoms were seen between 4 and 15 years . Incontinence , stress incontinence , and pain while urinating were increased after EBRT in comparison with the controls . Conventional EBRT did not result in a major deterioration in QOL 15 years after treatment Objective To report the first systematic investigation of the cognitive effects of luteinizing hormone‐releasing hormone ( LHRH ) analogues in male patients , as LHRH analogues have been associated with memory impairments in women using these drugs for gynaecological conditions OBJECTIVES We aim ed to describe the levels of  anxiety and depression  in patients during the 3 month period following the end of chemotherapy treatment and to identify factors that predict psychological morbidity . METHOD We performed a prospect i ve study in women with ovarian cancer to determine the changes in psychological status in the 3 months following completion of chemotherapy .  Sixty-three consecutive patients were assessed at the completion of chemotherapy ( Time 1 ) and 57 at 3 months follow-up ( Time 2 ) . Relevant disease and patient characteristics were recorded and patients were assessed at Time 1 for anxiety , depression and their perception of emotional support , an index of their psychosocial environment .  Anxiety and depression were re-assessed at Time 2 . RESULTS The results indicate significant initial psychological morbidity , with clinical caseness for anxiety ( 38 % ) and depression ( 33 % ) being common . Follow-up at Time 2 shows that patients undergo a significant reduction in cases ( 19 % ) and symptoms of depression but an increase in cases of anxiety ( 47 % ) . The principal factors associated with symptoms of anxiety at Time 2 were poor perceived social support , increased intrusive thoughts and , to a lesser extent , younger age . Medical parameters , such as the stage of disease , response of the cancer to treatment , Ca125 ( a tumour glycoprotein ) and Karnofsky Performance status ( a measure of how well the patients is ) were not associated with worse psychological outcome . CONCLUSION These data show for the first time that social support and intrusive thoughts , rather than physical parameters , are the principal determinants of psychological morbidity in patients with ovarian cancer Summary : This prospect i ve longitudinal study examined both short- and long-term changes in health-related quality of life ( HRQL ) in 52 breast cancer patients with poor prognosis receiving high-dose chemotherapy ( HDC ) treatment with autologous blood stem cell transplantation ( ASCT ) .  HRQL was measured seven times from baseline to 2 years post enrollment with the Functional Living Index-Cancer ( FLIC ) , the EuroQol ( EQ-5D ) , and a  quality of life visual analogue scale . The percentage of question naires returned at each assessment time ranged from 80 to 92 % . All three measures showed a similar pattern of change , with HRQL decreasing following administration of HDC , and returning to baseline levels 8 weeks post HDC . A repeated- measures analysis of variance showed that the FLIC at 2 years was significantly better than baseline ( P=<0.0001 ) . Difficulty sleeping , headaches , and decreased sexual interest were the most common symptoms reported in the longer term . Our results have implication s for early psychosocial intervention in the care of breast cancer patients with poor prognosis undergoing treatment with HDC and ASCT because such interventions can further improve the quality of their survival OBJECTIVES To report on the longitudinal cognitive functioning of older women receiving adjuvant chemotherapy for breast cancer . DESIGN Neuropsychological and functional status testing were performed before chemotherapy and 6 months after chemotherapy . SETTING Cancer center . PARTICIPANTS Thirty-one patients aged 65 and older with Stage I to III breast cancer . Of the 31 patients enrolled , three refused post-testing , and 28 were evaluable . MEASUREMENTS The following domains of cognitive function were examined : attention ; verbal memory ; visual memory ; and verbal , spatial , psychomotor , and executive functions . RESULTS Participants had a mean age of 71 ( range 65 - 84 ) : 39 % Stage I , 50 % Stage II , and 11 % Stage III . The number of scores 2 st and ard deviations ( SDs ) below the norm were calculated for each patient before and 6 months after chemotherapy ; 14 ( 50 % ) had no change , 11 ( 39 % ) worsened , and three ( 11 % ) improved ( P=.05 ) . Seven patients ( 25 % ) experienced a decline in cognitive function , defined as a 1-SD decline from pre- to post-testing in two or more neuropsychological domains . Exploratory analyses revealed no significant difference between functional status , comorbidity , and depression scale scores and change in overall quality -of-life scores before and after chemotherapy . CONCLUSION In this cohort of older women receiving adjuvant chemotherapy , a subset experienced a decline in cognitive function from before chemotherapy to 6 months after chemotherapy . Further prospect i ve study is needed to confirm these observations and to identify the subgroup at special risk No long term prospect i ve study has investigated  arm morbidity and patient quality of life .  It is unclear to what extent breast cancer patients suffer from arm problems , how long such problems affect their lives , and whether quality of life improves as arm problems abate . This prospect i ve cohort study aims to provide data on the clinical factors associated with arm dysfunction , to estimate its prevalence and to relate arm morbidity to quality of life . The Munich Cancer Registry records clinical details of all cancer patients in and around Munich .  Quality of life information was provided directly by breast cancer patients ( n = 990 ) over 5 years .  Arm morbidity , including movement limitations , swelling and lymph drainage , and quality of life ( EORTC QLQ-C30 ) were assessed . Up to 5 years after diagnosis , 38 % of patients were still experiencing arm problems ( swelling and limited movement ) . Consistently over the 5 years , quality of life was significantly ( p < 0.001 ) lower for patients with arm difficulties . For those whose arm problems dissipated , quality of life significantly improved ( p < 0.01 ) . A logistic regression analysis showed that extent of axilla surgery ( p < 0.003 ) , comorbidity ( CVD and diabetes ) ( p < 0.003 ) , employment ( p < 0.01 ) , younger age ( p < 0.02 ) , and operating clinic ( p < 0.05 ) significantly contributed to arm problems . Axilla surgery should be re-evaluated since arm morbidity has such a profound effect on patient quality of life PURPOSE We sought to eluci date long-term changes in health-related quality -of-life ( HRQOL ) outcomes by prospect ively re-evaluating a well-characterized cohort of prostate cancer ( PC ) survivors 4 to 8 years after primary treatment . PATIENTS AND METHODS Patients who had been evaluated previously at a median of 2.6 years after radical prostatectomy ( RP ) , external radiation ( three-dimensional conformal radiation therapy [ 3-D CRT ] ) , or brachytherapy ( BT ) were recontacted at a median of 6.2 years after treatment . The clinical relevance of long-term HRQOL impairment among survivors was established by comparison with controls of similar age . Factors associated with HRQOL changes during this interval were evaluated . RESULTS Of the 964 eligible men , 709 ( 73.5 % ) completed measurable question naires . In four domains ( urinary irritative-obstructive , urinary incontinence , bowel , and sexual ) , significant HRQOL differences were detected for at least one of the therapy groups , compared with controls ( all P < .05 ) . During the 4-year interval , significant improvement was observed for the urinary irritative-obstructive ( P < .0001 ) and bowel ( P < .0001 ) domains among BT patients , whereas urinary incontinence HRQOL worsened for both the BT ( P = .0017 ) and 3-D CRT ( P = .0008 ) treatment groups . Overall sexual HRQOL deteriorated for the 3-D CRT cohort ( P = .0017 ) , as well as for controls ( P = .0136 ) . Among RP patients , significant HRQOL changes were not observed . CONCLUSION During a 4-year interval from earlier to longer-term phases of PC treatment survivorship , sexual , urinary , and bowel dysfunction remain significant concerns among early-stage PC treatment survivors , compared with control men . Although postprostatectomy HRQOL remains relatively stable during this interval , disease-specific HRQOL continues to evolve among men treated with BT and 3-D CRT PURPOSE / OBJECTIVES To examine patterns of and relationships between activity , sleep , symptom distress , health status , and fatigue during and following adjuvant breast cancer chemotherapy with doxorubicin and cyclophosphamide . DESIGN Prospect i ve , descriptive , repeated measures . SETTING Midwestern , urban , oncology clinics . SAMPLE 14 women , ages 32 - 69 ( X = 52.4 ) , with stage I or II breast cancer receiving four cycles of chemotherapy .  METHODS Wrist actigraph , modified Morin Sleep Diary , Symptom Experience Scale , Medical Outcomes Study -Short Form 36 , and Piper Fatigue Scale  were used to collect data two days prior to and during the 21-day cycle 3 , and for three days at three weeks and two months following treatment 4 . MAIN RESEARCH VARIABLES Activity , sleep , symptom distress , health status , and fatigue . FINDINGS Fluctuating patterns of lowered activity , disturbed sleep , mild-to-moderate symptom distress , and moderate fatigue were identified . Mean activity levels ranged from 65%-80 % of norms during and following treatments . Patterns of sleep ( total rest , sleep latency , wake after sleep onset , and sleep efficiency ) differed from established norms . Patients experienced the highest levels of fatigue and symptom distress during the first four days after treatment 3 . Correlates of fatigue were greater symptom distress , lower activity , and poorer physical and social health status ; variables representing disturbed sleep trended toward associations with fatigue . CONCLUSION Activity , sleep , symptom distress , and health status cluster in patterns associated with either lower or higher fatigue . IMPLICATION S FOR NURSING PRACTICE Efforts to manage symptoms , remain active , and obtain quality sleep , especially in women with poorer health status , may assist in modifying fatigue OBJECTIVE The objective was to describe the change in psychosocial state over time and to identify risk factors for maladjustment in gynecologic cancer survivors . Awareness of these issues is important for planning supportive care services for cancer patients . METHODS A longitudinal prospect i ve study of patients with newly diagnosed gynecologic cancer using individual patients as their own control was performed . Patients were interviewed after confirmation of the diagnosis and were reassessed at 6 and 18 months after completion of treatment and with no evidence of recurrent disease . Psychological adjustment was measured by self-rating on self-esteem , outlook on life , self-role , and femininity . Neuroticism and anxiety were assessed using a neuroticism score and the Hamilton Anxiety Scale . Depressive symptoms were question ed directly . Social adjustment was assessed by changes in working capacity or work status , leisure activity , marital relationship , and sexual activity . RESULTS Seventy-four women participated .  Adjustment problems did not occur in the majority of patients . Psychosocial adjustment was different for patients receiving different types of treatments . Improvement in feminism ( P = 0.050 ) and neuroticism ( P = 0.010 ) was observed for patients receiving chemotherapy and deterioration was observed in patients treated with surgery . Deterioration in neuroticism was associated with lower education level ( P = 0.032 ) . With religious belief , there was better family support and more significant improvement in social activity ( P = 0.038 ) . CONCLUSION Most patients adapted well . Patients at risk for psychosocial maladjustment include those who are treated surgically , less educated , and without religious belief PURPOSE Use a proposed case-definition approach to identify the prevalence of  cancer-related fatigue ( CRF )  , demographic , clinical and psychosocial predictors of subsequent CRF , and psychosocial factors associated with concurrent CRF . PATIENTS AND METHODS Women ( n = 288 ) undergoing adjuvant therapy for early-stage breast cancer were recruited from two outpatient clinics . Women completed a baseline assessment before adjuvant therapy and a post-treatment assessment at the conclusion of an initial course of adjuvant chemotherapy or radiotherapy . At both assessment s , women completed a  clinical interview  and measures of  fatigue , distress , coping , and quality of life ( QOL ) . The clinical interview consisted of modules from the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition ( DSM-IV ) and a diagnostic interview to identify cases of CRF . RESULTS CRF prevalence at the baseline and post-treatment assessment s was 10 % and 26 % , respectively . Multivariate analyses identified factors prospect ively associated with greater risk for CRF at the post-treatment assessment , including receipt of adjuvant chemotherapy and a tendency to catastrophize in response to fatigue . Patients with and without CRF differed on a host of concurrent measures of fatigue , depression , functioning , and QOL with mean effect sizes in the range of 1.0 st and ard deviation . CONCLUSION CRF is a clinical syndrome experienced before and during adjuvant therapy for breast cancer . Results suggest CRF has a multifactorial etiology and support use of the proposed case definition approach to defining CRF . Future research is necessary to determine the scientific value of these criteria for underst and ing the etiology and management of fatigue in the oncology setting Objectives Improvements in the life expectancy of women with breast cancer raise important questions how to improve quality of life ( QoL ) for women sustaining complications and side effects of cancer treatment . The presented study examined the prevalence of arm morbidity in a cohort of primary breast cancer patients over time as a result of the extent of axillary lymph node dissection . Of particular interest is the question of using a recognized QoL assessment instrument at defined assessment points as an endpoint criteria of oncological treatment . Methods A prospect i ve , population -based , longitudinal cohort study of patients with primary breast cancer was performed ( n = 389 ) .  QoL data ( EORTC QLQ C30 + BR23 ) and clinical data were assessed at design ated time points . Primary endpoint of this analysis was patient reported arm morbidity assessed with the three-idem scale in the BR 23 ( swelling , moving , pain ) . Results 20 % of the patients evidence d considerable impairments in arm functioning . Arm morbidity was significantly related to the number of lymph nodes dissected ( P < 0.002 entire cohort , P < 0.001 lymph node negatives ) and was independent of age , stage of the disease , kind of breast surgery and radiation treatment . Early impairments in arm functioning ( below 50 score values ) assessed within 6 months after axillary surgery was a good predictor for late arm morbidity at 12 months RR 11.5 ( CI 95 % 4.7–28.4 ) , 24 months RR 6.0 ( CI95 % 2.8–13.3 ) and 36 months RR 3.8 ( CI 95 % 1.8–7.9 ) . Conclusions Arm morbidity after axillary surgery is a severe and chronic condition affecting many breast cancer patients . The recognized QoL assessment instrument depict patients with severe impairments in arm functioning after axillary lymph node dissection and predict late arm morbidity . To increase patients ’ quality of life it thus may serve as a valid assessment tool for screening , allowing early referral for treatment and monitoring Retrospective trials have reported that  chemotherapy‐induced cognitive dysfunction was experienced by a subset of patients with breast carcinoma . However , recent evidence indicated that a subset also exhibited impaired cognitive function at baseline , before the start of chemotherapy . A prospect i ve , longitudinal trial that incorporates baseline neuropsychologic evaluations is necessary to determine to what extent cognitive dysfunction is attributable to chemotherapy in this population While long-term survivors ( 5 years+ ) do not face the stressors of diagnosis and treatment , they continue to face the uncertainties that survivorship brings : recurrence , other cancers , late effects of treatment , and the potential of a shortened life expectancy . This research focuses on the cancer-related health worries of older adult , long-term cancer survivors , the factors that predict these worries , and their link to traditional measures of psychological distress . Specifically , a model is proposed that identifies the personal ( including race and gender ) and illness/treatment characteristics of survivors that are significantly associated with cancer-related health worries and their effects on anxiety and depression . Descriptive and multivariate analyses of a r and om sample of 321 long-term survivors in a major cancer center tumor registry are used to address these issues . About one-third of survivors continue to report worries about recurrence , worries about a second cancer , and worries that symptoms they experience may be from cancer . The regression analyses show that cancer-related health worries is a significant predictor of both depression ( beta=0.36 ) and anxiety ( beta=0.21 ) . Race is a significant predictor ; being African American is related to fewer cancer-related health worries ( beta=-0.22 ) . Having more symptoms during treatment is also a predictor of having more cancer-related health worries ( beta=0.20 ) . The most consistent predictor of psychosocial distress is dispositional optimism/pessimism , with more optimistic individuals reporting fewer cancer-related health worries ( beta=-0.27 ) , lower levels of both anxiety ( beta=-0.16 ) and depression ( beta=-0.23 ) . Overall , for many older adult , long-term survivors , the legacy of cancer continues in terms of cancer-related health worries . In spite of these , for most survivors , their quality of life is not dramatically compromised either physically or psychologically To determine how quality of life changes over time and to assess gender-related differences in quality of life of rectal cancer patients we conducted a 5-year study . Little is known about how quality of life ( QoL ) changes over time in patients after surgery for rectal cancer , and whether gender of the patients is associated with a different perception of QoL. The aim of this study was to assess prospect ively , changes in quality of life after surgery for rectal cancer , with a focus on gender related differences . Over a 5-year period , the EORTC-QLQ-C-30 and a tumor-specific module were prospect ively administered to patients before surgery , at discharge , 3 , 6 , 12 , and 24 months postoperatively . Comparisons were made between female and male patients . A total of 519 patients participated in the study , 264 men and 255 women . The two groups were comparable in terms of surgical procedures , adjuvant treatment , tumor stage , and histology . Most QoL scores dropped significantly below baseline in the early postoperative period . From the third month onward , global health , emotional and physical functioning , improved . Female gender was associated with significantly worse global health and physical functioning and with higher scores on treatment strain and fatigue . Men reported difficulties with sexual enjoyment ; furthermore , over time , sexual problems created high levels of strain in men , worse than baseline levels in the early postoperative period . These problems tended to continue over the course of time . The findings in this study confirm that QoL changes after surgery and differs between men and women . Women appear to be affected by impaired physical functioning and global health . Female gender is associated with significantly higher fatigue levels and increased strain values after surgery . Through impaired sexual enjoyment , men are put more under strain than woman The first aim of this study was to assess prospect ively the incidence of phantom breast sensations ( PB sensations ) and phantom breast pain ( PB pain ) in a sample of patients treated for breast cancer ( n = 204 ) by means of a modified radical mastectomy ( n = 82 ) . Patients were assessed 6 weeks , 6 , 12 and 24 months after mastectomy , by means of a question naire . After 24 months , assessment s of 74 ( 90 % ) patients were available Some breast cancer survivors experience cognitive decline following chemotherapy . We prospect ively examined changes in cognitive performance among high-risk breast cancer patients who had received high-dose chemotherapy with cyclophosphamide , thiotepa , and carboplatin ( CTC group ; n = 28 ) or st and ard-dose chemotherapy with 5-fluorouracil , epirubicin , and cyclophosphamide ( FEC group ; n = 39 ) ; stage-I breast cancer patients who had received no systemic chemotherapy ( no-CT group ; n = 57 ) ; and healthy control subjects ( n = 60 ) . All patients underwent  neuropsychologic testing  before and 6 months after treatment ( 12-month interval ) ; control subjects underwent repeated testing over a 6-month interval . No differences in cognitive functioning between the four groups were observed at the first assessment . More of the CTC group than the control subjects experienced a deterioration in cognitive performance over time ( 25 % versus 6.7 % ; odds ratio [ OR ] = 5.3 , 95 % confidence interval [ CI ] = 1.3 to 21.2 , P = .02 ) . No such difference was observed for the FEC or the no-CT groups ( FEC versus control : OR = 2.2 , 95 % CI = 0.5 to 9.1 , P = .27 ; no-CT versus Control : OR = 2.2 , 95 % CI = 0.6 to 8.0 ; P = .21 ) . Some cytotoxic treatment for breast cancer affects cognition in a subset of women BACKGROUND The purpose of this study is to determine the course of fatigue referring to cognitive symptoms ( scale ' mental fatigue ' ) as well as the motivation to start any activity ( scale ' reduced motivation ' ) , as a function of chemotherapy , in breast cancer patients undergoing adjuvant chemotherapy .  PATIENTS AND METHODS In a prospect i ve cohort study a sample of 157 patients with breast cancer was interviewed at the first , third and fifth cycle of adjuvant chemotherapy as well as 4 and 12 weeks after completion of adjuvant chemotherapy . Patients were treated with st and ard adjuvant chemotherapy , either a doxorubicin containing schedule or CMF ( cyclophosphamide , methotrexate and fluorouracil ) . The psychological dimensions of fatigue were measured by the Multidimensional Fatigue Inventory .  A linear multilevel model was used for analysing the courses . RESULTS The course of mental fatigue and motivation were not affected by the type of chemotherapy . The course of mental fatigue and motivation varied , but seemed to be stable during the treatment of chemotherapy . After the completion of chemotherapy , a weak improvement was seen . Relatively many patients experienced depressive symptoms during the study . These symptoms were correlated with both dimensions of fatigue . At all measurements mental fatigue was influenced by type of operation where women with a mastectomy were significantly more mentally fatigued than women that had undergone a lumpectomy , but nevertheless they were significantly more motivated to start any activity . Age , marital status , number of treatments and the interval between the operation and the first treatment of chemotherapy also seemed to be important determinants . CONCLUSIONS An unequivocal pattern of mental fatigue and reduced motivation during as well as after adjuvant chemotherapy was not found . Depressive symptoms were definitely related to these variables . Type of operation had a significant impact on mental fatigue and motivation to start any activity . Health care providers should be aware of the high rate of patients who experience depressive symptoms during and after the treatment of chemotherapy . Further research should include the trajectory preceding adjuvant chemotherapy and a longer study period afterwards . Moreover , the exact influence of the variables ' age ' , ' marital status ' , ' number of treatments ' and ' the interval between the operation and the first treatment of chemotherapy ' on fatigue is unclear and needs further study PURPOSE To evaluate and compare health-related quality of life ( HRQOL ) after conventional- and high-dose adjuvant chemotherapy in patients with high-risk breast cancer . PATIENTS AND METHODS Patients were r and omly assigned to either a conventional or high-dose chemotherapy regimen ; both regimens were followed by radiotherapy and tamoxifen .  HRQOL was evaluated until disease progression using the Short Form-36 ( SF-36 ) , Visual Analog Scale , and Rotterdam Symptom Checklist and assessed every 6 months for 5 years after r and om assignment . For the SF-36 , data from healthy Dutch women with the same age distribution served as reference values . RESULTS Eight hundred four patients ( conventional-dose chemotherapy , n = 405 ; high-dose chemotherapy , n = 399 ) were included . Median follow-up time was 57 months . Directly after high-dose chemotherapy , HRQOL decreased more compared with conventional chemotherapy for all SF-36 subscales . After 1 year , the reference value of healthy women was reached in both groups . Small differences were observed between the two groups in the role-physical and role-emotional subscales , but 1 year after treatment , these differences were minor and not clinical ly relevant . During follow-up , patients with a lower educational level and many complaints before chemotherapy experienced a worse HRQOL . CONCLUSION Shortly after high-dose chemotherapy , HRQOL was more affected than after conventional-dose chemotherapy . One year after r and om assignment , differences were negligible . Identifying patients who have a higher chance of persistent impaired quality of life after treatment ( which , in the present study , included patients with a lower educational level and many complaints before chemotherapy ) is important and may open the way for better patient-tailored prevention strategies
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