paywalled: Treatment of Chemotherapy-Induced Anemia in Ovarian Cancer Patients: Does the Use of Erythropoiesis-Stimulating Agents Worsen Survival?

Treatment of Chemotherapy-Induced Anemia in Ovarian Cancer P... : International Journal of Gynecological Cancer

Abstract

Objective: 

Considering the paucity of data relating erythropoiesis-stimulating agent (ESA) use to ovarian cancer survival, our objective was to evaluate the effect of ESA as used for the treatment of chemotherapy-induced anemia (CIA) on survival in ovarian cancer patients.

Materials and Methods:  

A multi-institution retrospective chart review was performed on ovarian cancer patients. Data collection included patient demographic, surgicopathologic, chemotherapy, ESA, and survival data. Patients were stratified by ever-use of ESA and were compared using appropriate statistical methods.

Results: A total of 581 patients were eligible for analysis with 39% (n = 229) patients with ever-use of ESA (ESA-YES) and 61% (n = 352) never-use ESA (ESA-NO). Mean age was 60.4 years with most patients having stage IIIC (60%) of papillary serous histological diagnosis (64%) with an optimal cytoreduction (67%). Median follow-up for the cohort was 27 months. Both ESA-YES and ESA-NO groups were similar regarding age, body mass index, race, stage, histological diagnosis, and debulking status. Compared with the ESA-NO group, ESA-YES patients were significantly more likely to experience recurrence (56% vs 80%, P < 0.001) and death (46% vs 59%, P = 0.002). Kaplan-Meier curves demonstrated a significant reduction in progression-free survival for ESA-YES patients (16 vs 24 months, P < 0.001); however, overall survival was statistically similar between the 2 groups (38 vs 46 months, P = 0.10). When stratifying by ever experiencing a CIA, ESA-YES patients demonstrated a significantly worse progression-free survival (17 vs 24 months, P = 0.02) and overall survival (37 vs 146 months, P < 0.001).

Conclusions: 

Our data evaluating the use of ESA as a treatment of CIA in ovarian cancer patients are similar to reports in other tumor sites. Considering that patients who used ESA were more likely to experience recurrence and death and to have decreased survival, the use of ESA in ovarian cancer patients should be limited.

abstract: Web-Based Tailored Education Program for Disease-Free Cancer Survivors With Cancer-Related Fatigue: A Randomized Controlled Trial

Web-Based Tailored Education Program for Disease-Free Cancer Survivors With Cancer-Related Fatigue: A Randomized Controlled Trial
  
Abstract

Purpose 

To determine whether an Internet-based tailored education program is effective for disease-free cancer survivors with cancer-related fatigue (CRF). 

Conclusion 

An Internet-based education program based on NCCN guidelines and TTM may help patients manage CRF.

full free access: Cancer-related fatigue: a practical review

Physicians often have insufficient knowledge about fatigue and its treatments or underestimate the impact of fatigue on quality of life, while patients may consider it an unavoidable and untreatable side-effect and fear that reporting it may incite a change toward less aggressive cancer treatment.

Review Article: A Systematic Review of Cancer-Related Fatigue Measurement Questionnaires

Discussion:
Most tools had been validated in mixed populations and are relatively insensitive to differences in fatigue to cancer stage. Most instruments are burdensome for those with advanced cancer.


Conclusions:
In all, 40 CRF instruments were identified. Validity and reliability varied by questionnaire. The ideal item numbers, scale, and domains are not established and may be population dependent.

2nd source: EvidenceUpdates: Cochrane Collaboration review; Drug therapy for the management of cancer-related fatigue including professional comment

2010 Cochrane Collaboration Review: Drug therapy for the management of cancer-related fatigue

Blogger's disclaimer/comments:
1) consumer reviewer of this Cochrane Collaboration review; 
2) a special appreciation to our own ovarian cancer survivors for their input/opinions on this issue
                  ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Note: included in the review were recent studies on the side effects of 
erythropoietin and darbopoetin

Abstract

Background

This is an updated version of the original Cochrane review published in issue 1 2008 (Minton 2008). Cancer-related fatigue (CRF) is common, under-recognised and difficult to treat. There have been studies looking at drug interventions to improve CRF but results have been conflicting depending on the population studied and outcome measures used. No previous reviews of this topic have been exhaustive or have synthesised all available data.

Objectives

To assess the efficacy of drugs for the management of CRF.

Authors' Conclusions
There is increasing evidence that psychostimulant trials provide evidence for improvement in CRF at a clinically meaningful level. There is still a requirement for a large scale RCT of methylphenidate to confirm the preliminary results from this review. There is new safety data which indicates that the haemopoietic growth factors are associated with increased adverse outcomes. These drugs can no longer be recommended in the treatment of CRF. Readers of the first review should re-read the document in full.

Plain language summary

Drugs for cancer-related fatigue
Fatigue associated with cancer is a significant problem. It can occur because of side effects of treatment or because of the disease itself. It can have a significant impact on a person's ability to function. The causes of fatigue are not fully understood and so it is very difficult to treat appropriately. This review has examined drug treatment for fatigue as it represents one of the ways this problem can be tackled. The review authors looked at trials in all types of cancer and at all stages of treatment. Fifty studies met the inclusion criteria but only 31 (7104 participants) were deemed suitable for detailed analysis as they explored fatigue in sufficient detail. They found mixed results with some drugs showing an effect on fatigue - most notably drugs that stimulate red blood cell production and also drugs that improve levels of concentration. Methylphenidate, a stimulant drug that improves concentration, is effective for the management of cancer-related fatigue but the small samples used in the available studies mean more research is needed to confirm its role. Erythropoietin and darbopoetin, drugs that improve anaemia, are effective in the management of cancer-related fatigue. However safety concerns and side effects from these drugs mean that they can no longer be recommended to treat cancer fatigue.

Long-Acting Methylphenidate Falls Short for Cancer Fatigue - Drug not linked to reduced fatigue; may be more helpful in advanced cancer or worse fatigue - ModernMedicine

Editorial: Challenge of Managing Cancer-Related Fatigue JCO

"...Ultimately, the best intervention for CRF will be the development of a personalized treatment plan based on the identification of the main contributing factors to fatigue in a given patient followed by evidence-based combined therapies.
One more important contribution of this study by Moraska et al7**
is that it demonstrates that clinical trials of agents for the management
of fatigue can be successfully completed by cooperative clinical trial
groups. This is of great importance for the development of a body of
knowledge on supportive and palliative interventions for patients
with cancer."

** 7. Moraska AR, Sood A, Dakhil SR, et al: Phase III, randomized, double-blind,placebo-controlled study of long-acting methylphenidate for cancer-related fatigue:NCCTG Trial NO5C7. J Clin Oncol doi: 10.1200.JCO.2010.28.1444

Ovacome :News survey on cancer related fatigue (online) - survey is cancer related fatigue not specific to ovarian cancer

Can you help with research on cancer related fatigue?
"This study on cancer fatigue is being carried out by researchers in the School of Psychology, Trinity College Dublin. The study is funded by the Irish Cancer Society and the Irish Research Council for Science Engineering and Technology."

March 2010
Researchers in Trinity College Dublin are investigating the causes of cancer fatigue and the factors that contribute to the development of chronic fatigue in some cancer patients. The study is funded by the Irish Cancer Society and the IRCSET 'Embark Initiative'.
Who can participate?
Anyone who (a) has been treated for cancer or is currently being treated for cancer and (b) is experiencing fatigue.
What does participation involve?
Participation involves filling in a number of questionnaires about your fatigue, the factors you believe contribute to your fatigue, and the coping strategies you use to manage this symptom.
How can I participate?
If you would like to participate please complete this online questionnaire: http://www.surveymonkey.com/s/CancerFatigueStudy

If you would prefer to complete the questionnaire in hard copy or if you would like further information, please contact the researcher: Maria Pertl (Phone: 01 896 3083 / E-mail: pertlm@tcd.ie).