paywalled: Sleep disturbance, cytokines, and fatigue in women with ovarian cancer.

Sleep disturbance, cytokines, and fatigue in women with ovarian cancer.

Abstract

Pro-inflammatory cytokines, such as interleukin-6 (IL-6), have been implicated in the underlying processes contributing to sleep regulation and fatigue. Despite evidence for sleep difficulties, fatigue, and elevations in IL-6 among women with ovarian cancer, the association between these symptoms and IL-6 has not been investigated. To address this knowledge gap, we examined relationships between sleep disturbance, fatigue, and plasma IL-6 in 136 women with ovarian cancer prior to surgery. These relationships were also examined in 63 of these women who were disease-free and not receiving chemotherapy 1 year post-diagnosis. At both time-points, higher levels of IL-6 were significantly associated with sleep disturbances (p<0.05), controlling for potentially confounding biological and psychosocial covariates. Higher IL-6 was significantly associated with fatigue prior to surgery (p<0.05); however, when sleep disturbance was included in the model, the relationship was no longer significant. IL-6 was not significantly associated with fatigue at 1 year. Changes in sleep over time were significantly associated with percent change in IL-6 from pre-surgery to 1 year, adjusting for covariates (p<0.05). These findings support a direct association of IL-6 with sleep disturbances in this population, whereas the relationship between IL-6 and fatigue prior to surgery may be mediated by poor sleep. As this study is the first to examine cytokine contributions to sleep and fatigue in ovarian cancer, further research is warranted to clarify the role of biological correlates of sleep and fatigue in this population.

abstract: [Assessment of health-related quality of life in cancer outpatients treated with chemotherapy] Japanese study

[Assessment of health-related quality of life in cancer outpatients treated with chemotherapy].


Abstract
Purpose: 
Few studies have been conducted to elucidate the health-related quality of life(HR-QOL) of cancer outpatients treated with chemotherapy. In this study, we attempted to determine the physical and psychological distress of cancer outpatients treated with chemotherapy.

Methods:
Two-hundred and ninety-six outpatients with various malignancies, including malignant lymphoma, and esophageal, gastric, pancreatic, colon, lung, breast, ovarian, uterine and skin cancers, were investigated using the Japanese version of the M. D. Anderson symptom inventory from March through June 2010 in Tokyo Medical University Hospital.

Results:
The results of the survey questionnaire indicated that 59 patients suffered from fatigue, 56 experienced numbness or tingling, 48 felt drowsy, 39 had low moods, 40 felt distressed, 38 had no appetite, 38 had dry mouth, 37 were in pain, 37 had disturbed sleep, 31 had shortness of breath, 24 had nausea, 17 suffered from vomiting, and 13 patients had memory problems. Furthermore, these symptoms interfered with work(65 patients), walking(56 patients), mood(52 patients), life enjoyment(49 patients), general activity(49 patients), and relationships with other people(42 patients). Medications prescribed for HR-QOL control were non-steroidal anti-inflammatory drugs (93 patients), morphine(32 patients), and adjuvant analgesics(47 patients).

Conclusion:
The present findings may help in the development of management strategies for physical and psychological distress, and improve HR-QOL of cancer outpatients treated with chemotherapy.

Cancer-Related Fatigue: Integrative Therapies Can Help - Cancerwise | Cancer blog from MD Anderson Cancer Center

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.

abstract: Sympathetic and parasympathetic activity in cancer-related fatigue: More evidence for a physiological substrate in cancer survivors

also media report

"Persistent fatigue that plagues many breast cancer survivors even 10 years after treatment may be caused by the autonomic nervous, U.S. researchers say.'

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.

Perspectives: Sleep Deprivation, Elective Surgical Procedures, and Informed Consent — NEJM (including commentaries)

CBC News (including public commentaries) - Health - Sleepy surgeons a problem: medical journal

EvidenceUpdates- A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy

CONCLUSIONS: Our home-based exercise intervention had no effect on fatigue or related symptoms associated with cancer treatment. The optimal timing of exercise remains to be determined.
IMPLICATIONS FOR PRACTICE: Clinicians need to be aware that some physical activity is better than none, and there is no harm in exercise as tolerated during cancer treatment. Further analysis is needed to examine the adherence to exercise. More frequent assessments of fatigue, sleep disturbance, depression, and pain may capture the effect of exercise.

Comments from Clinical Raters
Oncology - Gynecology

Impact will be muted, as this is a negative trial: exercise is not harmful but doesn't seem to improve any of the outcomes measured, including fatigue.

Host Factors and Cancer Progression: Biobehavioral Signaling Pathways and Interventions — JCO

Abstract

Whereas evidence for the role of psychosocial factors in cancer initiation has been equivocal, support continues to grow for links between psychological factors such as stress, depression, and social isolation and progression of cancer. In vitro, in vivo, and clinical studies show that stress- related processes can impact pathways implicated in cancer progression, including immuno-regulation, angiogenesis, and invasion. Contributions of systemic factors, such as stress hormones to the crosstalk between tumor and stromal cells, appear to be critical in modulating downstream signaling pathways with important implications for disease progression. Inflammatory pathways may also be implicated in fatigue and other factors related to quality of life. Although substantial evidence supports a positive effect of psychosocial interventions on quality of life in cancer, the clinical evidence for efficacy of stress-modulating psychosocial interventions in slowing cancer progression remains inconclusive, and the biobehavioral mechanisms that might explain such effects are still being established. This article reviews research findings to date and outlines future avenues of research in this area.

Review Article: Influence of Viscum album L (European Mistletoe) Extracts on Quality of Life in Cancer Patients: A Systematic Review of Controlled Clinical Studies

Conclusions.
VAEs seem to have an impact on QoL and reduction of side effects of conventional therapies (chemotherapy, radiation) in experimental trials as well as in routine daily application. The influence on fatigue especially should be investigated further.

(abstract) Review: The use of proteomics as a research methodology for studying cancer-related fatigue: a review

Note: limited information in the abstract

Cancer Symptom Clusters: Old Concept But New Data

Abstract:
Individuals with cancer have multiple symptoms, which frequently co-occur. A nonrandom distribution of symptoms suggests a common mechanism. Symptom clusters (SCs) were considered part of various syndromes in the early years of medicine. The SC concept in clinical medicine is old. Symptom clusters were commonly described in the psychology/psychiatry and neurology literature. Symptom cluster may be defined either clinically or statistically. Statistically derived clusters can differ from clinically defined clusters. The clinical importance of statistically derived clusters is unclear. Pain-insomnia-fatigue and pain-depression-fatigue are commonly recognized clinical clusters. Nausea-vomiting and anxiety-depression are also statistically observed clusters.

Placebo Eases Cancer-Related Fatigue - Dr Markman/video

Note: site requires sign on/password - free
short video with Dr Markman - March 26, 2010

Age and gender differences in symptom intensity and symptom clusters among patients with metastatic cancer

Note: abstract denotes 'common cancers' only, no reference to ovarian cancer

"Analyses of symptom clusters revealed that fatigue and drowsiness were included in the cluster of pain, nausea, and appetite in younger but not older patients. In men, pain clustered together with depression and anxiety; for women, physical and psychological symptoms formed separate clusters.

CONCLUSIONS: In patients with advanced cancers, symptom patterns differ according to age and gender. Palliative interventions tailored for symptoms that are more prominent in specific patient subgroups may offer greater therapeutic benefit."

March 23, 2010 - NCI: Fatigue: Is it Normal or Pathological? And How Can We Best Treat It?

"Despite years of scientific study of cancer-related fatigue (CRF), questions related to its definition, measurement, underlying mechanisms, and effective interventions remain unanswered. Yet, the high prevalence of CRF and its negative effects on quality-of-life outcomes, including work and family functioning, make it a critical problem for cancer patients and survivors. Clearly, more research is needed to reduce morbidity associated with this symptom.

To address this, on April 13 and 14, NCI’s Symptom Management and Health-related Quality of Life Steering Committee will convene a closed-attendance state-of-the-science meeting on CRF, which I will chair. During this meeting, we will summarize the science, address gaps in knowledge that require further study, and develop a focused agenda for future research......

Perhaps the best way to appreciate the urgent need to better understand and treat CRF is from the perspective of cancer patients and survivors who have experienced it. In discussing CRF, invariably they talk about their inability to get out of the house, work, cook meals and do dishes, get up the stairs to go to bed, or do half the things they did before. It is for these reasons that scientists need to fill the gaps in our knowledge of CRF."