The Clinical Course of Cirrhosis Patients Hospitalized for Acute Hepatic Deterioration: A Prospective Bicentric Study.
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):e2031. doi: 10.1097/MD.2031.The Clinical Course of Cirrhosis Patients Hospitalized for Acute Hepatic Deterioration: A Prospective Bicentric Study.1, , , , , , , , , , , , , .1From the State Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (YS, ZZ, HF, YY, ZC, JS); Department of Infectious Diseases, Ningbo Multiple Organ Injury Research Center, Ningbo No. 2 Hospital, School of Medicine, Ningbo University, Ningbo, China (HY, WZ, JY, YH); Department of Cardiology, Ningbo Multiple Organ Injury Research Center, Ningbo No. 2 Hospital, School of Medicine, Ningbo University, Ningbo, China (HY); Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, China (WS); Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China (QY); and Center for Hepatology, University College London, London, United Kingdom (JL).AbstractPatients with cirrhosis are vulnerable to acute hepatic insults and are more likely to develop rapid hepatic deterioration. The aim of this study is to describe the clinical course of patients with cirrhosis and hospitalized for acute hepatic deterioration (AHD).This is a prospective study involving 163 patients with cirrhosis and AHD. The occurrence of organ failures, systemic inflammatory response syndrome (SIRS), and infections during hospital stay were recorded and the relationship between organ failure and death or SIRS/infection was subsequently analyzed.Of 163 patients, 35 did not develop any organ failure during in-hospital follow-ups (90-day mortality: 0%); 84 had intrahepatic organ failures (IH-OFs, defined by liver and/or coagulation failure) (90-day mortality: 22.0%); and 44 patients developed extra-hepatic organ failures (EH-OFs, defined by kidney, cerebral, circulation, and respiratory failure) on the basis of IH-OF with a 90-day mortality of 90.9%. On multivariable analysis by a Cox proportion hazard model, age, WBC, presence of IH-OF, and EH-OF all predicted 90-day death. A logistic regression analysis identified SIRS being associated with the development of EH-OF. Furthermore, IH-OF at admission and infections occurred during the hospital stay were shown to be another 2 potential risk factors.The clinical course of cirrhosis patients with acute hepatic injury was characterized by 3 consecutive stages (AHD, IH-OF, and EH-OF), which provided a clear risk stratification. The PIRO criteria provided an accurate frame for prognostication of those patients. The systemic inflammatory response syndrome may be a target for blocking the progression to the EH-OF stage. PMID:
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External link. Please review our .Variants of CARD15 are associated with an aggressive clinical course of Crohn's disease--an IG-IBD study.
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):84-92.Variants of CARD15 are associated with an aggressive clinical course of Crohn's disease--an IG-IBD study.1, , , , , , , , , , , , , , .1Gastroenterology Unit, CSS-IRCCS Hospital, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy.AbstractBACKGROUND: Three major variants of the CARD15 gene confer susceptibility to Crohn's disease (CD). Whether or not these variants correlate with specific clinical features of the disease is under evaluation.AIM: We investigated the possible association of CARD15 variants with specific clinical characteristics, including the occurrence of anti-Saccharomyces cerevisiae antibodies (ASCA) and antineutrophil cytoplasmic antibodies (ANCA), in a large cohort of inflammatory bowel disease (IBD) patients and their unaffected relatives.METHODS: Three hundred and sixteen CD patients (156 with positive family history), 408 ulcerative colitis (UC) patients (206 with positive family history), 588 unaffected relatives, and 205 unrelated healthy controls (HC) were studied. Single nucleotide polymorphisms (SNPs) R702W, G908R, and L1007finsC of the CARD15 gene were investigated and correlated to age at diagnosis, gender, family history, localization, extraintestinal manifestations, previous resective surgery, stenosing/fistulizing pattern, ANCA, and ASCA.RESULTS: Compared to HC, the frequencies of all three variants in CD were significantly increased: 8.7% versus 4.1% for R702W (p & 0.006), 7.3% versus 2.7% for G908R (p & 0.002), 9.3% versus 0.7% for L1007finsC (p & 0.00001). At least one risk allele was found in 38.2% (p & 0.0001, compared to HC), 13.7% (NS), and 15.1% of CD, UC, and HC, respectively. The L1007finsC risk allele was also significantly increased in unaffected relatives of familial (9.5%; p & 0.00001), and sporadic CD (9%; p & 0.00001), compared to HC (0.7%). Sixteen healthy relatives, carriers of two risk alleles, were asymptomatic after 5-8 yr of follow-up. CD carriers of at least one variant were younger (p= 0.03), more likely to have ileal localization (p= 0.0001), stenosing pattern (p= 0.01), previous resective surgery (p= 0.0001), and presence of ASCA (p= 0.0001). No difference in SNPs frequency between familial and sporadic cases of CD was found.CONCLUSION: In our population, both familial and sporadic CD patients carrying at least one major variant of CARD15 had an aggressive clinical course.PMID:
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临床表现临床表现 基本解释 临床表现 网络解释1. Clinical Situation& & ● 临床表现(clinical situation) 脓毒症的临床表现● 体温升高、头痛、头昏、食欲不振等 急性中毒症状,且急剧加重,迅速发展● 血液系统改变 黄疸、贫血 (溶血) 皮下淤血 (Cap壁受损、凝血障碍)致病菌进入血液,繁殖并产生大量毒素 各脏器受损的临床表现●脑 神志淡漠,2. clinical manifestation& & [临床表现] (clinical manifestation)参见上述1~4级[诊断](diagnosis)本病依靠病史诊断不难,3~4级患者往往贫血貌,精神萎靡,自干堕落,甚至拒绝治疗,对未来失去信心,得过且过. 3. Clinical features& & Granulomas肉芽肿 0 3+ | Clinical Features临床表现 | Bleeding per rectum直肠出血 3+ 1+4. clinical phenotype& & oxidative phosphorylation 氧化磷酸化 | clinical phenotype 临床表现 | inheritance 遗传临床表现 网络例句1. There are 13 of typical ... & &有典型临床表现的13例，占48％。2. What is the clinical course of this disease? & &该疾患的主要临床表现是什么？3. Methods The clinical data and CT findings of 48 cases were retrospectively analyzed. & &回顾性分析48例直肠癌的临床资料和CT表现。4. Objective:To study the clinical features of patients with senile dementia in the rural areas of China. & &目的 ：探讨农村的老年期痴呆的临床表现。5. Objective:To study the special symptom of thyroid carcinoma in children. & &目的：探讨小儿甲状腺癌的一种特殊临床表现。6. Objective To investigate the clinical manifestations, diagnosis and treatment of tumor in spinal canal. & &目的 总结椎管内肿瘤的临床表现、诊断和治疗。7. Results: 39 cases had typically clinical manifestations(87%). & &结果 具有典型临床表现者39例(87%)。临床表现是什么意思,临床表现在线翻译,临床表现什么意思,临床表现的意思,临床表现的翻译,临床表现的解释,临床表现的发音,临床表现的同义词,临床表现的反义词,临床表现的例句,临床表现的相关词组,临床表现意思是什么,临床表现怎么翻译,单词临床表现是什么意思常用英语教材考试英语单词大全 (7本教材)
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&2016 　京ICP备号-6　京公网安备30　[A case of familial myoclonus showing extremely benign clinical course].
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):430-4.[A case of familial myoclonus showing extremely benign clinical course]. [Article in Japanese]1, , , , .1Department of Internal Medicine, Saga Medical School.AbstractWe report a patient with familial myoclonus showing an extremely benign clinical course. The patient was a 70-year-old woman, who first noticed shaking of hands at age of 25. The symptom did not worsen for more than 40 years. She visited our hospital at the age of 70 because of disturbance in chores because of worsening of her hand shaking in the past one year. A family history showed that 4 members had similar symptoms and that the two were afflicted with fits of loss of consciousness. On neurologic examination, rhythmic myoclonic jerks were noted in all the extremities, more in the upper limbs, both at rest and during action. Tandem gait was mildly disturbed. The remainings of neurologic examination were normal. SEP and jerk-locked back averaging provided evidence of cortical myoclonus. EEG showed multifocal polyspike discharges. Gene analysis for DRPLA, pyruvate and lactate levels in serum and the cerebrospinal fluid, serum amino acid levels, and CSF HVA and 5-HIAA levels were all normal. No brain atrophy was noted in cranial MRI. Myoclonus was markedly reduced after administration of clonazepam. The clinical features and electrophysiological data of our patient are consistent with the clinical diagnosis of familial essential myoclonus and epilepsy/benign adult familial myoclonic epilepsy.PMID:
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External link. Please review our .Frequency, severity, clinical course, and correlates of fatigue in 372 patients during 5 weeks of radiotherapy for cancer - Hickok - 2005 - Cancer -
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BACKGROUNDPatients often describe fatigue as the most distressing of the symptoms they experienced during their cancer treatment. Fatigue may increase from initial levels experienced during cancer treatment with the addition of radiotherapy (RT).METHODSThree hundred seventy-two patients completed a Symptom Inventory at the initiation of RT and weekly for 4 weeks thereafter. Descriptive statistics were used to evaluate differences in fatigue at baseline by demographics and diagnosis. Changes over the course of treatment were evaluated by repeated-measures analysis of variance and Student t tests for paired data. The effect of diagnosis, age, gender, and previous treatment on fatigue was investigated by linear and hierarchical regression.RESULTSFifty-seven percent of patients reported some degree of fatigue at the initiation of RT. The proportion increased to 76% by Week 3 and then to 78% at Week 5. Eighty-four percent of patients with initial fatigue remained fatigued throughout the 5-week course. Of the 160 patients without initial fatigue, 70% subsequently developed it. By Week 5, only 13% of patients had never reported any fatigue. Severity was found to be related to diagnosis, with patients with prostate carcinoma reporting the least severe fatigue and patients with lung, alimentary, and head and neck carcinoma reporting the most severe fatigue. Neither gender, age, nor total dose of RT predicted significant variance in severity.CONCLUSIONSFatigue was a common adverse effect of RT for cancer, reported by more than three-fourths of patients by the third to fifth weeks of treatment. Cancer diagnosis was the only factor found to be significantly related to variation in fatigue severity. Additional studies should be devised to identify other underlying causes of RT-related fatigue. Cancer 2005. & 2005 American Cancer Society.Fatigue is one of the most common adverse effects experienced by patients receiving radiotherapy (RT) for cancer. Cancer-related fatigue has been described by patients as pervasive, unusual, or excessive tiredness that involves the whole body, is disproportionate to or unrelated to activity or exertion, and is usually not relieved by rest or sleep. Several studies have reported that patients describe it as the most distressing of the symptoms they experience during their cancer treatment. In a retrospective chart review of the records of 50 patients receiving RT for lung carcinoma at the James P. Wilmot Cancer Center (JPWCC) at the University of Rochester (Rochester, NY), we found that 39 of 50 patients (78%) who were questioned about symptoms by health care providers reported the presence of fatigue during the course of treatment. In 9 previously published small series of patients undergoing RT for cancer, a very wide variation in the frequency of fatigue was reported, from 31% to 100%, with a mean of 78%. Fatigue may increase from initial levels during cancer treatment with RT. A recently published prospective study of 42 patients undergoing pelvic RT for rectal carcinoma found that 64% of patients in the sample reported an increase in their fatigue over the 4&6-week treatment period.Some investigators have reported that the degree of fatigue varies according to the anatomic area being irradiated. King et al. interviewed 96 patients receiving RT weekly during treatment and found that the frequency of fatigue varied by treatment site, with 93% of patients receiving RT to the chest experiencing fatigue compared with 50% of those with head and neck carcinoma, 72% of those with gynecologic malignancies, and 65% of those with genitourinary carcinomas.Most previous studies of fatigue related to the receipt of RT have involved relatively small patient samples. In the current study, we attempted to confirm and extend earlier findings by prospectively assessing and characterizing the frequency, severity, course, and potential correlates of fatigue experienced by a large sample of 372 patients receiving RT without concurrent chemotherapy for a variety of cancer diagnoses. Each patient voluntarily completed a 1-page Symptom Inventory (SI) weekly for 5 weeks during RT for cancer.MATERIALS AND METHODSPatientsThe convenience sample for the current study comprised 372 patients just beginning RT at the University of Rochester JPWCC. All radiation oncology clinic patients were asked to complete an SI every Monday by a clinical research associate who spent the entire day in the clinic. Patients who completed the SI weekly for & 5 consecutive weeks, indicating that they were receiving nonpalliative RT, were included in the current analysis. Patients received their first RT treatment between January 3, 2001 and March 4, 2004.MethodsAs part of their routine clinical care in the JPWCC Department of Radiation Oncology, patients are asked to fill out the SI before being treated on Monday of each week they receive RT. The symptom inventories are part of the usual clinical chart data reviewed during regular patient follow-up visits. In addition, all patients complete a patient authorization form allowing the information obtained in the SI to be stored in a database that is maintained by the JPWCC Behavioral Medicine Unit for research purposes. Permission to maintain the database and for patient chart review was obtained from the University of Rochester Research Subjects Review Board.All baseline fatigue data were gathered before patients completed their first full week of RT. Patients who began their treatment on a Monday, or had their treatment simulations on a Monday, completed a form that day. That SI was designated the Week 0 SI. Those who started treatment later in the week completed the SI for the first time on a Monday after 1&4 days of treatment. This SI was designated as the Week 1 SI. If an SI was completed at both time points, the form designated Week 0 was
otherwise, the Week 1 form was used.MeasuresDemographicsDemographic and relevant medical information was obtained from a review of patient medical records.Symptom inventoryThe SI is a list of 12 symptoms (fatigue, pain, nausea, sleep disturbance, feeling distressed [upset] shortness of breath, memory, appetite, drowsiness, emesis, skin problems, and urination difficulty) that has been adapted from a similar measure created at The University of Texas M. D. Anderson Cancer Center (Houston, TX) and used by our group in numerous studies of patients with cancer. The 1-page questionnaire consists of a series of scales on which the presence and severity of each symptom are indicated by filling in the appropriate circle on an 11-point horizontal scale anchored by 0 = &Not Present& and 10 = &As Bad As You Can Imagine.& For the assessment of fatigue, patients were asked to rate how severe their &fatigue (tiredness) at its worst& had been in the past week. The presence of any fatigue was defined as a score of & 1 on the scale. Based on the work of Mendoza et al. at the M. D. Anderson Cancer Center during development and validation of the Brief Fatigue Inventory (BFI), we further categorized fatigue as mild (a score of 1&3), moderate (a score of 4&6), and severe (a score of 7&10). The Mendoza group categorized fatigue scores based on the &fatigue worst& item from the BFI (the same question that was used in the current study) and determined that each of these cut points was associated with a large increase in the degree to which the fatigue interfered with patients' ability to function.Statistical AnalysesPatients providing complete data on fatigue measures from just before beginning RT through Week 5 of their treatment, as well as patients for whom pretreatment fatigue severity scores were not collected but who did report fatigue severity at their first treatment week and through Week 5, were included in analyses (n =372). An independent Student t test showed no significant difference between the mean baseline level of fatigue between patients reporting pretreatment and those reporting at Week 1. Consequently, the baseline variable used in analyses is pooled data, representing general initial levels of fatigue among patients beginning RT.All tests for significant differences were performed at the 0.05 level of significance. The Student t tests and one-way analyses of variance (ANOVA) were used to evaluate baseline differences in fatigue frequency and severity by demographic factors and diagnosis. Repeated-measures ANOVA and Student t tests for paired data were used to evaluate the change in fatigue severity over the 5-week time period. The chi-square test and the Student t test were used to determine the significance of differences in fatigue frequency by diagnostic group, and by demographic characteristics as appropriate. One-way ANOVA was used to determine the significance of differences in fatigue severity by diagnostic categories and demographic groups. Repeated-measures ANOVA was used to evaluate changes in fatigue and the effects of diagnosis, age, and gender as potential correlates for the experience of fatigue. The effect of diagnosis, age, gender, and previous treatment on fatigue was also investigated by linear and hierarchical regression.RESULTSPatientsA total of 372 patients who were receiving RT without concurrent chemotherapy provided complete data on fatigue at baseline and weekly thereafter through Week 5 (5 data points: baseline and Weeks 2, 3, 4, and 5). There were no significant differences noted in any demographic or clinical measures (all Ps & 0.05) or in the severity of fatigue (P & 0.05) between patients who completed the SI for the first time before receiving RT (n = 101) and those who completed it for the first time within the first 4 days of RT (n = 271).Of the 372 patients, 206 (55%) were female and 166 (45%) were male. The mean and median age for all patients was 59 years. The mean age for women was 56 years and was 64 years for males. Of the 371 patients for whom information concerning race was available, 343 (92%) were white and 22 (6%) were black. Among the most frequent diagnoses for which patients were receiving RT were the following: breast carcinoma, 158 patients (42% of the 372 patients); prostate carcinoma, 84 patients (22%); brain or peripheral nervous system (PNS) carcinomas, 45 patients (12%); lung carcinoma, 10 patients (3%); head and neck carcinoma, 23 patients (6%); and alimentary tract carcinoma, 12 patients (3%). The remaining 39 patients (10%) had been diagnosed with a variety of soft tissue sarcomas (n = 14), hematologic malignancies (n = 12), gynecologic or genitourinary carcinomas other than prostate carcinoma (n = 1), skin cancer (n = 4), or bone or cartilage carcinomas (n = 6). In one patient, the primary site had not been identified. The sample was characteristic of the clinic population treated at the JPWCC Department of Radiation Oncology. Table
shows the distribution of patients by age, gender, race, and diagnosis.Table&1.&Age, Gender, and Race by Cancer Diagnosis (n = 372)Breast21561459456 (29&91)Prostate840803168 (45&88)Brain/PNS2520432056 (28&85)Head/neck176194061 (28&82)Lung4681165 (56&77)Alimentary111111066 (48&91)Other2217362154 (25&91)Frequency and Severity of Fatigue at BaselineTotal sampleApproximately 57% (n = 212) of the 372 patients indicated they were feeling fatigued at baseline. The mean severity of fatigue for all patients at baseline was 1.9, whereas the mean severity was 3.3 for those who indicated they were fatigued. Eighty-one patients (22%) rated their fatigue severity level as & 4 at the onset of treatment.By demographic characteristics and cancer diagnosisThere were no significant differences noted in the frequency of fatigue at the beginning of RT by age, racial group, or gender (all P values & 0.05), although the difference by gender closely approached statistical significance (P = 0.06) with 61% of women reporting fatigue compared with 52% of men. Fatigue severity at baseline did not vary by demographic characteristics.At the onset of RT, both the frequency and the severity of fatigue varied significantly by cancer diagnosis in the subgroup of 332 patients (89% of the sample) who were being treated for 1 of 6 common malignancies (both Ps & 0.001). Patients with prostate carcinoma were the least likely to report fatigue at the beginning of treatment, with only 35 of the 84 men (42%) indicating the presence of fatigue at the baseline assessment. By contrast, 91 (58%) of the 156 female patients and 2 male patients receiving RT for breast carcinoma, 13 (56%) of 23 patients with head and neck carcinoma, 6 (60%) of 10 with lung carcinoma, 13 (56%) of 23 with alimentary tract carcinomas, and 34 (76%) of 45 with brain or PNS carcinomas were already experiencing fatigue at the beginning of their RT.Frequency and Severity of Fatigue over 5 Weeks of RadiotherapyTotal sampleFor the total sample, the proportion of patients reporting fatigue significantly increased from 57% at baseline to 76% at Week 3 (P & 0.001) after which it increased slightly to 78% at Week 5 (Fig. ). At each assessment point after baseline, a few patients who had been fatigued no longer felt that way whereas others became fatigued. By the 5th week, only 48 (13%) of the 372 patients had never reported any fatigue.Figure&1. Tree diagram of the development of fatigue during radiotherapy.The mean severity of fatigue increased three-fourths of a point from the baseline level of 1.9 to 2.6 at Week 5, a significant 37% increase (P & 0.001). The proportion of patients who rated their fatigue as & 4 also increased significantly from 22% at baseline to 30%, at Week 5 (P & 0.001). The mean fatigue severity for the 179 patients (48%) who reported feeling fatigue at all 5 time points was 3.48 at baseline and worsened significantly over the course of treatment to 3.91 at Week 5 (P & 0.01).Patients with initial fatigueThe presence of fatigue at the initiation of RT was found to be a strong predictor of remaining fatigued throughout the treatment course (P & 0.001). Approximatey 84% (n = 179) of the 212 patients who reported fatigue at the initiation of therapy also reported fatigue at each of the following 4 assessment times. Although there was no significant overall increase in the severity of fatigue over the 5-week period for this subset of patients, greater than one-fourth (59 patients [28%]) of the 212 patients who were experiencing fatigue at baseline had an increase in their fatigue of & 2 points by the 5th week of treatment, and 16 (8%) had an increase of & 4 points.Patients without initial fatigueOf the 160 patients who did not have any fatigue at the start of RT, 70% (112 patients) went on to develop the symptom at some point during the 5-week period. One-third (n = 54) of the patients not experiencing fatigue at baseline reported a fatigue level of & 2 by the 5th week of treatment and 22 patients (14%) reported a fatigue level of & 4. Although the mean fatigue intensity increased steadily and significantly (P & 0.001) over the course of RT for those patients who were not fatigued initially, the severity remained consistently lower than that of fellow patients who reported fatigue at baseline.By diagnosisAs the frequency of fatigue at baseline varied by cancer diagnosis, so the course of fatigue also varied by diagnosis. Patients with prostate carcinoma were the least likely to report fatigue throughout the 5-week period, with the frequency increasing from 42% at baseline to 71% by the 5th week. For patients with breast carcinoma, the frequency increased from 57% at the beginning of treatment to 77% by Week 5. By comparison, the frequency of fatigue was higher at baseline and also remained higher throughout the 5-week period for patients with head and neck (64&93%), alimentary (78&87%), brain or PNS (74&85%), and lung carcinoma (78&93%). Figure
shows the frequency of fatigue at baseline, and at the 3rd and the 5th weeks for all patients by diagnosis. Increases in fatigue were significant at the 0.05 level for patients with head and neck, prostate, and breast carcinomas and marginally significant for those with lung carcinoma (P = 0.06), but were not significant for patients with brain or PNS or gastrointestinal tract carcinomas.Figure&2. Frequency of fatigue during radiotherapy by cancer diagnosis and for all patients. GI: gastrointestinal. Black bars: light-shaded bars: Week 3; dark-shaded bars: Week 5.The likelihood of being fatigued over the entire 5 weeks of RT also differed by diagnosis (P & 0.05). One-third of men with prostate carcinoma reported feeling fatigued throughout the course of RT, compared with approximately one-half of the patients with breast (48%) or head and neck carcinoma (52%) and approximately two-thirds of those with brain or PNS (64%), lung (60%), or alimentary tract carcinoma (67%).Figure
shows the mean fatigue severity at the first, middle, and last time points for all patients and by diagnostic group. For all patients together, and for most diagnoses, fatigue severity increased over the course of treatment. Exceptions were noted for patients with brain or PNS carcinomas, for whom fatigue severity remained relatively high and constant over time, and carcinomas of the gastrointestinal tract, for whom fatigue severity initially increased and then decreased between Weeks 3 and 5. (The graphs in Figures
were restricted to three time points for ease of visual interpretation.)Figure&3. Severity of fatigue during radiotherapy by cancer diagnosis and for all patients. GI: PNS: peripheral nervous system. Black bars: light-shaded bars: Week 3; dark-shaded bars: Week 5.The proportion of patients with fatigue severity of & 4 at Weeks 3 and 5 also varied by diagnosis (P & 0.001 and P & 0.01, respectively). By the 3rd week of treatment, greater than one-half of all patients with lung carcinoma had fatigue of & 4, as did approximately 40% of those with carcinomas of the brain or PNS, gastrointestinal tract, or head and neck compared with 13% of men with prostate carcinoma and 20% of patients with breast carcinoma. Nearly one-third (29%) of those with breast carcinoma and 20% of men with prostate carcinoma reported their fatigue as & 4 by the 5th week of RT.Factors with Potential Influence on the Occurrence of FatigueThe effect of diagnosis, gender, and age on fatigue at each of the five time points was evaluated in a series of hierarchical linear regression equations. Dummy-coded variables for the six most frequent diagnoses were entered together at the first step, gender as the second step, and age was entered at the third step. In these 5 equations, the variance in fatigue severity accounted for by diagnosis ranged from 6.6% to 9.5% (all Ps & 0.001). Neither gender nor age was predictive of fatigue severity at any time point.The effect of previous treatment on fatigue severity was evaluated in a series of regression equations similar to those previously described. As before, diagnosis was entered first followed by previous surgery (yes, no) at Step 2 and previous chemotherapy (yes, no) at Step 3. Diagnosis predicted between 7.0% and 12.1% of the variance in fatigue severity (all P values & 0.01). The latter 2 variables did not consistently account for significant additional variance in fatigue except at Week 5, when previous chemotherapy accounted for an additional 1.5% of the total of 13.7% of the variance explained by the 3 variables (P & 0.05). Repeated-measures ANOVA confirmed these findings.Characteristics of RT such as total dose might also be expected to influence the severity of fatigue. Two regression equations with fatigue severity at Weeks 4 or 5, respectively, as the dependent variable showed that total dose did not account for any additional variance in fatigue beyond that represented by the effect of diagnosis.DISCUSSIONResults from this prospective descriptive study confirm and extend findings from previous smaller studies., ,
Fatigue was present in the majority of patients before they began RT, and developed in the majority of patients who did not report it before the initiation of RT. Over the 5 weeks of treatment, the frequency and severity of fatigue both increased by approximately 30%, with the majority of the increase in frequency occurring by the 3rd week of treatment. Cancer diagnosis was the only factor significantly related to variation in fatigue severity.The presence of fatigue at the initiation of RT in a large proportion of patients suggests that factors related to the cancer itself, or to a non-RT treatment modality, could be associated with the fatigue experienced by patients undergoing RT. Both surgery and chemotherapy are often associated with this symptom and it is conceivable that some of the baseline fatigue could be ascribed to fatigue persisting after primary therapy. However, analysis of our data did not support the hypothesis that previous cancer treatment was a significant factor in the fatigue experienced by these patients. The development of fatigue in a substantial minority of patients who did not report it at the beginning of their RT suggests that the experience of receiving RT in itself contributes to fatigue.For patients, the experience of undergoing RT for cancer encompasses many factors in addition to the effects of ionizing radiation on the body. The treatment regimen, requiring daily trips to the hospital or clinic, involves a radical change in each individual's daily schedule. Even a relatively small amount of fatigue may make those responsibilites especially grueling for those who continue to work outside the home. The anxiety and turmoil surrounding diagnosis, coexisting illnesses, and concurrent medications (factors that were not measured) also could potentially explain some of this fatigue. The psychologic impact of receiving less than desirable prognostic information could also contribute to feelings of anxiety, depression, and fatigue. The majority of patients with lung or head and neck carcinomas in particular have been made aware that the probability of cure for their disease is poor. By contrast, the prognosis for patients with carcinomas of the breast or prostate generally is much more optimistic, perhaps accounting, at least in part, for the somewhat less fatigue reported by these individuals. Patients with cancer diagnoses generally associated with poorer outcomes had more severe fatigue than those with malignancies with more favorable prognosis, giving credence to this hypothesis.Previous studies of other symptoms in patients undergoing treatment for cancer have identified differences by gender or age. For example, younger patients tend to have more chemotherapy-related nausea than older individuals.,
Our data do not support a role for these factors in RT-related fatigue. Some researchers have also found differences in fatigue levels by RT site that could be related to diagnosis and possibly to the amount of RT administered. Other researchers in this field report findings similar to ours that demonstrated a lack of association between RT-associated fatigue and demographic, clinical, and treatment characteristics., Acknowledged limitations of this descriptive study should be briefly mentioned. We did not systematically address potential causes of fatigue. Information related to disease stage and indication for RT (curative or palliative) was not collected directly. However, it is unlikely that any of these patients, all of whom received & 5 weeks of RT, were receiving palliative RT. These omissions may have resulted in more heterogeneous disease categories than would be desirable. Data were not collected regarding comorbid physical illnesses (such as hypothyroidism or congestive heart failure), psychologic states (such as depression), or concurrent medications (e.g., antidepressants) that could contribute to feelings of fatigue. Use of hormone therapy was not assessed, nor were hemoglobin levels systematically surveyed. Sleep quality and functional status, identified in one study as factors predictive of fatigue before the initiation of RT, were not measured. Although it might have been ideal to assess fatigue in a more functional manner, that was not within the scope of this clinical survey. Previous research has indicated that a fatigue level of 4 based on the question and scale used in the current study may result in significant functional impairment. The assessment of the effect of fatigue on patients' ability to function should be included in future work on the nature of fatigue related to receipt of RT.To the best of our knowledge, this is the largest study published to date presenting detailed information regarding the frequency, severity, and course of fatigue during receipt of RT for cancer. The information presented may be of practical importance to clinicians who can more readily identify those patients most likely to develop fatigue and who therefore maybe most likely to benefit from receiving information about its occurrence and interventions to counteract it. Similarly, researchers in the field of cancer control may find the data beneficial in their efforts to develop methods for preventing or reducing fatigue in patients receiving RT for cancer. Future prospective studies should be designed to capture details about RT and associated health conditions that could help discriminate between potential treatable causes of fatigue and take care to assess fatigue in all patients before any RT is administered. Studies that assess fatigue in patients before RT is initiated should question patients about when and under what circumstances they first noted the onset of fatigue after their cancer diagnosis and query them regarding situations or activities that exacerbate or ameliorate it.AcknowledgementsThe authors thank Ms. Leslie Gillies for her assistance with data collection.
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