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The study of assessment and coping of anxiety in cancer patients who received radiotherapy
Proceedings of the 43rd Annual ASTRO Meeting
2285
Assessment of Fatigue in Cancer Patients Undergoing External Radiotherapy
B.M. Biswal1, N. Kumaraswami2 1 Radiotherapy & Oncology, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia, 2Psychiatry, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
Purpose: Fatigue is a multidimensional symptom complex frequently noted among cancer patients. Anti cancer treatments further aggravate fatigue syndrome leading to poor quality of life and discontinuation of useful radiotherapy. Fatigue is an ill-recognized symptom, which most oncologist underevaluate during a course of radiotherapy. In order to evaluate the incidence of radiation induced fatigue, we conducted this study since July 2000. Materials and Methods: This is an ongoing study, where 115 cancer patients on external radiotherapy had completed assessment of fatigue. A 22-item modified Piper Fatigue Score (PFS) containing four dimentions of fatigue were evaluated. There were 6-items for behavioral severity, 5-items for affective meaning, 5-items for sensory, and 6-items for cognitive/mood diemnsions of fatigue. The above fatigue score was assessed in the middle of the external radiotherapy course during usual weekly review of radiotherapy patients. We used conventional fractionated radiotherapy with 2 Gy/day fraction, treating 5-day a week for 5 to 7 week period using a 6 MV linear accelerator. Results: There were 53 men and 62 women in the study with a mean age of 48 year in our study. The sites of irradiation were head and neck (35), breast (16), pelvis (26), brain and spinal cord (9), and other minor sites (29). The median tumor dose delivered to the above site was 45 Gy. The area of the radiation field varied from 25cm2 to 352 cm2 with significant fatigue score encountered with large field area. Significant fatigue score (score ⬎6) was encountered among 50 (43%) patients. The behavioral severity (36%) and affective meaning (21%) dimension of the Piper Fatigue Score (PFS) was affected most than the sensory (15%) or cognitive/mood (7%)dimension. Further patients, exposed to head and neck and pelvic areas had shown higher PFS than breast and other sites. Conclusion: In conclusion, radiation induced fatigue is a very common and under-recognized symptom among cancer patients. Piper Fatigue Score is a very simple system to use during radiotherapy review. A careful detection of fatigue during radiotherapy and appropriate management would improve the compliance of radiotherapy among cancer patients.
2286
The Study of Assessment and Coping of Anxiety in Cancer Patients Who Received Radiotherapy
K.M. Karasawa1, K. Seki1, M. Kohno1, H. Shinoda1, N. Hanyuu1, M. Isobe1, N. Mituhashi1, N. Horikawa2 1 Radiology, Tokyo Women’s Medical University, Shinjuku-ward, Japan, 2Psychiatry, Tokyo Women’s Medical University, Shinjuku-ward, Japan
Purpose: We assessed the coping of anxiety in cancer patients who received radiotherapy by psychiatric methods, and considered how to deal with that as medical staff. Materials and Methods: For one year from September 1999, 116 cases who admitted in our department and agreed on the study were entered. Before radiotherapy, a psychiatrist had an interview in all cases for about one hour. That consisted of questions about socio-demographic and medical characteristics of the patients, followed by additional questions for making the Axis 1 diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV). He also did emotional condition assessment according to the Hamilton racing scale for depression (HAM-D) and for anxiety (HAM-A), asked their anxiety by “Questions about Anxiety of Radiotherapy” by Holland psycho-oncology and requested to write the questionnaire of Profile of mood states (POMS), Dealing with illness (DWI), Mental adjustment to cancer scale(MAC). Excluding 6 cases because of cognitive disorder or brain metastasis, we analyzed 109 cases. The age of the patients ranged from 23 to 84 (median 63). The male to female ratio was 56 to 53. There were 52 Performance Status (PS) 0 cases, 46 cases with PS 1-2, and 11 cases with PS 3-4 before radiotherapy. As for stages, there were 72 cases with initial treatment among them 26 were stage I-II and 46 cases were stage III-IV, and 37 recurrent cases. As for primary site, there were 23 gastrointestinal cases, 23 breast cases, 20 genitourinary cases, 18 head & neck cases, 12 lymphoma cases, 11 lung cases, and so on. As for the treatment intent, 52 cases were treated curatively, 32 were subcuratively and 25 cases palliatively. In 67 cases, interview and tests were repeated after radiotherapy. Results: The contents of explanation were, diagnosis and treatment method in 82 cases, diagnosis, treatment method and good prognosis in 12 cases, diagnosis, treatment method and poor prognosis in 5 cases, diagnosis, treatment method and palliative treatment in 5 cases, one’s remaining life in 1 case and vague diagnosis in one case. The answers concerning the question about the estimation of one’s diagnosis were, suspicious of cancers in 55 cases, not suspicious of cancers in 38 cases, and convinced of cancers in 8 cases. Eight patients answered that they didn’t have a family member they can talk to the problems. Those who were mentally most dependable for the patient were family in 61 cases (56%), the doctor in charge in 34 cases (39%), friend in 4 cases and nurse in 1 case. Prior to radiotherapy, the patients diagnosed as major depressive episode were 15 cases, adaptation disorder were 11 cases, dependence on alcohol were 3 cases, other were 2 and the remaining 78 had no diagnosis according to DSM-IV. Major depressive episode and adaptation disorder were higher in the recurrent cases (recurrent 35% vs. fresh 19%). The average of HAM-D scores was 6.4 before radiotherapy, 5.9 after radiotherapy and that of HAM-D scores was 6.3 before radiotherapy, 5.4 after radiotherapy. These scores were higher in recurrent and/or palliative cases. The scores of low order scales such as depression-dejection, anger-hostility, fatigue, tension-anxiety, confusion in POMS were higher in palliatively treated cases. Following radiotherapy the scores were decreased in most of the cases. In DWI and MAC, the scores of active coping were high in all cases. Concerning radiotherapy, 89% of the cases complained of the anxiety. The anxiety of the advanced stage of their disease because of the use of radiotherapy and the anxiety for the treatment efficacy were high in the palliatively-treated group and after treatment, whereas anxiety for side effects and radiation exposure was high in definitively treated cases and before treatment. Conclusion: From this study it is suggested that for recurrent cases and/or palliatively treated cases it is important to give the support for coping and to give proper informations.
373
2285
Assessment of Fatigue in Cancer Patients Undergoing External Radiotherapy
B.M. Biswal1, N. Kumaraswami2 1 Radiotherapy & Oncology, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia, 2Psychiatry, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
Purpose: Fatigue is a multidimensional symptom complex frequently noted among cancer patients. Anti cancer treatments further aggravate fatigue syndrome leading to poor quality of life and discontinuation of useful radiotherapy. Fatigue is an ill-recognized symptom, which most oncologist underevaluate during a course of radiotherapy. In order to evaluate the incidence of radiation induced fatigue, we conducted this study since July 2000. Materials and Methods: This is an ongoing study, where 115 cancer patients on external radiotherapy had completed assessment of fatigue. A 22-item modified Piper Fatigue Score (PFS) containing four dimentions of fatigue were evaluated. There were 6-items for behavioral severity, 5-items for affective meaning, 5-items for sensory, and 6-items for cognitive/mood diemnsions of fatigue. The above fatigue score was assessed in the middle of the external radiotherapy course during usual weekly review of radiotherapy patients. We used conventional fractionated radiotherapy with 2 Gy/day fraction, treating 5-day a week for 5 to 7 week period using a 6 MV linear accelerator. Results: There were 53 men and 62 women in the study with a mean age of 48 year in our study. The sites of irradiation were head and neck (35), breast (16), pelvis (26), brain and spinal cord (9), and other minor sites (29). The median tumor dose delivered to the above site was 45 Gy. The area of the radiation field varied from 25cm2 to 352 cm2 with significant fatigue score encountered with large field area. Significant fatigue score (score ⬎6) was encountered among 50 (43%) patients. The behavioral severity (36%) and affective meaning (21%) dimension of the Piper Fatigue Score (PFS) was affected most than the sensory (15%) or cognitive/mood (7%)dimension. Further patients, exposed to head and neck and pelvic areas had shown higher PFS than breast and other sites. Conclusion: In conclusion, radiation induced fatigue is a very common and under-recognized symptom among cancer patients. Piper Fatigue Score is a very simple system to use during radiotherapy review. A careful detection of fatigue during radiotherapy and appropriate management would improve the compliance of radiotherapy among cancer patients.
2286
The Study of Assessment and Coping of Anxiety in Cancer Patients Who Received Radiotherapy
K.M. Karasawa1, K. Seki1, M. Kohno1, H. Shinoda1, N. Hanyuu1, M. Isobe1, N. Mituhashi1, N. Horikawa2 1 Radiology, Tokyo Women’s Medical University, Shinjuku-ward, Japan, 2Psychiatry, Tokyo Women’s Medical University, Shinjuku-ward, Japan
Purpose: We assessed the coping of anxiety in cancer patients who received radiotherapy by psychiatric methods, and considered how to deal with that as medical staff. Materials and Methods: For one year from September 1999, 116 cases who admitted in our department and agreed on the study were entered. Before radiotherapy, a psychiatrist had an interview in all cases for about one hour. That consisted of questions about socio-demographic and medical characteristics of the patients, followed by additional questions for making the Axis 1 diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV). He also did emotional condition assessment according to the Hamilton racing scale for depression (HAM-D) and for anxiety (HAM-A), asked their anxiety by “Questions about Anxiety of Radiotherapy” by Holland psycho-oncology and requested to write the questionnaire of Profile of mood states (POMS), Dealing with illness (DWI), Mental adjustment to cancer scale(MAC). Excluding 6 cases because of cognitive disorder or brain metastasis, we analyzed 109 cases. The age of the patients ranged from 23 to 84 (median 63). The male to female ratio was 56 to 53. There were 52 Performance Status (PS) 0 cases, 46 cases with PS 1-2, and 11 cases with PS 3-4 before radiotherapy. As for stages, there were 72 cases with initial treatment among them 26 were stage I-II and 46 cases were stage III-IV, and 37 recurrent cases. As for primary site, there were 23 gastrointestinal cases, 23 breast cases, 20 genitourinary cases, 18 head & neck cases, 12 lymphoma cases, 11 lung cases, and so on. As for the treatment intent, 52 cases were treated curatively, 32 were subcuratively and 25 cases palliatively. In 67 cases, interview and tests were repeated after radiotherapy. Results: The contents of explanation were, diagnosis and treatment method in 82 cases, diagnosis, treatment method and good prognosis in 12 cases, diagnosis, treatment method and poor prognosis in 5 cases, diagnosis, treatment method and palliative treatment in 5 cases, one’s remaining life in 1 case and vague diagnosis in one case. The answers concerning the question about the estimation of one’s diagnosis were, suspicious of cancers in 55 cases, not suspicious of cancers in 38 cases, and convinced of cancers in 8 cases. Eight patients answered that they didn’t have a family member they can talk to the problems. Those who were mentally most dependable for the patient were family in 61 cases (56%), the doctor in charge in 34 cases (39%), friend in 4 cases and nurse in 1 case. Prior to radiotherapy, the patients diagnosed as major depressive episode were 15 cases, adaptation disorder were 11 cases, dependence on alcohol were 3 cases, other were 2 and the remaining 78 had no diagnosis according to DSM-IV. Major depressive episode and adaptation disorder were higher in the recurrent cases (recurrent 35% vs. fresh 19%). The average of HAM-D scores was 6.4 before radiotherapy, 5.9 after radiotherapy and that of HAM-D scores was 6.3 before radiotherapy, 5.4 after radiotherapy. These scores were higher in recurrent and/or palliative cases. The scores of low order scales such as depression-dejection, anger-hostility, fatigue, tension-anxiety, confusion in POMS were higher in palliatively treated cases. Following radiotherapy the scores were decreased in most of the cases. In DWI and MAC, the scores of active coping were high in all cases. Concerning radiotherapy, 89% of the cases complained of the anxiety. The anxiety of the advanced stage of their disease because of the use of radiotherapy and the anxiety for the treatment efficacy were high in the palliatively-treated group and after treatment, whereas anxiety for side effects and radiation exposure was high in definitively treated cases and before treatment. Conclusion: From this study it is suggested that for recurrent cases and/or palliatively treated cases it is important to give the support for coping and to give proper informations.
373