Monday, November 21, 2005

Fatigue after breast cancer treatment & a review of treatment for cancer-related anorexia in JCO

The current J of Clinical Oncology has several articles of note.
First, a longitudinal look at factors related to fatigue in woman undergoing standard vs. high-dose chemotherapy for breast cancer. This was a prospective study looking at levels of fatigue, mental health, musculoskeletal pain, and hemoglobin/anemia in women receiving standard vs. high-dose chemo for high risk breast cancer. They were followed for 3 years. Fatigue occurred in ~20% of patients, did not change over time, and was not different between the treatment groups. There was a minor relationship between anemia and fatigue, a moderate one between musculoskeletal pain and fatigue, and a strong one between "mental health" and fatigue. This mental health score was derived from the Short Form 36 quality of life assessment & can't directly be used as an index of depression or anxiety or any specific mental health diagnosis. No conclusions can be drawn as to a causative relationship between mental health<-->fatigue<-->pain in any direction; however the relationship between mental health and fatigue was evident at the time of randomization suggesting that it is not a treatment effect.
Also, there's a systematic review of treatment for cancer-related anorexia and weight loss. It is not a metaanalysis due, presumably, to the heterogeneity between the trials; only randomized controlled trials were considered & each was systematically rated for quality however. I won't belabor this: the authors found evidence only for progestins (megestrol and medroxyprogesterone acetate) and corticosteroids for improving appetite or weight gain (which were their major outcome measures). They did mention if quality of life was measured/affected during the trials & it overall appears to be a wash--maybe for methylprednisolone & maybe for MPA. How much, and in what ways, treatment improved QOL was not included in this study. The authors note: "treatment of anorexia alone is unlikely to have a major impact on the course of disease, because tumor biology and the proinflammatory response by the host will not be altered by appetite stimulants." Overall one is left with a sense of therapeutic nihilism about the current state of the art. Anorexia and weight loss are poor prognostic markers, as well as often disturbing to patients and families. A couple treatments for this symptom (progestins and steroids) work, as far as subjectively improving anorexia and curbing weight loss, but evidence of further benefits is small.
Happy Thanksgiving to all of Pallimed's readers. My posts this week will probably be sparse as I celebrate the holiday.

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