Rating the Severity of Side Effects

A little-noticed article in the journal Cancer could have important implications for gauging the severity of side effects suffered by patients during cancer treatment.

Charles Cleeland, Ph.D. and colleagues at the University of Texas M.D. Anderson Cancer Center have developed an easy-to-use patient checklist that appears to accurately assess the severity of most symptoms experienced by cancer patients.

The new "symptom inventory" is easy to complete, taking less than 5 minutes for most patients, and can be performed by the patient at home. It also can be adapted to interactive voice response systems, allowing patients to record their responses and transmit them directly to their healthcare provider.

"Patients frequently hesitate to report symptoms until they reach a severity that requires an emergency room visit or hospitalization," they wrote. This new method of assessment is instant, convenient, and enables physicians to immediately address symptoms that the patient may be experiencing.

The researchers initially tested the system with 527 outpatients and 30 inpatients at M.D. Anderson. After whittling down an original scale that included 26 broad symptoms, they re-tested a smaller, more defined 13-point scale with a separate group of 113 outpatients.

The result was a more targeted rating system that the researchers say accounts for close to two-thirds (64 percent) of the symptoms—including all of the major ones—experienced by cancer patients. These included: pain, fatigue, nausea, disturbed sleep, emotional distress, shortness of breath, lack of appetite, drowsiness, dry mouth, sadness, nausea and vomiting, feeling bloated, and numbness or tingling.

The researchers acknowledged that the scale was not all-inclusive, but they encouraged clinicians to modify its components for individual patients.

Fatigue is the Major Complaint

Interestingly, cancer patients using the M.D. Anderson scale generally rated fatigue as the worst of their complaints, even ahead of pain. Studies show that fatigue affects more than three-quarters of all patients undergoing cancer treatment. It can include feeling tired, weak, exhausted, slow, or simply lethargic.

Fatigue may be acute or chronic. Acute fatigue is normal tiredness with occasional symptoms that begin quickly and last for a short time. Simple rest and "taking it easy" may be all that is necessary to overcome it. Chronic fatigue is longer lasting, however. It can be a direct result of the cancer treatment, or can result from the spread of the cancer itself. It can become physically—and even emotionally—debilitating.

Fatigue can occur for many reasons. It can be caused by anemia, loss of appetite, decreased levels of hormones, medications, emotional distress, difficulty sleeping, pain, and other factors. In the case of radiation, it may also be caused by the increased energy needed to repair damaged skin tissue.

Treatments for fatigue can include certain medications to stimulate blood cell production, or psychostimulant drugs to improve emotional well being. Treatment for chronic fatigue that is related to anemia may include red blood cell transfusions. Beyond these, moderate exercise, sufficient rest, or simply setting priorities in your life, have been shown to result in significant improvements.

Helping Yourself Overcome Fatigue

The American Cancer Society offers the following suggestions for overcoming cancer-related fatigue:

• Get enough rest. Plan your day so you have time to rest. Take short naps or breaks, rather than one long rest period. However, while sleep and rest are important, don’t overdo it. Too much rest can decrease your energy levels. If you have trouble sleeping, talk to your health care professional.
• Stay as active as you can. Regular exercise—especially walking—has been found to be a wonderful remedy for fatigue.
• Save your energy. Spread your activities throughout the day. Take rest breaks between activities to save your strength for the things you want to do. Most of all, prioritize. Decide which activities are really important to you and which ones aren’t.
• Don’t hesitate to ask for help. Ask your family or friends to help with tasks you find difficult or tiring, like mowing the lawn, preparing meals, doing housework, or running errands. Don’t force yourself to do more than you can manage.
• Get support. Join a support group. Sharing your feelings with others can ease the burden of fatigue. And you can learn valuable coping hints from others in your similar situation.
• Eat as nutritiously as you can. Try to eat at least five servings of fruits and vegetables each day. Drink plenty of water and juices.

SOURCES:

Cancer, October 1, 2000; 89:1634-1646
The University of Texas M.D. Anderson Cancer Center (http://www.mdanderson.org)
The American Cancer Society (http://www.cancer.org)

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