Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A co-operative phase II study of the semisynthetic podophyllotoxin derivative Etoposide (VP-16) was undertaken in patients with genitourinary tumors. A total of 83 out of 115 patients entered into the study were evaluable for response. Antitumor effects were evaluated according to "Standards for the Evaluation of Direct Effects of Chemotherapy in Solid Tumors" (otherwise known as the Koyama-Saito Group Criteria). Objective response was noted in 2 patients (6.3%) out of 32 with testicular cancer, whereas no responders were seen in bladder and renal cancer patients. In patients with prostatic cancer, 1 out of 13 (7.7%) responded. Major clinical side effects were alopecia and gastrointestinal toxicities (anorexia, nausea and vomiting). Mucositis, abdominal pain, diarrhea and general fatigue were also noted. Anomalies in laboratory test findings were mainly myelosuppression-related, with leukopenia being observed in 66.3% of patients.
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PMID:[Phase II study of etoposide (VP-16-213) in genitourinary tumors. VP-16-213 Genitourinary Study Group]. 375 24

A phase II study on recombinant human leukocyte A interferon (rIFN-alpha A) was carried out in 30 patients with urogenital cancers. Each patient received rIFN-alpha A by i.m. injection every day for at least 4 weeks. The initial daily dose was 3 X 10(6) U, being escalated at intervals of 3 days or more up to 50 X 10(6) U. The results are summarized as follows: In aged patients, the daily dose appropriate for everyday i.m. injection was considered to be 9 X 10(6) U or below, judging from the adverse reactions observed. According to Koyama and Saito's response criteria, partial response (PR) and minor response (MR) were obtained, respectively, in 3 and 1 out of 12 patients with renal cell carcinoma, while PR was seen in 1 out of 9 with urothelial cancer. No response was observed in patients with testicular cancer and in those with prostatic cancer. Various kinds of adverse reactions were recognized and each patient showed one reaction or more. Fever, fatigue, leukopenia, anemia, thrombocytopenia and elevation of GOT and GPT were observed relatively frequently. Among these, fatigue and thrombocytopenia were regarded as dose limiting factors.
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PMID:[Phase II study of recombinant human leukocyte A interferon on urogenital cancer patients]. 400 82

Recent results demonstrate an emerging role for paclitaxel in patients with urothelial-tract cancer and in patients with testicular cancer. Yielding response rates in the range of 40-50% as a single agent, paclitaxel is one of the most active drugs in metastatic bladder cancer. Ongoing trials of paclitaxel combination chemotherapy with cisplatin or cisplatin and ifosfamide demonstrate substantial objective remission rates above 70% and, in addition, a high range of complete responses. Thus, paclitaxel appears to be an important drug when used as part of first-line combination chemotherapy for metastatic bladder cancer. Ongoing clinical trials focus on the combination of paclitaxel with cisplatin, ifosfamide, gemcytabine, and carboplatin. Furthermore, paclitaxel administration has been demonstrated to be easily applicable to patients with reduced renal function, requiring no dose reduction and producing no increase in toxicity. Future strategies will have to compare the most active paclitaxel combination regimen with first-line MVAC (methotrexate, vinblastine, adriamycin, cisplatin) chemotherapy. Finally, the role of paclitaxel combination regimens needs to be explored in the adjuvant and neoadjuvant setting in patients with bladder cancer. In testicular cancer, paclitaxel has initially been tested in patients with cisplatin-refractory disease. Among 4 consecutive trials involving a total of 83 patients a response rate of 26% has been observed using dose schedules varying from 3-h to 24-h infusions and doses ranging from 175 to 250 mg/m2. The major toxicities of paclitaxel include neutropenia, neurotoxicity, and fatigue syndrome. Currently, combinations of paclitaxel with cisplatin +/- ifosfamide are used as first- or second-line salvage therapy in patients with relapsed metastatic testicular cancer. The German Testicular Cancer Study Group uses a paclitaxel (Taxol, ifosfamide, cisplatin; TIP) combination regimen as salvage treatment. Following the TIP regimen and the application of granulocyte colony-stimulating factor (G-CSF), peripheral blood stem cells (PBSC) are harvested and the patients subsequently receive high-dose chemotherapy with PBSC rescue. Since only a few drugs have demonstrated substantial activity in cisplatin-refractory disease, paclitaxel will be used in early salvage strategies and, possibly, as first-line chemotherapy as a part of platinum-based combination regimens in patients with testicular cancer. Further trials confirming the important role of paclitaxel in this highly curable malignancy and a thorough investigation of its acute and long-term toxicity will be the future tasks.
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PMID:The role of paclitaxel in chemosensitive urological malignancies: current strategies in bladder cancer and testicular germ-cell tumors. 898 35

This synthesis of the literature on the quality of life in relation to radiotherapy is based on 78 scientific articles, including 12 randomized studies, 25 prospective studies, and 20 retrospective studies. These studies involve 9884 patients. Radiotherapy is often organ-preserving, which inherently promotes a better quality of life. Many quality of life aspects related to radiotherapy have been studied, but seldom by prospective randomized studies that compare radiotherapy to other treatment (eg, surgery or chemotherapy). Radiotherapy involves numerous physical and psychological symptoms, mainly during the course of treatment. Examples include skin irritation and fatigue. Radiotherapy directed at the brain has delayed effects, in children treatment carries a substantial risk for lowering the IQ. The risk for encephalopathy in adults is probably underestimated. Patients with cancer in the head and neck may experience adverse side effects in the irradiated area long after the conclusion of radiotherapy. There are no confirmed differences in quality of life between breast cancer patients receiving adjuvant radiotherapy and those receiving chemotherapy. Impotency problems and urinary incontinence appear following radical surgery and radiotherapy for prostate cancer. The risk for delayed complications is low after radiotherapy for testicular cancer. Patients receiving radiotherapy for gynecologic cancers are often troubled by local side effects long after the conclusion of treatment.
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PMID:Radiotherapy for cancer. Quality of life. 915 7

Quality of life (QOL) issues in testis cancer have recently assumed great importance for both physicians and patients. Since most of the patients are going to be long-term survivors, with modern therapeutic approaches, psychosocial difficulties and sexual life problems may become one of the major long-term complications of testis cancer treatment. QOL studies available demonstrate that approximately 10% of the patients will suffer from enduring long-term psychological problems, namely anxiety, depression, fatigue, and disrupted intimate relationships. Since these problems develop unrelated to the therapeutic approach, one has to develop risk profiles predicting psychological illness, such as with psychological counseling, prior to the initiation of the therapy. Impairment of sexual life and infertility distress represent other long-term sequelae of testis cancer treatment. The highest incidence of sexual dysfunction develops within the first 6 months following therapy, with most patients recovering within the next 3 years, resulting in a 15% rate of long-term sexual dysfunction. This relatively high frequency of sexual problems warrants an adequate counseling before and after therapy. Future perspectives of QOL research in testis cancer has to concentrate on the development of a site- specific questionnaire. Since the different therapeutic strategies in clinical stage 1 testis cancer result in the same high cure rates but may encounter various levels of psychosocial distress, QOL appears to represent the most important endpoint end of different treatment modalities in the clinical setting of different treatment modalities and QOL documentation must be integrated in all clinical study protocolls. QOL studies are important issues in the evaluation of each new future method of treatment modality going to be established for testis cancer.
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PMID:Quality-of-life issues in the treatment of testicular cancer. 1046 Apr 6

Testicular cancer is the most common cancer in white males between the ages of 15 and 45 years. Treatment may include the administration of chemotherapy which has been associated with changes in emotional distress, quality of life, and symptom distress in other cancers. The current study was designed to evaluate the course of these constructs in a sample of testicular cancer patients undergoing chemotherapy. Patients completed measures of emotional distress and quality of life prior to, during, and after chemotherapy, with symptom distress measured during chemotherapy. Thirty percent of patients reported moderate to high levels of distress at pre-treatment baseline that was associated with worse quality of life. Initial anxiety and distress decreased and stayed low through chemotherapy and post-treatment follow-up. There were no significant changes in fatigue, nausea or change in appearance during chemotherapy. The results suggest that some patients evidence pre-treatment anxiety and distress that appears to be primarily anticipatory, decreases over the course of chemotherapy, and occurs in the context of improved quality of life and reduced symptom severity. Deleterious changes in emotional distress, quality of life, and symptom distress seen in other cancer populations were not apparent in our sample of testicular cancer patients.
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PMID:Course of distress and quality of life in testicular cancer patients before, during, and after chemotherapy: results of a pilot study. 1468 54

A 39-year-old man whose chief complaints were general fatigue and bloody phlegm was diagnosed with testicular cancer and underwent left high orchiectomy at an affiliated hospital. The histopathologic diagnosis was chorio carcinoma. Several imaging examinations revealed the metastases in the lung, liver, brain, stomach, kidneys and skin. In spite of various chemotherapies, he died 17 months after the operation. Skin metastasis of testicular cancer is very rare and this is the twelfth case reported in the world, to our knowledge. The significance of skin metastasis in testicular cancer is discussed.
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PMID:[Testicular cancer metastatic to multiple organs including the stomach, kidneys, and skin: a case report]. 1668 60

This article examines the metabolic performance of an elite cyclist, Lance Armstrong, before and after his diagnosis with testicular cancer. Although a champion cyclist in 1-day events prior to his diagnosis of testicular cancer at age 25, he was not a contender in multi-day endurance cycle races such as the 3-week Tour de France. His genetic makeup and physiology (high VO2max, long femur, strong heavy build) coupled with his ambition and motivation enabled him at an early age to become one of the best 1-day cyclists in the world. Following his cancer diagnosis, he underwent a unilateral orchiectomy, brain surgery and four cycles of chemotherapy. After recovering, he returned to cycling and surprisingly excelled in the Tour de France, winning this hardest of endurance events 7 years running. This dramatic transformation from a 1-day to a 3-week endurance champion has led many to query how this is possible, and under the current climate, has led to suggestions of doping as to the answer to this metamorphosis. Physiological tests following his recovery indicated that physiological parameters such as VO2max were not affected by the unilateral orchiectomy and chemotherapy. We propose that his dramatic improvement in recovery between stages, the most important factor in winning multi-day stage races, is due to his unilateral orchiectomy, a procedure that results in permanent changes in serum hormones. These hormonal changes, specifically an increase in gonadotropins (and prolactin) required to maintain serum testosterone levels, alter fuel metabolism; increasing hormone sensitive lipase expression and activity, promoting increased free fatty acid (FFA) mobilization to, and utilization by, muscles, thereby decreasing the requirement to expend limiting glycogen stores before, during and after exercise. Such hormonal changes also have been associated with ketone body production, improvements in muscle repair and haematocrit levels and may facilitate the loss of body weight, thereby increasing power to weight ratio. Taken together, these hormonal changes act to limit glycogen utilization, delay fatigue and enhance recovery thereby allowing for optimal performances on a day-to-day basis. These insights provide the foundation for future studies on the endocrinology of exercise metabolism, and suggest that Lance Armstrong's athletic advantage was not due to drug use.
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PMID:Metabolic clues regarding the enhanced performance of elite endurance athletes from orchiectomy-induced hormonal changes. 1709 67

Low-grade inflammatory responses may be related to the pathogenesis of cancer-related fatigue (CRF). We investigated circulating levels of various inflammatory markers in relation to chronic CRF (6 month duration) in Norwegian long-term survivors of testicular cancer (TCSs). We compared 92 TCSs with chronic CRF (cases) to 191 TCS without (controls) at median age 45 years (range 23-73), and median 11 years post-treatment (range 5-20). Chronic CRF was defined using the Fatigue Questionnaire, while plasma concentrations of cytokines and serum CRP were determined by various immunoassays. Higher levels of interleukin-1 receptor antagonist (IL-1ra) (p=.002) and C-Reactive protein (CRP) (p=.036) were found in cases compared to controls. No differences were observed for interleukin-6 (IL-6), soluble Tumor Necrosis Factor Receptor type 1 (sTNF-R1) or neopterin. Both IL-1ra and CRP were correlated with physical but not with mental fatigue. In logistic regression analyses IL-1ra and CRP explained 3.5% and 2.8%, respectively, of the variance in chronic CRF. Single adjustments for depression, anxiety and neuroticism each raised the models' explained variance to approximately 35%. Those factors did not significantly alter the relationship between chronic CRF and IL-1ra/CRP. BMI and smoking emerged as possible confounding factors. These results indicate that chronic CRF in TCSs is associated with higher levels of circulating IL-1ra and CRP, possibly mediated by physiological morbidity. Hence, the findings lend some support to the hypothesis that low-grade inflammatory processes are involved in the pathogenesis of chronic CRF in cancer survivors.
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PMID:Levels of circulating interleukin-1 receptor antagonist and C-reactive protein in long-term survivors of testicular cancer with chronic cancer-related fatigue. 1936 38

The primary objective of this study was to explore approach and avoiding coping strategies in long-term testicular cancer survivors (TCSs) as self-rated by the brief approach/avoidance coping questionnaire (BACQ). As the BACQ is a new instrument, the second objective was to examine critical psychometric properties of the instrument. The third objective was to examine the correlation between the BACQ and established self-rating instruments commonly used in psychosocial oncology to explore if the BACQ added an additional perspective to the characterization of TCSs. In this cross-sectional questionnaire study, 1326 Norwegian TCSs at a mean of 11.3 years (SD 4.2, median 10.7, range 5-21 years) after diagnosis gave information about their medical and social situation, distress, fatigue, quality of life, self-esteem, and neuroticism. The BACQ ratings of the TCSs were compared to those of a control sample of men from the general population (N = 566; NORM). Among TCSs 84% (95% CI 82-86%) used more approach coping, and this proportion did not differ significantly from 86% among NORM (95% CI 83-89%). The mean BACQ approach/avoidance score of TCSs were similar to that observed in NORM adjusted for age and work status (p = 0.33). The BACQ approach/avoidance score showed only moderate associations with established instruments used in psychosocial oncology. TCSs with more avoidance coping (N = 216) differed significantly from TCSs with more approach coping (N = 1110) by showing a lower proportion in paired relations and in paid work, more somatic and mental morbidity, more fatigue and poorer quality of life and self-esteem. In multivariate analyses lower self-esteem, higher cancer-related avoidance, more depression and neuroticism were most strongly associated with avoidant coping. In conclusion, we found that TCSs used similar coping patterns as NORM, avoidant coping was associated with significantly more problems than observed among TCSs who used more approach coping.
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PMID:A study of coping in long-term testicular cancer survivors. 2039 Dec 32


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