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)

Anaemia is common in patients with haematological malignancy, occurring in the majority of patients with malignant disease who are treated with chemotherapy. Most patients will have their anaemia attributed to the cytokine-mediated anaemia of chronic disease. Many of these patients with anaemia will be symptomatic with fatigue, which is the single most important symptom reported. Data from many studies indicate that treatment of patients with anaemia with recombinant human erythropoietin (rHuEpo) will increase their haemoglobin level, decrease transfusion need and also improve their quality of life. Recent clinical and experimental work suggest that improving the haemoglobin level may improve the patients' prognosis but this finding needs to be confirmed. Treatment of anaemia with rHuEpo in patients with cancer may produce many benefits. Unfortunately, rHuEpo is effective in only around 60% of patients, is slow acting and is expensive. These drawbacks have restricted its use in many healthcare systems. However, a failure to treat anaemia may have important adverse effects for the patient both in terms of their quality of life and, just possibly, in terms of their life expectancy.
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PMID:Management options for cancer therapy-related anaemia. 1209 10

The farnesyltransferase inhibitors (FTIs) have been shown in early clinical trials to elicit antitumor actions in a broad range of solid and hematologic malignancies. The mechanism of FTI action involves blockade of farnesyltransferase, an enzyme implicated in multiple cell-signaling pathways involved in proliferation, angiogenesis, or decreased apoptosis. Of the four main classes of FTIs, two orally bioavailable FTIs have advanced farthest in clinical development. ZARNESTRA (formerly R115777, Ortho Biotech Oncology, Raritan, NJ) and Sarasar (formerly SCH66336, Schering-Plough, Kenilworth, NJ) have demonstrated biologic and clinical activity in a range of solid tumors, and Zarnestra phase I trials have documented clinical responses in approximately 30% of patients with high-risk leukemias or myelodysplastic syndrome (MDS). The main across-class toxicities associated with the use of FTIs are myelosuppression and fatigue. Certain toxicities, such as the QTc abnormalities associated with L-778,123, do not appear to be class related. As results of phase II trials with FTIs in acute and chronic myeloid leukemias and in MDS become available, clinicians will learn more about the potential role of this class of targeted anticancer drugs-and possibly about the clinical distinctions among members of this class.
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PMID:Farnesyltransferase inhibitors: novel compounds in development for the treatment of myeloid malignancies. 1221 90

Nursing Science and research within BMT started in the early 80s and has been shown to be a useful contribution to obtain and maintain high standards of care. Trial and error are no longer accepted. The first studies were conducted together with the clinical developments and focused specifically on symptom control and management of the treatment. The term "evidence-based nursing" (EBN) is nowadays often used to describe the influence of research on practice. And yet we find that in general, care given by nurses is not yet based according to the guidelines established by research. There are several reasons why care is not (yet) based on results from research, like language barrier, diversity in health care and nursing educational systems, financial restrains and different roles and perceptions of nurses around the globe. Many nursing or multidisciplinary research studies have been conducted worldwide on areas such as the prevention or care for patients with mucositis, fatigue or pain, care for the central venous access devices, outpatient management of care, care for the donor and aspects of quality of life. Results have implications on practice and start to show their impact on quality of care. Many questions remain unanswered. Results from basic science (e.g. the discussion around fetal liver and embryonic derived stemcells and their use in treatment other than hematologic malignancies) and developments in medical treatments (e.g. introduction of tyrosin-kinase inhibitor, biotherapy and genetherapy) have an impact on nursing and should therefore be investigated closely to develop clinical pathways. It is obvious that much more time, finances, collaboration and support is needed to conduct powerful studies that can influence care for the BMT patient. This presentation will focus on developments through nursing research within the field of BMT and discuss gaps that will need to be filled in the near future.
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PMID:Research within the field of blood and marrow transplantation nursing: how can it contribute to higher quality of care? 1243 Sep 39

Anemia is prevalent among cancer patients with hematologic malignancies, with fatigue and weakness, major symptoms of anemia, contributing to diminished quality of life (QOL). Data from several randomized, placebo-controlled clinical trials and three large community-based studies in patients with hematologic malignancies indicate that recombinant human erythropoietin (r-HuEPO, epoetin alfa) can correct anemia, reduce transfusion requirements, and improve QOL. Moreover, a positive relationship has been found between increased hemoglobin (Hb) levels and improvements in QOL assessments, regardless of disease state, with the greatest incremental improvement occurring when Hb increases from 11 g/dL to 12 g/dL (range, 11 to 13 g/dL). This suggests that patients with mild-to-moderate anemia may achieve the greatest QOL benefit from epoetin alfa therapy. Evidence from community-based studies suggests that epoetin alfa administered once weekly has a similar safety and efficacy profile as three-times-weekly administration. Further research is ongoing with less frequent dosing regimens. The beneficial effects of epoetin alfa therapy have been reported in studies involving patients with chronic lymphocytic leukemia (CLL), multiple myeloma, and lymphomas. Evidence also exists that epoetin alfa can benefit patients with myelodysplastic syndromes (MDS), although these results have not been as impressive. Combining epoetin alfa with other cytokine growth factors may confer some additional benefit in these patients, but more rigorous investigation is required.
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PMID:Epoetin alfa as a supportive measure in hematologic malignancies. 1244 49

Cancer patients frequently experience anemia as a complication of chemotherapy. Recent advances in assessing the relationships between anemia, fatigue and quality of life (QOL) in such patients have resulted in a new multidimensional perspective of these parameters. Clinical data suggest that even a mild-to-moderate chemotherapy-induced anemia results in a significant reduction in a patient's energy level and QOL. As recombinant human erythropoetin has recently become available for the treatment of this condition, we performed a review of the incidence and severity of anemia associated with commonly employed chemotherapy regimens in the major non-hematologic malignancies. Although evident flaws in the grading and reporting of treatment-related anemia have limited analysis, the results clearly indicate a relatively high incidence of mild-to-moderate anemia. Research in progress is likely to result in a new classification of chemotherapy-induced anemia that can guide therapeutic interventions on the basis of outcomes and hemoglobin levels. The once widespread belief that lesser degrees of anemia must be endured without treatment may be overcome as greater emphasis is placed on the QOL of the oncology patient. Further insights into the relationships between hemoglobin levels, patient well-being and symptoms may lead to a refinement of current strategies of approaching the treatment of anemia.
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PMID:[Anemia induced by solid tumor chemotherapy]. 1248 77

Anemia is a common finding in patients with hematologic malignancies and most commonly can be attributed to the anemia of chronic disease compounded by the myelotoxic effects of chemotherapy. Symptoms of anemia include fatigue, and the patient's quality of life may be impaired. Possible treatments for the anemia are to do nothing, to transfuse with red cells, or to treat with recombinant human erythropoietin (rhEPO). rhEPO has become standard treatment for the anemia in chronic renal failure and has been successfully used in anemia secondary to malignancy. In patients with lymphoproliferative diseases, rhEPO increases the hemoglobin concentration, decreases the need for transfusion, and improves the patients' quality of life. Disadvantages of rhEPO include its cost, efficacy in only around 60% of patients, and delay of 4 to 8 weeks before maximum benefit is achieved. The anemia in patients with myelodysplasia responds less well to rhEPO. Misuse of rhEPO is common in the clinical setting but usually not of clinical importance. Misuse to enhance sporting prowess is probably rare but has potentially serious consequences.
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PMID:Update on the clinical use and misuse of erythropoietin. 1290 Nov 41

Fatigue and impaired physical performance are common and sometimes serious problems of cancer patients during and after treatment. To avoid fatigue, cancer patients are often advised to rest and downregulate their daily activities. However, these recommendations can cause paradoxical results. Since inactivity induces muscular wasting, prolonged rest can result in further loss of endurance. Recent studies suggest that exercise, as well as behavioral and some psychosocial interventions, may reduce fatigue and improve the performance status of cancer patients. In this paper, we review interventions proposed for the treatment of cancer-related fatigue and present the results of a study about the effects of exercise on the physical performance of patients with hematological malignancies. Sixty-six inpatients (34 men, 32 women) undergoing conventional ( n=45) or high-dose chemotherapy with stem cell rescue ( n=21) for the treatment of a hematological malignancy exercised daily on a treadmill. Physical performance was assessed on admission and once a week during hospitalization (30+/-10 days, range 10-49). Physical performance remained unchanged in a submaximal standard stress test (on admission: 5.5+/-1.4 km/h; midhospitalization: 5.3+/-1.3 km/h; at discharge: 5.5+/-1.3 km/h; p=0.60) despite chemotherapy and its related complications. A significant decrease in the mean hemoglobin concentration (from 10.3+/-2.0 g/dl on admission to 9.6+/-1.2 g/dl at discharge; p=0.03). We conclude that a daily endurance-training program reduces the treatment-related loss of physical performance in patients with hematological malignancies undergoing chemotherapy.
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PMID:Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. 1294 60

Multiple myeloma (MM), a malignancy of the plasma cells, accounts for an estimated 14% of all newly diagnosed hematologic malignancies. Advances in chemotherapy and stem cell transplantation have improved survival rates, but MM remains incurable. Bortezomib (Velcade, Millennium Pharmaceuticals, Inc., Cambridge, MA), a first-in-class proteasome inhibitor, has been approved for patients with MM who have received at least two prior treatments and have demonstrated disease progression on the most recent one. During clinical trials, most side effects were manageable with standard interventions. The most common toxicities were asthenic conditions (fatigue, malaise, and weakness), gastrointestinal disturbances (nausea, vomiting, diarrhea, and constipation), thrombocytopenia, peripheral neuropathy, pyrexia, and anemia. Supportive therapies and strategies for side-effect management can prevent worsening of these symptoms, thereby avoiding dose reductions and treatment delays. Oncology nurses play a key role in ensuring the proper and safe administration of bortezomib and often are the first to identify the signs of side effects. Patient education about anticipated side effects and close monitoring of patients can lead to symptom management interventions that are essential to patient comfort and safety.
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PMID:Bortezomib, a newly approved proteasome inhibitor for the treatment of multiple myeloma: nursing implications. 1551 81

Proteasome inhibitors, a novel class of chemotherapeutic agents, enhance the antitumor efficacy of anthracyclines in vitro and in vivo. We therefore sought to determine the maximum tolerated dose (MTD) and dose-limiting toxicities of bortezomib and pegylated liposomal doxorubicin (PegLD). Bortezomib was given on days 1, 4, 8, and 11 from 0.90 to 1.50 mg/m2 and PegLD on day 4 at 30 mg/m2 to 42 patients with advanced hematologic malignancies. Grade 3 or 4 toxicities in at least 10% of patients included thrombocytopenia, lymphopenia, neutropenia, fatigue, pneumonia, peripheral neuropathy, febrile neutropenia, and diarrhea. The MTD based on cycle 1 was 1.50 and 30 mg/m2 of bortezomib and PegLD, respectively. However, due to frequent dose reductions and delays at this level, 1.30 and 30 mg/m2 are recommended for further study. Pharmacokinetic and pharmacodynamic studies did not find significant drug interactions between these agents. Antitumor activity was seen against multiple myeloma, with 8 of 22 evaluable patients having a complete response (CR) or near-CR, including several with anthracycline-refractory disease, and another 8 having partial responses (PRs). One patient with relapsed/refractory T-cell non-Hodgkin lymphoma (NHL) achieved a CR, whereas 2 patients each with acute myeloid leukemia and B-cell NHL had PRs. Bortezomib/PegLD was safely administered in this study with promising antitumor activity, supporting further testing of this regimen.
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PMID:Phase 1 trial of the proteasome inhibitor bortezomib and pegylated liposomal doxorubicin in patients with advanced hematologic malignancies. 1562 43

Anemia in cancer patients undergoing treatment is common and can cause debilitating symptoms such as fatigue and reduced exercise tolerance. The introduction of recombinant human erythropoietin represents a potential improvement in the treatment of this condition. Clinical studies in patients with solid tumors and nonmyeloid hematologic malignancies have convincingly shown an improvement in mean hemoglobin concentration, a reduction in transfusion requirement along with an improvement in quality of life scores, although an effect on survival is less clear. In myeloid disorders such as myelodysplasia, response to single-agent recombinant human erythropoietin is disappointing but significant synergism with granulocyte colony stimulating factor has been demonstrated and different dosing regimens may also improve response. Unfortunately, a significant proportion of patients remain refractory to treatment. Efforts have been made to identify treatable causes of erythropoietin refractoriness, such as functional iron deficiency, and concomitant intravenous iron supplementation does appear to improve response rates. The search for pretreatment factors that predict response has been largely disappointing, although a promising model for myelodysplasia has been developed that awaits large-scale evaluation. Recombinant human erythropoietin is well tolerated, although there were concerns in the late 1990s due to a rising incidence of pure red cell aplasia in chronic renal failure patients treated with subcutaneous Eprex (Ortho Biologics) in Europe. Since potentially contributory manufacturing processes have been identified and corrected, the incidence of this complication has been falling.
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PMID:Epoetin alfa: basic biology and clinical utility in cancer patients. 1633 85


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