• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.205-215
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• 2013

Most terminally ill cancer patients experience various physical and psychological symptoms during their illness. In addition to pain, they commonly suffer from fatigue, anorexia-cachexia syndrome, nausea, vomiting and dyspnea. In this paper, I reviewed some of the common non-pain symptoms in terminally ill cancer patients, based on the National Comprehensive Cancer Network (NCCN) guidelines to better understand and treat cancer patients. Cancer-related fatigue (CRF) is a common symptom in terminally ill cancer patients. There are reversible causes of fatigue, which include anemia, sleep disturbance, malnutrition, pain, depression and anxiety, medical comorbidities, hyperthyroidism and hypogonadism. Energy conservation and education are recommended as central management for CRF. Corticosteroid and psychostimulants can be used as well. The anorexia and cachexia syndrome has reversible causes and should be managed. It includes stomatitis, constipation and uncontrolled severe symptoms such as pain or dyspnea, delirium, nausea/vomiting, depression and gastroparesis. To manage the syndrome, it is important to provide emotional support and inform the patient and family of the natural history of the disease. Megesteol acetate, dronabinol and corticosteroid can be helpful. Nausea and vomiting will occur by potentially reversible causes including drug consumption, uremia, infection, anxiety, constipation, gastric irritation and proximal gastrointestinal obstruction. Metoclopramide, haloperidol, olanzapine and ondansetron can be used to manage nausea and vomiting. Dyspnea is common even in terminally ill cancer patients without lung disease. Opioids are effective for symptomatic management of dyspnea. To improve the quality of life for terminally ill cancer patients, we should try to ameliorate these symptoms by paying more attention to patients and understanding of management principles.

• The Journal of Korean Society for Radiation Therapy
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• v.16 no.1
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• pp.79-89
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• 2004

This study carried a comparative analysis of quality of living perceived by cancer and hospiece patients who received radiotheraphy, and influential factors in order to provide basic data for nursing goals and establishment of strategy. The subjects of the study were 50 cancer patients who were more than twenty years old and was receiving radiotheraphy in therapeutic radiology department of C university hospital, and fourteen hospiece patients who were in J hospital in Gwangju. They were conveniently sampled according to the selection standard, and researchers personally interviewed them using questionnaire and patient scripts to obtain necessary data. The results were presented as follows: 1. When cancer and hospiece patients were examined demographically, the number of 60 year-old patients were the most. The subjects whose marriage period was more than thirty-one years were the most. In medical expense, more than $70.0\%$ of the patients bore their expenses themselves. 2. When disease-related characteristics of the cancer and pospiece patients were exmained, more than $75\%$ of the patients had experience of being in hospital, and more than $60.0\%$ experienced operation. However, for prevalence period, $57.5\%$ of the cancer patients had less than six months, and $64.3\%$ of the hospiece patients had more than two years. 3. For physical symptoms of cancer patients, $77.5\%$ had fatigue, $60.0\%$ had loss of appetite, and $52.5\%$ had loss of weight while for the hospiece patients, $100\%$ had loss of weight, and $92.9\%$ had fatigue and loss of appetite. For the cancer patients, $0.0\%$ had swelling, and $7.5\%$ had bleeding, For the hospiece patients, $7.1\%$ had change in skin, and $14.3\%$ had diarrhea. 4. Mean score of the cancer subjects were as follows: family support, social support, emotional and spiritual support, physical symptoms, and periods were 3.87, 2.88, 3.10, 2.80, and 2.94 respectively. Those of the hospiece patients were 3.80, 1.96, 1.58, 2.64 and 3.24 respectively. 5. Mean score of family support of both patients were almost identical, but in character, a considerable difference was found: 3.10 and 1.58. In qualify of living, the mean score of hospiece patients was slightly lower.

• Nuclear Engineering and Technology
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• v.24 no.1
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• pp.98-109
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• 1992

In this study uniaxial cyclic loading tests were performed on Cheon-Ho Mt. Limestone specimens to investigate the fatigue failure behavior. The loading rate was kept constantly at 760kg/$\textrm{cm}^2$/sec under cyclic loading. In order to reveal the fatigue behavior for each rock type, the test results were mutually compared with previous studies carried out on Indiana Limes-tone and Seong-Ju Sandstone. Fatigue data is presented in the form of S-N curves, which illustrate the relationship of maximum applied stress(S) to the number of cycles(N) required to produce failure. For the purpose of comparing the S-N curves for each rock type, the test data were formulated up to 10$^4$cycles and the correlation coefficients(R) on Cheon-Ho Mt. Limestone and Seong-Ju Sandstone specimen are 0.886 and 0.983, respectively. All three rock specimens were found to have shorter fatigue life at higher applied stress levels. The fatigue life for each rock type was considered as no less than 81.5, 70 and 74.8%, for Cheon-Ho Mt. Limestone, Indiana Limestone and Seong-Ju Sandstone, respectively. The comparison in static strength for monotonic loaded specimens and specimens which did not fail even after 10$^4$cycles indicated that the increasing rate of strength was about 6.18 and 10.96% , for Cheon-Ho Mt. Limestone and Indiana Limestone, respectively. Poisson's ratio and volumetric strain for Cheon-Ho Mt. Limestone and Seong-ju Sandstone, tended in all the cases to rapidly increase at higher stress levels and with an increase in number of cycles. This increasing trend becomes rapid and obvious just before failure. Also Poisson's ratio and volumetric strain for each stress level were compared and analyzed at the first cycle and the cycle prior to failure.

• Asian Oncology Nursing
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• v.10 no.1
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• pp.10-18
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• 2010

Purpose: This study was intended to identify the patterns of fatigue and its related factors in patients with stomach cancer during chemotherapy. Methods: Thirty participants (24 males and 6 females) were recruited for this study which utilized a longitudinal and descriptive approach. The research instruments included the Revised Piper Fatigue Scale, Symptom Distress Scale, and Linear Analogue Self Assessment Scale. The participants received 5-FU and Adriamycin at the first week and 5-FU only at the second and third week. The instruments were measured six times in total. The data were analyzed using SPSS 17.0. Results: It was found that fatigue scores in patients with stomach cancer, receiving 5-FU and Adriamycin (FA) regimen, reached the highest level on the third day (F=9.37, p=.024) after the initial infusion, and decreased gradually afterward. The symptom and psychological distress scores illustrated very similar pattern. The concept of multidimensionality of fatigue in patients with stomach cancer was supported in this study, showing that all four dimensions of the scale were positively correlated. Conclusion: The results of this study provided useful information of patients with stomach cancer on fatigue and other related symptoms which they experienced during weekly scheduled chemotherapy with FA regimen.

• Korean Journal of Adult Nursing
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• v.23 no.4
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• pp.386-396
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• 2011

Purpose: This study was conducted to examine the level of physical activities at time points of pre-illness and current treatment, and the differences in body mass index (BMI), anxiety, depression and fatigue according to their physical activity in cancer patients undergoing chemotherapy. Methods: The survey was used with 126 cancer patients undergoing daily chemotherapy at injection room, cancer clinic of C University Hospital in G city. Data were collected from June to September, 2009 using a structured questionnaire. The data were analyzed by descriptive statistics, chi-square, Fisher's exact test and t-test using SPSS/WIN15.0. Results: The significant increase in physical activity was reported from pre-illness to the time in treatment (${\chi}^2$=69.027, p<.001). The anxiety level of the group with increased physical activity was significantly lower than those who did not (t=-2.218, p =.028). There were no significant differences in BMI, depression, and fatigue according to physical activity. Conclusion: The level of physical activity was significantly associated with the anxiety level of the cancer patients undergoing chemotherapy. Cancer patients should been encouraged regular physical activity during chemotherapy treatment. And an appropriative nursing intervention should be established in order to motivate cancer patients to increase physical activity.

• Journal of Korean Biological Nursing Science
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• v.14 no.4
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• pp.258-267
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• 2012

Purpose: The purpose of this study was to identify the relationship between energy intake and fatigue in cancer patients receiving chemotherapy. Methods: A total of 106 subjects had participated in this study. Data were collected at a university hospital in D city from September 1st to November 10th, 2010. Energy intake including carbohydrates, protein and fat was measured by scale and analyzed using Can Pro 3.0 program. Fatigue level was measured by the Revised Piper Fatigue Scale. Data were analyzed using descriptive analysis, t-test, ANOVA and Pearson correlation coefficient with SPSS/WIN 15.0. Results: The mean calorie intake during chemotherapy was $906.53{\pm}201.28Kcal/day$ which was 45.3% of the recommended daily calorie intake. The mean of protein intake level was $43.62{\pm}11.13g/day$, and it was low compared to the recommended daily protein intake. Calories, carbohydrates, and protein levels on 3rd day after chemotherapy were significantly lower than those of 2nd day after chemotherapy (p<.001). The fatigue level during chemotherapy was $5.77{\pm}0.77$ which was moderate level of fatigue. There was a significant negative interrelation between energy intake and fatigue. Conclusion: Theses results suggested that nursing approaches to encourage dietary intake may be helpful to reduce fatigue for cancer patients receiving chemotherapy.

• Korean Journal of Adult Nursing
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• v.17 no.2
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• pp.310-319
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• 2005

Purpose: The purpose of the study is to investigate the degree of fatigue and its related factors in patients with breast cancer. Method: The subjects of this study consisted of 62 breast cancer patients receiving chemotherapy. The Revised Piper Fatigue Scale, Disruption of Usual Activity Scale, Linear Analogue Self Assessment Scale and Self-Care Diary Scale were employed to measure fatigue, disruption of usual activity, mood state and physical symptom respectively. Collected data were analyzed using SPSS-PC to obtain summary statistics for the descriptive analysis, Pearson Correlation, and Stepwise Multiple Regression. Result: The results are as follows. 1. The mean score of the degree of fatigue was 4.82 points indicating moderate level. 2. The mean score of the degree of disruption of usual activity, mood state and physical symptom were 2.66, 5.00, and 4.69 points. 3. Fatigue of the subjects was significantly correlated with disruption of usual activity(r=.517, p<.01), mood state(r=.420, p<.01) and physical symptom(r=.463, p<.01). 4. With the result of stepwise multiple regression, disruption of usual activity, mood state and physical symptom being the three variables which could explain fatigue by 39.1%. The results of this study suggest that comprehensive intervention strategy for fatigue should be developed to maintain quality of life during and following chemotherapy considering these factors.

• Korean Journal of Adult Nursing
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• v.17 no.2
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• pp.298-309
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• 2005

Purpose: The purpose of this study was to investigate the effect of a comprehensive rehabilitation program on grip strength, pinch strength, the shoulder joint function, flexibility, and fatigue in mastectomy patients. Method: The subjects were fifty-five women with breast cancer (27 in the control group and 28 in the experimental group). The subjects in the experimental group participated in a comprehensive rehabilitation program for 10 weeks, which was composed of education, stress management, exercise, and peer support group activity. Results: The results revealed that the increase in grip strength, key pinch, the shoulder joint function, and flexibility (Back & Reach test, Standing & Bending reach test) of the operated extremity, and the decrease in fatigue were significantly higher in the experimental group than in the control group. However, the results revealed that tip strength and palmar pinch of the experimental group increased but there was no significant difference from that of the control group. Conclusions: The 10-week comprehensive rehabilitation program showed much affirmative effect on physical function, and fatigue of breast cancer patients after mastectomy.

• Korean Journal of Adult Nursing
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• v.15 no.1
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• pp.33-44
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• 2003

Purpose: The purpose of this study was to identify the patterns and related factors of fatigue in patients with breast cancer undergoing radiotherapy. Method: 31 women with breast cancer receiving radiotherapy were recruited from the out-patient radiologic clinic of the university hospital in Seoul, Korea over a period of 3 months. Data was collected prospectively concerning three points for $5\frac{1}{2}\;-\;6\frac{1}{2}$ weeks : before radiotherapy(T1), 2 weeks after starting radiotherapy(T2) and the completion of radiotherapy(T3). Data were analysed by repeated measure ANOVA, Pearson correlaton, and multiple regression. Result: 1. Score of fatigue increased significantly over the course of radiotherapy. 2. Score of symptom distress and emotional distress increased and functional status scores decreased significantly over time. 3. Fatigue was positively related with symptom distress and emotional distress and negatively related with functional status over the course of radiotherapy. 4. At T2, emotional distress explained 24.7% of the variation in fatigue. At T3, symptom distress(41.9%) and emotional distress(7.2%) explained the variance in fatigue. Conclusion: The results of this study provided evidence that fatigue increased over the course of radiotherapy and symptom distress and emotional distress were influencing factors of fatigue in this group. The results of this study suggest that comprehensive intervention strategy for fatigue should be developed to maintain quality of life during and following radiotherapy considering these factors.

• Asian Oncology Nursing
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• v.2 no.1
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• pp.72-82
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• 2002

Purpose : To observe changes in side effects and fatigue of the cancer patients receiving radiation therapy on the head/neck and the chest over a period from the start to the end of the therapy, and to analyze correlation between side effects and fatigue. Method : Twenty seven patients receiving radiation therapy 5 days per week for longer than 6 weeks participated in the present study. Fatigue was measured for when healthy, before-, and after-therapy. Side effects was surveyed by structured questionnaire on the last day of each therapy. Result : The results of this study were as follows. 1. Major side effects of the head/neck patients were skin irritation, change of taste, sore throat and xerostomia, while the chest patients experienced fatigue, skin irritation, anorexia, difficulty swallowing and cough increased with therapy. 2. Although fatigue was significantly changed for when healthy and before-therapy (F=60.25, p <.05) and also for before- and after-therapy, no statistical significance was demonstrated in fatigue of both the chest head/neck patients (p> .05). 3. Fatigue and side effects showed high correlation form the 4-th week with after the therapy Conclusion : The present results could be of great use to develop systematic intervention technique, leading to practical help for patients, since side effects and fatigue change to a large degree depending on the disease and the timing and technique of the therapy.