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Reductions in anaemia and fatigue are associated with improvements in productivity in cancer patients receiving chemotherapy

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Abstract

Objective: Cancer-related anaemia is associated with fatigue that adversely affects patients’ everyday functioning and wellbeing. We explore the impact of fatigue on patient productivity and caregiver burden.

Methods: The analyses are based on data from a randomised, open-label, active-controlled, dose-finding trial of darbepoetin alfa among solid-tumour cancer patients with anaemia, who are receiving chemotherapy. Fatigue is assessed with the Functional Assessment of Cancer Therapy (FACT)-Fatigue subscale score. Productivity and caregiver outcomes include time (hours) missed from usual activities, amount of assistance (hours) needed from others, overall ability to perform desired activities and ability to perform family responsibilities. These outcomes are assessed at baseline and the end of the 12-week treatment period. ANOVA and linear regression models are used to evaluate associations.

Results: Patients (n = 300) were aged 61 years on average, with a mean (SD) baseline haemoglobin of 9.9 (0.9) g/dL. FACT-Fatigue subscale score improvements were significantly (p = 0.003) associated with haemoglobin improvements. Over a 2-week period, after controlling for age, sex and disease progression, one-point improvements in FACT-Fatigue subscale scores corresponded to a 1-hour (95% CI 0.5, 1.5) gain in productive time, 0.7-hour (95% CI 0.4, 1.0) reduction in caregiver time and 1.6% (95% CI 1.4, 1.7) improvement in overall activity.

Conclusions: Reducing fatigue is associated with gains in productive time, reductions in caregiver burden and enhanced ability to perform activities. These outcomes may have broader implications for patients’ wellbeing and for the societal impact of cancer-related fatigue and anaemia.

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  1. The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Groopman J, Itri L. Chemotherapy-induced anemia in adults: incidence and treatment. J Nall Cancer Just 1999; 91: 1616–34

    Article  CAS  Google Scholar 

  2. Glaspy J, Bukowski R, Steinberg D, et al. Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. J Clin Oncol 1997; 15: 1218–34

    PubMed  CAS  Google Scholar 

  3. Littlewood TJ, Bajetta E, Nortier JAM, et al. Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 2001; 19: 2865–74

    PubMed  CAS  Google Scholar 

  4. Demetri GD, Kris M, Wade J, et al. Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumour type: results from a prospective community oncology study. J Clin Oncol 1998; 16: 3412–25

    PubMed  CAS  Google Scholar 

  5. Gabrilove JL, Cleeland CS, Livingston RB, et al. Clinical evaluation of once-weekly dosing of epoetin alfa in chemotherapy patients: improvements in haemoglobin and quality of life are similar to three-times-weekly dosing. J Clin Oncol 2001; 19: 2875–82

    PubMed  CAS  Google Scholar 

  6. Richardson A. Fatigue in cancer patients: a review of the literature. Fur J Cancer Care (Engl) 1995; 4: 20–32

    Article  CAS  Google Scholar 

  7. Curt G, Breitbart W, Cella D, et al. Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 2000; 5: 353–60

    Article  PubMed  CAS  Google Scholar 

  8. Cella D, Peterman A, Passik S, et al. Progress toward guidelines for the management of fatigue. Oncology 1998; 12: 369–77

    PubMed  CAS  Google Scholar 

  9. Lyman GH, Berndt ER, Kallich JD, et al. The economic burden of anemia in cancer patients receiving chemotherapy. Value Health 2005; 8 (2): 149–56

    Article  PubMed  Google Scholar 

  10. Berndt E, Crown W, Kallich J, et al. The impact of anaemia and its treatment on employee disability and medical costs. PharmacoEconomics 2005; 23 (2): 183–92

    Article  PubMed  Google Scholar 

  11. Glaspy J, Jadeja J, Justice G, et al. Darbepoetin alfa given every 1 or 2 weeks alleviates anaemia associated with cancer chemotherapy. Br J Cancer 2002; 87: 268–76

    Article  PubMed  CAS  Google Scholar 

  12. Cella D. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 1997; 34 Suppl. 2: 13–9

    PubMed  CAS  Google Scholar 

  13. Cella D. Manual of the Functional Assessment of Chronic Illness Therapy (FACT) Scales, Version 4. Evanston (IL): Center on Outcomes Research and Education, Evanston Northwestern Healthcare and Northwestern University, 1997

    Google Scholar 

  14. Cella D, Lai J, Chang C, et al. Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 2002; 94: 528–38

    Article  PubMed  Google Scholar 

  15. Cella D, Eton D, Lai J, et al. Combining anchor and distribution based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) Anemia and Fatigue Scales. J Pain Symptom Manage 2002; 24: 547–61

    Article  PubMed  Google Scholar 

  16. Hedenus M, Adriansson M, San Miguel J, et al. Efficacy and safety of darbepoetin alfa in anaemic patients with lymphoproliferative malignancies: a randomized, double blind, placebo-controlled study. Br J Haematol 2003; 122: 394–403

    Article  PubMed  CAS  Google Scholar 

  17. Vansteenkiste J, Pirker R, Massuti B, et al. Double-blind, placebo-controlled, randomized phase III trial of darbepoetin alfa in lung cancer patients receiving chemotherapy. J Nall Cancer Inst 2002; 94: 1211–20

    Article  CAS  Google Scholar 

  18. National Comprehensive Cancer Network, Inc. Clinical practice guidelines in oncology: cancer-related fatigue. Version 1, 2004 [online]. Available from URL: http://www.neen.org/professionals/physician-gls/PDF/fatigue.pdf [Accessed 2005 Mar 29]

  19. Kallich J, Tchekmedyian NS, Damiano A, et al. Psychological outcomes associated with anemia-related fatigue in cancer patients. Oncology (Huntingt) 2002 Sep; 16 (9 Suppl. 10): 117–24

    Google Scholar 

  20. Barnett A, Cremieux PY, Fendrick AM, et al. Anemia-related costs for cancer patients. J Managed Care Med 2002; 6: 20–8

    Google Scholar 

  21. Osterborg A, Brandberg Y, Molostova V, et al. Randomized, double-blind, placebo-controlled trial of recombinant human erythropoietin, epoetin beta, in hematologic malignancies. J Clin Oncol 2002; 20: 2486–94

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This research was supported by Amgen, Inc., Thousand Oaks, California, USA.

Ernst Berndt was responsible for the conceptual and statistical approach to the data and analysis, writing of sections and overall responsibility for content and analysis. Dr Berndt has had a consulting contract with Amgen, Inc. Anne McDermott and Xiao Xu were responsible for the statistical approach, writing of sections of the manuscript and completion of statistical analyses. Neither have individual conflicts of interest but both are employed by Covance Incorporated, which has contracts with Amgen, Inc. Howard Lee and John Glaspy were responsible for the clinical and conceptual approach to the data and analysis, writing of sections and editorial responsibilities. Drs Lee and Glaspy have no conflicts of interest. Joel Kallich was responsbile for the design and execution of the studies/patient-reported outcome data collection, conceptual and statistical approach to analysis and writing of sections. Dr Kallich is an employee of Amgen, Inc., Thousand Oaks, California, USA.

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Authors and Affiliations

  1. Massachusetts Institute of Technology Sloan School of Management, Room E52-452, 50 Memorial Drive, Cambridge, Massachusetts, 02142, USA

    Ernst Berndt

  2. Amgen, Inc., Thousand Oaks, California, USA

    Joel Kallich

  3. Covance Health Economics and Outcomes Services Inc., Gaithersburg, Maryland, USA

    Anne McDermott & Xiao Xu

  4. School of Medicine, University of California Los Angeles, Los Angeles, California, USA

    Howard Lee & John Glaspy

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  1. Ernst Berndt
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  2. Joel Kallich
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  3. Anne McDermott
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  4. Xiao Xu
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  5. Howard Lee
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  6. John Glaspy
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Correspondence to Ernst Berndt.

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Berndt, E., Kallich, J., McDermott, A. et al. Reductions in anaemia and fatigue are associated with improvements in productivity in cancer patients receiving chemotherapy. Pharmacoeconomics 23, 505–514 (2005). https://doi.org/10.2165/00019053-200523050-00009

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