INTRODUCTION: Cancer-related fatigue is the most frequently reported symptom of patients with cancer. The National Cancer Institute describes it as “an extreme tiredness, one that decreases a patient's ability to function, causing them distress.” The National Comprehensive Cancer Network defines distress as “a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and spiritual crisis.” Hyperarousal is defined here as a heightened state of psychological and physiological tension, and hypervigilance is a state of excessive wakefulness, watchfulness, and arousal. The loss of control, feelings of helplessness and hopelessness, and the unpredictability of brain cancer propel patients into a psychologically complex state. They fear exposure and embarrassment, secondary to their cognitive injuries, and loss of independence and dignity. METHODS: A search was conducted that included the databases OVID Medline, OVID Nursing, and the American Psychological Association's PsycINFO for articles written about cancer symptom clusters, psychological comorbidities related to the diagnosis of brain cancer, and articles about cancer-related fatigue, daytime sleepiness, and insomnia. RESULTS: Some studies supported the theory that the hyperaroused/hypervigilant state related to the psychological comorbidities of depression, anxiety, and stress associated with being diagnosed with brain cancer disrupts patients' Circadian rhythm and thus prohibits them from getting sufficient restorative sleep. Consequently, patients experience daytime sleepiness, which affects all physical and cognitive function and perpetuates the cycle of the psychological comorbidities and hyperaroused/hypervigilant state. CONCLUSION: I hypothesize that this continuous cycle is one of the major contributing factors to brain cancer-related fatigue and one of the most deleterious interferences with the health-related quality of life of patients with brain cancer. BACKGROUND: Patients with primary brain tumors (PBTs) experience psychological distress in several ways during the disease trajectory. Medications can have an important impact on patients' mood during this time. Limited research exists on the association between certain medications and mood disturbance; therefore, opportunities to improve quality of life in this patient population are limited. METHODS: Adult patients with PBT were eligible for participation. Data collection tools included a patient-completed demographic data sheet, an investigator-completed clinician checklist, and the Profile of Mood States-Short Form (POMS-SF), a 37-item assessment of moods within 6 subscales (depression, vigor, anger, tension, confusion, and fatigue) on a 0-4 scale that was used to evaluate patients' mood disturbance. Relationships between mood, concurrent medication use, and demographic characteristics were examined. RESULTS: A total of 168 patients (mean age 43.5 years, range 19-79) completed the POMS-SF. Participants were primarily white (80%) and male (54%) with a variety of brain tumors, most commonly glioblastoma (41%). Current medications included anticonvulsants (70%), corticosteroids (16%), and antidepressants (16%). Participants receiving corticosteroids reportedly had more total mood disturbance (m = 19.72) and less vigor (m = 7.37) than those not taking corticosteroids, who scored higher on the vigor subscale (m = 11.26). Participants receiving anticonvulsants had higher total mood disturbance (m = 14.23) and higher scores on all other subscales, with the exception of vigor (m = 10.48), than those not receiving anticonvulsants, who scored less than half on total mood disturbance (m = 7.62). Participants receiving antidepressants showed high total mood disturbance scores (m = 16.28) than participants not taking antidepressants and had slightly higher scores on the confusion, tension, and fatigue subscales. CONCLUSION: The results indicate the importance of concurrent medication use and the affect it may have on mood disturbance during the illness trajectory. Further studies are needed to focus on this relationship to implement helpful interventions for managing mood disturbance and improving overall well-being.
