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39
THE EXPERIENCE OF CHEMOTHERAPY-INDUCED NEUTROPENIA: QUALITY-OF-LIFE INTERVIEWS
WITH ADULT CANCER PATIENTS. Jeri Ashley, RN, MSN, AOCN®, CCRC, The
West Clinic, Memphis, TN; Daniel Taylor, MS, and Art Houts, PhD, University
of Memphis, Memphis, TN; Barry Fortner, PhD, and Heith Durrence, MS, The
West Clinic, Memphis, TN; and Adrienne Kovacs, MS, University of Memphis,
Memphis, TN.
Background: CIN is a problem for many cancer patients, but its impact
on quality of life (QoL) is not well understood, particularly in those
cases where patients become neutropenic but never develop fever or other
alarming signs of infection. This paper presents the results of a series
of structured interviews with adult cancer patients about the effects
of CIN on QoL.
Methods: Participation was restricted to cancer patients receiving the
first cycle of a 21–28 day myelosuppressive chemotherapy regimen.
Absolute neutrophil count (ANC) was assessed on days 7, 10, 14, 21, and
28 (if necessary). QoL interviews commenced when ANC fell below 1.5 x
109/L and at every time point thereafter. The QoL interviews asked about
the effects of neutropenia since the previous visit in the following areas:
physical feelings and sensations, daily activities, interactions with
others, financial impacts, ability to work, sex life, emotions, satisfaction
with medical care, thoughts about disease, thoughts about treatment procedures,
and overall QoL. All interviews were transcribed and reviewed independently
by two reviewers to isolate specific complaints and problem domains.
Results: 34 patients developed grade 4 neutropenia and were included in
the analysis. 100 QoL interviews (mode per patient = 4) were transcribed,
and two independent raters inductively developed 5 broad categories comprising
80 specific complaint domains. Fatigue was the most common physical symptom
and was described in terms of being tired, exhausted, or weak. Interference
in daily routine and social isolation were also common complaints that
focused on restrictions attributed to being ill and prevention of infection.
Patients reported psychological problems including feelings of reduced
self-worth associated with inability to fulfill normal roles and feelings
of sadness and anxiety about their disease and treatment.
Discussion: The results provide a rich description of the perceived impact
of CIN on QoL and underscore the need for further consideration of treatments
that minimize severity of CIN. Furthermore, the results can serve as a
foundation for the development of neutropenia-specific research and clinical
measures and guide research methods aimed at better understanding of the
effects of CIN and the potential benefit of therapeutic and prophylactic
treatments for CIN.
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