To earn continuing education (CE) credit, follow these instructions:
1. Read the article on page 283. Complete sections A, B, and C* on the enrollment coupon. Each question has only one correct answer.
2. Send the coupon with your $14.95 registration fee to: Continuing Education Department, Lippincott Williams & Wilkins, 345 Hudson Street, New York, NY 10014.
This continuing nursing education (CNE) activity for 2.0 contact hours is provided by Lippincott Williams & Wilkins, which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center’s Commission on Accreditation and by the American Association of Critical-Care Nurses (AACN 9722, Category O). This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP11749 for 2.0 contact hours. Lippincott Williams & Wilkins is also an approved provider of CNE in Alabama, Florida, and Iowa and holds the following provider numbers: AL #ABNP0114, FL #FBN2454, IA #75. All of its home study activities are classified for Texas nursing continuing education requirements as Type I.
*In accordance with the Iowa Board of Nursing Administrative rules governing grievances, a copy of your evaluation of the CE offering (section C) may be submitted directly to the Iowa Board of Nursing.
To provide registered professional nurses with an analysis of a literature review that evaluated the prevalence and course of fatigue in patients with breast cancer and factors related to fatigue.
After you read this article and take this test, you will be able to:
1. Explain the pattern of fatigue in women who have breast cancer.
2. Discuss the factors related to fatigue in women who have breast cancer.
3. Describe the limitations of the studies reviewed and implications for future research.
1. Which of these factors contributes to the impact of fatigue on the quality of life of patients who have cancer?
a. Fatigue is usually a late sign of an abnormality in an individual.
b. Patients are surviving cancer for longer lengths of time.
c. Fatigue in patients who have cancer usually decreases over time.
d. Patients who have cancer usually also experience insomnia.
2. This literature review addressed all of the following questions except
a. to what extent do patients with breast cancer receiving chemotherapy experience fatigue?
b. how does the experience of fatigue in patients with breast cancer receiving chemotherapy change over the course of time?
c. how patients with breast cancer receiving chemotherapy cope with fatigue?
d. what are the factors relating to fatigue in patients with breast cancer receiving chemotherapy?
3. The National Comprehensive Cancer Network (NCCN) defined cancer-related fatigue as
a. an unusual and persistent sense of tiredness.
b. an objective experience related to treatment.
c. generally relieved by prolonged rest.
d. a rapidly developing phenomena.
4. Ream and Richardson’s 1996 study identified that fatigue interferes with an individual’s
b. perceptions of reality.
c. ability to cope with treatment.
d. ability to function to normal capacity.
5. Holley (2000) reported that when compared to “typical fatigue,” cancer-related fatigue
a. is less intense.
b. develops more insidiously.
c. is more energy draining.
d. disappears suddenly.
6. Berger (1998) reports that fatigue levels in patients with breast cancer receiving adjuvant chemotherapy
a. increase over time as patients receive further chemotherapy.
b. were not significantly different 48 hours after each chemotherapy treatment.
c. decrease over time as patients receive further chemotherapy.
d. peak 12-24 hours after the third cycle of chemotherapy.
7. Jacobsen et al (1999) found that when compared to age-matched women with no cancer history, women receiving adjuvant chemotherapy for breast cancer experienced
a. earlier menopause.
b. more frequent bouts of depression.
c. increased episodes of anxiety.
d. significantly worse fatigue.
8. The study by Longman et al (1996) of the prevalence of fatigue among women receiving adjuvant therapy for treatment of cancer failed to distinguish between the
a. ages of the patients in both groups.
b. types of cancer that patients had.
c. kinds of treatment that patients underwent.
d. levels of fatigue that patients experienced.
9. According to Wyatt and Friedman (1998), at which of these points were reports of fatigue most prevalent among women with breast cancer who received adjuvant therapy?
a. 6 weeks
b. 3 months
c. 6 months
d. 1 year
10. Schwartz (2000) identified which of the following as the most common pattern of fatigue among women with breast cancer receiving 3 cycles of chemotherapy?
a. a decline with each cycle of chemotherapy
b. a rapid increase in the first 24-48 hours after chemotherapy
c. a steady decrease between cycles 1 and 2
d. an insidious increase 12-24 hours after each cycle
11. Which of the following statements about the 1991 study by Berglund et al is true?
a. The most commonly reported symptom was pain followed by insomnia.
b. Significant differences were found between the two groups in the reported frequency of fatigue.
c. No data were collected on the time between treatment completion and onset of fatigue.
d. The instrument used was not tested for reliability and validity.
12. Which of these statements accurately reflects the authors’ summary of the reviewed studies?
a. Fatigue is less intense in patients who are treated with surgery alone.
b. The two days prior to a chemotherapy cycle is the worst period for fatigue.
c. Fatigue becomes more intense with each chemotherapy cycle.
d. High prevalence rates of fatigue were found during and after administration of chemotherapy
13. Which of the following was most frequently identified as a factor having a positive relationship to fatigue in the studies reviewed for this article?
d. sleeping problems
14. Which of these factors did Mast (1998), Jacobsen et al (1999), and Okuyama et al (2000) find to have the strongest positive relation with fatigue?
b. biochemical factors
c. concurrent illness
d. type of surgery
15. Response shift can be defined as
a. adapting one’s focus to the “here and now.”
b. developing resistance to external pressures.
c. changing one’s internal standard.
d. decreasing tolerance for unpleasant events.
16. Which of these instructions is most appropriate to give to a woman who is scheduled to have chemotherapy for treatment of breast cancer?
a. “Cancel all your appointments for 3 days before you start chemotherapy and get lots of rest.”
b. “You should plan to rest during the first 48 hours after you receive your chemotherapy treatment.”
c. “You’ll need to take a 6-week leave of absence from work before you begin chemotherapy.”
d. “Try to avoid attending any family functions for 6 weeks after you finish your chemotherapy treatments.”
17. Which of the following factors hindered comparisons between the various studies reviewed by the authors?
a. instruments lacked validity and reliability
b. fatigue was uniformly defined
c. measurement points were uniform
d. measuring instruments were all multidimensional.
18. The authors suggest that further research on this topic is indicated using
a. more heterogeneous samples.
b. designated time points.
c. healthy control subjects.
d. a flexible definition of fatigue.
CONTINUING EDUCATION ENROLLMENT FORM: FATIGUE IN PATIENTS WITH BREAST CANCER RECEIVING ADJUVANT CHEMOTHERAPY: A REVIEW OF THE LITERATURE