Hello jlrrn-ga
Thank you for your generosity. However, I did not want to supply so
little information as an Answer, so I went back and dug around some
more. I did manage to find some extra references that might be useful.
Obviously they will refer to combinations of drugs with or without
radiation, so it’s not possible to pinpoint exactly the effect of any
one agent. URLs are to summaries, except for the first article and
the two statements from the NIH, where they are to the full text. By
the way, the generic name for adriamycin is doxorubicin. I could not
find references to Cytoxin. I’m thinking you might mean Cytoxan
(cyclophosphamide), which is used in chemotherapy. The generic name
for Taxol is paclitaxel. Sometimes, it is possible to find extra
information by searching on generic names. Trying to find information
on long-term immunosuppression following the use of cyclophosphamide
and/or radiation is problematical, because these are used deliberately
for this purpose, eg in transplant recipients. However, I hope that
what I have found will be of relevance to you.
1. Dr Jamey Morgan, a Consultant Clinical Oncologist from Ipswich
Hospital NHS Trust, UK writes in the newsletter of the Lymphoma
Association that
tiredness and lack of stamina following chemotherapy and radiotherapy
“is perhaps one of the most common problems and can take months or
sometimes years to resolve”. If the radiotherapy has been to the
neck, it can cause the thyroid to become underactive, and this might
only appear years later, causing tiredness and lethargy. This can be
treated with replacement thyroxine. However, the cause need not be so
specific. “Both radiotherapy and chemotherapy can damage normal
tissues and may cause long term effects. The effects vary depending on
where the radiotherapy is directed and which chemotherapy drugs you
receive.” “…both radiotherapy to the chest and chemotherapy (in
particular the Anthracyclines), potentially damage the heart”.
http://www.lymphoma.org.uk/support/Newsletter/summer99/Question_Time.htm
2. Bull Cancer 2002 Jul-Aug; Vol 89(7-8):666-70
Cured from Hodgkin's disease [Article in French]
Brice P.
HDJ d'hematologie, Hopital Saint-Louis, 1, avenue Claude-Vellefaux,
75475 Paris
An article on treatment of Hodgkin's disease with chemotherapy (which
includes adriamycin (doxorubicin)) and radiotherapy, which reports:
“At the end most long-term survivors of Hodgkin's disease recover a
normal socioprofessional life, while reporting a longer duration
of fatigue..”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12206979&dopt=Abstract
3. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997 Apr; Vol
83(4):447-52
Five-year follow-up of saliva in patients treated for lymphomas.
Meurman JH, Laine P, Keinanen S, Pyrhonen S, Teerenhovi L, Lindqvist
C.
Institute of Dentistry, University of Helsinki, Finland
This article provides evidence of long-term immunosuppression as
reflected by decreased levels of antibody in saliva (IgA, IgM and IgG
are different types of antibodies) in lymphoma patients given
chemotherapy which included adriamycin.
“…IgA, IgG, and IgM concentrations decreased after chemotherapy.
Significantly lower values were observed at the 5-year examination
than at baseline. This was particularly evident in IgA, which is the
major immunoglobulin in saliva; mean IgA was 70.5 +/- 52.8 mg/mL at
baseline, 35.8 +/- 15.0 mg/mL 5 years later”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9127375&dopt=Abstract
4. National Institutes Of Health, State-Of-The-Science Statement,
Symptom Management in Cancer: Pain, Depression and Fatigue
July 15-17, 2002, Final Statement, October 26, 2002
“Among the most common symptoms of cancer and treatments for cancer
are pain, depression, and fatigue. These symptoms may persist or
appear, even after treatment ends.”
“Major barriers to effective management of fatigue in cancer patients
include a lack of awareness that fatigue is the most prevalent
symptom, lack of knowledge of the causes of fatigue, and lack of
proven methods to treat fatigue. It is not known whether aerobic
exercise programs, primarily conducted in patients with breast cancer,
are feasible for or generalizable to other cancer patients, especially
older patients with other medical conditions. Stimulant medications
have been suggested for improving fatigue in cancer patients but have
not been studied adequately in prospective studies.”
The statement criticizes the quality of studies into these topics.
http://consensus.nih.gov/ta/022/022_statement.htm
5. Adjuvant Therapy for Breast Cancer
National Institutes of Health
Consensus Development Conference Statement
November 1-3, 2000
“The simultaneous combination of chemotherapy plus tamoxifen is
associated with an increased risk of thromboembolism when compared to
tamoxifen alone. Premature menopause, weight gain, and fatigue are the
most frequent ****long-**** and short-term problems that have been
documented.”
http://consensus.nih.gov/cons/114/114_statement.htm#5
6. J Clin Oncol 2001 Jul 1; Vol19(13):3226-3233
Late medical complications and fatigue in Hodgkin's disease survivors.
Knobel H, Havard Loge J, Brit Lund M, Forfang K, Nome O, Kaasa S.
Unit for Applied Clinical Research, Faculty of Medicine, Norwegian
University of Science and Technology, Trondheim, Norway.
“Long-term medical complications, such as cardiac, pulmonary, and
thyroid dysfunction, are frequent among Hodgkin's disease survivors
(HDSs). Chronic fatigue is also highly prevalent among HDSs”
This was a study in 116 patients. “All patients had received
radiotherapy, and 63 patients had received additional chemotherapy. ….
HDSs with pulmonary dysfunction were more fatigued than HDSs with
normal pulmonary function (PF 10.9 v 8.9; P <.05). Gas transfer
impairment was the most prevalent pulmonary dysfunction, and three
times as many patients with gas transfer impairment reported chronic
fatigue (duration, 6 months or longer), compared with patients without
pulmonary dysfunction (48% v 17%, P <.01). No associations were found
between cardiac sequelae or hypothyroidism and fatigue.”
The authors were, however, surprised by the lack of association with a
thyroid effect in this group of patients.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11432890&dopt=Abstract
7. Anticancer Res 2000 Jan-Feb;20(1B):563-568
Treatment modality affects long-term quality of life in gynaecological
cancer.
Carlsson M, Strang P, Bjurstrom C.
Department of Public Health and Caring Sciences, Uppsala, Sweden.
“In order to survey the side effects after cancer treatment, quality
of life data were collected from females in clinical remission…
Patients previously treated with chemotherapy had poorer role- and
cognitive functioning and more problems with fatigue, nausea,
vomiting, dyspnoea, constipation and financial problems, compared with
those not treated with chemotherapy (p < 0.05 to p < 0.01). Those
patients who had been treated with external radiotherapy and/or
brachytherapy had significantly more problems with flatulence and
diarrhoea (p < 0.05 to p < 0.001). In conclusion, patients who
underwent treatment for gynaecological cancer reported long-term side
effects also many years after finishing treatment.”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10769726&dopt=Abstract
8. Cancer Control 1999 May;6(3):256-263
Is Fatigue a Long-term Side Effect of Breast Cancer Treatment?
Jacobsen PB, Stein K.
Psychosocial Oncology Program, H. Lee Moffitt Cancer Center and
Research Institute, Tampa, Florida 33612, USA.
“A review of the literature suggests that breast cancer patients who
undergo adjuvant chemotherapy or autologous bone marrow
transplantation experience clinically significant levels of fatigue
for months or even years following the completion of active treatment.
In contrast, there is little evidence that patients who receive only
regional therapy (ie, surgery plus adjuvant radiotherapy) experience
clinically significant fatigue as a long-term treatment side effect.”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10758555&dopt=Abstract
9. Oncol Nurs Forum 1996 Sep;23(8):1181-1187
Concerns, affect, and cognitive disruption following completion of
radiation treatment for localized breast or prostate cancer.
Walker BL, Nail LM, Larsen L, Magill J, Schwartz A.
University of Utah College of Nursing, Salt Lake City, USA.
In contrast to the previous study, this one does find fatigue related
to radiotherapy:
“Fatigue was the most common long-term side effect.”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8883068&dopt=Abstract
And finally, the one I found before:
7. International Journal of Oncology 2002 Nov; Vol 21(5): pp.
1093-1099
Cancer-related fatigue
Tavio M, Milan I, Tirelli U.
Division of Medical Oncology A, National Cancer Institute, I-33081
Aviano (PN), Italy.
The authors say that fatigue "affects the majority of patients
actively undergoing cancer related therapies, but also a meaningful
number of those who successfully completed therapy and are
disease-free and potentially cured at the end of the treatments."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12370760&dopt=Abstract
I carried out most of the searches on Medline
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi with an additional
search on Google
Search strategy: 1. chemotherapy long-term effects 2. radiotherapy
long-term effects
3. a combination of radiotherapy or the name of each individual drug
as a search term with fatigue or immunosuppression as a search term |
