1. Szirony, Tracy A. PhD, RNC, CHPN

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by Roberto Patarca-Montero The Haworth Medical Press, 10 Alice Street, Binghamton New York 13904-1580 Tele: 1-800-HAWORTH (429-6784) US/Canada 1-800-895-0582 (US/Canada) E-mail: Website: Hardcover: $89.95 Softcover: $49.94


The Handbook of Cancer-Related Fatigue, written by Roberto Patarca-Montero, begins with a four-page preface and overview that clearly delineates what the reader can expect from the text. The goal of the book is to define the symptom of fatigue and to provide information related to its assessment and management. It was written for patients who suffer from cancer-related fatigue, their families, and any member of the healthcare profession who would like to gain knowledge of this distressful symptom. Persons suffering from fatigue who are looking for specific information and healthcare professionals who work with any type of patient and any disease process that includes the symptom of fatigue would benefit from the tremendous amount of research-based information that the book contains. Researchers interested in the exploration of this symptom will find the most up-to-date material related to fatigue.


The book is composed of four chapters: Chapter 1, Cancer-Related Fatigue: Definition and Factors that Influence its Recognition and Treatment; Chapter 2, Relevance of Cancer-Related Fatigue to Other Cancer-Related Symptoms and to Cancer Diagnosis, Predisposition, and Treatment; Chapter 3, Possible Causative, Predisposing, and Perpetuating Factors of Cancer-Related Fatigue; and Chapter 4, Treatment of Cancer-Related Fatigue.


Each chapter begins with an outline that allows the reader to identify the contents easily while reading the text. The headings are clearly highlighted in an effort to guide the reader through each chapter. Various charts, tables, and clinical studies are included to support the content and visually represent the subject matter.


Cancer-related fatigue is identified as "the most frequent, distressing, persistent, important, and underdiagnosed, and untreated symptom in cancer medicine."


The problem of fatigue is yet another symptom, such as pain, that needs to be treated to maintain a quality of life important for those with any type of disease, especially those with a chronic or terminal illness. Chapter 1 identifies fatigue as a frequent symptom found while caring for patients with cancer. Numerous studies are referenced, which identify the effect of fatigue as it relates to quality of life. Fatigue is defined as a commonly used term that is often not clearly defined by practitioners. A key concept of this chapter is that fatigue is a subjective symptom, similar to pain. An individual's perception of the symptom and one's coping styles are essential in the determination of the effects of the symptom. Factors that influence a person's perception of fatigue are explored as they relate to quality of life and level of disability. Beliefs of not just the patient but also of healthcare providers affect the identification and treatment of this symptom. Sociodemographic factors are explored as they relate to fatigue. Instruments to measure fatigue are discussed and evaluated as to their usefulness for healthcare providers.


Chapter 2 further discusses fatigue as it relates to quality of life. Again, a plethora of research-based information grounds this discussion. It is in this chapter that cancer-related fatigue is clearly delineated. The relevance of this symptom as a predisposition to cancer, the diagnosis of cancer, the effects of the cancer itself, and treatment measures, such as specific chemotherapeutic agents, immunotherapy, radiation therapy, and surgery, are explored in great detail.


Chapter 3 explores cancer-related fatigue as it relates to potential causes. Patarca-Montero notes that there has been minimal research related to the cause or treatment of cancer-related fatigue. Immunological factors, such as the role of cytokines, humoral immunity, auto-antibodies, a genetic predisposition, inflammatory processes, viral reactivation, endocrine factors, and the role of stress are discussed. Neurological factors, such as autonomic dysfunction, and sleep and circadian rhythms are considered. Cognitive function and psychological and psychiatric factors are also implicated as effects of cancer-related fatigue. Behavior, mood, personality, and social support are identified as factors that may have a significant impact on an individual's specific coping abilities because they are related to the symptom of fatigue.


Chapter 4 contains a thorough discussion of potential treatment measures for cancer-related fatigue. A panel of experts has identified clinical practice guidelines, and these are available from the National Comprehensive Cancer Network. Five factors of fatigue, including pain, emotional distress, sleep disturbance, anemia, and hypothyroidism, should be evaluated as identified by these guidelines. Pharmacologic, nonpharmacologic, and complementary and alternative treatment measures are described. The benefits of graded exercise are noted as one of the most effective nonpharmacologic interventions. Sleep therapy, cognitive-behavioral therapy, and nutritional therapy are other nonpharmacologic interventions. Pharmacological therapy, including erythropoietin, psychostimulants, selective serotonin reuptake inhibitors, and corticosteroids, is considered. Complementary and alternative therapies include a variety of herbal remedies, which are discussed in the text. Massage therapy and acupuncture are also identified as treatments for cancer-related fatigue.


The title of the book, Handbook of Cancer-Related Fatigue, is appropriate because the disease of cancer is discussed throughout, but it must be noted again that this text would be useful for any type of illness or disease that has fatigue as a component. The author is clearly an expert on the symptom of fatigue and has authored a multitude of journal articles and books related to this symptom, a symptom that is more common than many healthcare providers may actually realize. Any healthcare professional will benefit from reading this book, whatever their practice arena entails.


I cannot end this review without mentioning that this book was a bit difficult to read because there were so many references that the content of the text was often hard to follow. It is not the fault of the author, who has obviously done his work; it is only because of the 225 pages of research-based references that the book has been noted as "the most comprehensive text" addressing cancer-related fatigue. I used a yellow highlighter to identify key information pertinent to my practice. Again, researchers will benefit from this book and will be amazed with the valuable references outlined in the text!