Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 31100
Assessing Chemo-Radiotherapy Induced Toxicity and Quality of Life of Cancer Patients

Authors: A. Taqaddas


Chemotherapy and radiotherapy are one of the major treatment modalities that play important role in the management of a number of different cancers. This study for the first time evaluates the toxicity of these treatment modalities and its impact on quality of life of cancer patients in Pakistan. The study also for the first time determines what cancer patients of different ages and cancer stages believe would be an effective intervention to manage their psychosocial needs and treatment induced toxicity. The article also provides evidence based approach for the use of variety of interventions to mange cancer treatment induced morbidity and toxicity. In light of the present study and reviewed research data, evidence based recommendations are also made for selection of appropriate interventions to manage Pain, Nausea and Vomiting, Anxiety and Depression, Fatigue and Overall QOL of cancer survivors.

Keywords: Quality of Life, Chemotherapy Toxicity, Psycho-Social Interventions, Radiotherapy Toxicity

Digital Object Identifier (DOI):

Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 1790


[1] International Agency for Research on Cancer and WHO Press release No 223, “Latest World Cancer statistics,” 2013. Available at: (Accessed 02/01/2015)
[2] Cancer Therapy Evaluation Program, “Common Toxicity Criteria Ver 2,” 1999. Available at: common-toxicity-criteria.pdf. (Accessed 25/12/2014)
[3] Quality Health, “Radiotherapy Patient Experience Survey 2013 National Report,” 2013. Available at: onal_report.pdf. (Accessed 25/12/2014).
[4] C. Booth, M. Clemon, G. BPharm, A. Joy, S. Young, W. Callaghan, et al., “Chemotherapy Induced Nausea and Vomiting in Breast Cancer Patients: A prospective Observational study,” The Journal of Supportive Oncology, 5, 374-380, 2007.
[5] P. Chambers, and S. Daniels, “Antiemetic Guidelines for Adult Patients receiving Chemotherapy and Radiotherapy,” 2010. Available at: 2010.pdf. (Accessed 25/12/2014).
[6] A. Bhal, D. Sharma, P. Julka, and G. Rath, “Chemotherapy related toxicity in locally advanced non-small cell lung cancer,” Journal of Cancer Research and Therapeutics, 2, 14-16, 2006. Available at:; year=2006;volume=2;issue=1;spage=14;epage=16;aulast=Bahl. (Accessed 25/12/2014).
[7] A. Nowak, M. Stockler, and M. Byrne, “Assessing Quality of Life during chemotherapy for Pleural Mesothelioma: Feasibility, Validity and Results of Using the European Organization for Research and Treatment of Cancer Core Quality of Life questionnaire and Lung Cancer Module,” Journal of Clinical Oncology., 22, 3172-3180, 2004.
[8] W. Pril, “Evidence report on the occurrence, assessment, and treatment of depression in cancer patients,” Journal of the National Cancer Institute. Monographs, 32, 32–9, 2004.
[9] D. Stark, and A. House, “Anxiety in cancer patients,” British Journal of Cancer, 83, 1261–7, 2000. Available at: pmc/articles/PMC2408796/pdf/83-6691405a.pdf. (Accessed 25/12/2014)
[10] D. Cella, K. Davis, W. Breitbart G. Curl, and Fatigue Coalition, “Cancer-related fatigue: Prevalence of proposed diagnostic criteria in a United States sample of cancer survivors,” Journal of Clinical Oncology, 19, 3385–3391, 2001.
[11] P. G. Fine, “The evolving and important role of anesthesiology in palliative care,” Anesthesia Analgesia, 100,183–188, 2005.
[12] WHO, “WHO’s Cancer Pain ladder for adults,” Available at: (Accessed 9/12/2014).
[13] G. Pharo, and D. Zhou, “Pharmacological Management of Pain,” JAOA, 105, S21-S28, 2005.
[14] M. Lema, “Invasive procedures for cancer pain,” Pain Clin Update, 6, 1- 8, 1998.
[15] Y. Kanpolat, “Percutaneous destructive pain procedures on the upper spinal cord and brain stem in cancer pain: CT-guided techniques, indications and results,” Advances and Technical Standards in Neurosurgery, 32, 147-73, 2007.
[16] R. Miguel, “Interventional treatment of cancer pain: The Fourth Step in the World Health Organization Analgesic Ladder?,” Cancer Control, 7, 149-56, 2000. Available at: viewarticle/408976. (Accessed 9/12/2014)
[17] G. Vargas-Schaffer, “Is the WHO Analgesic ladder still valid?,” Canadian Family Physician, 56, 514-7, 2010. Available at: Accessed 9/12/2014
[18] D. Carr, L. Goudas, E. Balk, R. Bloch, J. Ionnidis, and J. Lau, “Evidence report on the treatment of pain in cancer patients,” Journal of the National Cancer Institute. Monographs, 32, 23–31, 2004.
[19] E. Dunteman, “Levetiracetam as an adjunctive analgesic in neoplastic plexopathies: case series and commentary,” Journal of Pain & Palliative Care Pharmacotherapy, 19, 35–43, 2005.
[20] H. Adriaensen, K. Plaghki, C. Mathieu, A. Joffro, and K. Vissers, “Critical review of oral drug treatments for diabetic neuropathic pain— clinical outcomes based on efficacy and safety data from placebocontrolled and direct comparative studies,” Diabetes Metab Res Rev, 21, 231–240, 2005.
[21] P. Demoly, and K. Chung, “Pharmacology of corticosteroids,” Respir Med, 92, 385–394, 1998.
[22] L. Pujol, and D. Monti, “Managing Cancer Pain with Non Pharmacologic and Complimentary Therapies,” JAOA., 107, ES15-ES21
[23] S. Willick, S. Herring, and J. Press, “Basic concepts in biomechanics and musculoskeletal rehabilitation,” In: J. Loeser, S. Bugler, C. Chapman, C. Turk, eds. Bonica’s Management of Pain. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001, 1815-1831.
[24] T. Field, “Massage therapy effects,” The American Psychologist, 53,1270-1281, 1998.
[25] S. Weinrich, and M. Weinrich, “The effect of massage on pain in cancer patients,” Applied Nursing Research. 3, 140-145, 1990.
[26] M. Falkensteiner, F. Mantovan, I. Muller, and C. Them, “The Use of Message Therapy for reducing pain, Anxiety and depression in Oncological palliative care patients: A narrative review of the Literature,” International Scholarly Research Network Nursing, 2011 Available at: Accessed 11/12/2014.
[27] D. Wilkie, J. Kampbell, S. Cutshall et al., “Effects of massage on pain intensity, analgesics and quality of life in patients with cancer pain: a pilot study of a randomized clinical trial conducted within hospice care delivery,” The Hospice Journal, 15, pp. 31–53, 2000.
[28] A. Cassileth and A. Vickers, “Massage therapy for symptom control: outcome study at a major cancer center,” Journal of Pain and Symptom Management, 28, pp. 244–249, 2004.
[29] J. Kutner, M. Smith, L. Corbin, L. Hemphill, K. Benton, B. Mellis, et al., “Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial,” Annals of Internal Medicine, 149, 369–379, 2008. Available at: (Accessed 26/12/2014)
[30] L. Downey, P. Diehr, L. Standish D. Patrick, L. Kozak, D. Fisher et al., “Might massage or guided meditation provide “means to a better end”? Primary outcomes from an efficacy trial with patients at the end of life,” Journal of Palliative Care, 25, 2, 100–108, 2009. Available at: 189022.pdf. (Accessed 26/12/2014)
[31] N. Russell, S. Sumler, C. Beinhorn, and M. Frenkel, “Role of massage therapy in cancer care,” The Journal of Alternative and Complementary Medicine, 14, 209– 214, 2008.
[32] S. Nagele and A. Feichtner, “Lehrbuch der Palliativpflege,” Facultas, Wien, Austria, 2005
[33] “Integration of behavioural and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioural and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia,” JAMA, 276, 313-318, 1996.
[34] G. Montgomery, C. Weltz, M. Seltz, and D. Bovbjerg, “Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients,” The International Journal of Clinical and Experimental Hypnosis, 50, 17-32, 2002.
[35] International Association for the Study of Pain, “Global Year against Pain, Psychosocial Interventions for Cancer Pain,” 2008. Available at: stPain2/CancerPainFactSheets/PsychosocialInterventions_Final.pdf. (Accessed 11/12/2014)
[36] F. Keefe, A. Abernethy, and L. Campbell, “Psychological approaches to understanding and treating disease-related pain,” Annu Rev Psychol, 56:601-630, 2005.
[37] A. Miaskowski, M. Dodd, C. West, K. Schumacher, S. Paul, D. Tripathy, and P. Koo, “Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management,” Journal of Clinical Oncology, 22, 1713–20, 2004. T. Rustoen, B. Valeberg, E. Kolstad, E. Wist, S. Paul, and C. Miaskowski, “A randomized clinical trial of the efficacy of a self care Intervention to improve cancer pain management,” Cancer Nursing, 37, 34-43, 2014.
[38] T. Rustoen, B. Valeberg, E. Kolstad, E. Wist, S. Paul, and C. Miaskowski, “A randomized clinical trial of the efficacy of a self care Intervention to improve cancer pain management,” Cancer Nursing, 37, 34-43, 2014.
[39] A. Abernethy, F. Keefe, D. McCrory, C. Scipio, and D. Matchar, “Behavioral therapies for the management of cancer pain: a systematic review,” In: H. Flor, E. Kalso, J. Dostrovsky, editors. Proceedings of the 11th World Congress on Pain. Seattle: IASP Press, 2006, 789–798
[40] J. Dalton, F. Keefe, J. Carlson, and R. Youngblood, “Tailoring cognitive-behavioural treatment for cancer pain,” Pain Management Nursing, 5, 3–18, 2004.
[41] A. Liossi, and P. Hatira, “Clinical hypnosis versus cognitive behavioural training for pain management with pediatric cancer patients undergoing bone marrow aspirations,” The International Journal of Clinical and Experimental Hypnosis, 47, 104–16, 1999.
[42] C. Liossi, and P. Hatira, “Clinical hypnosis in the alleviation of procedure-related pain in pediatric oncology patients,” The International Journal of Clinical and Experimental Hypnosis, 51:4–28, 2003.
[43] A. Spiegel, and J. Bloom, “Group therapy and hypnosis reduce metastatic breast carcinoma pain,” Psychosomatic Medicine, 45, 333–9, 1983. Available at: Spiegel-Group_therapy_hypnosis_reduce_metastatic_breast_carcinoma_ pain.pdf. (Accessed 26/12/2014).
[44] K. Syrjala, G. Donaldson, M. Davis, M. Kippes, and J. Carr, “Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial,” Pain, 1995, 63, 189–98, 1995.
[45] A. Wood, J. Sega, B. Lynch, and J. Roenn, “Mangement of intractable Nausea and vomiting in patients at the end of life,” JAMA, 298, 1196- 1207, 2007.
[46] M. Kris, P. Hesketh, M. Somerfield, P. Feyer, R. Clark-snow, J. Koeller, et al., “American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006,” Journal of Clinical Oncology, 24, 2932- 2947, 2006. Available at: 24/18/2932.full.pdf. (Accessed 26/12/2014)
[47] J. Roberts, and T. Priestman, “A review of ondansetron in the management of radiotherapy- induced emesis,” Oncology, 50, 173-179, 1993.
[48] T. Gan, T. Meyer, C. Apfel, F. Chung, P. Davis, S. Eubanks, et al., “Consensus guidelines for managing postoperative nausea and vomiting,” Anesthesia and Analgesia, 97, 62-71, 2003.
[49] K. Mystakidou, S. Befon, C. Liossi, and L. Vlacho, “Comparison of tropisetron and chlorpromazine combinations in the control of nausea and vomiting of patients with advanced cancer,” J Pain Symptom Manage, 15, 176-184, 1998.
[50] R. Cole, F. Robinson, L. Harvey, K. Trethowan, and V. Murdoch, “ Successful control of intractable nausea and vomiting requiring combined ondansetron and haloperidol in a patient with advanced cancer,” J Pain Symptom Manage, 9, 48-50, 1994.
[51] S. Grunberg, R. Deuson, P. Mavros, O. Geling, M. Hansen, G. Cruciani et al., “Incidence of chemotherapy induced nausea and emesis after modern antiemetics,” Cancer, 100, 2261-2268, 2004. Available at: (Accessed 26/12/2014)
[52] D. Theobald, K. Kirsh, E. Holtsclaw, K. Donaghy, and S. Passik, “An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms,” J Pain Symptom Manage, 23, 442-447, 2002.
[53] A. Malik, W. Khan, M. Qazilbash, E. Ata, A. Butt, and M. Khan, “Clinical efficacy of lorazepam in prophylaxis of anticipatory, acute, and delayed nausea and vomiting induced by high doses of cisplatin,” American Journal of Clinical Oncology, 18, 170-175, 1995.
[54] S. Simms, V. Rhodes, and R. Madsen, “Comparison of prochlorperazine and lorazepam antiemetic regimens in the control of postchemotherapy symptoms,” Nursing Research, 42, 234-239, 1993.
[55] T. Priestman, J. Roberts, H. Lucraft, C. Collis, M. Adams, B. Upadhyaya et al., “Results of a randomized, double blind comparative study of ondansetron and metoclopramide in the prevention of nausea and vomiting following high-dose upper abdominal irradiation,” Clinical Oncology (R Coll Radiol), 2, 71-75, 1990.
[56] M. Burmeister, T. Standl, M. Wintruff, P. Brauer, I. Blanc, J. Schulte am Esch, “Dolasetron prophylaxis reduces nausea and postanaesthesia recovery time after remifentanil infusion during monitored anaesthesia care for extracorporeal shock wave lithotripsy,” Br J Anaesth, 90, 194- 198, 2003.
[57] B. Brücher, H. Stein, H. Bartels, H. Feussner, J. Siewert, “Achalasia and esophageal cancer: incidence, prevalence, and prognosis,” World Journal of Surgery, 25, 745-749, 2001.
[58] M. Gupta, M. Davis, S. LeGrand, D. Welsh, R. Lagman, “Nausea and Vomiting in Advanced cancer: the Cleveland Clinic Protocol,” The Journal of Supportive Oncology, 11, 8-13, 2013.
[59] D. Salvia, P. Reis, I. Gomes, S. Funghetto, C. Leon, “Non Pharmacological Interventions for chemotherapy Induced Nausea and Vomits: Integrated review,” Online Brazilian Journal of Nursing, 8, 2009. Available at: nursing/article/view/j.1676-4285.2009.2098/463 (8/12/2014).
[60] A. Marchioro, G. Azzarello, F .Viviani, F. Barbato, M. Pavanetto, F. Rosetti F, et al., “Hypnosis in the Treatment of Anticipatory Nausea and Vomiting in Patients Receiving Cancer Chemotherapy,” Oncology, 59 100-104, 2000.
[61] R. Raghavendra, R. Nagarathna, H. Nagendra, K. Gopinath, B. Srinth, B. Ravi, et al., “Effects of an integrated yoga program on chemotherapyinduced nausea and emesis in breast cancer Patients,” European Journal of Cancer Care, 16, 462-474, 2007.
[62] A. Slevin, S. Nichols, S. Downer, P. Wilson, T. Lister, S. Arnott, et al., “Emotional support for cancer patients: What do patients really want?,” British Journal of Cancer, 74, 1275-1279, 1996.
[63] K. Jamison, D. Wellisch, and R. Pasnau, “Psychosocial Aspects of mastectomy: 1. The women’s perspective,” The American. Journal of Psychiatry,, 34, 432-436, 1978.
[64] C. Dunkel-Schetter, “Social Support and Cancer: Findings based on patient interviews and their implications,” Journal of Social Issues, 40, 77-98, 1984.
[65] R. Chlebowski, G. Blackburn, C. Thomson, D. Nixon, A. Shapiro, M. Hoy, et al., “Dietary fat reduction and breast cancer outcome: Interim efficacy results from the Women’s Intervention Nutrition Study,”. Journal of the National Cancer Institute, 98, 1767-76, 2006.
[66] J. Pierce, L. Natarajan, B. Caan, B. Parker, E. Greenberg, S. Flatt, et al., “Influence of a Diet Very High in Vegetables, Fruit, and Fibre and Low in Fat on Prognosis Following Treatment for Breast Cancer: The Women’s Healthy Eating and Living (WHEL) Randomized Trial,” JAMA, 18, 289-98, 2007. Available at: pmc/articles/PMC2083253/. (Accsessed 8/12/2014)
[67] Y. Lee, S. Lee, J. Choi, M. Song, H. Sung, S. Jeon, et al., “Prognosis of breast cancer is associated with one carbon metabolism related nutrients among Korean women,” Nutrition Journal, 11, 1-9, 2012. Available at: (Accessed 8/12/2014).
[68] A. Harris, L. Bergkvist, and A. Wolk, “Folate intake and breast cancer mortality in a cohort of Swedish women,” Breast Cancer Research and Treatment, 132, 243–250, 2011. Available at: (Accessed 26/12/2014)
[69] M. Holmes, M. Stampfer, G. Colditz, B. Rosner, D. Hunter, and W. Willett, “Dietary factors and the survival of women with breast carcinoma,” Cancer, 86, 826–835, 1999.
[70] E. Rossi, J. Hung, J. Beilby, M. Knuiman, M. Divitini, and H. Bartholomew, “Folate levels and cancer morbidity and mortality: prospective cohort study from Busselton, Western Australia,” Annals of Epidemiology, 16, 206–212, 2006.
[71] Z. Guo, H. Tang, H. Li, S. Tan, K. Feng, Y. Huang, et al., “The Benefits of psychosocial interventions for Cancer patients undergoing Radiotherapy,” Health and Quality of Life outcomes, 11, 1-12, 2013. Available at: (Accessed 26/12/2014)
[72] P. Jacobsen, K. Donovan, Z. Swaine, et al., “Management of anxiety and depression in adult cancer patients: toward an evidence-based approach,” in A. Chang, P. Ganz, D. Hayes, et al., (eds). Oncology: An Evidence-Based Approach. New York, NY: Springer-Verlag; 2006:1552–1579 Available at: Anxiety%20depression%20review.pdf (Accessed 8/12/2014).
[73] A. Greer, L. Traeger, H. Bemis, J. Solis, E. Hendriksen, and E. Park, “A Pilot randomized controlled Trial of Brief Cognitive Behavioural Therapy for Anxiety in Patients with Terminal Cancer,” The Oncologist, 17, 1337-1345, 2012. Available at: pmc/articles/PMC3481900/. (Accessed 26/12/2014)
[74] S. Moorey, E. Cort, M. Kapari B. Monroe, P. Hansford, K. Mannix, et al., “A cluster randomized controlled trial of cognitive behaviour therapy for common mental disorders in patients with advanced cancer,” Psychological Medicine, 39, 713–723, 2009.
[75] D. Kissane, B. Grabsch, D. Clarke, G. Smith, A. Love, S. Bloch et al., “Supportive‑expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial 2,” Psychooncology, 16, 277–286, 2007.
[76] D. Spigel, L. Butler, J. Giese-Davis, C. Koopman, E. Miller, S. DiMiceli et al., “Effects of supportive expressive group Therapy on survival of patients with metastatic breast cancer,” Cancer, 110, 1130-1138, 2007. Available at: (Accessed 25/12/2014)
[77] National Breast Cancer Centre and National Cancer Control Initiative, “Clinical Practice Guidelines for the psychosocial care of adults with cancer,” 2003.
[78] M. Holmes, W. Chen, D. Feskanich, C. Kroenke, and G. Colditz, “Physical activity and survival after breast cancer diagnosis,” JAMA, 25, 293:2479-86, 2005.
[79] A. Meyerhardt, E. Giovannucci, M. Holmes, A. Chan, J. Chan, G. Colditz, et al, “Physical Activity and Survival After Colorectal Cancer Diagnosis,” J Clin Oncol, 1, 3527-34, 2006.
[80] C. Holick, P. Newcomb, A. Trentham-Dietz, L. Titus-Ernstoff, A. Bersch, M. Stampfer, et al, “Physical Activity and Survival after Diagnosis of Invasive Breast Cancer,” Cancer Epidemiology, Biomarkers & Prevention, 1, 379-86, 2008.
[81] M. Irwin, A. Smith, A. McTiernan, R. Ballard-Barbash, K. Cronin, F. Gilliland, et al., “Influence of Pre- and Postdiagnosis Physical Activity on Mortality in Breast Cancer Survivors: The Health, Eating, Activity, and Lifestyle Study,” Journal of Clinical Oncology, 20, 3958-64, 2008.
[82] Daley, H. Crank, J. Saxton,N. Mutrie, R. Coleman, and A. Roalfe et al., “Randomized trial of Exercise Therapy in Women Treated with Breast Cancer”, Journal of Clinical Oncology, 25, 13, 2007. Available at: (Accessed 25/12/2014).
[83] Courneya, R. Segal, J. Mackey, K. Gelmon, R. Reid, C. Friedenreich, et al., “Effects of Aerobic and Resistance Exercise in Breast Cancer Patients receiving Adjuvant Chemotherapy: A Multicentre Randomized Controlled Trial,” Journal of Clinical Oncology, 25, 4396-4404, 2007.
[84] Courneya, J. Mackey, G. Bell, L. Jones, C. Field, and A. Fairey, “Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes,” Journal of Clinical Oncology, 21, 1660-1668, 2003. Available at: (Accessed 25/12/2014)
[85] P. Fobair, S. Stewart, S. Chang, C. Onofrio, P. Banks, and J. Bloom, “Body image and sexual problems in young women with breast cancer,” Psychooncology, 15, 579-594, 2006.
[86] McNeely, K. Campbell, B. Rowe, T. Klassen, J. Mackey, K. Courneya, “Effects of Exercise on Breast Cancer Patients and Survivors; a systematic review and meta-analysis,” CMAJ, 175, 34-41, 2006.
[87] V. Conn, A. Hafdahl, D. Porock, R. McDaniel, and P. Nielsen, “A meta analysis of exercise interventions among people treated for cancer,” Supportive Care in Cancer, 14, 699-712, 2006
[88] K. Schmitz, J. Holtzman, K. Courneya, L. Masse, S. Duval, R. Kane, “Controlled physical activity trials in cancer survivors: A systematic review and meta-analysis,” Cancer Epidemiology Biomarkers & Prevention, 14, 1588-1595, 2005. Available at: (Accessed 25/12/2014).
[89] A. Moadel, C. Shah, J. Wylie-Rosett, M. Harris, S. Patel, and C. Hall, et al., “Randomized controlled Trial of Yoga among a multiethnic sample of breast cancer patients: Effects on Quality of Life,” Journal of Clinical Oncology, 25, 2007
[90] S. Culos-Reed, L. Carlson, L. Daroux, and S. Hately, “A pilot study of yoga for breast cancer survivors:Physical and psychological benefits,” Psychooncology, 15, 891-897, 2006.
[91] R. Segal, R. Reid, K. Courneya, R. Sigal, G. Kenny, D. Homme, et al., “Randomized Controlled Trial of Resistance or Aerobic Exercise in Men Receiving Radiation Therapy for Prostate Cancer,” Journal of Clinical Oncology, 27, 344-351, 2009.
[92] P. Windsor, K. Nicol, and J. Potter, “A randomized, controlled trial of aerobic exercise for treatment related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma,” Cancer, 101, 550-557, 2004.
[93] Culos-Reed SN, Robinson JL, Lau H, K. O’Connor, and M. Keats, “Benefits of a physical activity intervention for men with prostate cancer,” Journal of Sport & Exercise Psychology, 29,118- 127, 2007
[94] B. Jereczek-Fossa, H. Marsiglia, and R. Orecchia, “Radiotherapy-related fatigue,” Critical Reviews in Oncol Hematology, 41:317-325, 2002
[95] C. Bennett, S. Silver, B. Djulbegovic, A. Samaras, C. Blau, K. Gleason, et al., “Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer associated anemia,” JAMA, 299, 914-924, 2008.
[96] J. Lemieux, A. Topp, H. Chappell, M. Ennis, and P. Goodwin, “Economic analysis of psychosocial group therapy in women with metastatic breast cancer,” Breast Cancer Research and Treatment, 100,183-190, 2006.
[97] S. Hayes, R. Spence, D. Galvão, and R. Newton, “Australian Association for Exercise and Sport Science position stand: Optimising cancer outcomes through exercise,” Journal of Science and Medicine in Sport, 12, 428-34, 2009.
[98] Minton, A. Berger A, A. Barsevick, F. Cramp, M. Goedendorp, S. Mitchell, et al., “Cancer-related fatigue and its impact on functioning,” Cancer, 119, 2124–30, 2013.
[99] L. Whitehead, “The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures,” J Pain Symptom Manage, 37, 107–28, 2009.
[100]A. Aaronson, V. Mattioli, O. Minton, J. Weis, C. Johansen, S. Dalton, et al., “Beyond Treatment-Psychosocial and behavioural issues in cancer survivorship research and practice,” EJC Supplements, 12, 54-64, 2014.
[101] W. Linden, and A. Girgis, “Psychological treatment outcomes for cancer patients: what do meta-analyses tell us about distress reduction?,” Psychooncology, 2012;21(4):343–50
[102] K. Boyes, L. Hodgkinson, Alridge, and J. Turner, “Issues for Cancer Survivors in Australia,” Cancer Forum, 33, 164-167, 2009.
[103] J. Bloom, R. Hoppe, P. Fobair , R. Cox, A. Varghese, D. Spiegel, “Effects of treatment on the work experiences of long-term survivors of Hodgkin’s disease,” Journal of Psychosocial Oncology, 1989, 6, 65-80. Available at: J077v06n03_05?journalCode=wjpo20#.VKZFuXtrJOY. (Accessed 02/01/2015)
[104]Wingard JR, Curbow B, Baker F, Piantadosi S. Health, functional status, and employment of adult survivors of bone marrow transplantation. Ann Intern Med. 1991;114:113-118.
[105]S. Schagen, M. Muller, W. Boogerd, G. Mellenbergh, and F. van Dam, “Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients,” Journal of National Cancer Institute, 98, 1742-1745, 2006. Available at: (Accessed 25/12/2014).
[106]D. Coward, “Supporting Health Promotion in Adults with Cancer,” Family & Community Health, 19, 52S-60S, 2005.
[107]L. Forsythe, E. Kent, K. Weaver, N. Buchanan, N. Hawkins, J. Rodriguez, “Receipt of Psychosocial care among Cancer Survivors in the United States,” Journal of Clinical Oncology, 31, 1961-69.
[108]J. Guidry , L. Aday, D. Zhang, and R. Winn, “The role of informal and formal social support networks for patients with cancer,” Cancer Practice, 5, 241–246, 1997.
[109]A. Leis, C. Haines, and G. Pancyr, “Exploring oncologists’ beliefs about psychosocial groups: implications for patient care and research,” Journal of Psychosocial Oncology, 12, 77–87, 1994.