10.1007/s11060-008-9738-7</TIT= LE> <META content=3D"text/html; charset=3DISO-8859-1" = http-equiv=3DContent-Type><LINK=20 rel=3DstyleSheet type=3Dtext/css=20 href=3D"http://www.springerlink.com/config/css/A++_common.css"><LINK=20 rel=3DstyleSheet type=3Dtext/css=20 href=3D"http://www.springerlink.com/config/css/content_A++_SpringerLink.c= ss"> <META name=3DGENERATOR content=3D"MSHTML 8.00.6001.18247"></HEAD> <BODY class=3Dfor-print> <TABLE border=3D1 cellPadding=3D2> <TBODY> <TR class=3Dheader> <TD>Journal of Neuro-Oncology</TD></TR> <TR> <TD>=A9 The Author(s) 2008</TD></TR> <TR> <TD>10.1007/s11060-008-9738-7</TD></TR></TBODY></TABLE> <H2 class=3Drubric>Clinical Study - Patient Study</H2> <DIV class=3DHeading1><A name=3Dtitle></A>Fatigue in low-grade glioma = </DIV> <P class=3DAuthorGroup>Karin Struik<SUP>1</SUP>,=20 Martin Klein<SUP>2</SUP>, Jan J. Heimans<SUP>1</SUP>,=20 Marieke F. Gielissen<SUP>3</SUP>, = Gijs Bleijenberg<SUP>3</SUP>,=20 Martin J. Taphoorn<SUP>4</SUP>,=20 Jaap C. Reijneveld<SUP>1</SUP> and=20 Tjeerd J. Postma<SUP>1 <A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#ContactOfAuthor8"><IMG=20 border=3D0 alt=3D"Contact Information"=20 src=3D"http://www.springerlink.com/content/tm31nq867x423h13/contact.gif">= </A></SUP></P> <TABLE> <TBODY> <TR vAlign=3Dtop> <TD><SPAN class=3DAffiliation><A = name=3DAff1></A>(1) </SPAN></TD> <TD><SPAN class=3DAffiliation>Department of Neurology, VU University = Medical=20 Center, P.O. Box 7057, 1007 MB Amsterdam, The=20 Netherlands</SPAN></TD></TR></TBODY></TABLE> <TABLE> <TBODY> <TR vAlign=3Dtop> <TD><SPAN class=3DAffiliation><A = name=3DAff2></A>(2) </SPAN></TD> <TD><SPAN class=3DAffiliation>Department of Medical Psychology, VU=20 University Medical Center, Amsterdam, The=20 Netherlands</SPAN></TD></TR></TBODY></TABLE> <TABLE> <TBODY> <TR vAlign=3Dtop> <TD><SPAN class=3DAffiliation><A = name=3DAff3></A>(3) </SPAN></TD> <TD><SPAN class=3DAffiliation>Expert Center Chronic Fatigue, Radboud = University, Nijmegen Medical Center, Nijmegen, The=20 Netherlands</SPAN></TD></TR></TBODY></TABLE> <TABLE> <TBODY> <TR vAlign=3Dtop> <TD><SPAN class=3DAffiliation><A = name=3DAff4></A>(4) </SPAN></TD> <TD><SPAN class=3DAffiliation>Department of Neurology, Medical = Center=20 Haaglanden, Den Haag, The = Netherlands</SPAN></TD></TR></TBODY></TABLE> <P><A name=3DContactOfAuthor8></A></P> <TABLE class=3DContact> <TBODY> <TR> <TD vAlign=3Dtop><IMG border=3D0 alt=3D"Contact Information"=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/contact.gif">= </TD> = <TD><STRONG>Tjeerd </STRONG><STRONG>J. </STRONG><STRONG>Postma<= /STRONG><STRONG></STRONG><BR><STRONG>Email:=20 </STRONG><A=20 = href=3D"mailto:TJ.Postma@vumc.nl">TJ.Postma@vumc.nl</A></TD></TR></TBODY>= </TABLE> <P class=3DAffiliation><STRONG>Received:=20 </STRONG>25 February 2008 <STRONG>Accepted:=20 </STRONG>4 November 2008 <STRONG>Published online:=20 </STRONG>9 December 2008 </P> <DIV class=3DAbstract><A name=3DAbs1></A><SPAN=20 class=3DAbstractHeading>Abstract </SPAN>The aim of this study = was to=20 determine the prevalence and severity of fatigue in long-term survivors = with a=20 low-grade glioma (LGG), and to analyze the relationship between fatigue = and=20 demographic variables, disease duration, tumor characteristics, former = tumor=20 treatment modalities, antiepileptic drug (AED) use, self-reported = concentration,=20 motivation, and activity. Fifty-four patients with stable disease (age = range,=20 25=9673 years) who were diagnosed and treated more than = 8 years ago were=20 included in this study. Fatigue was analyzed with the Checklist = Individual=20 Strength (CIS). Thirty-nine percent of the LGG patients were severely = fatigued,=20 with older patients being most affected. Severe fatigue was associated = with AED=20 use, and with reduced self-reported concentration, motivation, and = activity. No=20 relation was found between fatigue and gender, histology, tumor = laterality,=20 disease duration, type of neurosurgical intervention and radiation = treatment.=20 Fatigue is a severe problem in a large proportion of long-term surviving = LGG=20 patients. </DIV> <P class=3DKeyword><SPAN=20 class=3DKeywordHeading>Keywords </SPAN>Fatigue - Low= -grade=20 glioma - Prevalence studies - Quality of life </P> <DIV><A name=3DSec1></A> <HR> <DIV class=3Dheading2>Introduction</DIV> <P>Low-grade gliomas are primary malignant brain tumors of glial origin=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR1">1</A></CITE>].=20 The median survival time for patients with LGG ranges from 5 to = 15 years=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR2">2</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR3">3</A></CITE>],=20 and some patients may survive in a stable state for many years after the = diagnosis and initial treatment. Frequent symptoms experienced by = patients with=20 LGG are epileptic seizures and cognitive disturbances [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR4">4</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR5">5</A></CITE>].=20 </P> <P>Fatigue is frequently reported by patients with cancer [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR6">6</A></CITE>].=20 During treatment, in advanced stages of the disease, and after curative=20 treatment, fatigue has been described as a major problem. In the last=20 10 years, the amount of research on the relationship between cancer = and=20 fatigue has increased remarkably [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>].=20 However, little is known about the variables associated with the = initiation and=20 persistence of cancer-related fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR8">8</A></CITE>].=20 The assumption is that fatigue develops during the treatment phase, but = later on=20 there seems to be no clear relationship between persistent fatigue and = initial=20 disease and treatment variables [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR11">11</A></CITE>].=20 Estimations of fatigue during treatment of cancer range from 25% to 75%=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>].=20 In addition, based on several cross-sectional and longitudinal studies, = fatigue=20 seems to be a problem for a considerable number of cancer survivors = [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR8">8</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR11">11</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR14">14</A></CITE>].=20 </P> <P>Clinical practice suggests that fatigue is also important in glioma = patients.=20 However, the level of fatigue and its associated factors have not been = studied=20 extensively in LGG patients. Studies assessing fatigue in this patient = group=20 mostly use only a limited number of items from a quality of life = instrument=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR15">15</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR17">17</A></CITE>].=20 However, the most comprehensive approach to assess fatigue would be = using a=20 multidimensional instrument [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR18">18</A></CITE>],=20 because fatigue is a multidimensional concept with several modes of = expression=20 (physical, cognitive, and affective) [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>].=20 In one cross-sectional study, fatigue was assessed in 39 LGG patients = with help=20 of the European Organization for Research and Treatment of Cancer = (EORTC) Core=20 Quality of Life Questionnaire, containing three items for fatigue. The = majority=20 of these patients reported tiredness and about half of them had sleep=20 disturbances [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR15">15</A></CITE>].=20 In another quality of life study, LGG patients scored higher on the = subscale=20 fatigue compared to control subjects, using the Profile of Mood States = to=20 measure affective disturbances [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR16">16</A></CITE>].=20 </P> <P>In this study the following research questions are addressed: (1) = What is the=20 prevalence and severity of fatigue in LGG patients? (2) Is fatigue = associated=20 with demographic variables (age and gender), disease duration, tumor=20 characteristics (histology and tumor laterality), former tumor treatment = modalities (type of neurosurgical intervention, post-surgery = radiotherapy), the=20 use of AEDs, or with self-reported concentration, reduced motivation and = activity? </P></DIV> <DIV><A name=3DSec2></A> <HR> <DIV class=3Dheading2>Methods</DIV> <DIV><A name=3DSec3></A> <DIV class=3DHeading3>Patients</DIV> <P>Fifty-eight patients aged 25=9673 (mean 48) years with a LGG = diagnosed and=20 treated 8=9629 years ago were approached for this study. These = patients were=20 part of a group of LGG patients recruited between 1997 and 2000 for a = large=20 nationwide study into the neuropsychological status and quality of life=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR5">5</A></CITE>].=20 We exclusively approached long-term survivors of a histologically proven = LGG=20 without signs of tumor recurrence, and who already participated in a = follow-up=20 study on cognition and quality of life between 2004 and 2005. </P></DIV> <DIV><A name=3DSec4></A> <DIV class=3DHeading3>Recruitment procedure</DIV> <P>We sent a fatigue questionnaire to the 58 patients, together with a = letter=20 from the research coordinator in the summer of 2006, explaining the = intention of=20 the study. Furthermore, an informed consent form was enclosed. Those = patients=20 who were willing to participate in the study were asked to complete the=20 questionnaire, and sign the informed consent form at home. </P></DIV> <DIV><A name=3DSec5></A> <DIV class=3DHeading3>Measures</DIV> <P>Fatigue and fatigue related symptoms were measured with the Checklist = Individual Strength (CIS). The CIS is a multidimensional fatigue scale; = it=20 measures four aspects of fatigue during the previous 2 weeks, = namely:=20 fatigue severity (eight items), concentration problems (five items), = reduced=20 motivation (four items), and reduced activity (three items) [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR19">19</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR20">20</A></CITE>].=20 Each item is scored on a seven-point Likert scale. Total scores of every = subscale are obtained by adding the individual items, with high scores=20 indicating a high level of fatigue, a high level of concentration = problems, low=20 motivation, and a low level of activity. Patients with a score of 35 or = higher=20 on the fatigue severity subscale are considered to be severely fatigued. = This=20 cut-off value is based on data obtained in patients with chronic fatigue = syndrome [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR20">20</A></CITE>].=20 </P></DIV> <DIV><A name=3DSec6></A> <DIV class=3DHeading3>Statistical analysis</DIV> <P>Data analysis was accomplished using SPSS software, version 12.0. As = a result=20 of small sample size we had to use a non-parametric approach when = selecting=20 statistical methods. Mann=96Whitney tests were conducted to test the = differences=20 between groups. To test the relation between fatigue and age, disease = duration,=20 self-reported concentration, motivation and activity, comparisons were = made=20 between severely fatigued (CIS ≥ 35) and non-severely = fatigued=20 (CIS < 35) LGG patients. The level of statistical = significance for=20 all tests was set at <I>P</I> value less than 0.05. </P></DIV></DIV> <DIV><A name=3DSec7></A> <HR> <DIV class=3Dheading2>Results</DIV> <DIV><A name=3DSec8></A> <DIV class=3DHeading3>Patient characteristics</DIV> <DIV class=3DPara> <DIV>Fifty-four of the 58 patients we approached (93%) completed and = returned=20 the CIS questionnaire. One patient was unable to participate due to = foreign=20 residence. One patient declined participation in the study, and the = reasons of=20 two other non-participants are unknown. Non-participants did not differ = from the=20 participants with respect to gender, histology, disease duration, type = of=20 neurosurgical intervention, and AED use. On the other hand, the = non-participants=20 were slightly younger (mean 43.5 years), and none of them had = received=20 radiotherapy. Information about the characteristics of the LGG patients = is=20 listed in Table <A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#Tab1">1</A>.<A=20 name=3DTab1></A> <DIV class=3DCapt><SPAN = class=3DCaptNr>Table 1 </SPAN>Low-grade glioma=20 patient group (<I>n</I> =3D 54): characteristics </DIV> <TABLE border=3D1> <COLGROUP> <COL align=3Dleft> <COL align=3Dchar char=3D"("></COLGROUP> <THEAD> <TR class=3Dheader> <TH align=3Dleft> <P>Characteristics</P></TH> <TH align=3Dleft char=3D"("> <P>Data</P></TH></TR></THEAD> <TBODY> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean age<SUP>a</SUP> </P></TD> <TD align=3Dchar char=3D"("> <P>48 (SD 11.8, range 25=9673)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Gender: M</P></TD> <TD align=3Dchar char=3D"("> <P>28 (52%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean level of education<SUP>b</SUP> </P></TD> <TD align=3Dchar char=3D"("> <P>4.1 (SD 2.0, range 1=968)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean disease duration<SUP>a</SUP> </P></TD> <TD align=3Dchar char=3D"("> <P>15.0 (SD 4.0, range 8=9629)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Histological diagnosis</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Astrocytoma</P></TD> <TD align=3Dchar char=3D"("> <P>39 (72%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Oligodendroglioma</P></TD> <TD align=3Dchar char=3D"("> <P>10 (19%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Oligoastrocytoma</P></TD> <TD align=3Dchar char=3D"("> <P>5 (9%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Tumor location</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Left-sided</P></TD> <TD align=3Dchar char=3D"("> <P>32 (59%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Right-sided</P></TD> <TD align=3Dchar char=3D"("> <P>20 (37%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Midline</P></TD> <TD align=3Dchar char=3D"("> <P>2 (4%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Neurosurgical intervention</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Biopsy</P></TD> <TD align=3Dchar char=3D"("> <P>17 (31%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Resection</P></TD> <TD align=3Dchar char=3D"("> <P>37 (69%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Radiotherapy</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Yes</P></TD> <TD align=3Dchar char=3D"("> <P>29 (54%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> No</P></TD> <TD align=3Dchar char=3D"("> <P>25 (46%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Antiepileptic drug use</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Yes</P></TD> <TD align=3Dchar char=3D"("> <P>26 (48%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> No</P></TD> <TD align=3Dchar char=3D"("> <P>26 (48%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Missing</P></TD> <TD align=3Dchar char=3D"("> <P>2 (4%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Type of antiepileptic drug use</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Monotherapy</P></TD> <TD align=3Dchar char=3D"("> <P>14 (54%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Polytherapy</P></TD> <TD align=3Dchar char=3D"("> <P>12 (46%)</P></TD></TR></TBODY></TABLE> <DIV class=3DCapt> <DIV class=3DCaptCont> <DIV>Data are number (%) of patients, unless otherwise = indicated</DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>a</SUP>Years </DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>b</SUP>Education was assessed by a Dutch scoring system = ranging from=20 unfinished primary education (level 1) to university education (level 8) = </DIV></DIV></DIV></DIV></DIV></DIV> <DIV><A name=3DSec9></A> <DIV class=3DHeading3>Fatigue prevalence and severity</DIV> <P>The mean CIS-fatigue severity score of the sample LGG patients was = 28.2 (SD=20 15.5). The CIS-fatigue cut-off score of ≥35 for severe fatigue was = crossed by 21=20 patients. Hence, 39% of the LGG patients experienced severe fatigue. The = remaining 33 patients were classified as non-severely fatigued. = </P></DIV> <DIV><A name=3DSec10></A> <DIV class=3DHeading3>Fatigue related to patient, tumor and treatment=20 characteristics</DIV> <P>To test the relationship between age, disease duration, and fatigue,=20 comparisons were made between severely fatigued = (CIS ≥ 35,=20 <I>n</I> =3D 21) and non-severely fatigued = (CIS < 35,=20 <I>n</I> =3D 33) LGG patients. Severely fatigued patients were = older=20 than the non-severely fatigued patients (Mann=96Whitney,=20 <I>P</I> =3D 0.012). We did not find any differences in = disease duration=20 for severely and non-severely fatigued patients (Mann=96Whitney,=20 <I>P</I> =3D 0.404). Fatigue severity was not related to = gender=20 (Mann=96Whitney, <I>P</I> =3D 0.640), and no association could = be=20 established between histological diagnosis (astrocytoma and = oligodendroglioma)=20 and fatigue severity (Mann=96Whitney, <I>P</I> =3D 0.766). Due = to the=20 small number of patients with mixed glioma (oligoastrocytoma), data of = these=20 patients were excluded from the analyses. Furthermore, the association = between=20 tumor laterality and fatigue severity was investigated, while excluding = midline=20 tumor locations because of the small sample size = (<I>n</I> =3D 2).=20 Results of a Mann=96Whitney test indicated that there was no association = between=20 tumor laterality and fatigue severity (<I>P</I> =3D 0.435). = </P> <DIV class=3DPara> <DIV>No association was found between type of neurosurgical intervention = and=20 fatigue severity (Mann=96Whitney, <I>P</I> =3D 0.081). = Approximately half=20 of the LGG patients (<I>n</I> =3D 29) received radiotherapy. = Again, no=20 effect was found between former radiation treatment and fatigue severity = (Mann=96Whitney, <I>P</I> =3D 0.993). However, patients = treated with AEDs=20 were more fatigued (Mann=96Whitney, <I>P</I> =3D 0.004), = irrespective of=20 the use of mono- or polytherapy (Mann=96Whitney, = <I>P</I> =3D 0.738)=20 (Table <A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#Tab2">2</A>).<A=20 name=3DTab2></A> <DIV class=3DCapt><SPAN class=3DCaptNr>Table 2 </SPAN>Tumor = and treatment=20 characteristics in relation to fatigue </DIV> <TABLE border=3D1> <COLGROUP> <COL align=3Dleft> <COL align=3Dchar char=3D"."> <COL align=3Dchar char=3D"("> <COL align=3Dchar char=3D"."></COLGROUP> <THEAD> <TR class=3Dheader> <TH align=3Dleft> <P>Variables</P></TH> <TH align=3Dleft char=3D"."> <P>N</P></TH> <TH align=3Dleft char=3D"("> <P>Mean CIS-fatigue (SD)</P></TH> <TH align=3Dleft char=3D"."> <P><I>P-</I>value<SUP>a</SUP> </P></TH></TR></THEAD> <TBODY> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Histological diagnosis</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Astrocytoma</P></TD> <TD align=3Dchar char=3D"."> <P>39</P></TD> <TD align=3Dchar char=3D"("> <P>27.2 (15.2)</P></TD> <TD rowSpan=3D3 align=3Dchar char=3D"."> <P>0.766</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Oligodendroglioma</P></TD> <TD align=3Dchar char=3D"."> <P>10</P></TD> <TD align=3Dchar char=3D"("> <P>29.1 (18.5)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Oligoastrocytoma<SUP>b</SUP> </P></TD> <TD align=3Dchar char=3D"."> <P>5</P></TD> <TD align=3Dchar char=3D"("> <P>34.6 (12.3)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Tumor location</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Left-sided</P></TD> <TD align=3Dchar char=3D"."> <P>32</P></TD> <TD align=3Dchar char=3D"("> <P>27.4 (15.5)</P></TD> <TD rowSpan=3D3 align=3Dchar char=3D"."> <P>0.435</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Right-sided</P></TD> <TD align=3Dchar char=3D"."> <P>20</P></TD> <TD align=3Dchar char=3D"("> <P>30.7 (15.8)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Midline<SUP>b</SUP> </P></TD> <TD align=3Dchar char=3D"."> <P>2</P></TD> <TD align=3Dchar char=3D"("> <P>17.5 (13.4)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Neurosurgical intervention</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Biopsy</P></TD> <TD align=3Dchar char=3D"."> <P>17</P></TD> <TD align=3Dchar char=3D"("> <P>33.8 (15.7)</P></TD> <TD rowSpan=3D2 align=3Dchar char=3D"."> <P>0.081</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Resection</P></TD> <TD align=3Dchar char=3D"."> <P>37</P></TD> <TD align=3Dchar char=3D"("> <P>25.7 (15.0)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Radiotherapy</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Yes</P></TD> <TD align=3Dchar char=3D"."> <P>29</P></TD> <TD align=3Dchar char=3D"("> <P>28.3 (15.0)</P></TD> <TD rowSpan=3D2 align=3Dchar char=3D"."> <P>0.993</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> No</P></TD> <TD align=3Dchar char=3D"."> <P>25</P></TD> <TD align=3Dchar char=3D"("> <P>28.2 (16.4)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Antiepileptic drug use</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Yes</P></TD> <TD align=3Dchar char=3D"."> <P>26</P></TD> <TD align=3Dchar char=3D"("> <P>34.5 (14.6)</P></TD> <TD rowSpan=3D3 align=3Dchar char=3D"."> <P>0.004</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> No</P></TD> <TD align=3Dchar char=3D"."> <P>26</P></TD> <TD align=3Dchar char=3D"("> <P>22.2 (13.9)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Missing</P></TD> <TD align=3Dchar char=3D"."> <P>2</P></TD> <TD align=3Dleft char=3D"("> </TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Type of antiepileptic drug</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Monotherapy</P></TD> <TD align=3Dchar char=3D"."> <P>14</P></TD> <TD align=3Dchar char=3D"("> <P>33.6 (14.6)</P></TD> <TD rowSpan=3D2 align=3Dchar char=3D"."> <P>0.738</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Polytherapy</P></TD> <TD align=3Dchar char=3D"."> <P>12</P></TD> <TD align=3Dchar char=3D"("> <P>35.7 (15.2)</P></TD></TR></TBODY></TABLE> <DIV class=3DCapt> <DIV class=3DCaptCont> <DIV>Abbreviation: CIS, Checklist Individual Strength</DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>a</SUP>Mann=96Whitney tests were conducted to analyze the = association=20 between fatigue and tumor and treatment characteristics </DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>b</SUP>Variables which were excluded in testing=20 </DIV></DIV></DIV></DIV></DIV></DIV> <DIV><A name=3DSec11></A> <DIV class=3DHeading3>Fatigue related problems: concentration, = motivation and=20 activity</DIV> <DIV class=3DPara> <DIV>To test the association between fatigue and self-reported = concentration,=20 motivation and activity, comparisons were made between severely fatigued = (CIS ≥ 35) and non-severely fatigued = (CIS < 35) LGG=20 patients. Severely fatigued LGG patients reported reduced motivation, a = lower=20 level of activity, and more problems with concentration (Mann=96Whitney, = <I>P</I> < 0.001) (Table <A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#Tab3">3</A>).<A=20 name=3DTab3></A> <DIV class=3DCapt><SPAN = class=3DCaptNr>Table 3 </SPAN>Fatigue-related=20 problems: concentration, motivation and activity </DIV> <TABLE border=3D1> <COLGROUP> <COL align=3Dleft> <COL align=3Dchar char=3D"("> <COL align=3Dchar char=3D"("> <COL align=3Dchar char=3D"."></COLGROUP> <THEAD> <TR class=3Dheader> <TH align=3Dleft> <P>CIS-subscales</P></TH> <TH align=3Dleft char=3D"("> <P>Non-severely fatigued patients (<I>n</I> =3D 33) = </P></TH> <TH align=3Dleft char=3D"("> <P>Severely fatigued patients (<I>n</I> =3D 21) = </P></TH> <TH align=3Dleft char=3D"."> <P><I>P-</I>value<SUP>a</SUP> </P></TH></TR></THEAD> <TBODY> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean CIS-concentration (SD)</P></TD> <TD align=3Dchar char=3D"("> <P>14.5 (7.8)</P></TD> <TD align=3Dchar char=3D"("> <P>26.1 (7.5)</P></TD> <TD align=3Dchar char=3D"."> <P><0.001</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean CIS-motivation (SD)</P></TD> <TD align=3Dchar char=3D"("> <P>9.5 (4.8)</P></TD> <TD align=3Dchar char=3D"("> <P>17.0 (6.8)</P></TD> <TD align=3Dchar char=3D"."> <P><0.001</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean CIS-activity (SD)</P></TD> <TD align=3Dchar char=3D"("> <P>6.4 (3.9)</P></TD> <TD align=3Dchar char=3D"("> <P>14.5 (5.8)</P></TD> <TD align=3Dchar char=3D"."> <P><0.001</P></TD></TR></TBODY></TABLE> <DIV class=3DCapt> <DIV class=3DCaptCont> <DIV>Abbreviation: CIS, Checklist Individual Strength</DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>a</SUP>The Mann=96Whitney test was conducted to test the = differences=20 between non-severely and severely fatigued LGG patients=20 </DIV></DIV></DIV></DIV></DIV></DIV></DIV> <DIV><A name=3DSec12></A> <HR> <DIV class=3Dheading2>Discussion</DIV> <P>In this study, we found that 39% of long-term survivors with a LGG = experience=20 severe fatigue. Few studies assessed fatigue in LGG patients [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR15">15</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR17">17</A></CITE>].=20 In one quality of life study, fatigue is mentioned as a problem for the = majority=20 of glioma patients [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR15">15</A></CITE>].=20 The current study confirms these results. However, the 39% prevalence = rate of=20 severe fatigue is the highest found among all cancer patients measured = with the=20 CIS. Only the percentage of severe fatigue in a sample of breast cancer=20 survivors (38%) 2.5 years after curative treatment equals our = findings=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR12">12</A></CITE>].=20 This percentage declines to 24% after a follow-up period of = 2 years. Other=20 cross-sectional and longitudinal studies investigating the prevalence = and course=20 of fatigue show similar results, revealing that fatigue continues to = decrease=20 during the first years after curative treatment. For about a quarter of = cancer=20 survivors fatigue remains a problem [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR21">21</A></CITE>].=20 Since the LGG patients in our study finished their treatment more than=20 8 years ago, the percentage of severe fatigue of nearly 40% is = remarkably=20 high. It is important to note that the LGG population differs from = non-glioma=20 cancer populations. In these non-glioma cancer studies, patients are = considered=20 to be disease-free. In contrast, LGG patients are considered to be never = completely free of disease [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR5">5</A></CITE>].=20 As a consequence, being confronted with a life-threatening illness can = lead to=20 feelings of depression and anxiety for the future, which both may be = correlated=20 with fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR6">6</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR22">22</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR27">27</A></CITE>].=20 Furthermore, LGG patients have specific cognitive problems [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR5">5</A></CITE>],=20 which presumably may also be related to fatigue. </P> <P>Moreover, our results show that fatigue is related to other problems. = Severely fatigued LGG patients have more problems with regard to = self-reported=20 concentration, and they experience reduced motivation and activity. = These=20 results are comparable to the extent of problems experienced by patients = with=20 chronic fatigue syndrome. However, compared to severely fatigue = disease-free=20 cancer patients, the LGG patients in our study report more problems with = concentration [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR6">6</A></CITE>].=20 </P> <P>In this study no association was found between gender and fatigue = severity,=20 but fatigue complaints were more severe in older LGG patients. Also in=20 testicular cancer patients [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR28">28</A></CITE>]=20 and in patients with hematological malignancies [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR29">29</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR30">30</A></CITE>]=20 the older patients reported more fatigue, whereas in breast cancer = patients the=20 younger participants were more fatigued [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR31">31</A></CITE>].=20 </P> <P>Furthermore, we found no relation between fatigue severity, tumor=20 characteristics, and former tumor treatment. In one prospective quality = of life=20 study it was demonstrated that patients with a high-grade glioma in the = right=20 hemisphere were more fatigued than those with a left-sided tumor = [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR32">32</A></CITE>].=20 However, in most studies, no associations were found between = tumor-related=20 variables and fatigue intensity with regard to disease duration = [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR23">23</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR25">25</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR26">26</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR29">29</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR33">33</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR35">35</A></CITE>],=20 type of cancer [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR27">27</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR36">36</A></CITE>],=20 disease stage at diagnosis [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR23">23</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR25">25</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR27">27</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR33">33</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR37">37</A></CITE>],=20 size of the original tumor [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR25">25</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR26">26</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR37">37</A></CITE>],=20 number of nodes involved [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR25">25</A></CITE>]=20 and tumor recurrence [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR33">33</A></CITE>].=20 </P> <P>Literature data suggest that fatigue arises during the active = treatment phase=20 in nearly all cancer patients, but little is known about the etiology of = persistent fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR11">11</A></CITE>].=20 Some studies suggest that patients with more aggressive former = treatments are=20 more at risk for persistent fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR21">21</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR31">31</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR38">38</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR39">39</A></CITE>],=20 but others do not find a strong association between initial cancer = treatment and=20 off-treatment fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR11">11</A></CITE>].=20 In our study, no differences in fatigue severity were observed for = patients who=20 had a biopsy and for patients who underwent a resection. Furthermore, no = differences were observed in patients with or without prior = radiotherapy.=20 However, fatigue was significantly more pronounced in patients that used = AEDs.=20 </P> <P>This study has its limitations. Small sample size was the reason we = had to=20 exclude some variables from the analyses (i.e., oligoastrocytomas, = tumors in=20 midline locations). Furthermore, we have no data of current epileptic = activity=20 in this study. Therefore, we are not able to distinguish whether = seizures or the=20 use of AEDs contributed to the experience of fatigue. It would be very=20 interesting to study a larger group of glioma patients with emphasis on = fatigue,=20 AED use, and epilepsy burden. Nonetheless, we conclude that fatigue is a = major=20 problem in LGG patients. The current study demonstrates that almost 40% = of=20 long-term survivors with a LGG experience severe fatigue. These findings = are=20 important because fatigue has a serious impact on quality of life = [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR40">40</A></CITE>].=20 Furthermore, a decreased level of quality of life in LGG patients is=20 significantly related to shorter survival [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR41">41</A></CITE>].=20 Assessment and treatment of fatigue in LGG patients need to be further=20 investigated, potentially resulting in improvement of quality of life.=20 </P></DIV> <DIV class=3DAcknowledgments><SPAN class=3DAcknowledgmentsHeading>Open=20 Access </SPAN><SPAN>This article is distributed under the = terms of=20 the Creative Commons Attribution Noncommercial License which permits any = noncommercial use, distribution, and reproduction in any medium, = provided the=20 original author(s) and source are credited.</SPAN></DIV> <P></P> <HR> <H2><A name=3DBib1></A>References </H2> <TABLE> <TBODY class=3DCitation> <TR vAlign=3Dtop> <TD>1.</TD> <TD><A name=3DCR1></A>Hickey JV (2003) Brain tumors. In: Hickey JV = (ed) The=20 clinical practice of neurological and neurosurgical nursing. = Lippincott,=20 Williams & Wilkins, Philadelphia, pp 483=96508 </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>2.</TD> <TD><A name=3DCR2></A>Olson JD, Riedel E, DeAngelis LM (2000) = Long-term=20 outcome of low-grade oligodendroglioma and mixed glioma. Neurology = 54:1442=961448<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10751254"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3c3hsFSnug%253D%253D&md5=3D2491673fd0811a5f8721ed3256d1171c"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>3.</TD> <TD><A name=3DCR3></A>Karim ABMF, Maat B, Hatlevoll R et al (1996) A = randomised trial on dose response in radiation therapy of low = grade=20 cerebral glioma: EORTC study 22844. Int J Radiat Oncol Biol Phys=20 36:549=96556. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0360-3016(96)00352-5">10.1016/S0360-30= 16(96)00352-5</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D8948338"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= AByiC3cvhvVQ%253D&md5=3De986df815277c409dff54d4b96d0f964"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>4.</TD> <TD><A name=3DCR4></A>Klein M, Engelberts NHJ, van der Ploeg HM et = al (2003)=20 Epilepsy in low-grade gliomas: the impact on cognitive function = and=20 quality of life. Ann Neurol 54:514=96520. doi:<A=20 href=3D"http://dx.doi.org/10.1002/ana.10712">10.1002/ana.10712</A> = <BR><A=20 target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D14520665"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1002/ana.10712"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>5.</TD> <TD><A name=3DCR5></A>Klein M, Heimans JJ, Aaronson NK et al (2002) = Effect=20 of radiotherapy and other treatment-related factors on mid-term to = long-term cognitive sequelae in low-grade gliomas: a comparative = study.=20 Lancet 360:1361=961368. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0140-6736(02)11398-5">10.1016/S0140-67= 36(02)11398-5</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D12423981"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0140-6736(02)11398-5"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD38nmsVWmsg%253D%253D&md5=3Defdbe964e0d8ac4969f044072476fbb1"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>6.</TD> <TD><A name=3DCR6></A>Servaes P, van der Werf S, Prins J et al = (2001)=20 Fatigue in disease-free cancer patients compared with fatigue in = patients=20 with Chronic Fatigue Syndrome. Support Care Cancer 9:11=9617. = doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s005200000165">10.1007/s005200000165</A= >=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D11147137"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s005200000165"><IMG border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3M7itlKktQ%253D%253D&md5=3D0e48848a3e48658189019786f95f6e2e"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>7.</TD> <TD><A name=3DCR7></A>Servaes P, Verhagen C, Bleijenberg G (2002) = Fatigue in=20 cancer patients during and after treatment: prevalence, correlates = and=20 interventions. Eur J Cancer 38:27=9634. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0959-8049(01)00332-X">10.1016/S0959-80= 49(01)00332-X</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D11750837"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0959-8049(01)00332-X"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD38%252Fgt1yjtQ%253D%253D&md5=3D27bbb2fdc690ad0f63f4c2818c2ea= 73e"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>8.</TD> <TD><A name=3DCR8></A>Prue G, Rankin J, Allen J et al (2006) = Cancer-related=20 fatigue: a critical appraisal. Eur J Cancer 42:846=96863. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/j.ejca.2005.11.026">10.1016/j.ejca.2005= .11.026</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16460928"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/j.ejca.2005.11.026"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD283lslKgsw%253D%253D&md5=3Dae6dbd6f5cad4c129280f83bcb07de34"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>9.</TD> <TD><A name=3DCR9></A>Young KE, White CA (2006) The prevalence and=20 moderators of fatigue in people who have been successfully treated = for=20 cancer. J Psychosom Res 60:29=9638. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/j.jpsychores.2005.03.011">10.1016/j.jps= ychores.2005.03.011</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16380307"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/j.jpsychores.2005.03.011"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>10.</TD> <TD><A name=3DCR10></A>Ng AK, Li S, Recklitis C et al (2005) A = comparison=20 between long-term survivors of Hodgkin=92s disease and their = siblings on=20 fatigue level and factors predicting for increased fatigue. Ann = Oncol=20 16:1949=961955. doi:<A=20 = href=3D"http://dx.doi.org/10.1093/annonc/mdi407">10.1093/annonc/mdi407</A= >=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16227316"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1093/annonc/mdi407"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD2MnisVOmsw%253D%253D&md5=3D83fd3bc9d4bd4a23859a7fb2dc653357"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>11.</TD> <TD><A name=3DCR11></A>Hjermstad MJ, Fossa SD, Oldervoll L et al = (2005)=20 Fatigue in long-term Hodgkin=92s disease survivors: a follow-up = study. J=20 Clin Oncol 23:6587=966595. doi:<A=20 = href=3D"http://dx.doi.org/10.1200/JCO.2005.09.936">10.1200/JCO.2005.09.93= 6</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16170166"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1200/JCO.2005.09.936"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>12.</TD> <TD><A name=3DCR12></A>Servaes P, Verhagen S, Bleijenberg G (2002)=20 Determinants of chronic fatigue in disease-free breast cancer = patients: a=20 cross-sectional study. Ann Oncol 13:589=96598. doi:<A=20 = href=3D"http://dx.doi.org/10.1093/annonc/mdf082">10.1093/annonc/mdf082</A= >=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D12056710"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1093/annonc/mdf082"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD38zhsVyntQ%253D%253D&md5=3Dcaf98f8e0e1dc90f16ea9d9258bb507d"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>13.</TD> <TD><A name=3DCR13></A>Bennett B, Goldstein D, Lloyd A et al (2004) = Fatigue=20 and psychological distress; exploring the relationship in women = treated=20 for breast cancer. Eur J Cancer 40:1689=961695. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/j.ejca.2004.03.021">10.1016/j.ejca.2004= .03.021</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D15251158"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/j.ejca.2004.03.021"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD2czkvVCqtw%253D%253D&md5=3D6d371dbf42355abd6fea7ccf468f939c"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>14.</TD> <TD><A name=3DCR14></A>Sugawara Y, Akechi T, Okuyama T et al (2005)=20 Occurrence of fatigue and associated factors in disease-free = breast cancer=20 patients without depression. Support Care Cancer 13:628=96636. = doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s00520-004-0763-6">10.1007/s00520-004-0= 763-6</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D15668753"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s00520-004-0763-6"><IMG = border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>15.</TD> <TD><A name=3DCR15></A>Gustafsson M, Edvardsson T, Ahlstr=F6m G = (2006) The=20 relationship between function, quality of life and coping in = patients with=20 low-grade gliomas. Support Care Cancer 14:1205=961212. doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s00520-006-0080-3">10.1007/s00520-006-0= 080-3</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16710652"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s00520-006-0080-3"><IMG = border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>16.</TD> <TD><A name=3DCR16></A>Taphoorn MJB, Klein Schiphorst A, Snoek FJ et = al=20 (1994) Cognitive functions and quality of life in patients with = low-grade=20 gliomas: the impact of radiotherapy. Ann Neurol 36:48=9654. doi:<A = = href=3D"http://dx.doi.org/10.1002/ana.410360111">10.1002/ana.410360111</A= >=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D8024261"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1002/ana.410360111"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= AByuB1Mngs1M%253D&md5=3De093eaee2898d2cd8d5d117efe42d4fe"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>17.</TD> <TD><A name=3DCR17></A>Kiebert GM, Curran D, Aaronson NK et al = (1998)=20 Quality of life after radiation therapy of cerebral low-grade = gliomas of=20 the adult: results of a randomised Phase III trial on dose = response (EORTC=20 trial 22844). Eur J Cancer 34:1902=961909. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0959-8049(98)00268-8">10.1016/S0959-80= 49(98)00268-8</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10023313"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0959-8049(98)00268-8"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1M7ksleqtg%253D%253D&md5=3D578b1167a10d000dd1758d74944bc0d9"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>18.</TD> <TD><A name=3DCR18></A>Jacobsen PB, Thors CL (2003) Fatigue in the = radiation=20 therapy patient: current management and investigations. Semin = Radiat Oncol=20 13:372=96380. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S1053-4296(03)00021-3">10.1016/S1053-42= 96(03)00021-3</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D12903024"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S1053-4296(03)00021-3"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>19.</TD> <TD><A name=3DCR19></A>Vercoulen JH, Alberts M, Bleijenberg G (1999) = De=20 Checklist Individual Strength (CIS). Tijdschr Gedragstherapie = 32:131=96136=20 </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>20.</TD> <TD><A name=3DCR20></A>Vercoulen JH, Swanink CM, Fennis JF et al = (1994)=20 Dimensional assessment of chronic fatigue syndrome. J Psychosom = Res=20 38:383=96392. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/0022-3999(94)90099-X">10.1016/0022-3999= (94)90099-X</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D7965927"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/0022-3999(94)90099-X"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= AByqD2MrjtFM%253D&md5=3D2c182bf4f5d8df88510090551a1e727e"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>21.</TD> <TD><A name=3DCR21></A>Servaes P, Gielissen MFM, Verhagen S et al = (2006) The=20 course of severe fatigue in disease-free breast cancer patients: a = longitudinal study. Psychooncology 16:787=96795. doi:<A=20 href=3D"http://dx.doi.org/10.1002/pon.1120">10.1002/pon.1120</A> = </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>22.</TD> <TD><A name=3DCR22></A>Andrykowski MA, Curran SL, Lightner R (1998)=20 Off-treatment fatigue in breast cancer survivors: a controlled = comparison.=20 J Behav Med 21:1=9618. doi:<A=20 = href=3D"http://dx.doi.org/10.1023/A:1018700303959">10.1023/A:101870030395= 9</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9547419"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1023/A:1018700303959"><IMG border=3D0 = alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1c3gvVKgtw%253D%253D&md5=3Dc88f8ae295a665e0f040741a784a5420"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>23.</TD> <TD><A name=3DCR23></A>Broeckel JA, Jacobsen PB, Horton J et al = (1998)=20 Characteristics and correlates of fatigue after adjuvant = chemotherapy for=20 breast cancer. J Clin Oncol 16:1689=961696<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9586880"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1c3ks1aqsA%253D%253D&md5=3D880c97e014ec65e3bf553211df0e7864"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>24.</TD> <TD><A name=3DCR24></A>Fobair P, Hoppe RT, Bloom J et al (1986)=20 Psychological problems among survivors of Hodgkin=92s disease. J = Clin Oncol=20 4:805=96814<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D3486256"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ABimC1MfosVM%253D&md5=3D49a2d5704932da0f55aac6b67cd06121"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>25.</TD> <TD><A name=3DCR25></A>Hann DM, Jacobsen PB, Martin SC et al (1997) = Fatigue=20 in women treated with bone marrow transplantation for breast = cancer: a=20 comparison with women with no history of cancer. Support Care = Cancer=20 5:44=9652. doi:<A=20 = href=3D"http://dx.doi.org/10.1007/BF01681961">10.1007/BF01681961</A> = <BR><A=20 target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9010989"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/BF01681961"><IMG border=3D0 = alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= AByiC28vislI%253D&md5=3Db056c35eeb74011f1cf0f0a6f4bf6401"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>26.</TD> <TD><A name=3DCR26></A>Hann DM, Jacobsen P, Martin S et al (1998) = Fatigue=20 and quality of life following radiotherapy for breast cancer: a=20 comparative study. J Clin Psychol Med Sett 5:19=9633. doi:<A=20 = href=3D"http://dx.doi.org/10.1023/A:1026249702250">10.1023/A:102624970225= 0</A>=20 <BR><A target=3D_blank = href=3D"http://dx.doi.org/10.1023/A:1026249702250"><IMG=20 border=3D0 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>27.</TD> <TD><A name=3DCR27></A>Smets EMA, Visser MRM, Willems AFMN et al = (1998)=20 Fatigue and radiotherapy: (B) experience in patients 9 months = following treatment. Br J Cancer 78:907=96912<BR><A = target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9764582"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1cvjsFKisw%253D%253D&md5=3Da9788a9c3ab7e8cc32e7d25357e4c685"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>28.</TD> <TD><A name=3DCR28></A>Fossa SD, Dahl AA, Loge JH (2003) Fatigue, = anxiety,=20 and depression in long term survivors of testicular cancer. J Clin = Oncol=20 21:1249=961254. doi:<A=20 = href=3D"http://dx.doi.org/10.1200/JCO.2003.08.163">10.1200/JCO.2003.08.16= 3</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D12663711"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1200/JCO.2003.08.163"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>29.</TD> <TD><A name=3DCR29></A>Barstch HH, Weis J, Moser MT (2003) = Cancer-related=20 fatigue in patients attending oncological rehabilitation programs: = prevalence, patterns and predictors. Onkologie 26:51=9657 = </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>30.</TD> <TD><A name=3DCR30></A>So WK, Tai JW (2005) Fatigue and fatigue = relieving=20 strategies used by Hong Kong Chinese patients after hemopoietic = stem cell=20 transplantation. Nurs Res 54:48=9655. doi:<A=20 = href=3D"http://dx.doi.org/10.1097/00006199-200501000-00007">10.1097/00006= 199-200501000-00007</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D15695939"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1097/00006199-200501000-00007"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>31.</TD> <TD><A name=3DCR31></A>Woo B, Dibble SL, Piper BF et al (1998) = Differences=20 in fatigue by treatment methods in women with breast cancer. Oncol = Nurs=20 Forum 25:915=96920<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9644708"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1czgvVGkug%253D%253D&md5=3Df5a43dca37d60caad701a76a925eb631"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>32.</TD> <TD><A name=3DCR32></A>Brown PD, Ballman KV, Rummans TA et al (2006) = Prospective study of quality of life in adults with newly = diagnosed=20 high-grade gliomas. J Neurooncol 76:283=96291. doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s11060-005-7020-9">10.1007/s11060-005-7= 020-9</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16163448"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s11060-005-7020-9"><IMG = border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>33.</TD> <TD><A name=3DCR33></A>Loge JH, Abrahamsen AF, Ekeberg O et al = (1999)=20 Hodgkin=92s disease survivors more fatigued than the general = population. J=20 Clin Oncol 17:253=96261<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10458240"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1MzosFChsA%253D%253D&md5=3Dd0524e2d9c86d84986350017a4c479c7"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>34.</TD> <TD><A name=3DCR34></A>Knobel H, Loge JH, Nordoy T et al (2000) High = level=20 of fatigue in lymphoma patients treated with high dose therapy. J = Pain=20 Symptom Manage 19:446=96456. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0885-3924(00)00144-5">10.1016/S0885-39= 24(00)00144-5</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10908825"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0885-3924(00)00144-5"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3cvivFWguw%253D%253D&md5=3D1a73d0462591d7d8e012acbbde3a79e7"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>35.</TD> <TD><A name=3DCR35></A>Okuyama T, Tanaka K, Akechi T et al (2001) = Fatigue in=20 ambulatory patients with advanced lung cancer: prevalence, = correlated=20 factors, and screening. J Pain Symptom Manage 22:554=96564. doi:<A = = href=3D"http://dx.doi.org/10.1016/S0885-3924(01)00305-0">10.1016/S0885-39= 24(01)00305-0</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D11516597"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0885-3924(01)00305-0"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3MvntVSrtA%253D%253D&md5=3D4754d6cfec9ecfb4e3b9e490692344aa"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>36.</TD> <TD><A name=3DCR36></A>Howell SJ, Radford JA, Smets EM et al (2000) = Fatigue,=20 sexual function and mood following treatment for haematological=20 malignancy: the impact of mild Leydig cell disfunction. Br J = Cancer=20 82:789=96793. doi:<A=20 = href=3D"http://dx.doi.org/10.1054/bjoc.1999.1000">10.1054/bjoc.1999.1000<= /A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10732747"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1054/bjoc.1999.1000"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3c7psVyrtw%253D%253D&md5=3Db8dd64e953790f6ca8eb7c9b12748768"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>37.</TD> <TD><A name=3DCR37></A>Okuyama T, Akechi T, Kugaya A et al (2000) = Factors=20 correlated with fatigue in disease-free breast cancer patients:=20 application of the cancer fatigue scale. Support Cancer Care = 8:215=96222.=20 doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s005200050288">10.1007/s005200050288</A= >=20 <BR><A target=3D_blank = href=3D"http://dx.doi.org/10.1007/s005200050288"><IMG=20 border=3D0 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3c3kvVyhtw%253D%253D&md5=3Df56d9548033c846fb78cea7033d6d27b"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>38.</TD> <TD><A name=3DCR38></A>Servaes P, Verhagen S, Schreuder HWB et al = (2003)=20 Fatigue after treatment for malignant and benign bone and soft = tissue=20 tumors. J Pain Symptom Manage 26:1113=961122. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/j.jpainsymman.2003.03.001">10.1016/j.jp= ainsymman.2003.03.001</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D14654263"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/j.jpainsymman.2003.03.001"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>39.</TD> <TD><A name=3DCR39></A>Bower JE, Ganz PA, Desmond KA et al (2006) = Fatigue in=20 long-term breast carcinoma survivors. A longitudinal = investigation. Cancer=20 106:751=96758. doi:<A=20 = href=3D"http://dx.doi.org/10.1002/cncr.21671">10.1002/cncr.21671</A> = <BR><A=20 target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16400678"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1002/cncr.21671"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>40.</TD> <TD><A name=3DCR40></A>Portenoy RK (2000) Cancer-related fatigue: an = immense=20 problem. Oncologist 5:350=96352. doi:<A=20 = href=3D"http://dx.doi.org/10.1634/theoncologist.5-5-350">10.1634/theoncol= ogist.5-5-350</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D11040269"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1634/theoncologist.5-5-350"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3crgtFWntQ%253D%253D&md5=3D76d1678eef3f36448cedefc6d8b69f82"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>41.</TD> <TD><A name=3DCR41></A>Mainio A, Tuunanen S, Hakko H et al (2006) = Decreased=20 quality of life and depression as predictors for shorter survival = among=20 patients with low-grade gliomas: a follow-up from 1990 to 2003. = Eur Arch=20 Psychiatry Clin Neurosci 256:516=96521. doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s00406-006-0674-2">10.1007/s00406-006-0= 674-2</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16960653"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s00406-006-0674-2"><IMG = border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR></TBODY></TABLE></BODY></HTML> ------=_NextPart_000_0000_01C96F52.4D0D79E0 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://www.springerlink.com/content/tm31nq867x423h13/contact.gif R0lGODdhDgAKAKIAAP////r7v+rrl8TFDKOkAH1+AElKAAAAACwAAAAADgAKAAADLWi63AQwynEM KCLrXEgFAraFgmdxm2iCpdhla8mpZRUQo0aYw+7/u8phSCwSEwA7 ------=_NextPart_000_0000_01C96F52.4D0D79E0 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.gif R0lGODlhQQAUAPcAAAAAAAAICAgQEBAYGBAYIRghKSEpMSExOSExQik5SjlKWjlKY0JSa0pKSkpa c0pje0pjhFJSUlJSjFJrhFJzjFpaWlpalFp7lFp7nFqUlGNjnGOEnGOEpWOMrWOcnGOczmOl1muU tWuUvWul1nOUvXOcvXOcxnulzoSEhISt1oSt3oS154yMjIy13oy154y975SUlJTG95TG/5TO/5yc zpyl1pzO/62trbW1tff39/////////////////////////////////////////////////////// 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From: Subject: 10.1007/s11060-008-9738-7 Date: Mon, 5 Jan 2009 16:26:02 +0100 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01C96F52.4D0D79E0" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5579 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C96F52.4D0D79E0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.springerlink.com/content/tm31nq867x423h13/fulltext.html 10.1007/s11060-008-9738-7</TIT= LE> <META content=3D"text/html; charset=3DISO-8859-1" = http-equiv=3DContent-Type><LINK=20 rel=3DstyleSheet type=3Dtext/css=20 href=3D"http://www.springerlink.com/config/css/A++_common.css"><LINK=20 rel=3DstyleSheet type=3Dtext/css=20 href=3D"http://www.springerlink.com/config/css/content_A++_SpringerLink.c= ss"> <META name=3DGENERATOR content=3D"MSHTML 8.00.6001.18247"></HEAD> <BODY class=3Dfor-print> <TABLE border=3D1 cellPadding=3D2> <TBODY> <TR class=3Dheader> <TD>Journal of Neuro-Oncology</TD></TR> <TR> <TD>=A9 The Author(s) 2008</TD></TR> <TR> <TD>10.1007/s11060-008-9738-7</TD></TR></TBODY></TABLE> <H2 class=3Drubric>Clinical Study - Patient Study</H2> <DIV class=3DHeading1><A name=3Dtitle></A>Fatigue in low-grade glioma = </DIV> <P class=3DAuthorGroup>Karin Struik<SUP>1</SUP>,=20 Martin Klein<SUP>2</SUP>, Jan J. Heimans<SUP>1</SUP>,=20 Marieke F. Gielissen<SUP>3</SUP>, = Gijs Bleijenberg<SUP>3</SUP>,=20 Martin J. Taphoorn<SUP>4</SUP>,=20 Jaap C. Reijneveld<SUP>1</SUP> and=20 Tjeerd J. Postma<SUP>1 <A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#ContactOfAuthor8"><IMG=20 border=3D0 alt=3D"Contact Information"=20 src=3D"http://www.springerlink.com/content/tm31nq867x423h13/contact.gif">= </A></SUP></P> <TABLE> <TBODY> <TR vAlign=3Dtop> <TD><SPAN class=3DAffiliation><A = name=3DAff1></A>(1) </SPAN></TD> <TD><SPAN class=3DAffiliation>Department of Neurology, VU University = Medical=20 Center, P.O. Box 7057, 1007 MB Amsterdam, The=20 Netherlands</SPAN></TD></TR></TBODY></TABLE> <TABLE> <TBODY> <TR vAlign=3Dtop> <TD><SPAN class=3DAffiliation><A = name=3DAff2></A>(2) </SPAN></TD> <TD><SPAN class=3DAffiliation>Department of Medical Psychology, VU=20 University Medical Center, Amsterdam, The=20 Netherlands</SPAN></TD></TR></TBODY></TABLE> <TABLE> <TBODY> <TR vAlign=3Dtop> <TD><SPAN class=3DAffiliation><A = name=3DAff3></A>(3) </SPAN></TD> <TD><SPAN class=3DAffiliation>Expert Center Chronic Fatigue, Radboud = University, Nijmegen Medical Center, Nijmegen, The=20 Netherlands</SPAN></TD></TR></TBODY></TABLE> <TABLE> <TBODY> <TR vAlign=3Dtop> <TD><SPAN class=3DAffiliation><A = name=3DAff4></A>(4) </SPAN></TD> <TD><SPAN class=3DAffiliation>Department of Neurology, Medical = Center=20 Haaglanden, Den Haag, The = Netherlands</SPAN></TD></TR></TBODY></TABLE> <P><A name=3DContactOfAuthor8></A></P> <TABLE class=3DContact> <TBODY> <TR> <TD vAlign=3Dtop><IMG border=3D0 alt=3D"Contact Information"=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/contact.gif">= </TD> = <TD><STRONG>Tjeerd </STRONG><STRONG>J. </STRONG><STRONG>Postma<= /STRONG><STRONG></STRONG><BR><STRONG>Email:=20 </STRONG><A=20 = href=3D"mailto:TJ.Postma@vumc.nl">TJ.Postma@vumc.nl</A></TD></TR></TBODY>= </TABLE> <P class=3DAffiliation><STRONG>Received:=20 </STRONG>25 February 2008 <STRONG>Accepted:=20 </STRONG>4 November 2008 <STRONG>Published online:=20 </STRONG>9 December 2008 </P> <DIV class=3DAbstract><A name=3DAbs1></A><SPAN=20 class=3DAbstractHeading>Abstract </SPAN>The aim of this study = was to=20 determine the prevalence and severity of fatigue in long-term survivors = with a=20 low-grade glioma (LGG), and to analyze the relationship between fatigue = and=20 demographic variables, disease duration, tumor characteristics, former = tumor=20 treatment modalities, antiepileptic drug (AED) use, self-reported = concentration,=20 motivation, and activity. Fifty-four patients with stable disease (age = range,=20 25=9673 years) who were diagnosed and treated more than = 8 years ago were=20 included in this study. Fatigue was analyzed with the Checklist = Individual=20 Strength (CIS). Thirty-nine percent of the LGG patients were severely = fatigued,=20 with older patients being most affected. Severe fatigue was associated = with AED=20 use, and with reduced self-reported concentration, motivation, and = activity. No=20 relation was found between fatigue and gender, histology, tumor = laterality,=20 disease duration, type of neurosurgical intervention and radiation = treatment.=20 Fatigue is a severe problem in a large proportion of long-term surviving = LGG=20 patients. </DIV> <P class=3DKeyword><SPAN=20 class=3DKeywordHeading>Keywords </SPAN>Fatigue - Low= -grade=20 glioma - Prevalence studies - Quality of life </P> <DIV><A name=3DSec1></A> <HR> <DIV class=3Dheading2>Introduction</DIV> <P>Low-grade gliomas are primary malignant brain tumors of glial origin=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR1">1</A></CITE>].=20 The median survival time for patients with LGG ranges from 5 to = 15 years=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR2">2</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR3">3</A></CITE>],=20 and some patients may survive in a stable state for many years after the = diagnosis and initial treatment. Frequent symptoms experienced by = patients with=20 LGG are epileptic seizures and cognitive disturbances [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR4">4</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR5">5</A></CITE>].=20 </P> <P>Fatigue is frequently reported by patients with cancer [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR6">6</A></CITE>].=20 During treatment, in advanced stages of the disease, and after curative=20 treatment, fatigue has been described as a major problem. In the last=20 10 years, the amount of research on the relationship between cancer = and=20 fatigue has increased remarkably [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>].=20 However, little is known about the variables associated with the = initiation and=20 persistence of cancer-related fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR8">8</A></CITE>].=20 The assumption is that fatigue develops during the treatment phase, but = later on=20 there seems to be no clear relationship between persistent fatigue and = initial=20 disease and treatment variables [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR11">11</A></CITE>].=20 Estimations of fatigue during treatment of cancer range from 25% to 75%=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>].=20 In addition, based on several cross-sectional and longitudinal studies, = fatigue=20 seems to be a problem for a considerable number of cancer survivors = [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR8">8</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR11">11</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR14">14</A></CITE>].=20 </P> <P>Clinical practice suggests that fatigue is also important in glioma = patients.=20 However, the level of fatigue and its associated factors have not been = studied=20 extensively in LGG patients. Studies assessing fatigue in this patient = group=20 mostly use only a limited number of items from a quality of life = instrument=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR15">15</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR17">17</A></CITE>].=20 However, the most comprehensive approach to assess fatigue would be = using a=20 multidimensional instrument [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR18">18</A></CITE>],=20 because fatigue is a multidimensional concept with several modes of = expression=20 (physical, cognitive, and affective) [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>].=20 In one cross-sectional study, fatigue was assessed in 39 LGG patients = with help=20 of the European Organization for Research and Treatment of Cancer = (EORTC) Core=20 Quality of Life Questionnaire, containing three items for fatigue. The = majority=20 of these patients reported tiredness and about half of them had sleep=20 disturbances [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR15">15</A></CITE>].=20 In another quality of life study, LGG patients scored higher on the = subscale=20 fatigue compared to control subjects, using the Profile of Mood States = to=20 measure affective disturbances [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR16">16</A></CITE>].=20 </P> <P>In this study the following research questions are addressed: (1) = What is the=20 prevalence and severity of fatigue in LGG patients? (2) Is fatigue = associated=20 with demographic variables (age and gender), disease duration, tumor=20 characteristics (histology and tumor laterality), former tumor treatment = modalities (type of neurosurgical intervention, post-surgery = radiotherapy), the=20 use of AEDs, or with self-reported concentration, reduced motivation and = activity? </P></DIV> <DIV><A name=3DSec2></A> <HR> <DIV class=3Dheading2>Methods</DIV> <DIV><A name=3DSec3></A> <DIV class=3DHeading3>Patients</DIV> <P>Fifty-eight patients aged 25=9673 (mean 48) years with a LGG = diagnosed and=20 treated 8=9629 years ago were approached for this study. These = patients were=20 part of a group of LGG patients recruited between 1997 and 2000 for a = large=20 nationwide study into the neuropsychological status and quality of life=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR5">5</A></CITE>].=20 We exclusively approached long-term survivors of a histologically proven = LGG=20 without signs of tumor recurrence, and who already participated in a = follow-up=20 study on cognition and quality of life between 2004 and 2005. </P></DIV> <DIV><A name=3DSec4></A> <DIV class=3DHeading3>Recruitment procedure</DIV> <P>We sent a fatigue questionnaire to the 58 patients, together with a = letter=20 from the research coordinator in the summer of 2006, explaining the = intention of=20 the study. Furthermore, an informed consent form was enclosed. Those = patients=20 who were willing to participate in the study were asked to complete the=20 questionnaire, and sign the informed consent form at home. </P></DIV> <DIV><A name=3DSec5></A> <DIV class=3DHeading3>Measures</DIV> <P>Fatigue and fatigue related symptoms were measured with the Checklist = Individual Strength (CIS). The CIS is a multidimensional fatigue scale; = it=20 measures four aspects of fatigue during the previous 2 weeks, = namely:=20 fatigue severity (eight items), concentration problems (five items), = reduced=20 motivation (four items), and reduced activity (three items) [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR19">19</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR20">20</A></CITE>].=20 Each item is scored on a seven-point Likert scale. Total scores of every = subscale are obtained by adding the individual items, with high scores=20 indicating a high level of fatigue, a high level of concentration = problems, low=20 motivation, and a low level of activity. Patients with a score of 35 or = higher=20 on the fatigue severity subscale are considered to be severely fatigued. = This=20 cut-off value is based on data obtained in patients with chronic fatigue = syndrome [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR20">20</A></CITE>].=20 </P></DIV> <DIV><A name=3DSec6></A> <DIV class=3DHeading3>Statistical analysis</DIV> <P>Data analysis was accomplished using SPSS software, version 12.0. As = a result=20 of small sample size we had to use a non-parametric approach when = selecting=20 statistical methods. Mann=96Whitney tests were conducted to test the = differences=20 between groups. To test the relation between fatigue and age, disease = duration,=20 self-reported concentration, motivation and activity, comparisons were = made=20 between severely fatigued (CIS ≥ 35) and non-severely = fatigued=20 (CIS < 35) LGG patients. The level of statistical = significance for=20 all tests was set at <I>P</I> value less than 0.05. </P></DIV></DIV> <DIV><A name=3DSec7></A> <HR> <DIV class=3Dheading2>Results</DIV> <DIV><A name=3DSec8></A> <DIV class=3DHeading3>Patient characteristics</DIV> <DIV class=3DPara> <DIV>Fifty-four of the 58 patients we approached (93%) completed and = returned=20 the CIS questionnaire. One patient was unable to participate due to = foreign=20 residence. One patient declined participation in the study, and the = reasons of=20 two other non-participants are unknown. Non-participants did not differ = from the=20 participants with respect to gender, histology, disease duration, type = of=20 neurosurgical intervention, and AED use. On the other hand, the = non-participants=20 were slightly younger (mean 43.5 years), and none of them had = received=20 radiotherapy. Information about the characteristics of the LGG patients = is=20 listed in Table <A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#Tab1">1</A>.<A=20 name=3DTab1></A> <DIV class=3DCapt><SPAN = class=3DCaptNr>Table 1 </SPAN>Low-grade glioma=20 patient group (<I>n</I> =3D 54): characteristics </DIV> <TABLE border=3D1> <COLGROUP> <COL align=3Dleft> <COL align=3Dchar char=3D"("></COLGROUP> <THEAD> <TR class=3Dheader> <TH align=3Dleft> <P>Characteristics</P></TH> <TH align=3Dleft char=3D"("> <P>Data</P></TH></TR></THEAD> <TBODY> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean age<SUP>a</SUP> </P></TD> <TD align=3Dchar char=3D"("> <P>48 (SD 11.8, range 25=9673)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Gender: M</P></TD> <TD align=3Dchar char=3D"("> <P>28 (52%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean level of education<SUP>b</SUP> </P></TD> <TD align=3Dchar char=3D"("> <P>4.1 (SD 2.0, range 1=968)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean disease duration<SUP>a</SUP> </P></TD> <TD align=3Dchar char=3D"("> <P>15.0 (SD 4.0, range 8=9629)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Histological diagnosis</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Astrocytoma</P></TD> <TD align=3Dchar char=3D"("> <P>39 (72%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Oligodendroglioma</P></TD> <TD align=3Dchar char=3D"("> <P>10 (19%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Oligoastrocytoma</P></TD> <TD align=3Dchar char=3D"("> <P>5 (9%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Tumor location</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Left-sided</P></TD> <TD align=3Dchar char=3D"("> <P>32 (59%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Right-sided</P></TD> <TD align=3Dchar char=3D"("> <P>20 (37%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Midline</P></TD> <TD align=3Dchar char=3D"("> <P>2 (4%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Neurosurgical intervention</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Biopsy</P></TD> <TD align=3Dchar char=3D"("> <P>17 (31%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Resection</P></TD> <TD align=3Dchar char=3D"("> <P>37 (69%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Radiotherapy</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Yes</P></TD> <TD align=3Dchar char=3D"("> <P>29 (54%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> No</P></TD> <TD align=3Dchar char=3D"("> <P>25 (46%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Antiepileptic drug use</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Yes</P></TD> <TD align=3Dchar char=3D"("> <P>26 (48%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> No</P></TD> <TD align=3Dchar char=3D"("> <P>26 (48%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Missing</P></TD> <TD align=3Dchar char=3D"("> <P>2 (4%)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D2 align=3Dleft> <P>Type of antiepileptic drug use</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Monotherapy</P></TD> <TD align=3Dchar char=3D"("> <P>14 (54%)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Polytherapy</P></TD> <TD align=3Dchar char=3D"("> <P>12 (46%)</P></TD></TR></TBODY></TABLE> <DIV class=3DCapt> <DIV class=3DCaptCont> <DIV>Data are number (%) of patients, unless otherwise = indicated</DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>a</SUP>Years </DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>b</SUP>Education was assessed by a Dutch scoring system = ranging from=20 unfinished primary education (level 1) to university education (level 8) = </DIV></DIV></DIV></DIV></DIV></DIV> <DIV><A name=3DSec9></A> <DIV class=3DHeading3>Fatigue prevalence and severity</DIV> <P>The mean CIS-fatigue severity score of the sample LGG patients was = 28.2 (SD=20 15.5). The CIS-fatigue cut-off score of ≥35 for severe fatigue was = crossed by 21=20 patients. Hence, 39% of the LGG patients experienced severe fatigue. The = remaining 33 patients were classified as non-severely fatigued. = </P></DIV> <DIV><A name=3DSec10></A> <DIV class=3DHeading3>Fatigue related to patient, tumor and treatment=20 characteristics</DIV> <P>To test the relationship between age, disease duration, and fatigue,=20 comparisons were made between severely fatigued = (CIS ≥ 35,=20 <I>n</I> =3D 21) and non-severely fatigued = (CIS < 35,=20 <I>n</I> =3D 33) LGG patients. Severely fatigued patients were = older=20 than the non-severely fatigued patients (Mann=96Whitney,=20 <I>P</I> =3D 0.012). We did not find any differences in = disease duration=20 for severely and non-severely fatigued patients (Mann=96Whitney,=20 <I>P</I> =3D 0.404). Fatigue severity was not related to = gender=20 (Mann=96Whitney, <I>P</I> =3D 0.640), and no association could = be=20 established between histological diagnosis (astrocytoma and = oligodendroglioma)=20 and fatigue severity (Mann=96Whitney, <I>P</I> =3D 0.766). Due = to the=20 small number of patients with mixed glioma (oligoastrocytoma), data of = these=20 patients were excluded from the analyses. Furthermore, the association = between=20 tumor laterality and fatigue severity was investigated, while excluding = midline=20 tumor locations because of the small sample size = (<I>n</I> =3D 2).=20 Results of a Mann=96Whitney test indicated that there was no association = between=20 tumor laterality and fatigue severity (<I>P</I> =3D 0.435). = </P> <DIV class=3DPara> <DIV>No association was found between type of neurosurgical intervention = and=20 fatigue severity (Mann=96Whitney, <I>P</I> =3D 0.081). = Approximately half=20 of the LGG patients (<I>n</I> =3D 29) received radiotherapy. = Again, no=20 effect was found between former radiation treatment and fatigue severity = (Mann=96Whitney, <I>P</I> =3D 0.993). However, patients = treated with AEDs=20 were more fatigued (Mann=96Whitney, <I>P</I> =3D 0.004), = irrespective of=20 the use of mono- or polytherapy (Mann=96Whitney, = <I>P</I> =3D 0.738)=20 (Table <A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#Tab2">2</A>).<A=20 name=3DTab2></A> <DIV class=3DCapt><SPAN class=3DCaptNr>Table 2 </SPAN>Tumor = and treatment=20 characteristics in relation to fatigue </DIV> <TABLE border=3D1> <COLGROUP> <COL align=3Dleft> <COL align=3Dchar char=3D"."> <COL align=3Dchar char=3D"("> <COL align=3Dchar char=3D"."></COLGROUP> <THEAD> <TR class=3Dheader> <TH align=3Dleft> <P>Variables</P></TH> <TH align=3Dleft char=3D"."> <P>N</P></TH> <TH align=3Dleft char=3D"("> <P>Mean CIS-fatigue (SD)</P></TH> <TH align=3Dleft char=3D"."> <P><I>P-</I>value<SUP>a</SUP> </P></TH></TR></THEAD> <TBODY> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Histological diagnosis</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Astrocytoma</P></TD> <TD align=3Dchar char=3D"."> <P>39</P></TD> <TD align=3Dchar char=3D"("> <P>27.2 (15.2)</P></TD> <TD rowSpan=3D3 align=3Dchar char=3D"."> <P>0.766</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Oligodendroglioma</P></TD> <TD align=3Dchar char=3D"."> <P>10</P></TD> <TD align=3Dchar char=3D"("> <P>29.1 (18.5)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Oligoastrocytoma<SUP>b</SUP> </P></TD> <TD align=3Dchar char=3D"."> <P>5</P></TD> <TD align=3Dchar char=3D"("> <P>34.6 (12.3)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Tumor location</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Left-sided</P></TD> <TD align=3Dchar char=3D"."> <P>32</P></TD> <TD align=3Dchar char=3D"("> <P>27.4 (15.5)</P></TD> <TD rowSpan=3D3 align=3Dchar char=3D"."> <P>0.435</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Right-sided</P></TD> <TD align=3Dchar char=3D"."> <P>20</P></TD> <TD align=3Dchar char=3D"("> <P>30.7 (15.8)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Midline<SUP>b</SUP> </P></TD> <TD align=3Dchar char=3D"."> <P>2</P></TD> <TD align=3Dchar char=3D"("> <P>17.5 (13.4)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Neurosurgical intervention</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Biopsy</P></TD> <TD align=3Dchar char=3D"."> <P>17</P></TD> <TD align=3Dchar char=3D"("> <P>33.8 (15.7)</P></TD> <TD rowSpan=3D2 align=3Dchar char=3D"."> <P>0.081</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Resection</P></TD> <TD align=3Dchar char=3D"."> <P>37</P></TD> <TD align=3Dchar char=3D"("> <P>25.7 (15.0)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Radiotherapy</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Yes</P></TD> <TD align=3Dchar char=3D"."> <P>29</P></TD> <TD align=3Dchar char=3D"("> <P>28.3 (15.0)</P></TD> <TD rowSpan=3D2 align=3Dchar char=3D"."> <P>0.993</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> No</P></TD> <TD align=3Dchar char=3D"."> <P>25</P></TD> <TD align=3Dchar char=3D"("> <P>28.2 (16.4)</P></TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Antiepileptic drug use</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Yes</P></TD> <TD align=3Dchar char=3D"."> <P>26</P></TD> <TD align=3Dchar char=3D"("> <P>34.5 (14.6)</P></TD> <TD rowSpan=3D3 align=3Dchar char=3D"."> <P>0.004</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> No</P></TD> <TD align=3Dchar char=3D"."> <P>26</P></TD> <TD align=3Dchar char=3D"("> <P>22.2 (13.9)</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Missing</P></TD> <TD align=3Dchar char=3D"."> <P>2</P></TD> <TD align=3Dleft char=3D"("> </TD></TR> <TR class=3Dnoclass> <TD colSpan=3D4 align=3Dleft> <P>Type of antiepileptic drug</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Monotherapy</P></TD> <TD align=3Dchar char=3D"."> <P>14</P></TD> <TD align=3Dchar char=3D"("> <P>33.6 (14.6)</P></TD> <TD rowSpan=3D2 align=3Dchar char=3D"."> <P>0.738</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P> Polytherapy</P></TD> <TD align=3Dchar char=3D"."> <P>12</P></TD> <TD align=3Dchar char=3D"("> <P>35.7 (15.2)</P></TD></TR></TBODY></TABLE> <DIV class=3DCapt> <DIV class=3DCaptCont> <DIV>Abbreviation: CIS, Checklist Individual Strength</DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>a</SUP>Mann=96Whitney tests were conducted to analyze the = association=20 between fatigue and tumor and treatment characteristics </DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>b</SUP>Variables which were excluded in testing=20 </DIV></DIV></DIV></DIV></DIV></DIV> <DIV><A name=3DSec11></A> <DIV class=3DHeading3>Fatigue related problems: concentration, = motivation and=20 activity</DIV> <DIV class=3DPara> <DIV>To test the association between fatigue and self-reported = concentration,=20 motivation and activity, comparisons were made between severely fatigued = (CIS ≥ 35) and non-severely fatigued = (CIS < 35) LGG=20 patients. Severely fatigued LGG patients reported reduced motivation, a = lower=20 level of activity, and more problems with concentration (Mann=96Whitney, = <I>P</I> < 0.001) (Table <A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#Tab3">3</A>).<A=20 name=3DTab3></A> <DIV class=3DCapt><SPAN = class=3DCaptNr>Table 3 </SPAN>Fatigue-related=20 problems: concentration, motivation and activity </DIV> <TABLE border=3D1> <COLGROUP> <COL align=3Dleft> <COL align=3Dchar char=3D"("> <COL align=3Dchar char=3D"("> <COL align=3Dchar char=3D"."></COLGROUP> <THEAD> <TR class=3Dheader> <TH align=3Dleft> <P>CIS-subscales</P></TH> <TH align=3Dleft char=3D"("> <P>Non-severely fatigued patients (<I>n</I> =3D 33) = </P></TH> <TH align=3Dleft char=3D"("> <P>Severely fatigued patients (<I>n</I> =3D 21) = </P></TH> <TH align=3Dleft char=3D"."> <P><I>P-</I>value<SUP>a</SUP> </P></TH></TR></THEAD> <TBODY> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean CIS-concentration (SD)</P></TD> <TD align=3Dchar char=3D"("> <P>14.5 (7.8)</P></TD> <TD align=3Dchar char=3D"("> <P>26.1 (7.5)</P></TD> <TD align=3Dchar char=3D"."> <P><0.001</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean CIS-motivation (SD)</P></TD> <TD align=3Dchar char=3D"("> <P>9.5 (4.8)</P></TD> <TD align=3Dchar char=3D"("> <P>17.0 (6.8)</P></TD> <TD align=3Dchar char=3D"."> <P><0.001</P></TD></TR> <TR class=3Dnoclass> <TD align=3Dleft> <P>Mean CIS-activity (SD)</P></TD> <TD align=3Dchar char=3D"("> <P>6.4 (3.9)</P></TD> <TD align=3Dchar char=3D"("> <P>14.5 (5.8)</P></TD> <TD align=3Dchar char=3D"."> <P><0.001</P></TD></TR></TBODY></TABLE> <DIV class=3DCapt> <DIV class=3DCaptCont> <DIV>Abbreviation: CIS, Checklist Individual Strength</DIV></DIV> <DIV class=3DCaptCont> <DIV><SUP>a</SUP>The Mann=96Whitney test was conducted to test the = differences=20 between non-severely and severely fatigued LGG patients=20 </DIV></DIV></DIV></DIV></DIV></DIV></DIV> <DIV><A name=3DSec12></A> <HR> <DIV class=3Dheading2>Discussion</DIV> <P>In this study, we found that 39% of long-term survivors with a LGG = experience=20 severe fatigue. Few studies assessed fatigue in LGG patients [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR15">15</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR17">17</A></CITE>].=20 In one quality of life study, fatigue is mentioned as a problem for the = majority=20 of glioma patients [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR15">15</A></CITE>].=20 The current study confirms these results. However, the 39% prevalence = rate of=20 severe fatigue is the highest found among all cancer patients measured = with the=20 CIS. Only the percentage of severe fatigue in a sample of breast cancer=20 survivors (38%) 2.5 years after curative treatment equals our = findings=20 [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR12">12</A></CITE>].=20 This percentage declines to 24% after a follow-up period of = 2 years. Other=20 cross-sectional and longitudinal studies investigating the prevalence = and course=20 of fatigue show similar results, revealing that fatigue continues to = decrease=20 during the first years after curative treatment. For about a quarter of = cancer=20 survivors fatigue remains a problem [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR21">21</A></CITE>].=20 Since the LGG patients in our study finished their treatment more than=20 8 years ago, the percentage of severe fatigue of nearly 40% is = remarkably=20 high. It is important to note that the LGG population differs from = non-glioma=20 cancer populations. In these non-glioma cancer studies, patients are = considered=20 to be disease-free. In contrast, LGG patients are considered to be never = completely free of disease [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR5">5</A></CITE>].=20 As a consequence, being confronted with a life-threatening illness can = lead to=20 feelings of depression and anxiety for the future, which both may be = correlated=20 with fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR6">6</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR22">22</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR27">27</A></CITE>].=20 Furthermore, LGG patients have specific cognitive problems [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR5">5</A></CITE>],=20 which presumably may also be related to fatigue. </P> <P>Moreover, our results show that fatigue is related to other problems. = Severely fatigued LGG patients have more problems with regard to = self-reported=20 concentration, and they experience reduced motivation and activity. = These=20 results are comparable to the extent of problems experienced by patients = with=20 chronic fatigue syndrome. However, compared to severely fatigue = disease-free=20 cancer patients, the LGG patients in our study report more problems with = concentration [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR6">6</A></CITE>].=20 </P> <P>In this study no association was found between gender and fatigue = severity,=20 but fatigue complaints were more severe in older LGG patients. Also in=20 testicular cancer patients [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR28">28</A></CITE>]=20 and in patients with hematological malignancies [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR29">29</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR30">30</A></CITE>]=20 the older patients reported more fatigue, whereas in breast cancer = patients the=20 younger participants were more fatigued [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR31">31</A></CITE>].=20 </P> <P>Furthermore, we found no relation between fatigue severity, tumor=20 characteristics, and former tumor treatment. In one prospective quality = of life=20 study it was demonstrated that patients with a high-grade glioma in the = right=20 hemisphere were more fatigued than those with a left-sided tumor = [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR32">32</A></CITE>].=20 However, in most studies, no associations were found between = tumor-related=20 variables and fatigue intensity with regard to disease duration = [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR23">23</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR25">25</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR26">26</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR29">29</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR33">33</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR35">35</A></CITE>],=20 type of cancer [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR27">27</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR36">36</A></CITE>],=20 disease stage at diagnosis [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR23">23</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR25">25</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR27">27</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR33">33</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR37">37</A></CITE>],=20 size of the original tumor [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR25">25</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR26">26</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR37">37</A></CITE>],=20 number of nodes involved [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR25">25</A></CITE>]=20 and tumor recurrence [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR33">33</A></CITE>].=20 </P> <P>Literature data suggest that fatigue arises during the active = treatment phase=20 in nearly all cancer patients, but little is known about the etiology of = persistent fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR11">11</A></CITE>].=20 Some studies suggest that patients with more aggressive former = treatments are=20 more at risk for persistent fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR21">21</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR31">31</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR38">38</A></CITE>,=20 <CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR39">39</A></CITE>],=20 but others do not find a strong association between initial cancer = treatment and=20 off-treatment fatigue [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR7">7</A></CITE>=96<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR11">11</A></CITE>].=20 In our study, no differences in fatigue severity were observed for = patients who=20 had a biopsy and for patients who underwent a resection. Furthermore, no = differences were observed in patients with or without prior = radiotherapy.=20 However, fatigue was significantly more pronounced in patients that used = AEDs.=20 </P> <P>This study has its limitations. Small sample size was the reason we = had to=20 exclude some variables from the analyses (i.e., oligoastrocytomas, = tumors in=20 midline locations). Furthermore, we have no data of current epileptic = activity=20 in this study. Therefore, we are not able to distinguish whether = seizures or the=20 use of AEDs contributed to the experience of fatigue. It would be very=20 interesting to study a larger group of glioma patients with emphasis on = fatigue,=20 AED use, and epilepsy burden. Nonetheless, we conclude that fatigue is a = major=20 problem in LGG patients. The current study demonstrates that almost 40% = of=20 long-term survivors with a LGG experience severe fatigue. These findings = are=20 important because fatigue has a serious impact on quality of life = [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR40">40</A></CITE>].=20 Furthermore, a decreased level of quality of life in LGG patients is=20 significantly related to shorter survival [<CITE><A=20 href=3D"http://www.springerlink.com/content/tm31nq867x423h13/fulltext.htm= l#CR41">41</A></CITE>].=20 Assessment and treatment of fatigue in LGG patients need to be further=20 investigated, potentially resulting in improvement of quality of life.=20 </P></DIV> <DIV class=3DAcknowledgments><SPAN class=3DAcknowledgmentsHeading>Open=20 Access </SPAN><SPAN>This article is distributed under the = terms of=20 the Creative Commons Attribution Noncommercial License which permits any = noncommercial use, distribution, and reproduction in any medium, = provided the=20 original author(s) and source are credited.</SPAN></DIV> <P></P> <HR> <H2><A name=3DBib1></A>References </H2> <TABLE> <TBODY class=3DCitation> <TR vAlign=3Dtop> <TD>1.</TD> <TD><A name=3DCR1></A>Hickey JV (2003) Brain tumors. In: Hickey JV = (ed) The=20 clinical practice of neurological and neurosurgical nursing. = Lippincott,=20 Williams & Wilkins, Philadelphia, pp 483=96508 </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>2.</TD> <TD><A name=3DCR2></A>Olson JD, Riedel E, DeAngelis LM (2000) = Long-term=20 outcome of low-grade oligodendroglioma and mixed glioma. Neurology = 54:1442=961448<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10751254"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3c3hsFSnug%253D%253D&md5=3D2491673fd0811a5f8721ed3256d1171c"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>3.</TD> <TD><A name=3DCR3></A>Karim ABMF, Maat B, Hatlevoll R et al (1996) A = randomised trial on dose response in radiation therapy of low = grade=20 cerebral glioma: EORTC study 22844. Int J Radiat Oncol Biol Phys=20 36:549=96556. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0360-3016(96)00352-5">10.1016/S0360-30= 16(96)00352-5</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D8948338"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= AByiC3cvhvVQ%253D&md5=3De986df815277c409dff54d4b96d0f964"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>4.</TD> <TD><A name=3DCR4></A>Klein M, Engelberts NHJ, van der Ploeg HM et = al (2003)=20 Epilepsy in low-grade gliomas: the impact on cognitive function = and=20 quality of life. Ann Neurol 54:514=96520. doi:<A=20 href=3D"http://dx.doi.org/10.1002/ana.10712">10.1002/ana.10712</A> = <BR><A=20 target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D14520665"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1002/ana.10712"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>5.</TD> <TD><A name=3DCR5></A>Klein M, Heimans JJ, Aaronson NK et al (2002) = Effect=20 of radiotherapy and other treatment-related factors on mid-term to = long-term cognitive sequelae in low-grade gliomas: a comparative = study.=20 Lancet 360:1361=961368. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0140-6736(02)11398-5">10.1016/S0140-67= 36(02)11398-5</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D12423981"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0140-6736(02)11398-5"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD38nmsVWmsg%253D%253D&md5=3Defdbe964e0d8ac4969f044072476fbb1"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>6.</TD> <TD><A name=3DCR6></A>Servaes P, van der Werf S, Prins J et al = (2001)=20 Fatigue in disease-free cancer patients compared with fatigue in = patients=20 with Chronic Fatigue Syndrome. Support Care Cancer 9:11=9617. = doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s005200000165">10.1007/s005200000165</A= >=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D11147137"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s005200000165"><IMG border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3M7itlKktQ%253D%253D&md5=3D0e48848a3e48658189019786f95f6e2e"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>7.</TD> <TD><A name=3DCR7></A>Servaes P, Verhagen C, Bleijenberg G (2002) = Fatigue in=20 cancer patients during and after treatment: prevalence, correlates = and=20 interventions. Eur J Cancer 38:27=9634. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0959-8049(01)00332-X">10.1016/S0959-80= 49(01)00332-X</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D11750837"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0959-8049(01)00332-X"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD38%252Fgt1yjtQ%253D%253D&md5=3D27bbb2fdc690ad0f63f4c2818c2ea= 73e"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>8.</TD> <TD><A name=3DCR8></A>Prue G, Rankin J, Allen J et al (2006) = Cancer-related=20 fatigue: a critical appraisal. Eur J Cancer 42:846=96863. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/j.ejca.2005.11.026">10.1016/j.ejca.2005= .11.026</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16460928"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/j.ejca.2005.11.026"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD283lslKgsw%253D%253D&md5=3Dae6dbd6f5cad4c129280f83bcb07de34"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>9.</TD> <TD><A name=3DCR9></A>Young KE, White CA (2006) The prevalence and=20 moderators of fatigue in people who have been successfully treated = for=20 cancer. J Psychosom Res 60:29=9638. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/j.jpsychores.2005.03.011">10.1016/j.jps= ychores.2005.03.011</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16380307"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/j.jpsychores.2005.03.011"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>10.</TD> <TD><A name=3DCR10></A>Ng AK, Li S, Recklitis C et al (2005) A = comparison=20 between long-term survivors of Hodgkin=92s disease and their = siblings on=20 fatigue level and factors predicting for increased fatigue. Ann = Oncol=20 16:1949=961955. doi:<A=20 = href=3D"http://dx.doi.org/10.1093/annonc/mdi407">10.1093/annonc/mdi407</A= >=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16227316"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1093/annonc/mdi407"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD2MnisVOmsw%253D%253D&md5=3D83fd3bc9d4bd4a23859a7fb2dc653357"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>11.</TD> <TD><A name=3DCR11></A>Hjermstad MJ, Fossa SD, Oldervoll L et al = (2005)=20 Fatigue in long-term Hodgkin=92s disease survivors: a follow-up = study. J=20 Clin Oncol 23:6587=966595. doi:<A=20 = href=3D"http://dx.doi.org/10.1200/JCO.2005.09.936">10.1200/JCO.2005.09.93= 6</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16170166"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1200/JCO.2005.09.936"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>12.</TD> <TD><A name=3DCR12></A>Servaes P, Verhagen S, Bleijenberg G (2002)=20 Determinants of chronic fatigue in disease-free breast cancer = patients: a=20 cross-sectional study. Ann Oncol 13:589=96598. doi:<A=20 = href=3D"http://dx.doi.org/10.1093/annonc/mdf082">10.1093/annonc/mdf082</A= >=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D12056710"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1093/annonc/mdf082"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD38zhsVyntQ%253D%253D&md5=3Dcaf98f8e0e1dc90f16ea9d9258bb507d"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>13.</TD> <TD><A name=3DCR13></A>Bennett B, Goldstein D, Lloyd A et al (2004) = Fatigue=20 and psychological distress; exploring the relationship in women = treated=20 for breast cancer. Eur J Cancer 40:1689=961695. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/j.ejca.2004.03.021">10.1016/j.ejca.2004= .03.021</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D15251158"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/j.ejca.2004.03.021"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD2czkvVCqtw%253D%253D&md5=3D6d371dbf42355abd6fea7ccf468f939c"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>14.</TD> <TD><A name=3DCR14></A>Sugawara Y, Akechi T, Okuyama T et al (2005)=20 Occurrence of fatigue and associated factors in disease-free = breast cancer=20 patients without depression. Support Care Cancer 13:628=96636. = doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s00520-004-0763-6">10.1007/s00520-004-0= 763-6</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D15668753"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s00520-004-0763-6"><IMG = border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>15.</TD> <TD><A name=3DCR15></A>Gustafsson M, Edvardsson T, Ahlstr=F6m G = (2006) The=20 relationship between function, quality of life and coping in = patients with=20 low-grade gliomas. Support Care Cancer 14:1205=961212. doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s00520-006-0080-3">10.1007/s00520-006-0= 080-3</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16710652"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s00520-006-0080-3"><IMG = border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>16.</TD> <TD><A name=3DCR16></A>Taphoorn MJB, Klein Schiphorst A, Snoek FJ et = al=20 (1994) Cognitive functions and quality of life in patients with = low-grade=20 gliomas: the impact of radiotherapy. Ann Neurol 36:48=9654. doi:<A = = href=3D"http://dx.doi.org/10.1002/ana.410360111">10.1002/ana.410360111</A= >=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D8024261"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1002/ana.410360111"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= AByuB1Mngs1M%253D&md5=3De093eaee2898d2cd8d5d117efe42d4fe"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>17.</TD> <TD><A name=3DCR17></A>Kiebert GM, Curran D, Aaronson NK et al = (1998)=20 Quality of life after radiation therapy of cerebral low-grade = gliomas of=20 the adult: results of a randomised Phase III trial on dose = response (EORTC=20 trial 22844). Eur J Cancer 34:1902=961909. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0959-8049(98)00268-8">10.1016/S0959-80= 49(98)00268-8</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10023313"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0959-8049(98)00268-8"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1M7ksleqtg%253D%253D&md5=3D578b1167a10d000dd1758d74944bc0d9"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>18.</TD> <TD><A name=3DCR18></A>Jacobsen PB, Thors CL (2003) Fatigue in the = radiation=20 therapy patient: current management and investigations. Semin = Radiat Oncol=20 13:372=96380. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S1053-4296(03)00021-3">10.1016/S1053-42= 96(03)00021-3</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D12903024"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S1053-4296(03)00021-3"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>19.</TD> <TD><A name=3DCR19></A>Vercoulen JH, Alberts M, Bleijenberg G (1999) = De=20 Checklist Individual Strength (CIS). Tijdschr Gedragstherapie = 32:131=96136=20 </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>20.</TD> <TD><A name=3DCR20></A>Vercoulen JH, Swanink CM, Fennis JF et al = (1994)=20 Dimensional assessment of chronic fatigue syndrome. J Psychosom = Res=20 38:383=96392. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/0022-3999(94)90099-X">10.1016/0022-3999= (94)90099-X</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D7965927"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/0022-3999(94)90099-X"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= AByqD2MrjtFM%253D&md5=3D2c182bf4f5d8df88510090551a1e727e"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>21.</TD> <TD><A name=3DCR21></A>Servaes P, Gielissen MFM, Verhagen S et al = (2006) The=20 course of severe fatigue in disease-free breast cancer patients: a = longitudinal study. Psychooncology 16:787=96795. doi:<A=20 href=3D"http://dx.doi.org/10.1002/pon.1120">10.1002/pon.1120</A> = </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>22.</TD> <TD><A name=3DCR22></A>Andrykowski MA, Curran SL, Lightner R (1998)=20 Off-treatment fatigue in breast cancer survivors: a controlled = comparison.=20 J Behav Med 21:1=9618. doi:<A=20 = href=3D"http://dx.doi.org/10.1023/A:1018700303959">10.1023/A:101870030395= 9</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9547419"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1023/A:1018700303959"><IMG border=3D0 = alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1c3gvVKgtw%253D%253D&md5=3Dc88f8ae295a665e0f040741a784a5420"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>23.</TD> <TD><A name=3DCR23></A>Broeckel JA, Jacobsen PB, Horton J et al = (1998)=20 Characteristics and correlates of fatigue after adjuvant = chemotherapy for=20 breast cancer. J Clin Oncol 16:1689=961696<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9586880"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1c3ks1aqsA%253D%253D&md5=3D880c97e014ec65e3bf553211df0e7864"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>24.</TD> <TD><A name=3DCR24></A>Fobair P, Hoppe RT, Bloom J et al (1986)=20 Psychological problems among survivors of Hodgkin=92s disease. J = Clin Oncol=20 4:805=96814<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D3486256"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ABimC1MfosVM%253D&md5=3D49a2d5704932da0f55aac6b67cd06121"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>25.</TD> <TD><A name=3DCR25></A>Hann DM, Jacobsen PB, Martin SC et al (1997) = Fatigue=20 in women treated with bone marrow transplantation for breast = cancer: a=20 comparison with women with no history of cancer. Support Care = Cancer=20 5:44=9652. doi:<A=20 = href=3D"http://dx.doi.org/10.1007/BF01681961">10.1007/BF01681961</A> = <BR><A=20 target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9010989"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/BF01681961"><IMG border=3D0 = alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= AByiC28vislI%253D&md5=3Db056c35eeb74011f1cf0f0a6f4bf6401"><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>26.</TD> <TD><A name=3DCR26></A>Hann DM, Jacobsen P, Martin S et al (1998) = Fatigue=20 and quality of life following radiotherapy for breast cancer: a=20 comparative study. J Clin Psychol Med Sett 5:19=9633. doi:<A=20 = href=3D"http://dx.doi.org/10.1023/A:1026249702250">10.1023/A:102624970225= 0</A>=20 <BR><A target=3D_blank = href=3D"http://dx.doi.org/10.1023/A:1026249702250"><IMG=20 border=3D0 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>27.</TD> <TD><A name=3DCR27></A>Smets EMA, Visser MRM, Willems AFMN et al = (1998)=20 Fatigue and radiotherapy: (B) experience in patients 9 months = following treatment. Br J Cancer 78:907=96912<BR><A = target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9764582"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1cvjsFKisw%253D%253D&md5=3Da9788a9c3ab7e8cc32e7d25357e4c685"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>28.</TD> <TD><A name=3DCR28></A>Fossa SD, Dahl AA, Loge JH (2003) Fatigue, = anxiety,=20 and depression in long term survivors of testicular cancer. J Clin = Oncol=20 21:1249=961254. doi:<A=20 = href=3D"http://dx.doi.org/10.1200/JCO.2003.08.163">10.1200/JCO.2003.08.16= 3</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D12663711"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1200/JCO.2003.08.163"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>29.</TD> <TD><A name=3DCR29></A>Barstch HH, Weis J, Moser MT (2003) = Cancer-related=20 fatigue in patients attending oncological rehabilitation programs: = prevalence, patterns and predictors. Onkologie 26:51=9657 = </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>30.</TD> <TD><A name=3DCR30></A>So WK, Tai JW (2005) Fatigue and fatigue = relieving=20 strategies used by Hong Kong Chinese patients after hemopoietic = stem cell=20 transplantation. Nurs Res 54:48=9655. doi:<A=20 = href=3D"http://dx.doi.org/10.1097/00006199-200501000-00007">10.1097/00006= 199-200501000-00007</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D15695939"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1097/00006199-200501000-00007"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>31.</TD> <TD><A name=3DCR31></A>Woo B, Dibble SL, Piper BF et al (1998) = Differences=20 in fatigue by treatment methods in women with breast cancer. Oncol = Nurs=20 Forum 25:915=96920<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D9644708"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1czgvVGkug%253D%253D&md5=3Df5a43dca37d60caad701a76a925eb631"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>32.</TD> <TD><A name=3DCR32></A>Brown PD, Ballman KV, Rummans TA et al (2006) = Prospective study of quality of life in adults with newly = diagnosed=20 high-grade gliomas. J Neurooncol 76:283=96291. doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s11060-005-7020-9">10.1007/s11060-005-7= 020-9</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16163448"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s11060-005-7020-9"><IMG = border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>33.</TD> <TD><A name=3DCR33></A>Loge JH, Abrahamsen AF, Ekeberg O et al = (1999)=20 Hodgkin=92s disease survivors more fatigued than the general = population. J=20 Clin Oncol 17:253=96261<BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10458240"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADyaK1MzosFChsA%253D%253D&md5=3Dd0524e2d9c86d84986350017a4c479c7"><IM= G=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>34.</TD> <TD><A name=3DCR34></A>Knobel H, Loge JH, Nordoy T et al (2000) High = level=20 of fatigue in lymphoma patients treated with high dose therapy. J = Pain=20 Symptom Manage 19:446=96456. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/S0885-3924(00)00144-5">10.1016/S0885-39= 24(00)00144-5</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10908825"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0885-3924(00)00144-5"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3cvivFWguw%253D%253D&md5=3D1a73d0462591d7d8e012acbbde3a79e7"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>35.</TD> <TD><A name=3DCR35></A>Okuyama T, Tanaka K, Akechi T et al (2001) = Fatigue in=20 ambulatory patients with advanced lung cancer: prevalence, = correlated=20 factors, and screening. J Pain Symptom Manage 22:554=96564. doi:<A = = href=3D"http://dx.doi.org/10.1016/S0885-3924(01)00305-0">10.1016/S0885-39= 24(01)00305-0</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D11516597"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/S0885-3924(01)00305-0"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3MvntVSrtA%253D%253D&md5=3D4754d6cfec9ecfb4e3b9e490692344aa"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>36.</TD> <TD><A name=3DCR36></A>Howell SJ, Radford JA, Smets EM et al (2000) = Fatigue,=20 sexual function and mood following treatment for haematological=20 malignancy: the impact of mild Leydig cell disfunction. Br J = Cancer=20 82:789=96793. doi:<A=20 = href=3D"http://dx.doi.org/10.1054/bjoc.1999.1000">10.1054/bjoc.1999.1000<= /A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D10732747"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1054/bjoc.1999.1000"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3c7psVyrtw%253D%253D&md5=3Db8dd64e953790f6ca8eb7c9b12748768"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>37.</TD> <TD><A name=3DCR37></A>Okuyama T, Akechi T, Kugaya A et al (2000) = Factors=20 correlated with fatigue in disease-free breast cancer patients:=20 application of the cancer fatigue scale. Support Cancer Care = 8:215=96222.=20 doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s005200050288">10.1007/s005200050288</A= >=20 <BR><A target=3D_blank = href=3D"http://dx.doi.org/10.1007/s005200050288"><IMG=20 border=3D0 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3c3kvVyhtw%253D%253D&md5=3Df56d9548033c846fb78cea7033d6d27b"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>38.</TD> <TD><A name=3DCR38></A>Servaes P, Verhagen S, Schreuder HWB et al = (2003)=20 Fatigue after treatment for malignant and benign bone and soft = tissue=20 tumors. J Pain Symptom Manage 26:1113=961122. doi:<A=20 = href=3D"http://dx.doi.org/10.1016/j.jpainsymman.2003.03.001">10.1016/j.jp= ainsymman.2003.03.001</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D14654263"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1016/j.jpainsymman.2003.03.001"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>39.</TD> <TD><A name=3DCR39></A>Bower JE, Ganz PA, Desmond KA et al (2006) = Fatigue in=20 long-term breast carcinoma survivors. A longitudinal = investigation. Cancer=20 106:751=96758. doi:<A=20 = href=3D"http://dx.doi.org/10.1002/cncr.21671">10.1002/cncr.21671</A> = <BR><A=20 target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16400678"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1002/cncr.21671"><IMG border=3D0 = alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>40.</TD> <TD><A name=3DCR40></A>Portenoy RK (2000) Cancer-related fatigue: an = immense=20 problem. Oncologist 5:350=96352. doi:<A=20 = href=3D"http://dx.doi.org/10.1634/theoncologist.5-5-350">10.1634/theoncol= ogist.5-5-350</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D11040269"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1634/theoncologist.5-5-350"><IMG = border=3D0=20 alt=3DCrossRef=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/crossref_link= .gif"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 = href=3D"http://chemport.cas.org/cgi-bin/sdcgi?APP=3Dftslink&action=3D= reflink&origin=3Dspringer&version=3D1.0&coi=3D1%3ASTN%3A280%3= ADC%252BD3crgtFWntQ%253D%253D&md5=3D76d1678eef3f36448cedefc6d8b69f82"= ><IMG=20 border=3D0 alt=3DChemPort=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/chemport_link= .gif"=20 width=3D65 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR> <TR vAlign=3Dtop> <TD>41.</TD> <TD><A name=3DCR41></A>Mainio A, Tuunanen S, Hakko H et al (2006) = Decreased=20 quality of life and depression as predictors for shorter survival = among=20 patients with low-grade gliomas: a follow-up from 1990 to 2003. = Eur Arch=20 Psychiatry Clin Neurosci 256:516=96521. doi:<A=20 = href=3D"http://dx.doi.org/10.1007/s00406-006-0674-2">10.1007/s00406-006-0= 674-2</A>=20 <BR><A target=3D_blank=20 = href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&= db=3DPubMed&dopt=3DAbstract&list_uids=3D16960653"><IMG=20 border=3D0 alt=3DPubMed=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.g= if"=20 width=3D65 height=3D20></A> <A target=3D_blank=20 href=3D"http://dx.doi.org/10.1007/s00406-006-0674-2"><IMG = border=3D0=20 alt=3DSpringerLink=20 = src=3D"http://www.springerlink.com/content/tm31nq867x423h13/springer_link= .gif"=20 width=3D108 height=3D20></A> </TD></TR> <TR> <TD> </TD></TR></TBODY></TABLE></BODY></HTML> ------=_NextPart_000_0000_01C96F52.4D0D79E0 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://www.springerlink.com/content/tm31nq867x423h13/contact.gif R0lGODdhDgAKAKIAAP////r7v+rrl8TFDKOkAH1+AElKAAAAACwAAAAADgAKAAADLWi63AQwynEM KCLrXEgFAraFgmdxm2iCpdhla8mpZRUQo0aYw+7/u8phSCwSEwA7 ------=_NextPart_000_0000_01C96F52.4D0D79E0 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://www.springerlink.com/content/tm31nq867x423h13/pubmed_link.gif R0lGODlhQQAUAPcAAAAAAAAICAgQEBAYGBAYIRghKSEpMSExOSExQik5SjlKWjlKY0JSa0pKSkpa c0pje0pjhFJSUlJSjFJrhFJzjFpaWlpalFp7lFp7nFqUlGNjnGOEnGOEpWOMrWOcnGOczmOl1muU tWuUvWul1nOUvXOcvXOcxnulzoSEhISt1oSt3oS154yMjIy13oy154y975SUlJTG95TG/5TO/5yc zpyl1pzO/62trbW1tff39/////////////////////////////////////////////////////// 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