not unexpectedly, dose-dense chemo found to cause more fatigue (expecially for her2+s

[Lani]

Oncol Nurs Forum. 2006 Sep 1;33(5):1015-21. Links
Level of fatigue in women receiving dose-dense versus standard chemotherapy for breast cancer: a pilot study.

Sura W,
Murphy S,
Gonzales I.
Southbay Oncology Hematology Partners, Campbell, CA wbbsura@yahoo.com.
PURPOSE/OBJECTIVES: To determine whether women receiving dose-dense chemotherapy for breast cancer experience different levels of fatigue than women receiving standard chemotherapy regimens for the disease. DESIGN: Quasi-experimental pilot study. SETTING: Private physicians' offices in California. SAMPLE: 15 women with stage I, II, or III breast cancer receiving dose-dense or standard chemotherapy. The average female participant was 48 years old (mean = 48.3), was married (80%), and had a college degree (73%). METHODS: The revised Piper Fatigue Scale was completed by patients at three different times: pretreatment, three days after their cycle 1 chemotherapy dose, and three days after their cycle 2 chemotherapy dose. Patients returned completed surveys by mail. MAIN RESEARCH VARIABLES: Fatigue levels associated with chemotherapy. FINDINGS: Pretreatment total fatigue scores were not significantly different in the dose-dense and standard chemotherapy groups. Total fatigue scores were significantly higher in the dose-dense group at the cycle 1 and 2 time points. Fatigue scores were significantly higher in women who had undergone a mastectomy, were working, were HER2 positive, and had a tumor size larger than 2 cm. CONCLUSIONS: Dose-dense chemotherapy resulted in significantly greater fatigue. IMPLICATIONS FOR NURSING: Nurses should educate women receiving dose-dense chemotherapy as part of informed consent and assist them in preparing and planning for fatigue. Information about which patients are more likely to experience significant fatigue allows nurses to judge the frequency with which they need to assess and manage fatigue to improve patient outcomes.
PMID: 16955128 [PubMed - in process]

[RhondaH]

it was WORK just lifting my head off the pillow some days. Some mornings I woke up excited to go to work, would get in the shower and by the time I got done w/ my shower, felt like I had run a race and would have to sit on the toilet a few minutes before getting back to bed. Curious though, why would it be more significant in HER2+'s...Lani? Take care and God bless.

Rhonda

[Christine MH-UK]

After all, there were only fifteen women involved in the study, so I don't know how much should be read into it.

[Montana]

I did dose dense and although I have nothing to compare it to,
I was sick and exhaused until just a few days before the NEXT chemo treatment. I pretty much stayed in bed the entire time and vegged. Thankfully, I did not have to work.

[Lani]

I thought it was one of many open access articles on the breast cancer research site. Unfortunately it was part of an editorial so it was subscription only--here is a hint of what they said and the references (need to put that in a different reply as I am lousy at cutting and pasting and not losing everything!):
Molecular characterization of CTCs

Abstract
Introduction
Techniques for detecting CTCs: new developments for tumor cell enrichment and cell detection
PCR-based assays for CTC detection
Can blood examination replace BM aspiration?
Molecular characterization of CTCs
Conclusion and perspectives
Abbreviations
Competing interests
References

Recent technical developments permit an examination of the genome of even single DTCs. Using immunocytochemistry, immunofluorescence, and/or fluorescence in situ hybridization (FISH), several groups have reported tumor-antigen expression and/or chromosomal aberrations of DTCs in BM and CTCs, indicating the malignant origin of these disseminated cells and indicating genetic heterogeneity [2,21].

The biologic properties of CTCs are not yet well understood. It seems that these cells have little proliferative potential [5]. With current techniques, it is also possible to perform gene expression profiling from CTCs [22,23]. This enables studies that should allow deeper insights into the mechanisms allowing CTCs to form manifest metastasis. For example, it seems that, for breast cancer, only a small proportion of tumor cells, so-called 'cancer stem cells', have the capacity for self-renewal and unlimited growth [24]. In view of the resistance of DTCs and CTCs to chemotherapy it is possible that some of these cells have stem-cell properties. Identifying these 'metastatic stem cells' will be the one of the challenges for future research.

One aspect of clinical importance is the identification of therapeutic targets such as HER-2/neu on CTCs. HER-2 can be detected on CTCs with cytogenetic [21], immunocyto-chemical [25,26] and PCR methods [27]. There are several possible implications of these findings. For example, it has been reported that nearly one-third of patients whose primary tumors were reportedly negative for HER-2 had CTCs with amplified HER-2 (as determined by FISH). Given the extraordinary impact of trastuzumab (Herceptin), a humanized monoclonal antibody directed against HER-2, in both the metastatic and adjuvant settings, monitoring CTCs for HER-2 could have an enormous influence on the application of this therapy. In addition, the presence of HER-2-positive CTCs seems to be associated with an impaired prognosis [26,27].