Development and preliminary testing of a brief clinical tool to enable daily monitoring of chemotherapy toxicity: The Daily Chemotherapy Toxicity self-Assessment Questionnaire.

Close monitoring of chemotherapy toxicity can be instrumental in ensuring prompt symptom management and quality care. Our aim was to develop a brief clinical tool to enable daily assessment of chemotherapy toxicity and investigate/establish its content validity, feasibility/applicability, internal consistency and stability. Development of the Daily Chemotherapy Toxicity self-Assessment Questionnaire (DCTAQ) was based on an initial item pool created from two scoping reviews. Expert panel review (n = 15) and cognitive debriefing with patients with cancer (n = 7) were used to establish content validity. Feasibility/acceptability, applicability (self-report vs. interview-like administration), internal consistency (KR-20) and test-retest reliability (at 1-hr intervals) of the DCTAQ were field-tested with 82 patients with breast or colorectal cancer receiving active chemotherapy at eight hospitals. Initial development/content validity stages enabled item revisions and re-wording that led to a final, 11-item DCTAQ version with 10 core symptom items plus one open-ended "any other symptom" item. Feasibility and acceptability were demonstrated through the absence of participant withdrawals, absence of missing data and no complaints about tool length. The DCTAQ was found to have modest internal consistency (KR-20 = 0.56), but very good test-retest reliability. The DCTAQ is a brief clinical tool that allows for rapid and accurate daily assessments of chemotherapy toxicity in clinical practice.

Constructing identities in the media: newspaper coverage analysis of a major UK Clostridium difficile outbreak.

AIM: To examine how a major Clostridium difficile outbreak in the UK was represented in the media. BACKGROUND: Clostridium difficile is a serious health care-associated infection with significant global prevalence. As major outbreaks have continued to occur worldwide over the last few decades, it has also resulted in increasing media coverage. Newspaper journalists are, however, frequently criticized for sensationalized and inaccurate reporting and alarming the public. Despite such criticisms, nothing is known about how the media frame Clostridium difficile related coverage. DESIGN: Qualitative interpretive descriptive study. METHOD: An interpretive analysis of newspaper articles from the national press that reported about the outbreak from the first day of coverage over 3 weeks (12 June-3 July 2008). FINDINGS: Twenty-eight newspaper articles were included in the study from tabloids, broadsheets, a regional and a Sunday newspaper. Monster and war metaphors were frequently adopted to portray the severity of Clostridium difficile and the impact it can have on patient safety. In addition, the positioning of the affected patients, their families, healthcare professionals and the Government produced representations of victims, villains and heroes. This subsequently evoked notions of vulnerability, blame and conflict. CONCLUSION: The media are and will remain critical convectors of public information and, as such, are hugely influential in risk perceptions and responses. Rather than simply dismissing media coverage, further understanding around how such stories in specific contexts are constructed and represented is needed so that it can help inform future communication and management strategies.

Self-care and end of life care--patients' and carers' experience a qualitative study utilising serial triangulated interviews.

PURPOSE: This study aimed to understand patient and carer experiences of end of life care and to explore how patients care for themselves at the end of life in Scotland. RESEARCH QUESTIONS: (1) From the perspectives of patients and carers, what are their experience of advanced cancer and end of life care? (2) What self-care strategies enable patient and carers to cope with their end of life care? METHODS: This paper reports a qualitative study using in-depth, unstructured serial interviews involving collaboration with and participation of people affected by advanced cancer. The study was a 2-year, three-phase study with multiple methods of data collection. The study was conducted in the Highlands and West of Scotland including rural, remote and socially deprived areas. Patient experience data were collected from 20 patients as well as their main carer and the health professional who they perceived had given them the most support. Triangulating data in this way allowed the totality of the patient experience to be captured. A total of 71 interviews were conducted. Data were analysed both within and across cases using framework analysis with the aid of QSR NVIVO 7. RESULTS: Maintaining normality and preparing for death were the two most important areas, for the patients in the study, as far as their self-care was concerned. Patients wished support that enabled them to maintain their independence and remain at home. People managed their illness both physically and emotionally; managing and adjusting to their lack of independence and keeping control were keys to most participants. CONCLUSIONS: Self-care is important to this group of people. People receiving end of life care want to and are able to engage in research. The findings are timely and relevant to current changes in palliative care policy and practice.

An evaluation of the use of Telehealth within palliative care settings across Scotland.

There is a lack of evidence-based research in the use of Telehealth within palliative care in the UK, particularly in Scotland. The aim of this project was to evaluate the current use of Telehealth applications within palliative care across Scotland, and how these and future applications are perceived by patients, carers and professionals. This paper reports on the qualitative findings from focus groups with patients and carers in three geographical areas in Scotland, and individual interviews with key stakeholders from across Scotland, who currently work within areas of high and low Telehealth activity. The key findings indicated that Telehealth initiatives are welcomed by patients and carers but that these should be an adjunct to clinical care rather than an alternative. The stakeholder interviews revealed several notable differences between those working within areas of high and low Telehealth activity. Principally, areas of high Telehealth activity appear to be driven by national and local policy and seem to benefit from a greater level of investment in Telehealth equipment and facilities than in the more central, and hence accessible, parts of Scotland.

Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART).

OBJECTIVE: To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. DESIGN: Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. SETTING: Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. PARTICIPANTS: 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin's disease, or non-Hodgkin's lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. INTERVENTION: Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. MAIN OUTCOME MEASURES: The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy-General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory-Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). RESULTS: For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference -0.15, 95% confidence interval -0.19 to -0.12; P<0.001; Cohen's D effect size=0.5). Analysis of MSAS sub-domains indicated significant reductions in favour of ASyMS for global distress index (-0.21, -0.27 to -0.16; P<0.001), psychological symptoms (-0.16, -0.23 to -0.10; P<0.001), and physical symptoms (-0.21, -0.26 to -0.17; P<0.001). FACT-G scores were higher in the intervention group across all cycles (mean difference 4.06, 95% confidence interval 2.65 to 5.46; P<0.001), whereas mean scores for STAI-R trait (-1.15, -1.90 to -0.41; P=0.003) and STAI-R state anxiety (-1.13, -2.06 to -0.20; P=0.02) were lower. CASE-Cancer scores were higher in the intervention group (mean difference 0.81, 0.19 to 1.43; P=0.01), and most SCNS-SF34 domains were lower, including sexuality needs (-1.56, -3.11 to -0.01; P<0.05), patient care and support needs (-1.74, -3.31 to -0.16; P=0.03), and physical and daily living needs (-2.8, -5.0 to -0.6; P=0.01). Other SCNS-SF34 domains and WLQ were not significantly different. Safety of ASyMS was satisfactory. Neutropenic events were higher in the intervention group. CONCLUSIONS: Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A "medium" Cohen's effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients' symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. TRIAL REGISTRATION: Clinicaltrials.gov NCT02356081.

Men with prostate cancer over the first year of illness: their experiences as biographical disruption.

GOALS: This paper is one of five interrelated papers about cancer, drawn from a larger study exploring the experiences of 66 people diagnosed with cancer. Findings are reported separately because the way in which people experience cancer can vary by cancer type. Here, we determine the utility of liminality and biographical disruption as explanatory theories in relation to men's experiences of prostate cancer. We situate and explore notions of liminality and disruption in relation to self, identity and context to inform debate about the provision of supportive care and highlight the contribution this study makes to the understandings of men's health. MATERIALS AND METHODS: This is a qualitative interview study of 66 people diagnosed with cancer. The study included five cancer types: gynaecological, prostate, lung, breast and colorectal. This paper illustrates the experiences of ten men diagnosed with prostate cancer. Three serial interviews were conducted at (1) diagnosis, (2) treatment and (3) follow-up. Drawing on the constant comparative method (Glaser and Strauss 1967), a descriptive and thematic approach to data analysis was adopted. This descriptive analysis evidenced that cancer caused disruption to people's lives. In order to move beyond this level of description, begin to explain this and develop theoretical insight, we drew on concepts of biographical disruption (Bury, Sociol Health Illn 4(2):167-182, 1982; Bury, Sociol Health Illn 13(4):451-468, 1991; Bury, Sociol Health Illn 23(3):263-285, 2001) and liminality (Navon and Morag, Soc Sci Med 58(11):2337-2347, 2004). MAIN RESULTS: Notions of biography and identity weave their way through men's accounts of prostate cancer. Physical side effects and reconstructed futures each form key parts of men's narratives. CONCLUSIONS: Our findings add to existing knowledge of supportive care needs for men living with prostate cancer. We suggest that studies exploring supportive care need to remain mindful of the disruption that cancer causes both during and after treatment, the complexity of such experience and respective demands on supportive care.

Transitional experiences of women with breast cancer within the first year following diagnosis.

AIMS AND OBJECTIVES: To explore the experiences of 12 women with breast cancer, involved in a large longitudinal qualitative study designed to explore the experiences of people with cancer within the first year following diagnosis. BACKGROUND: To understand experiences of breast cancer further as a chronic illness, this study draws on biographically informed and embodied perspectives of chronic illness. DESIGN: Qualitative, longitudinal study. METHOD: Interviews were conducted at three time-points within the first year following diagnosis with 12 women with breast cancer. Drawing on the constant comparative method, a descriptive and thematic approach to data analysis was adopted. To move beyond the descriptive level, we drew on the concepts of biographical disruption and embodiment to further explore and explain the disruption that was evident in these women's lives as a result of their diagnosis. RESULTS: Two key concepts emerged from the data: 'Identity Transition: moving between health and illness' and 'Making the Transition to the Future? Living with breast cancer and moving on'. Identity transition emerged as a result of the changes and adaptations participants were required to make as a result of their diagnosis. Making the transition to the future emerged as a result of the challenges these women faced living with cancer. CONCLUSIONS: This study showed that the longitudinal exploration of the experiences of cancer within the first year following diagnosis provides a vital understanding of the impact cancer can have on one's identity from the moment of diagnosis onwards. RELEVANCE TO CLINICAL PRACTICE: This study has implications for cancer services because it highlights the need for interventions that support people to both successfully manage the experience of cancer diagnosis and treatment and equip themselves with the necessary techniques to negotiate transitions towards the future and living with cancer.

Treatment decision-making in cancer care: the role of the carer.

AIMS AND OBJECTIVES: This study explores the role of the carer in treatment decision-making in cancer care. BACKGROUND: Literature about involvement in treatment decision-making tends to focus on patients and clinicians, with the carer rarely included. The absence of carers is problematic because the management of illness is often carried out in the context of complex networks of relationships. Although current policy encourages health care practitioners to work in partnership with family members, implementation is troubled by a lack of understanding of the significance of interpersonal relationships and interactions and the role of the relationship throughout the course of the illness experience. Despite awareness, there is little systematic, coherent analysis of the complexity of these interactional dynamics and, in particular, consideration of the implications for involvement and treatment decision-making. DESIGN: Qualitative, longitudinal. METHODS: Three serial semi-structured interviews with 66 patients and 43 carers within the first year following a diagnosis of cancer. A descriptive and thematic approach to data analysis was adopted. RESULTS: Carers are involved in treatment decision-making in cancer care and contribute to the involvement of patients through their actions during, before and after consultations with clinicians. Carers can act as conduits for information from patient to clinician and from clinician to patient. They can also act as facilitators during deliberations, helping patients to consider whether to have treatment or not and which treatment. CONCLUSIONS: Our study has highlighted the deficiency of models that fail to acknowledge the role of the carer in the treatment decision-making process. We propose the adoption of a relational approach by the inclusion of the carer in conceptual frameworks and recommend triadic (patient, carer and professional) models of involvement. RELEVANCE TO CLINICAL PRACTICE: Cancer care clinicians should recognise and actively involve the carer as well as the patient in treatment decision-making.

Engaging patients in health care: an empirical study of the role of engagement on attitudes and action.

OBJECTIVE: Identify the role of engaging people affected by cancer in service development in influencing healthcare professionals and service-users' attitudes toward, and enactment of, engagement. METHODS: Focus group discussions with healthcare professionals and people affected by lung cancer, prior to and following an intervention where lung cancer teams were supported to engage with patients and family members. RESULTS: Staff and people affected by cancer who participated displayed more positive attitudes toward involvement than those who did not participate. CONCLUSION: Progressing the involvement agenda requires the use of supported, small scale, projects where staff and patients/family members can develop their skills and knowledge of involvement. PRACTICE IMPLICATIONS: Doing patient engagement work is a vital step toward changing attitudes and actions toward the involvement agenda.

The use of technology in cancer care: applying Foucault's ideas to explore the changing dynamics of power in health care.

AIM: This study is a report to identify the utility of a hand-held side-effect monitoring system for people receiving chemotherapy in the home care setting. BACKGROUND: Increasingly, health care is being provided in people's own homes and communities rather than in hospitals. This has driven the development of technologies which support patients in the home environment. The meaning of such technologies can be explored from a Foucauldian perspective to shed light on how they enable new forms of medical surveillance. METHOD: An intervention study was performed in 2006 using new technologies for people receiving chemotherapy. Questionnaires were completed by 56 people affected by cancer who used the new technology; 12 of these people were then interviewed. Secondary analysis of the interview data is presented in this paper, drawing on Foucault's writing about surveillance and power in medical settings. FINDINGS: The interview transcripts contain numerous examples of people affected by cancer reflecting on issues such as power and surveillance in cancer care. While these terms are ordinarily considered to reflect negative elements of care, they were used by participants in an empowering manner. CONCLUSION: Theoretical insights can help nurses to think critically about the advances of technology. In particular, there are implications for how nurses consider the relationship of technology to patients and for power dynamics in healthcare relationships. We suggest that there is a need to problematize and celebrate the growth of technologically-driven health surveillance.

Patient and public involvement: models and muddles.

AIMS AND OBJECTIVES: This paper explores the range of models of involvement which are drawn upon in an empirical study and which are invoked in the literature and policy. The results and discussion of the study help to excavate and explore the muddle of conceptualisations of involvement and how this leads to difficulties for practitioners, patients and managers in implementing the relevant policy. BACKGROUND: Patient and public involvement has developed an important profile internationally within health and social care policy. However, its importance as a rhetorical device has not been accompanied by adequate developments in how it is operationalised. DESIGN: Cross-sectional study, with an intervention conducted at three sites, and non-intervention measures taken at two control sites. METHODS: This paper draws on an empirical study of involvement. Focus groups were conducted with a lung cancer team and people affected by cancer at five health boards across Scotland. Chief executives of each of these five health boards also took part in individual interviews. Participants were asked to describe their ideas of what involvement is and their application of it. RESULTS: A range of ways of conceptualising involvement were apparent. Few of these moved beyond the use of patient satisfaction questionnaires. At times, troubling understandings were articulated, for example, using public meetings to communicate decisions about service closures to the public. CONCLUSION: The slow escalation of involvement is in part because of the myriad ways in which it is conceptualised and discussed. Thus, we conclude that one of the greatest barriers to truly integrating patient involvement into health services, policy and research is the conceptual muddle with which involvement is articulated, understood and actioned. RELEVANCE TO CLINICAL PRACTICE. Clinicians need to be supported to seek clarity in the use and operationalisation of involvement if the agenda is to be truly adopted and strengthened.

Perceived control and involvement in self care in patients with colorectal cancer.

AIM: This paper reports the qualitative findings from a mixed methods study which explored patients' understandings of perceived control in relation to their self care during chemotherapy for colorectal cancer. BACKGROUND: A greater degree of patient involvement in self care is increasingly being encouraged; however, little is known about how factors such as perceived control influence patients' active involvement in self care. DESIGN: Qualitative, longitudinal study. METHODS: Semi structured interviews were conducted with 11 patients before and after six months of chemotherapy treatment for colorectal cancer in a Scottish cancer centre between March 2005-June 2006. The interviews, conducted as part of a larger study, explored patients' understandings of their perceived control over managing treatment-related side effects and how this influenced their attitudes toward, and role preferences in, self care. RESULTS: Patients fell into one of two groups: 'high' or 'low' perceived controllers. High-perceived controllers were more likely to view their active involvement in self care positively, as being necessary in managing treatment-related effects and were less likely to rely on nurses to take overall responsibility for the management of treatment-related side effects. Low-perceived controllers were less likely to believe in the importance or necessity of their active involvement in self care and more likely to perceive nurses as being the ones responsible for the management of treatment-related side effects. CONCLUSIONS: Perceived control during treatment for cancer influences patients' perceptions toward, and role preferences in, self care. RELEVANCE TO CLINICAL PRACTICE: Clinical interventions designed to enhance involvement in self care would benefit from focussing on enhancing patients' perceived control and understanding their role preferences in self care. Patients with different understandings of perceived control may require different help and support to encourage their involvement in self care.

Experiences of self-care in patients with colorectal cancer: a longitudinal study.

AIM: This paper is a report of a study to explore patients' experiences of self-care during a 6-month course of chemotherapy treatment for colorectal cancer. BACKGROUND: A greater degree of patient involvement in self-care is increasingly being encouraged, however, little is known about patients' experiences of being actively involved in their self-care. METHODS: Semi-structured interviews were carried out with 11 patients at the beginning and end of their treatment for colorectal cancer in a Scottish cancer centre between March 2005 and June 2006. The ways in which participants were actively involved in managing the impact of undergoing chemotherapy treatment and their understandings of the meaning of self-care were explored. FINDINGS: Patients carried out self-care in order to preserve their self-identity and maintain a sense of normality. Self-care activities intended to manage both the physical and emotional impact of undergoing treatment included the use of medications and nutritional supplements and reducing food intake, information-seeking and -sharing experiences with fellow patients and rationalizing the purpose and effects of their chemotherapy treatment. CONCLUSION: Nurses have an important role to play in ensuring that patients' perspectives and priorities for self-care, in particular what they do, why they do it and what it means to them, and that they are listened to, in order to help them achieve their desired level of involvement in self-care. Interventions to promote self-care should focus on helping people to preserve their self-identity, as well as managing the emotional toll and physical side effects associated with cancer treatment.

Clinical practice guidelines for the use of colony-stimulating factors in cancer treatment: Implications for oncology nurses.

Chemotherapy-induced neutropenia (CIN) is a common and serious toxicity of cancer chemotherapy. It can lead to febrile neutropenia (FN), which often requires patients to be hospitalised for intravenous antibiotic therapy. Chemotherapy dose reductions or delays, which can compromise clinical outcomes, may also result from CIN and FN. Prophylactic use of colony-stimulating factors (CSFs) reduces the incidence, duration, and severity of FN, and there is evidence that it helps maintain scheduled chemotherapy dose delivery. In 2006, three organisations published new or updated guidelines for the use of CSFs in cancer treatment. Each recommends that FN risk be determined individually for each patient, taking into account patient- and disease-specific risk factors, the chemotherapy regimen, and treatment intent. Particular consideration should be given to patients who are > or =65 years old, receiving chemotherapy regimens associated with > or =20% risk of FN, receiving dose-dense chemotherapy, and receiving treatment that is adjuvant, potentially curative, or intended to prolong survival. Accordingly, oncology nurses can play an important role in assessing and identifying patients at risk for FN before every chemotherapy cycle. There is evidence that, regardless of practice type or size, implementing guidelines for CSF use within a multidisciplinary team improves patient outcomes.

WISECARE+: Results of a European study of a nursing intervention for the management of chemotherapy-related symptoms.

While the use of chemotherapy has significantly improved survival rates, the symptoms associated with chemotherapy remain a major burden for patients. Preventing or appropriately managing side effects significantly improves patients' functional status and quality of life, ultimately leading to greater patient acceptance of chemotherapy. However, symptom assessment and management are fraught with difficulties such as poor patient recall, retrospective assessment conducted by clinicians and lack of appropriate, clinically relevant and patient friendly symptom assessment and management tools. Furthermore the differences between clinician and patient perceptions of stresses and distress during chemotherapy are well recognised. This study aimed to evaluate the impact of a nursing intervention incorporating structured symptom assessment and management, facilitated by information technology, on chemotherapy-related symptoms, nausea, vomiting, fatigue and mucositis. This pan-European study, involved 8 clinical sites from Belgium, Denmark, England, Ireland and Scotland. Adults (n=249) receiving first line chemotherapy for breast, lung, ovarian or colorectal cancer, osteosarcoma, acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL) or lymphoma were recruited to the study. Patients completed daily symptom assessment questionnaires for 14 days following consecutive cycles of chemotherapy. Symptom outcomes were compared before and after the introduction of the intervention with positive impact on patients' experiences of nausea, vomiting and oral problems. Fatigue was not significantly improved.

Using a rapid appraisal approach in a nationwide, multisite public involvement study in Scotland.

This article reflects on the use of a multisite rapid appraisal (RA) approach with reference to the (to-date) largest qualitative study gathering the views of cancer and cancer care in a cross-section of the Scottish population. A series of ten RAs were conducted in ten communities across Scotland, reflecting the geographical and socioeconomic spread of the Scottish population and involving 507 members of the public, including the views of people who are often termed "hard to reach." The research method is evaluated with reference to principles of RA approaches: the inductive approach, triangulation, assessment and response, and participation. Presentation of the methods adopted in this study demonstrates the value of the rapid appraisal approach in engaging with members of the public in health-related issues, which belies the "quick and dirty" reputation of RA approaches and offers a model for future public involvement work in health care. This makes the reflections on the method utilized particularly relevant to policy makers and researchers wishing to achieve meaningful public involvement and/or consider a method not previously used in this context.

Perceptions of the use of a remote monitoring system in patients receiving palliative care at home.

In remote communities, where frequent face-to-face contact with health professionals may be difficult, the ongoing review and management of symptoms--a fundamental part of good palliative care--can be difficult to achieve. Telecare and other developments in information technology are increasingly being sought as a means of addressing shifting population demographics and rising demands on stretched health services, and may help in providing a system which allows patients to report their symptoms as they are happening. This may be one way of enhancing symptom management and improving quality of care at the end of life. A study testing the feasibility of using mobile phone-based technology (Advanced Symptom Management System in Palliative Care (ASyMSp)) to monitor and manage symptoms reported by patients being cared for at home in the advanced stages of their illness was carried out in two rural communities in the north of Scotland. The results of this study show that the system was usable and acceptable to patients and the health professionals who cared for them.

A review of literature about involving people affected by cancer in research, policy and planning and practice.

OBJECTIVE: To systematically review the literature on involving people affected by cancer in healthcare research, policy and planning and practice. METHODS: Database searches, cited author, and grey literature searches were conducted. RESULTS: 131 documents were included. Rationales for the agenda of involvement represent two polar characteristics of modernity: individualism and collectivism. In research, people acted as advocates, strategists, advisors, reviewers and as participatory researchers. In policy and planning, people were involved in one-off involvement exercises and in longer-term partnerships. Men, those with rare cancers, children, and people who are socially deprived have been rarely involved. There is little research evidence about the impact of involvement. Training and information, resources and a change in attitudes and roles are required to implement an agenda of involvement. CONCLUSION: The USA, the UK, followed by Canada and Australia have promoted an agenda of involvement. PRACTICE IMPLICATIONS: A dissemination strategy to share good practice; involvement of all types of people; an individualised and flexible approach; training, resources and a shift in thinking from paternalism towards partnership working are required. More research is needed about the impact of involvement and relationships between rationales for involvement and implementation.

Patterns of fatigue during a course of chemotherapy: results from a multi-centre study.

Fatigue is a highly prevalent condition among patients with cancer affecting between 70% and 100% and patients describe their fatigue experiences as the most distressing of symptoms. However, the management of fatigue is complicated by our current lack of understanding of its pathophysiology. This study aimed to gain an insight into the longitudinal fatigue experiences of patients receiving chemotherapy. A convenience sample of patients receiving chemotherapy (n=249) were recruited and recorded their fatigue experiences using a paper questionnaire for 14 consecutive days following each cycle of chemotherapy. Fatigue was reported in 57% of all completed questionnaires. Patients report fatigue as a relatively constant presence following chemotherapy. Moreover, fatigue experiences increase over consecutive cycles of chemotherapy. This study supports the existing evidence illustrating fatigue as a significant problem for patients with cancer and provides new data demonstrating patterns of fatigue over the duration of a course of chemotherapy. Understanding this experience of fatigue should prompt health professionals providing care for this patient population to seek and test a range of management strategies to help patients maintain their quality of life during cancer treatment.