Discussion
The findings of the present study indicated the positive effect of the nursing care
program supplemented with iron intake on blood parameters and fatigue of the
patients undergoing chemotherapy.Accordingly, the studies reviewed above indicat-ed that anemia reduces the prognosis of cancer patients (29), influences the effec-tiveness of cancer treatments, and increases the likelihood of tumor cell resis-tance to treatment, which ultimately reduces the survival of the patient (30).It was also shown that
the patients' hemoglobin level increased by one gram during the intervention, in-
dicating that perhaps one of the factors that can affect the patients' fatigue is the
hemoglobin level since the patients reported lower levels of fatigue after the in-
crease in hemoglobin and iron intake in the form of the nursing care program
that focused on doing exercise and daily activities, as was confirmed in other stud-
ies (36, 37).It was also shown that the hemoglobin of the
patients in the intervention group increased after the nursing care program and
the severity of their anemia decreased, confirming the effect of training strategies
to increase iron absorption and intake.Probably the discrepancies observed in the frequencies re-ported in various studies are due to the type of study, the studied population, and
the definition of anemia.For in-
stance, Ghaffari et al. measured the relationship between the severity of fatigue
and anemia and reported a moderate level of anemia-induced fatigue (24).Despite the effectiveness of exercise in controlling fatigue, stud-
ies have shown that the most frequently used strategies by patients were lying
down (80.7%) and worshiping (77.9%) and the least frequently used strategies were
exercise (5%) and stretching movements (21.4%).Similarly, Rezaee Seraji et al. showed that
the hemoglobin concentration of people who did aerobic exercise increased com-
pared to patients who did not perform the aerobic exercise (27).The present study suggested that a significant reduction in the fatigue scores
of the patients in the intervention group indicated the effectiveness of the nurs-ing care program.Another study by Abdollahi and Shujaedin suggested that the training proto-
col improved all aspects of the quality of life and increased physical performance
in the intervention group compared to the control group (46), as was evident in
the present study.As
shown, the nursing care program with an emphasis on iron intake can significant-
ly affect anemia-induced fatigue.The present study also suggested that the severity of fatigue was lower in the
patients in the control group, but it was not significantly different from the fa-
tigue level reported by the participants in the intervention group.However, the au-
thors emphasized aerobic exercise, and the changes in hemoglobin ratio were not
very noticeable.One of the essential issues in treating patients with cancer is maintaining
blood parameters to be within the normal range or close to it. When the patient
refers to chemotherapy, nurses decide to perform or not to perform chemo-therapy after reviewing the results of blood cell counts.Studies have shown that a decrease in the level of erythrocytes and anemia is
one of the most common and persistent problems in cancer patients (31), and its
severity depends on the extent of the disease and the severity of treatment.The prevalence of
anemia was 50% in solid cancers, as reported in Groopman's study and 35% in Se-shardi's study (34, 35).The research sample in the present study included the
patients with mild anemia or no symptoms of anemia, and thus the sample was
different from those examined in previous studies.