A prospective analysis of shift work and fatigue scores in anaesthesiology registrars at four Johannesburg hospitals

Introduction: Breast cancer is on the rise in India and is the leading cause of cancer incidence in women. Indian Council of Medical Research - National Centre for Disease Informatics and Research report accounted for 13.5% of new cancer cases and 10% of cancer-related deaths in 2020 with higher burden in more developed states of India. The impact is seen on Quality of Life (QoL) attributed to physical, psychological and social factors. Breast cancer is a distinctive entity as it hampers physical appearance of women besides living with the fear of outcome. Treatments include chemotherapy, radiotherapy, breast surgeries all significantly influencing QoL in survivors. Depression, fertility-issues, economic burden and social issues negatively affect quality of life. European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaires-Core-30 and Breast-23 (QLQ-C30 and QLQ-BR23) are valid and reliable tools to assess QoL in breast cancer survivors (12,13,14,15). Due to high patient load in India and insufficient manpower, routine assessment of QoL in breast cancer patients is a challenge with scarce data from this part of the world. Objective: To administer QLQ-C30 and BR23 questionnaires to breast cancer patients receiving treatment at the tertiary hospital Cancer Unit to differentiate QoL among patients in varying stages of the disease and treatment. Methodology: 175 female breast cancer patients registered in the cancer unit in the last one year with a diagnosis established at least 6 months ago were included and other gynecological cancers were excluded. After obtaining written consent, QLQ-C30 a 30-item cancer specific questionnaire designed to measure QOL and QLQ-BR23 a 23-item breast cancer specific questionnaire were administered together. The assessment comprised of nine domains (physical, role, cognitive, emotional, social, fatigue, pain, nausea and vomiting) in QLQ-C30 and five domains (body image, sexuality, arm symptoms, breast symptoms, and systemic therapy side effects) in BR23. The impact on QoL was based on the Global Health Status (GHS), Physical functioning (PF), Emotional functioning (EF), Fatigue (FA) and Pain (PA) scores. Results: Mean age of the patients was 49.65 (±9.94) years with a mean duration of breast cancer of 2.17 (±1.61) years. 11.54% of patients did not receive counselling for various reasons. Correlation was established between GHS and PF [r=.69, p=.00001]; EF [r=.32, p=.02]; social functioning [r=.38, p=.005]; body image [r=.36, p=.01]; future perspective [r=.3, p=.03]. Analysis of PF, EF, Pain and Fatigue scores were performed based on whether treatment included only chemotherapy or was combined with radiation and surgery. Those who received only chemotherapy had better functional status compared to those with combined therapy. The symptom scale variables were negatively correlated with global health status. The study shows a higher decrease in physical functioning levels compared to other functional parameters due to factors like pain, chronic fatigue, balance impairment and lymphedema associated with breast cancer treatment. In alignment with PF scores were fatigue, pain, insomnia and appetite scores which were relatively higher. Conclusion: With an ever increasing incidence of breast cancer in India, QoL assessment can be a valuable tool for incorporating effective management strategies. The overall quality of life was reasonably good indicating presence of positive health ecosystem. Efforts were fruitful in recruiting participants implying high feasibility of such assessments. The findings form the basis for evaluation of predictive variables that impact quality of life in future while also boosting the confidence of patients, their families and stakeholders involved in patient services. QoL assessments in routine breast cancer care is recommended for better management and good clinical outcomes. Citation Format: Madhuri Taranikanti, Archana Gaur T, Roja Reddy Katta, Farheen Fatima, Vishesh Gumdal, Vidya Ganji, Kalpana Medala, Madhusudhan Umesh, Nitin Ashok John. Implementing Quality of Life assessment in breast cancer patients in India [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-03-07.

Identification of factors responsible for postdialysis fatigue.

Psychometric Validation and Meaningful Change Threshold Determination of EORTC QLQ-C30 Physical Functioning and Promis SF v1.0-Fatigue 7a Functional Domain in Patients with High-Risk Myelodysplastic Syndromes Treated with Venetoclax and Azacitidine

Investigating daily fatigue scores during two-week offshore day shifts

Physical activity (PA) and exercise is known to have a positive impact on a variety of variables pertinent to diabetes and cardiovascular disease. The aims of this study were to investigate the effects of physical activity on fatigue scores, oxidative stress, and glycemic control variables of individuals with type 2 diabetes mellitus (T2DM). Seventy-five subjects diagnosed with T2DM for more than 5 years aged 18–65 years participated in this study. The participants classified according to energy expenditure into, physically inactive [≤500 metabolic equivalents (METs)-min/week, n = 25], moderate PA (500–2500 METs-min/week, n = 25), and PA (≥2500 METs-min/week, n = 25). The Global Physical Activity Questionnaire (GPAQ) version 2.0 was used to classify physical activity. The multidimensional checklist individual strength questionnaire (CIS20r) was used to measure chronic fatigue. Blood glucose was measured using a glucose oxidase and peroxidase (GOD-POD) colorimetric method. HbA1c was measured using a commercial kit. Serum insulin level was determined using an ELISA. Analysis of oxidative stress parameters including malonaldehyde (MDA) and total antioxidant capacity (TAC) was done. To test differences between severely fatigued and healthy subjects, an independent t test was performed. Spearman correlations were used to assess correlations between fatigue severity score and disease-related and psychosocial factors. A level of significance was set at p < 0.05. The results showed a significant reduction of fasting blood sugar, glycosylated hemoglobin, fasting insulin, and MDA along with significant increase in TAC activity in the participants with moderate PA (P < 0.05) and PA (P < 0.01), respectively. In relation to CIS-fatigue measurements, about 33 % of the study population (n = 25) had a CIS score above the cutoff score of 37 with 59.5 mean CIS score, and 67 % of the study population (n = 50) had CIS score below the cutoff 37; they were classified into heightened fatigue (score 27–35) and healthy (score ≤27). There was a significant correlation between the reduction of diabetic related variables, BMI, PA status, and CIS-fatigue score analyses in T2DM patients. CIS-fatigue scores correlated positively with diabetic related variables and negatively with PA, BMI, and TAC activity. PA plays a vital role in improving CIS-fatigue score in type 2 diabetic patients via reducing oxidative stress and diabetic related variables.

Remotely piloted aircraft (RPA) with long endurance allow near-continuous operations, necessitating the implementation of shift work for crewmembers to provide the necessary manning of ground control stations. Shift work has a well-known association with fatigue, degraded work performance, and an increased risk for errors and accidents. This study presents the results of a follow-up survey of a particular population of shift-working RPA crewmembers 1 yr after modification of their shift work schedule. A cross-sectional survey of 66 RPA crewmembers was conducted using a collection of validated fatigue scales. This data was compared to survey data collected a year prior from the same population and from a reference group of non-shift-working aircrew. Shift system features and individual and situational differences associated with fatigue were explored. Additionally, several alternative types of shift schedules were assessed through modeling and simulation. The study found no significant reduction in reported fatigue despite prior modifications to the shift work schedule to increase opportunities for recovery. Months shift working, sleep quality, and disturbances in family and social activities were associated with overall fatigue scores. Approximately half of those surveyed met criteria for occupationally significant fatigue. Months shift working, use of on-duty napping, and fatigue scores were predictive of those with occupationally significant fatigue. Modeling of feasible variants of the current shift work schedule failed to reveal a significantly improved alternative schedule. Collectively, the results demonstrate a persistent problem with chronic fatigue in this study population, likely reflective of continued inadequate opportunities for recovery and restorative sleep.

The purpose of our study was mainly to explore the effect of different shift work on cognitive and executive performance in a real clinical environment among nurses from China. Working in shifts can disrupt circadian rhythm, resulting in reduced sleep duration, which can have a detrimental effect on cognitive function. To provide continuous service for patient care, shift work is often a special requirement for nurses. The Stroop test can be used to measure selective attention and reaction time during executive function. However, there have been limited studies about the effect of shift work on the cognitive performance of nurses by Stroop tests. Additionally, no study has been conducted in nurses working in shifts from China. Registered nurses in general ward, Department of Neurology, from West China Hospital of Sichuan University, were eligible and consecutively included if they were simultaneously responsible for the day, evening and night shifts on the shift work schedule. A fatigue questionnaire and Stroop tests were performed for each subject separately before and after three working shifts (morning, evening and night shift) to measure changes in fatigue, reaction time and accuracy. Eighteen registered nurses (4 males and 14 females) were included in our study, with a median age of 25 years old. The fatigue degree was significantly increased after day and evening shifts (p = .015 and <.001, respectively). Compared with those in the preshifts, the reaction time in the neutral task and incongruent task was significantly quicker after the day shift (p = .001, p < .001) and night shift (p = .008, .019). In contrast, the reaction time after the evening shift was mildly increased, although without significance. There was no significant difference in accuracy among the three different working shifts. In addition, there was a negative correlation between the fatigue score and reaction time on the incongruent task in the Stroop test before the day shift (r = -.542, p = .020). The fatigue score in the postday shift was found to be inversely related to working hours in the daytime (r = -.500, p = .034). Our study showed that increased fatigue was found in nurses after day and evening shifts, and shift work can affect the reaction time after the evening shift. However, there was no significant difference in accuracy and a high level of attention could be maintained among the three working shifts, suggesting a highly developed sense of responsibility in our nurses. In addition to focusing on the common adverse effects of evening or night shifts on nurses, fatigue in the day shift should be paid special attention to by the leadership in the nursing management. Also, nurse managers can implement specific strategies to reduce fatigue after the day shift by shortening the working hours in the daytime appropriately, setting rest periods in the day shift or dividing nurses into morning and afternoon shifts.

Fatigue is a state of physical and mental exhaustion in which people feel exhausted or drained of energy. Shift workers are highly vulnerable to fatigue, and this is especially true of emergency physicians (EPs). Shift scheduling (shift hours, frequency/length of breaks, time of shift, and number of hours off between shifts) can affect levels of fatigue in EPs. When EPs are fatigued, they experience decrements in cognition, resulting in an increased risk of errors. This study assessed the state of fatigue in EPs in the emergency department of a large, urban hospital using objective measures (sleep metrics and shift scheduling) over multiple months. Seventeen EPs, nine females, wore wrist-activity monitors called ReadiBands for 2 months. The ReadiBand is an objective actigraphy measure that communicates with a smartphone application to quantify sleep metrics and predict future fatigue. Throughout the 3083 on-shift hours of data, analyses revealed that EPs have poor sleep quality (mean ± SD 7.71 ± 1.84/10) and sleep quantity (mean ± SD 6.77 ± 1.66 h), with sleep efficiency within "normal" ranges (mean ± SD 87.26 ± 9.00). Participants spent 725 h (23.52%) on shifts with fatigue scores indicative of significant impairment (equivalent to BAC of .08%). In addition, results indicated that shift type (day, evening, night) was significantly associated with fatigue score, where night shifts were associated with higher fatigue scores. Fatigue is an issue for many EPs. The present study addressed the percentage of time EPs are in a fatigued state when on shift over an extended duration of time. More research is needed to examine system-level interventions for reducing fatigue in EPs.

PurposeCancer-related fatigue (CRF) is a common and relevant symptom in patients with advanced cancer that significantly decreases their quality of life. The aim of this study was to evaluate the effect of a physiotherapy programme on CRF and other symptoms in patients diagnosed with advanced cancer.MethodsThe study was designed as a randomized controlled trial. Sixty patients diagnosed with advanced cancer receiving palliative care were randomized into two groups: the treatment group (n = 30) and the control group (n = 30). The therapy took place three times a week for 2 weeks. The 30-min physiotherapy session included active exercises, myofascial release and proprioceptive neuromuscular facilitation (PNF) techniques. The control group did not exercise. The outcomes included Brief Fatigue Inventory (BFI), Edmonton Symptom Assessment Scale (ESAS) and satisfaction scores.ResultsThe exercise programme caused a significant reduction in fatigue scores (BFI) in terms of severity of fatigue and its impact on daily functioning. In the control group, no significant changes in the BFI were observed. Moreover, the physiotherapy programme improved patients’ general well-being and reduced the intensity of coexisting symptoms such as pain, drowsiness, lack of appetite and depression. The analysis of satisfaction scores showed that it was also positively evaluated by patients.ConclusionThe physiotherapy programme, which included active exercises, myofascial release and PNF techniques, had beneficial effects on CRF and other symptoms in patients with advanced cancer who received palliative care. The results of the study suggest that physiotherapy is a safe and effective method of CRF management.

A new method for the evaluation of the complaints reported by patients suffering from functional fatigue was investigated in the course of a multicentre, comparative, double-blind, clinical study of Pharmaton capsules versus placebo in a total of 232 patients aged between 25 and 60 years. The principle of the study was to allow the patient to choose, from a pre-established list of 20 suggestions, the five items that best described his complaints. An individual Fatigue Score was calculated for each patient on the basis of the sum of the scores given by the patient for each of the five items selected (each item was evaluated according to a 4-point time scale). This score was calculated on day 0 and after 21 and 42 days treatment. The analysis of the Fatigue Scores at the end of the study showed a statistically significant difference in favour of the Pharmaton group. The global assessment of the efficacy of the treatment (given by the investigators and by the patients) demonstrated the superior effect of the Pharmaton capsules, whereas the global assessment of the tolerability showed no difference between the two treatments. Pharmaton capsules proved their efficacy in improving the various complaints experienced by patients suffering from fatigue, with tolerability comparable to that of placebo.

Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

A fatigue questionnaire (QFES) for child athletes: A four-years follow-up study in young skiers

Quality of life (QoL) is an important outcome measure in clinical studies. However, there is little experience with the interpretation of QoL results. To guide interpretation of QoL results from a randomised controlled trial (RCT) targeting the effectiveness of the immune modulator G-CSF on postoperative recovery in high risk (ASA III/IV) colorectal cancer patients, we compared RCT data with data from a population based cohort study and norm reference data. QoL was assessed using the European Organisation for the Research and Treatment of Cancer (EORTC) QLQ-C30 and CR38 questionnaires. QoL results were analysed on discharge from hospital and six months postoperatively. Colorectal cancer patients (both from the RCT and the cohort study) showed the greatest differences in QoL scores compared to norm reference data at discharge from hospital. Six months postoperatively, global quality of life and pain approximated norm reference values indicating optimal recovery. However, deficits still appeared in scores for role functioning, physical functioning, social functioning and fatigue. The best improvements (discharge from hospital to six months postoperatively) were seen with respect to physical functioning, fatigue and pain. For further analysis of RCT data, physical functioning and fatigue scores may be more sensitive than global quality of life to detect differences in treatment effects.

Cancer-related fatigue (CRF) is a common and relevant symptom in patients with advanced cancer that significantly decreases their quality of life. The aim of this study was to evaluate the effect of a physiotherapy programme on CRF and other symptoms in patients diagnosed with advanced cancer. The study was designed as a randomized controlled trial. Sixty patients diagnosed with advanced cancer receiving palliative care were randomized into two groups: the treatment group (n = 30) and the control group (n = 30). The therapy took place three times a week for 2 weeks. The 30-min physiotherapy session included active exercises, myofascial release and proprioceptive neuromuscular facilitation (PNF) techniques. The control group did not exercise. The outcomes included Brief Fatigue Inventory (BFI), Edmonton Symptom Assessment Scale (ESAS) and satisfaction scores. The exercise programme caused a significant reduction in fatigue scores (BFI) in terms of severity of fatigue and its impact on daily functioning. In the control group, no significant changes in the BFI were observed. Moreover, the physiotherapy programme improved patients’ general well-being and reduced the intensity of coexisting symptoms such as pain, drowsiness, lack of appetite and depression. The analysis of satisfaction scores showed that it was also positively evaluated by patients. The physiotherapy programme, which included active exercises, myofascial release and PNF techniques, had beneficial effects on CRF and other symptoms in patients with advanced cancer who received palliative care. The results of the study suggest that physiotherapy is a safe and effective method of CRF management.

Randomized Phase 2 Trial of Pevonedistat Plus Azacitidine Versus Azacitidine in Higher-Risk Myelodysplastic Syndromes/Chronic Myelomonocytic Leukemia or Low-Blast Acute Myeloid Leukemia: Exploratory Analysis of Patient-Reported Outcomes