Effectiveness of pranayama on cancer-related fatigue in breast cancer patients undergoing radiation therapy: A randomized controlled trial

Emotional aspects and pranayama in breast cancer patients undergoing radiation therapy: A randomized controlled trial

To study the relevance between cancer related fatigue and coping styles in breast cancer patients after chemotherapy. A survey was conducted in 396 patients with breast cancer after chemotherapy on cancer related fatigue scale and Jalowiec coping scale, and the relation was analyzed. The rate of overall fatigue in breast cancer patients was 96.97%, mostly moderate fatigue. The rate of fatigue dimensions from high to low was physical fatigue, feeling fatigue and cognitive fatigue, respectively. The score of coping styles in patients with breast cancer after chemotherapy from high to low was optimistic coping, facing bravely, support seeking, self-reliance, emotional catharsis, avoidance, fatalism, and conservation. The most widely used coping style was optimistic coping style, and the least was emotional catharisis. There was a positive correlation between coping style of emotional catharsis and cancer related fatigue of all dimensions (P<0.01). There was a negative correlation between emotional fatigue and optimistic,facing bravely, support seeking, self-reliance, or conservation (P<0.05). There was also a negative correlation between physical fatigue and optimistic or support seeking (P<0.05), but there was a positive correlation between avoidance or fatalism and the dimensions of general fatigue, physical fatigue, and cognitive fatigue (P<0.05). There is prevalent cancer related fatigue in patients with breast cancer after chemotherapy. We should guide the patients to more active coping styles, to enhance the ability of psychological adaption in patients, reduce cancer related fatigue, and improve the quality of life.

IntroductionDance movement therapy (DMT) is a movement-based psychosocial intervention that incorporates the therapeutic components of dance movements and group psychotherapy. DMT, also known as creative movement therapy (CMT) is a psychotherapy used as a complementary therapy in cancer care. It helps in enhancing mood, emotions, self-expression and helps to rebuild self-confidence. Besides, it allows the patients to recognise their own strengths and weaknesses as well as helps to improve physical capabilities.MethodsBy simple random sampling method, 30 breast cancer patients were recruited at Pravara Rural Hospital, Loni, Maharashtra, India. The participants were in the age range of 30-60 years based on the inclusion and exclusion criteria. Pre-intervention scores of cancer-related fatigue (CRF) were taken using the Brief Fatigue Inventory (BFI) scale and intervention was given for 45 minutes each day for 5 days a week, over a span of 2 weeks. Thereafter, post-intervention assessment was done and the scores were noted. Pre-intervention and post-intervention scores were compared using paired t-test.ResultsThe mean and standard deviation (SD) of pre- and post-BFI scores derived by using paired t-test was 73.76 (8.6) and 69.33 (9.8), respectively, with a p-value of < 0.001, which is highly significant.ConclusionThe results of the present study revealed that DMT seems to be effective in reducing some amount of CRF in breast cancer patients undergoing radiation therapy. Besides, it turned out to be an engaging, entertaining and cost-effective approach. The investigation showed that DMT appears to be beneficial in reducing the side effects of radiation therapy such as pain, stress, anxiety and fear, giving a psychotherapeutic relief but did not completely remove the persistent fatigue experienced by the breast cancer patients. Thus, further investigation with long-term follow-up is recommended.

Objective To explore the intervention effect of yoga combined with music relaxation training on cancer related fatigue in breast cancer patients undergoing chemotherapy. Methods By convenience sampling method, a total of 89 inpatients with breast cancer after chemotherapy in our hospital from June 2015 to June 2016 were selected and were divided into 4 groups by random number table. Patients in the control group (n=23) were given routine nursing care. Based on routine nursing care, patients in experimental group 1 (n=20) received music relaxation training and patients in experimental group 2 (n=24) received yoga training, while patients in experimental group 3 (n=22) received music relaxation training combined with yoga. One month after continuous intervention, cancer fatigue scale (CFS) was applied to measure the degree of fatigue in four groups. Results Before intervention, the fatigue of patients in 4 groups had no difference (P>0.05) . After intervention, the scores of CFS in the control group was (25.65±5.79) , in experiment group 1 was (22.60±6.75) , in experiment group 2 was (22.08±6.57) , in experiment group 3 was (21.17±5.53) (F=12.395, P<0.001) . The scores of CFS in experiment group 2 and experiment group 3 were statistically decreased compared with those before intervention (t=2.089, 2.708; P<0.05) . Conclusions Yoga combined with music relaxation training can effectively alleviate the cancer related fatigue of breast cancer patients after chemotherapy, and the curative effect is better than single music training and yoga intervention. Key words: Breast neoplasms; Yoga; Music therapy; Cancer related fatigue

This study was designed to critically evaluate the effect of yoga on cancer-related fatigue in patients with breast cancer. Eight databases (Cochrane Library, PubMed, Ovid-Medline, Web of Science, CBM, Wanfang, VIP, and CNKI) were systematically reviewed from inception to January 2019 for randomized controlled trials (RCTs). Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. A total of 17 qualified studies that included 2183 patients (yoga: 1112, control: 1071) were included in the meta-analysis. Yoga had a large effect on fatigue in post-treatment breast cancer patients and had a small effect on intra-treatment patients. The meta-analysis also indicated that supervised yoga class had a significant effect on CRF; the six-week program had a moderate beneficial effect while the 60/90min/session supervised yoga class and the eight-week program demonstrated a large effect on fatigue in patients with breast cancer. Yoga could markedly mitigate the physical fatigue in breast cancer patients, had a medium impact on cognitive fatigue, and manifested a small effect on mental fatigue. Eight studies reported the adverse events, whereas ten studies did not. Yoga can be considered as an alternative therapy for relieving fatigue in breast cancer patients who have completed treatment or are undergoing anti-cancer treatment.

The aim of this study is to examine factors contributing to cancer-related fatigue (CRF) in breast cancer patients who have undergone surgery. Sixty women (mean age: 50.0) completed self-rated questionnaires assessing components of CRF, muscular and cognitive functions. Also, physiological and subjective data were gathered. Data were analyzed using partial least squares variance-based structural equation modeling in order to examine factors contributing to CRF after breast surgery. The tested model was robust in terms of its measurement quality (reliability and validity). According to the structural model results, emotional distress (β = 0.59; p < 0.001), pain (β = 0.23; p < 0.05), and altered vigilance (β = 0.30; p < 0.05) were associated with CRF, accounting for 61% of the explained variance. Also, emotional distress (β = 0.41; p < 0.05) and pain (β = 0.40; p < 0.05) were related to low physical function and accounted for 41% of the explained variance. However, the relationship between low physical function and CRF was weak and nonsignificant (β = 0.01; p > 0.05). Emotional distress, altered vigilance capacity, and pain are associated with CRF in postsurgical breast cancer. In addition, emotional distress and pain are related to diminished physical function, which, in turn, has no significant impact on CRF. The current model should be examined in subsequent phases of the treatment (chemotherapy and/or radiotherapy) when side effects are more pronounced and may lead to increased intensity of CRF and low physical function.

BackgroundFatigue is prevalent in breast cancer survivors and has profound effects on daily life. The interference of fatigue with endocrine therapy may be difficult to separate. This study investigates the prevalence and severity of fatigue and identifies the demographic, clinical, and lifestyle factors associated with cancer-related fatigue (CRF) in breast cancer patients undergoing endocrine therapy in an urban area.MethodsWomen with stage I-IIIA breast cancer were recruited and asked to participate (n = 371) in the study. The 315 women who responded to the questionnaire (84.9%), 54 (17.1%) had completed endocrine therapy and 261 (82.9%) were still undergoing endocrine therapy. The patients had been diagnosed at an average of 31 months prior to recruitment (range, 7 to 60 months); the average age was 48 (range, 33 to 72) years. The 11-point scale and Visual Analog Scale (VAS) were employed to quantify the level of fatigue experienced by the patients. Logistic regression analyses and a trend test method were performed to evaluate factors associated with CRF.ResultsAmong the 315 patients, 189 (60%) had experienced or were experiencing CRF during endocrine therapy. Logistic regression analysis was performed to identify factors associated with CRF, including BMI (body mass index), clinical stage, menopausal status, duration of endocrine therapy, physical activity, and diet. Factors unrelated to CRF were age, marital status, treatment, endocrine therapy drugs, alcohol intake, and smoking. The trend test method revealed an association between physical activity and dietary level and the intensity of CRF.ConclusionsThe present findings suggest that fatigue is an important problem in the majority of breast cancer patients during endocrine therapy. We found that BMI, clinical stage, menopausal status, duration of endocrine therapy, physical activity, and diet are associated with fatigue. Future research should focus on the impact factors of CRF and lifestyle in the management of breast cancer patients.

To evaluate the condition of cancer-related fatigue (CRF) in breast cancer patients with chemotherapy and to explore the effect of Yoga on it. After the completion of Yoga, 100 breast cancer patients with CRF (CFS>0) were selected and were randomly divided into the Yoga group and the control group (n=50). Patients in the control group only received routine cure and care while patients in the Yoga group received extra Yoga exercise, lasting for 4 months. Cancer fatigue scale (CFS) was evaluated in the 2nd, 4th and 6th round of chemotherapy. At the end, 82 cases qualified for the study, 42 cases for the control group and 40 for the Yoga group. The mean score of body fatigue was 12.67±3.46. There was no significant difference in CRF between the Yago group and the control group before the Yoga intervention (P>0.05). After the 4th round of chemotherapy, the mean scores of CFS and body fatigue in the Yoga group were significantly lower than that in the control group (P<0.05). After the 6th round of chemotherapy, the mean scores of CFS, body fatigue and cognitive fatigue in the Yoga group were lower than that in the control group (P<0.05). Repeated analysis of variance showed that the difference in the overall fatigue, body fatigue and cognitive fatigue between the Yoga group and the control group was significant (P<0.05); the time influence on the overall fatigue, body fatigue and emotional fatigue was significant difference between the 2 groups (P<0.05); there were interactions between the effect of Yago and time on the overall fatigue, body fatigue and cognitive fatigue (P<0.05). The body fatigue was more serious in breast cancer patients with chemotherapy. Yoga intervention could significantly reduce body fatigue, cognitive fatigue, thus reduce the overall fatigue in breast cancer patients with chemotherapy.

ObjectiveThis overview of systematic reviews aims to critically appraise and consolidate evidence from current systematic reviews (SRs)/meta-analyses on the effects of exercise interventions on cancer-related fatigue (CRF) in breast cancer patients.MethodsSRs/meta-analyses that explored the effects of exercise interventions on CRF in breast cancer patients compared with the routine methods of treatment and care were retrieved from nine databases. The methodological quality of the included SRs was appraised using A MeaSurement Tool to Assess systematic Reviews II (AMSTAR II). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to calculate the grading of outcomes in the included SRs. The exercise type, frequency, duration, and inclusion/absence of supervision were further evaluated with subgroup analyses. The Stata 16.0 software was utilized for data analysis.ResultsTwenty-nine reviews were included. The overall methodological quality and level of evidence of the included reviews were unsatisfactory, with only three reviews rated as high methodological quality and no review identified as high-quality evidence. Moderate certainty evidence indicated that exercise could improve fatigue in breast cancer patients (SMD = − 0.40 [95%CI − 0.58, − 0.22]; P = 0.0001). Subgroup analysis based on the types of exercise showed that yoga (SMD = − 0.30 [95%CI − 0.56, − 0.05]; I2 = 28.7%) and aerobic exercise (SMD = − 0.29 [95%CI − 0.56, − 0.02]; I2 = 16%) had a significantly better effect on CRF in breast cancer patients; exercising for over 6 months (SMD = − 0.88 [95%CI − 1.59, − 0.17]; I2 = 42.7%; P = 0.0001), three times per week (SMD = − 0.77 [95%CI − 1.04, − 0.05]; I2 = 0%; P = 0.0001), and for 30 to 60 min per session (SMD = − 0.81 [95%CI − 1.15, − 0.47]; I2 = 42.3%; P = 0.0001) can contribute to a moderate improvement of CRF. Supervised exercise (SMD = − 0.48 [95%CI − 0.77, − 0.18]; I2 = 87%; P = 0.001) was shown to relieve CRF.ConclusionExercise played a favorable role in alleviating CRF in breast cancer. Yoga was recommended as a promising exercise modality for CRF management in the majority of the included studies. Exercising for at least three times per week with 30 to 60 min per session could be recommended as a suitable dosage for achieving improvement in CRF. Supervised exercise was found to be more effective in alleviating CRF than unsupervised exercise. More rigorously designed clinical studies are needed to specify the exact exercise type, duration, frequency, and intensity to have an optimal effect on CRF in breast cancer patients.Trial registrationClinicalTrials.gov Identifier: CRD42020219866.

A Prospective Longitudinal Study of Radiation Therapy–Induced Skin Toxicity and Long-term Fatigue in Breast Cancer Patients

The impact of exercise during radiotherapy on treatment-related side effects in breast cancer patients: A systematic review and meta-analysis.

Introduction Cancer-related fatigue is one of the most prevalent symptoms reported by breast cancer survivors. Despite a corpus of literature dedicated to understanding and identifying evidence-based treatments for cancer-related fatigue, gaps in the literature remain, particularly for breast cancer survivors during their primary treatment. Exercise training may represent an efficacious behavioral modality for mitigating fatigue symptoms in cancer survivors; yet, the effects of exercise during adjuvant therapy is an understudied area. Areas covered In this review, we synthesize the most recent evidence of exercise’s effects on cancer-related fatigue during active treatment for breast cancer. We summarize the overall effects of exercise, moderators of these effects, and areas requiring further research. Expert opinion Strong evidence supports at least modest effects of exercise on cancer-related fatigue during breast cancer treatment. However, several knowledge gaps persist, including the need to: risk stratify patients to tailor exercise promotion strategies; implement higher-quality studies and translate this evidence to clinical practice; adopt biobehavioral models to better understand exercise’s effects on cancer-related fatigue; evaluate the effects of exercise modes besides aerobic and combined training; and integrate technology to better understand and promote fatigue-reducing behaviors, such as exercise, across cancer care.

Background: Cancer-related fatigue (CRF) is a prevalent, persistent, and multidimensional symptom in breast cancer patients, negatively affecting physical function and quality of life (QoL). Dietary interventions have emerged as safe and cost-effective strategies to alleviate CRF. Methods: This assessor-blinded, randomized controlled trial evaluated the effects of a 12-week dietary quality-based nutrition education program on CRF in breast cancer patients. A total of 128 participants were randomly assigned to the intervention, which received nutrition education based on the Chinese Healthy Eating Index (CHEI), or the control group, which received standard care. Outcomes, including CRF (Revised Piper Fatigue Scale), dietary quality (CHEI), body mass index (BMI), self-management efficacy (Strategies Used by People to Promote Health, SUPPH) and QoL (Functional Assessment of Cancer Therapy-Breast, FACT-B) were assessed at baseline and post-intervention. Results: Of the 128 participants, 111 (86.7%) completed follow-up. Linear mixed-effects models demonstrated a significant group × time interaction for total RPFS scores. After adjusting for age, BMI, cancer stage, pain, anxiety, and depression, the intervention group showed a significantly larger reduction in RPFS scores (β = -1.426, 95% CI: -1.959~-0.893, p < 0.001, Cohen's d = -0.97). In addition, after adjusting for the same covariates, significant improvements were observed in CHEI (β = 4.799, 95% CI: 1.383~8.215, p = 0.006, Cohen's d = 0.75), SUPPH scores (β = 16.657, 95% CI: 12.557~20.758, p < 0.001, Cohen's d = 1.65) and FACT-B scores (β = 12.688, 95% CI: 9.250~16.125, p < 0.001, Cohen's d = 1.16) in the intervention group, all showing meaningful changes compared with the control group. Conclusions: Dietary quality-based nutrition education significantly alleviated CRF and improved other health-related outcomes in breast cancer patients, suggesting that nutrition education may be an effective strategy for managing CRF and supporting recovery during breast cancer treatment.

Objective To understand the status quo of perception control, self-management and cancer-related fatigue (CRF) in breast cancer patients receiving chemotherapy, and to investigate the impacts of perception control and self-management on CRF. Methods In this study, 246 breast cancer patients undergoing chemotherapy from Shandong Cancer Hospital and Institute were investigated by means of cross-sectional survey. Cancer experience and efficiency scale was used to evaluate the patients′ perception control; cancer patients′ self-management scale was used to assess their self-management; and Piper Fatigue Scale was used to evaluate their CRF. Finally, the scores of CRF among the patients with different demographic data were compared, and the effects of perception control and self-management behavior on CRF were analyzed. Results In univariate analysis, there were statistically significant differences of CRF scores resulting from different educational backgrounds (F=3.392, P=0.019), sources of medical cost (F=4.368, P=0.005), disease stages (F=4.376, P=0.005), chemotherapy periods (F=3.865, P=0.010) and courses of disease (F=3.094, P=0.028). The differences in each dimension of perceived control cancer experience (F=7.248, P=0.001), control efficacy (F=96.595, P<0.001), self-management level of cancer patients (F=65.009, P<0.001) and CRF (F=130.973, P<0.001) were statistically significant. Cancer experience in perception control was positively correlated with CRF (r=0.467, P<0.001); control effectiveness and self-management of cancer patients were negatively correlated with CRF (r=-0.505, P<0.001; r=-0.564, P<0.001). Multiple linear regression showed that source of medical expenses (setting commercial insurance as the reference group), chemotherapy cycle (setting chemotherapy cycle ≥ 6 cycles as the reference group), cancer experience, control effectiveness, and self-management were entered in regression models, which could explain 55.5% of the total variation in CRF scores, and there was a significant linear relationship (F=17.100, P<0.001). Conclusion Medical staff should focus on CRF in patients at their own expense and in the 2-5 chemotherapy cycles. Cancer experience is positively correlated with CRF. Control effectiveness and self-management behavior are negatively correlated with CRF. Key words: Breast neoplasms; Fatigue; Analysis of influence factor; Perception control

AimTo assess the effect of different non‐pharmacological interventions on cancer‐related fatigue (CRF) in breast cancer (BC) patients and identify the most effective method for improving CRF.DesignA systematic review and network meta‐analysis.MethodsLiterature will be searched in the ongoing trail in the Clinical Trials.gov, World Health Organization, the International Clinical Trials Registry Platform, Cochrane Library, PubMed, EMBASE, Web of Science and CINAHL, from the inception until December 31, 2020. Two independent researchers will rigorously screen the literature according to the inclusion and exclusion criteria and assess the risk of bias based on the Cochrane Collaboration's Tool of RCTs. Stata 13.0 and Aggregate Data Drug Information System will be used for data analysis.ResultsThis protocol has been registered on the PROSPERO website (registration number is CRD42020222093). This study will provide the reliable evidence of the most effective non‐pharmacological intervention to improving CRF.