Brief Fatigue Inventory Score Research Articles

Infrared laser moxibustion for cancer-related fatigue in breast cancer survivors: a randomized controlled trial

BackgroundCancer-related fatigue (CRF) is a pervasive, persistent, and distressing symptom experienced by cancer patients, for which few treatments are available. We investigated the efficacy and safety of infrared laser moxibustion (ILM) for improving fatigue in breast cancer survivors.MethodsA three-arm, randomized, sham-controlled clinical trial (6-week intervention plus 12-week observational follow-up) was conducted at a tertiary hospital in Shanghai, China. The female breast cancer survivors with moderate to severe fatigue were randomized 2:2:1 to ILM (n = 56) sham ILM (n = 56), and Waitlist control (WLC)(n = 28) groups. Patients in the ILM and sham ILM (SILM) groups received real or sham ILM treatment, 2 sessions per week for 6 weeks, for a total of 12 sessions. The primary outcome was change in the Brief Fatigue Inventory (BFI) score from baseline to week 6 with follow-up until week 18 assessed in the intention-to-treat population.ResultsBetween June 2018 and July 2021, 273 patients were assessed for eligibility, and 140 patients were finally enrolled and included in the intention-to-treat analysis. Compared with WLC, ILM reduced the average BFI score by 0.9 points (95% CI, 0.3 to 1.6, P = .007) from baseline to week 6, with a difference between the groups of 1.1 points (95% CI, 0.4 to 1.8, P = .002) at week 18. Compared with SILM, ILM treatment resulted in a non-significant reduction in the BFI score (0.4; 95% CI, -0.2 to 0.9, P = .206) from baseline to week 6, while the between-group difference was significant at week 18 (0.7; 95% CI, 0.2 to 1.3, P = .014). No serious adverse events were reported.ConclusionWhile ILM was found to be safe and to significantly reduce fatigue compared with WLC, its promising efficacy against the sham control needs to be verified in future adequately powered trials.Trial registrationClinicaltrials.gov: NCT04144309. Registered 12 June 2018.

Establishing the minimal clinically important difference of the Brief Fatigue Inventory for brain or CNS cancer patients undergoing radiotherapy

Abstract Background Minimal clinically important differences (MCIDs) quantify the clinical relevance of quality of life results at the individual patient and group level. The aim of this study was to estimate the MCID for the Brief Fatigue Inventory (BFI) and the Worst and Usual Fatigue items in patients with brain or CNS cancer undergoing curative radiotherapy. Methods Data from a multi-site prospective registry was used. The MCID was calculated using distribution-based and anchor-based approaches. For the anchor-based approach, the fatigue item from the PROMIS-10 served as the anchor to determine if a patient improved, deteriorated, or had no change from baseline to end of treatment (EOT). We compared the unadjusted means on the BFI for the 3 groups to calculate the MCID. For the distribution-based approaches, we calculated the MCID as 0.5 SD of the scores and as 1.96 times the standard error of measurement. Results Three-hundred and fifty nine patients with brain or CNS tumors undergoing curative radiotherapy filled out the 9-item BFI at baseline and EOT. The MCID for the BFI was 1.33 (ranging from 0.99 to 1.70 across the approaches), 1.51 (ranging from 1.16 to 2.02) and 1.76 (ranging from 1.38 to 2.14) for the usual and worst fatigue items, respectively. Conclusions This study provides the MCID ranges for the BFI and Worst and Usual fatigue items, which will allow clinically meaningful conclusions to be drawn from BFI scores. These results can be used to select optimal treatments for patients with brain or CNS cancer or to interpret BFI scores from clinical trials.

Efficacy of ginseng-based Renshenguben oral solution for cancer-related fatigue among patients with advanced-stage hepatocellular carcinoma: A prospective multicenter cohort study

BackgroundCancer-related fatigue (CRF) is a common and debilitating symptom experienced by patients with advanced-stage cancer, especially those undergoing antitumor therapy. This study aimed to evaluate the efficacy and safety of Renshenguben (RSGB) oral solution, a ginseng-based traditional Chinese medicine, in alleviating CRF in patients with advanced hepatocellular carcinoma (HCC) receiving antitumor treatment. MethodsIn this prospective, open-label, controlled, multicenter study, patients with advanced HCC at BCLC stage C and a brief fatigue inventory (BFI) score of ≥ 4 were enrolled. Participants were assigned to the RSGB group (RSGB, 10 mL twice daily) or the control group (with supportive care). Primary and secondary endpoints were the change in multidimensional fatigue inventory (MFI) score, and BFI and functional assessment of cancer therapy-hepatobiliary (FACT-Hep) scores at weeks 4 and 8 after enrollment. Adverse events (AEs) and toxicities were assessed. ResultsA total of 409 participants were enrolled, with 206 assigned to the RSGB group. At week 4, there was a trend towards improvement, but the differences were not statistically significant. At week 8, the RSGB group exhibited a significantly lower MFI score (P < 0.05) compared to the control group, indicating improved fatigue levels. Additionally, the RSGB group showed significantly greater decrease in BFI and FACT-Hep scores at week 8 (P < 0.05). Subgroup analyses among patients receiving various antitumor treatments showed similar results. Multivariate linear regression analyses revealed that the RSGB group experienced a significantly substantial decrease in MFI, BFI, and FACT-Hep scores at week 8. No serious drug-related AEs or toxicities were observed. ConclusionsRSGB oral solution effectively reduced CRF in patients with advanced HCC undergoing antitumor therapy over an eight-week period, with no discernible toxicities. These findings support the potential of RSGB oral solution as an adjunctive treatment for managing CRF in this patient population.

Abstract 16880: Perceived Control Moderates the Relationship Between Fatigue and Self-Care in Patients With Heart Failure

Introduction: Fatigue is associated with poor self-care in patients with heart failure (HF). However, factors of fatigue include not only physical factors but also psychological factors, making it difficult to manage. Perceived control refers to the ability to cope with threats and has a significant impact on self-care and fatigue. Hypothesis: We hypothesized that a higher perceived control would lead to better self-care, even if the level of fatigue was comparable. This study aimed to determine whether the perceived control moderates the relationship between fatigue and self-care in patients with HF. Methods: In this cross-sectional study, outpatients with HF (n = 165, 78.8% male, mean age = 69.5 years) completed an assessment of fatigue using the Brief Fatigue Inventory (BFI) and perceived control using the Control Attitude Scale Revised (CAS-R). Participants were categorized into four groups with High (H) and Low (L), H/H, H/L, L/H, and L/L, using the median of BFI and CAS-R scores. Self-care was measured using the Self-Care of HF Index (SCHFI v 6.2), which consists of three subscales, maintenance (adherence to treatment), management (management of symptoms) and confidence. All SCHFI scores were standardized (0–100). A higher score indicates better self-care. Analysis of variance was used to examine differences in four groups using the SCHFI scores. Results: There was a significant difference in SCHFI-maintenance (p = 0.018), especially between H/L and L/H (61.8± 17.3 vs. 70.8 ± 17.3, p = 0.026). Additionally, H/H tended to be higher than H/L (71.3 ± 11.73 vs. 61.8 ± 17.3, p = 0.069). There was a significant difference in SCHFI-management (p &lt;0.001). H/H was significantly higher than H/L (60.1 ± 18.6 vs. 38.3 ± 22.5, p = 0.000), and L/H was significantly higher than L/L (53.3 ± 23.8 vs. 33.3 ±22.9, p &lt;0.001). Similarly, significant differences were found in SCHFI-confidence (p &lt;0.001). H/H was significantly higher than H/L (47.2 ± 21.6 vs. 28.8 ± 15.1, p &lt; 0.001), and L/H was significantly higher than L/L (50.2 ± 21.6 vs. 22.8 ± 10.7, p &lt;0.001). Conclusions: Perceived control might moderate the relationship between fatigue and self-care. Interventions for HF self-care require improvements in perceived control as well as physical factors, such as symptoms.

A Case Report: Korean Medicine Treatment for a Systemic Lupus Erythematosus Patient Persistently Complaining of Fatigue and Chest Tightness

Objective: This study reported the improved symptoms of integrative Korean medicine-based treatment in a patient diagnosed with Systemic Lupus Erythematosus (SLE) who persistently complained of fatigue and chest tightness.Methods: A 51-year-old female SLE patient persistently complaining of fatigue and chest tightness underwent an 18-day treatment with Kracie &lt;i&gt;Shihogayonggolmoryo-tang&lt;/i&gt;, Cheongpajeon-H, Gwanjeol-go, acupuncture, pharmacopuncture, cupping therapy, deep tissue meridian hot pack therapy, manual therapy, Interferential Current Therapy, and Extracorporeal Shock Wave Therapy. The Brief Fatigue Inventory (BFI) and Numeric Rating Scale (NRS) for each symptom were measured on admission, at one week, two weeks of hospitalization, and upon discharge. Clinical outcomes were assessed using these two figures.Results: After treatment, there was a reduction in the BFI score (7 to 3). The NRS score of chest tightness with hot flashes decreased from 8 to 5, neck pain lessened from 7 to 5, pain in both ankles diminished from 6 to 4, the cold hypersensitivity of both feet fell from 6 to 4, and heartburn decreased from 5 to 2. In order, the biggest clinical improvement was to heartburn, fatigue, and chest tightness with hot flashes.Conclusion: This case study shows that integrative Korean medicine-based treatment can improve symptoms of a Systemic Lupus Erythematosus patient persistently complaining of fatigue and chest tightness with hot flashes and suggests that &lt;i&gt;Shihogayonggolmoryo-tang&lt;/i&gt; may be an effective option for managing and treating SLE patients.

Physical function, nutritional status, and quality of life before and after chemotherapy in patients with malignant lymphoma.

This study investigates the efficacy of and gender differences in exercise therapy in patients with malignant lymphoma undergoing chemotherapy. Twenty-six patients (13 men, 13 women) received physical therapy (based on the Borg Scale 13) during hospitalization. Physical function was measured using grip and knee extension strength, 6-minute walking distance, and body composition; nutritional status assessed via Mini Nutritional Assessment (MNA®); and serum albumin levels analyzed. Fatigue was evaluated using the Brief Fatigue Inventory, and health-related quality of life was assessed with the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36v2). The analysis of all patients indicated that the right grip strength, skeletal muscle mass, skeletal muscle index, and leg muscle mass significantly decreased, whereas the serum albumin level, MNA® score, and scores of many items of the SF-36v2 significantly increased after chemotherapy. In a gender-specific analysis, only men showed significant declines in the skeletal muscle mass and skeletal muscle index, and improvement in the MNA® score after chemotherapy. In the SF-36v2, there were significant improvements in general health and physical component summary scores among men, and general health and mental component summary scores among women. Exercise therapy at a Borg Scale intensity of 13 may not prevent muscle mass decline in patients with malignant lymphoma, especially male patients. In addition, this study revealed that there is a gender difference in the effect of exercise therapy on quality of life. Thus, gender should be considered in exercise therapy for patients with malignant lymphoma.

A Case Report on Opioid-Induced Constipation in a Patient with Cancer Treated by &lt;italic&gt;Jowiseunggi-tang&lt;/italic&gt;

Objective: &lt;i&gt;Jowiseunggi-tang&lt;/i&gt; (JWSGT) is a traditional herbal medicine commonly used for purgative activity in constipation. This study evaluates JWSGT for the treatment of opioid-induced constipation (OIC), the most common and debilitating gastrointestinal effect of opioid use.Methods: A 64-year-old man with floor of mouth cancer was hospitalized for OIC, and JWSGT was administered orally twice a day for 10 days, along with acupuncture, moxibustion, and cupping. The primary outcome measures were defecation type according to the Bristol Stool Form Scale (BSFS) and the frequency of bowel movements. The Brief Fatigue Inventory (BFI) and the Functional Assessment of Cancer Therapy-General (FACT-G) were used as secondary measures.Results: After three days of JWSGT administration, spontaneous bowel movements were observed two to three times per week with improved BSFS from type 2 to 4. A reduction in BFI score (8.7 to 2.0) and an increase in FACT-G score (44.3 to 59.0) suggested an improvement in fatigue level and quality of life.Conclusion: This is the first report to assess the efficacy of JWSGT for the management of OIC in patients with cancer, and JWSGT may be an effective option to improve symptoms and quality of life in this group.

The effect of slow-stroke back massage on chemotherapy-related fatigue in women with breast cancer: An assessor blinded, parallel group, randomized control trial

ObjectiveThis randomized controlled parallel-group trial was conducted to investigate the effect of slow-stroke back massage (SSBM) on the level of fatigue in women with breast cancer undergoing chemotherapy. MethodsSixty-four women with breast cancer receiving chemotherapy were randomly assigned to SSBMG (n:32), who received SSBM, and CG (n:32), who received routine treatment only. Women with breast cancer in the intervention group received SSBM for a total of 20 min, 10 min before and after each chemotherapy infusion (2nd, 3rd, and 4th cycle). The Brief Fatigue Inventory (BFI) was completed before and after three cycles of chemotherapy (2nd, 3rd, and 4th) to assess the level of fatigue in women with breast cancer. ResultsAfter using SSBM, the BFI score was significantly lower in SSBMG than in CG (p 0.001) at all three-time points (1st, 2nd, and 3rd-time points). While the within-group change (Δ) in SSBMG differed significantly between time points (p = 0.018, η2 = 0.14), in contrast, the within-group change (Δ) in CG was found not to differ between time points. ConclusionThis study has shown that SSBM, one of the non-pharmacological methods, has a positive effect on the level of fatigue in women with breast cancer.

Are Fatigue and Pain Overlooked in Subjects with Stable Chronic Obstructive Pulmonary Disease?

Although there have been many published reports on fatigue and pain in patients with chronic obstructive pulmonary disease (COPD), it is considered that these symptoms are seldom, if ever, asked about during consultations in Japanese clinical practice. To bridge this gap between the literature and daily clinical experience, the authors attempted to gain a better understanding of fatigue and pain in Japanese subjects with COPD. The Brief Fatigue Inventory (BFI) to analyse and quantify the degree of fatigue, the revised Short–Form McGill Pain Questionnaire 2 (SF-MPQ-2) for measuring pain and the Kihon Checklist to judge whether a participant is frail and elderly were administered to 89 subjects with stable COPD. The median BFI and SF-MPQ-2 Total scores were 1.00 [IQR: 0.11–2.78] and 0.00 [IQR: 0.00–0.27], respectively. They were all skewed toward the milder end of the respective scales. A floor effect was noted in around a quarter on the BFI and over half on the SF-MPQ-2. The BFI scores were significantly different between groups regarding frailty determined by the Kihon Checklist but not between groups classified by the severity of airflow limitation. Compared to the literature, neither fatigue nor pain are considered to be frequent, important problems in a real-world Japanese clinical setting, especially among subjects with mild to moderate COPD. In addition, our results might suggest that fatigue is more closely related to frailty than COPD.

Exploring the employment readiness and return to work status of breast cancer patients and related factors

ObjectiveTo investigate the employment status, employment readiness, and other factors affecting the ease or difficulty with which breast cancer patients effect their return to work (RTW). MethodsThis study adopted a mixed-method design, recruiting participants from among breast cancer patients in a cancer hospital in Hunan from December 2018 to June 2019. We approached 300 individuals, 192 of whom ultimately participated in this study. The quantitative part of the study involved several scales: the Patient Health Questionnaire-9 (PHQ-9), the Brief Fatigue Inventory (BFI), the Work Ability Index (WAI), and the Lam Assessment of Employment Readiness (LASER). The qualitative part involved a set of open-ended questions and written responses collected from 41 participants who had already returned to work at the time of data collection. Their written responses mainly concerned factors influencing RTW. ResultsForty-one breast cancer patients had returned to work. The results reported a median total Cognitive Symptom Checklist score of 9.00 (6.00, 15.25), a median WAI score of 5.00 (3.50, 9.75), a median BFI score of 26.00 (14.75, 42.00), a median total PHQ-9 score of 8.00 (5.25, 17.00), and a LASER score of 50.35 ± 11.90. Multiple regression analysis showed that the participants’ cancer stage, cognitive limitations, depression, fatigue, and work ability were significant predictors of employment readiness (P < 0.05). Exploring the qualitative data, we found that higher skill levels, better social support, and a flexible work schedule facilitated RTW; stress, lack of confidence in one’s work skills, depression, and fatigue are all possible barriers to RTW. ConclusionThe findings indicate that breast cancer patients have a low level of employment readiness. Nurses and other healthcare providers can develop relevant interventions to promote employment readiness and ultimately achieve RTW in this study population.

Burosumab treatment in adults with X-linked hypophosphataemia: 96-week patient-reported outcomes and ambulatory function from a randomised phase 3 trial and open-label extension

ObjectivesTo report the impact of burosumab on patient-reported outcomes (PROs) and ambulatory function in adults with X-linked hypophosphataemia (XLH) through 96 weeks.MethodsAdults diagnosed with XLH were randomised 1:1 in a...

Yoga for cancer survivors with chemotherapy-induced peripheral neuropathy: Health-related quality of life outcomes.

BackgroundYoga is a meditative movement therapy focused on mind‐body awareness. The impact of yoga on health‐related quality of life (HRQOL) outcomes in patients with chemotherapy‐induced peripheral neuropathy (CIPN) is unclear.MethodsWe conducted a pilot randomized wait‐list controlled trial of 8 weeks of yoga (n = 21) versus wait‐list control (n = 20) for CIPN in 41 breast and gynecological cancer survivors with persistent moderate to severe CIPN. HRQOL endpoints were Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and Insomnia Severity Index (ISI). The Treatment Expectancy Scale (TES) was administered at baseline. We estimated mean changes and 95% confidence intervals (CIs) from baseline to weeks 8 and 12 and compared arms using constrained linear mixed models.ResultsAt week 8, HADS anxiety scores decreased −1.61 (−2.75, −0.46) in the yoga arm and −0.32 (−1.38, 0.75) points in the wait‐list control arm (p = 0.099). At week 12, HADS anxiety scores decreased −1.42 (−2.57, −0.28) in yoga compared to an increase of 0.46 (−0.60, 1.53) in wait‐list control (p = 0.017). There were no significant differences in HADS depression, BFI, or ISI scores between yoga and wait‐list control. Baseline TES was significantly higher in yoga than in wait‐list control (14.9 vs. 12.7, p = 0.019). TES was not associated with HADS anxiety reduction and HADS anxiety reduction was not associated with CIPN pain reduction.ConclusionsYoga may reduce anxiety in patients with CIPN. Future studies are needed to confirm these findings.Clinical Trial Registration Number: ClinicalTrials.gov Identifier: NCT03292328.

Moxibustion for treating cancer-related fatigue: A multicenter, assessor-blinded, randomized controlled clinical trial.

Cancer‐related fatigue (CRF) is one of the most common chronic symptoms experienced by cancer patients. As moxibustion is a popular traditional therapy for managing fatigue, it can be an alternative strategy to treat CRF as well. Therefore, we rigorously designed a full‐scale, multicenter, assessor‐blinded, randomized controlled trial to evaluate the efficacy and safety of moxibustion treatment for CRF. Ninety‐six subjects suffering from CRF were recruited and randomly assigned to moxibustion group, sham moxibustion group, or usual care group. Both the moxibustion group and the sham group received moxibustion treatment for 8 weeks and the usual care group did not. Brief fatigue inventory (BFI) score and Functional Assessment of Cancer Therapy‐Fatigue score were used to assess CRF at baseline and weeks 5, 9, and 13. Questionnaires for the assessment of cognitive impairment, quality of life, and Cold–Heat and Deficiency–Excess patterns were also evaluated. BFI scores significantly decreased in moxibustion group compared to the usual care group (mean difference of −1.92, p < 0.001 at week 9 and mean difference of −2.36, p < 0.001 at week 13). Although the sham group also showed significant improvement during the treatment period, only the moxibustion group showed improvement after 4 weeks of follow‐up period (mean difference of −1.06, p < 0.001). There were no serious adverse events. Our findings confirmed the efficacy and safety of moxibustion for CRF compared to usual care. We also found that moxibustion has a prolonged treatment effect during 4 weeks of follow‐up period.

Association between Fatigue and Hoehn-Yahr Staging in Parkinson's Disease: Eight-Year Follow-Up Study.

The severity of Parkinson’s disease (PD) is developed by multifactorial factors. Falls can worsen disease severity. We previously found that frontal assessment battery (FAB) score was associated with a higher risk of future falls. This eight-year follow-up study aimed to verify whether factors including low FAB score can be the risk of PD progression based on the Hoehn and Yahr scale. In total, 95 patients were initially enrolled in this research and 45 were included in the final follow-up. Then, the cohort was classified into patients with and without disease progression, defined by upgrade of Hoehn-Yahr stage. Differences in clinical characteristics between patients with disease progression and those without were evaluated using the Mann–Whitney U test. Eighteen independent variables were evaluated via a univariate logistic regression analysis. Of the 45 patients enrolled, 32 had disease progression and 13 had no progression. Age (p = 0.033), BFI score (p = 0.003), Zung self-rating depression (p = 0.011), and anxiety scale (p = 0.026) were significantly increased in patients who had disease progression than those with no disease progression. On multivariate logistic regression analysis, brief fatigue inventory (BFI) score (OR = 1.048, p = 0.045, 95% CI = 1.001–1.098) was significantly related to disease progression. All BFI subscores related to general fatigue. Fatigue could predict the progression of motor dysfunction severity over a longitudinal duration in patients with PD with disease progression, having declining physical and mental fatigue.

Impact of fatigue on quality of life among breast cancer patients receiving chemotherapy.

ObjectivesFatigue is the most frequently reported symptom experienced by cancer patients and has a profound effect on their quality of life (QOL). The study aimed to determine the impact of fatigue on QOL among breast cancer patients receiving chemotherapy and to identify the risk factors associated with severe fatigue incidence.MethodsThis was an observational prospective study carried out at multiple centers. In total, 172 breast cancer patients were included. The Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire was used to measure QOL, while the Brief Fatigue Inventory (BFI) was used to assess the severity of fatigue.ResultsThe total average mean and standard deviation of QOL were 84.58±18.07 and 4.65±1.14 for BFI scores, respectively. A significant association between fatigue and QOL was found in linear and multiple regression analyses. The relationships between fatigue severity and cancer stage, chemotherapy dose delay, dose reduction, chemotherapy regimen, and ethnicity were determined using binary logistic regression analysis.ConclusionThe findings of this study are believed to be useful for helping oncologists effectively evaluate, monitor, and treat fatigue related to QOL changes.

Associations of Coexisting Pain and Fatigue Severity with Physical Performance and Quality of Life Among Middle-Aged and Older Individuals with Chronic Knee Pain:Secondary Analysis of a Randomized Clinical Trial.

To examine associations of combined pain and fatigue severity with physical performance and quality of life in people with chronic knee pain. Cross-sectional. General community. Adults (N = 193) ≥50 years of age with chronic knee pain. Physical performance measures included the Six-Minute Walk test, Timed Up and Go test, and 20-foot timed walk test. Quality of life (QOL) was measured by the Medical Outcomes Study Short Form-12 Health Survey. The Brief Pain Inventory (BPI) and Brief Fatigue Inventory (BFI) were used to evaluate pain and fatigue. Multiple linear regression analyses were conducted to examine associations of coexisting pain and fatigue severity with physical performance and QOL. Participants were categorized by BPI and BFI scores into four severity groups: mild pain / mild fatigue; moderate pain / mild fatigue; mild pain / moderate fatigue; and moderate pain / moderate fatigue (which included severe pain / severe fatigue). The moderate pain / moderate fatigue group had significantly worse physical performance on the Six-Minute Walk (standardized beta [β] = -0.22, 95% confidence interval [CI] -0.38 to -0.06, P < 0.05) and poorer physical (β = -0.41, 95% CI -0.61 to -0.20, P < 0.001) and mental QOL (β = -0.26, 95% CI -0.46 to -0.07, P < 0.05) than the mild pain / mild fatigue group. Moreover, the mild pain / moderate fatigue group had significantly lower levels of mental QOL (β = -0.27, 95% CI -0.44 to -0.10, P < 0.05) than those of the mild pain / mild fatigue group. The moderate pain / mild fatigue group did not differ statistically from the mild pain / mild fatigue group. Coexisting moderate pain and moderate fatigue were related to worse physical performance and QOL. Fatigue contributed to lower levels of mental QOL. Clinical assessment of fatigue in addition to pain should be included as a standard examination for chronic knee pain.

Gut Microbiota Dysbiosis Associated with Persistent Fatigue in Hematopoietic Cell Transplantation Survivors

Fatigue is one of the most prevalent and distressing complications among hematopoietic stem cell transplantation (HCT) survivors, negatively affecting physical, social, and emotional domains of quality of life. Chronic systemic inflammation has been linked to alterations in nervous system activity and initiation of distressing symptoms, such as fatigue. Damage to gut mucosa due to alteration in gut microbiota (GM) composition and microbial translocation has been shown to increase systemic proinflammatory cytokines. The aim of this study was to evaluate the relationship between fatigue and GM by measuring the differences in GM composition in HCT survivors with and without persistent fatigue. This cross-sectional study included 30 adults who underwent HCT for a hematologic disease and were at least 1 year post-HCT. Patients with chronic graft-versus-host disease were excluded. Fatigue severity was assessed by the Brief Fatigue Inventory (BFI). Based on the BFI score, patients were grouped into 2 categories: 0 to 3 (without fatigue) and ≥4 (with fatigue). The V1 to V3 region of the 16S rRNA gene from fecal specimens was sequenced using the Illumina MiSeq. Sequencing reads were processed, denoised, and replicated, chimeras were filtered, amplicon sequence variants (ASVs) were generated, and taxonomy was assigned using DADA2. Beta diversity analysis through principal coordinate analysis was generated using the Bray-Curtis dissimilarity matrix, and the difference was tested using linear model with generalized least squares in R. An alpha diversity analysis was performed using Chao1. Linear discriminant analysis effect size (LEfSe) was used to find markers that differ between the 2 groups. Based on the BFI results, patients were categorized into 2 cohorts: with fatigue (n=14) and without fatigue (n=16). The 2 cohorts were similar in terms of demographics, disease, and transplant characteristics. Based on the GM analysis, there was a significant difference in GM composition (beta diversity) between the 2 cohorts (P=.001). Alpha diversity (richness) was also significantly lower in survivors with fatigue (P =.002). LEfSe analysis identified 46 discriminative features (P < .05; linear discriminant analysis score >2) whose relative abundance varied significantly among individuals with fatigue and those without fatigue. Ten ASVs were associated with the patients with fatigue, and 36 ASVs were associated with those without fatigue. Several ASVs enriched in survivors with fatigue included organisms such as Klebsiella and Enterococcus, which have been implicated in inflammatory bowel diseases. The ASVs enriched in the cohort without fatigue were members of the Ruminococcaceae family (Oscillospira spp) and the Lachnospiraceae family (Fusicatenibacter and Coprococcus spp), which are known to have the ability to ferment complex plant carbohydrates. These findings show an association between GM composition and fatigue and suggest a microbial contribution to clinically significant fatigue post-HCT, which may guide the development of new approaches to treating fatigue based on manipulation of the GM.

Abstract PS9-19: Health-related quality of life (HRQOL) outcomes in arandomized controlled trial of yoga in breast and gynecological cancer survivors with chemotherapy-induced peripheral neuropathy

Abstract Background: Yoga is a meditative movement therapy that improves body conditioning, flexibility, and balance through mind-body awareness. We conducted a two-armed pilot randomized wait-list controlled trial in breast and gynecological (GYN) cancer survivors with persistent moderate to severe chemotherapy-induced peripheral neuropathy (CIPN) and found that yoga significantly reduced CIPN pain. Here we report on the HRQOL results. Patients and Methods: We randomized breast and GYN cancer survivors with persistent moderate to severe CIPN to eight weeks of yoga or usual care (UC). The HRQOL endpoints were Hospital Anxiety and Depression Score (HADS), Treatment Expectancy Scale (TES), Brief Fatigue Inventory (BFI), and Insomnia Severity Index (ISI). We estimated and compared the mean changes from baseline to weeks 8 and 12 along with 95% confidence intervals (CIs) between arms using linear mixed models. Results: From February 2018 to May 2019, we enrolled and randomized 41 female cancer survivors (93% breast, 7% GYN; mean (SD) age 61.7 (10.2) years; 56% white/non-Hispanic, 20% African American, 12% Asian, 12% other) to yoga (N=21) and UC (N=20) arms. The HADS anxiety score significantly reduced in the yoga arm compared to usual care at weeks 8 and 12. At baseline, the mean (95% CI) HADS anxiety score was 9.23 (7.42, 11.04) in the yoga arm, and 5.05 (3.19, 6.91) in the UC arm (p=0.002). At week 8, the mean (95% CI) HADS anxiety score decreased by -1.91 (-3.07, -0.76) points in the yoga arm, and by -0.02 (-1.10, 1.06) points in the UC arm (p=0.019). At week 12, in the yoga arm, the mean HADS anxiety score was 7.50 (5.62, 9.39), and a decrease of 1.73 (-2.88, -0.57) points; in the UC arm, the mean was 5.81 (3.94, 7.69) with an increase of 0.76 (-0.32, 1.84) points (p=0.002). There was no difference in HADS depression, BFI, and ISI scores between yoga and UC arms at baseline, week 8, and week 12. The TES at baseline was 14.9 (3.27) in the yoga arm, which was significantly higher than in the UC arm 14.9 (SD 3.27) vs. 12.7 (SD: 2.58), p= 0.019. The TES was not associated with HADS anxiety reduction, and HADS anxiety reduction was not associated with CIPN pain reduction. Conclusions: Our trial showed that a yoga intervention may be useful to reduce anxiety in patients with CIPN. We previously found that a yoga intervention reduced CIPN pain. CIPN pain reduction was not associated with anxiety reduction or TES. Future studies are needed to confirm our findings and to explore the mechanism of yoga in CIPN pain reduction. Citation Format: Wanqing Iris Zhi, Raymond Baser, Lillian Zhi, Lauren Piulson, Qing Li, Ting Bao. Health-related quality of life (HRQOL) outcomes in arandomized controlled trial of yoga in breast and gynecological cancer survivors with chemotherapy-induced peripheral neuropathy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-19.

Effect of Tai Chi and Resistance Training on Cancer-Related Fatigue and Quality of Life in Middle-Aged and Elderly Cancer Patients

To study the effect of Tai Chi (TC) and resistance training (RT) with different intensity on the cancer-related fatigue (CRF) and quality of life (QoL) of middle-aged and elderly cancer patients. Totally 120 cancer patients were enrolled and randomly assigned to 4 groups by a random number table, including TC group, high-intensity 60% one repetition maximum (1-RM) RT group (HIRT), low-intensity (30% 1-RM) RT group (LIRT) and control group, 30 patients in each group. Participants in the TC group received 24-form simplified Yang-style TC training at a frequency of 40 min per day, 3 days per week for 12 weeks. Patients in the two RT groups received 10 sessions, 6 designated movements per day, 3 days per week for 12 weeks. The 1-RM of 6 muscle groups, fat mass (FM), lean body mass (LBM), along with the scores of Brief Fatigue Inventory (BFI), QoL questionnaire for Chinese cancer patients receiving chemobiotherapy (QLQ-CCC), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh Sleep Quality Index (PSQI) were measured before and after training. The adverse effect was also observed. After 12-week intervention, patients in both TC and RT groups showed significant improvements in CRF and QLQ-CCC compared to pre-treatment (P<0.05). Compared with the LIRT and TC groups, patients in the HIRT group improved more significantly in increasing muscle strength and LBM, and reducing in FM (P<0.05). Patients in the TC group significantly increased in lower limb muscle strength compared with the LIRT group (P<0.05). In addition, patients in the TC group showed more significant improvements in scores of GAD-7, PHQ-9 and PSQI than 2 RT groups (P<0.05). TC and RT, both low- and high-intensity training, can significantly increase muscle strength, reduce CRF and improve QoL in the middle-aged and elderly cancer patients. TC has a better effect than RT in terms of sleep quality and mental health. The long-term application is needed to substantiate the effect of TC as an alternative exercise in cancer patients.

Comparison of respiratory muscle strength and endurance, maximal oxygen consumption, and fatigue in colorectal cancer survivors with healthy adults.

This study aimed to evaluate respiratory muscle strength and endurance, maximal oxygen consumption, and fatigue of colorectal cancer (CRC) survivors and compare them with healthy individuals. Demographic and clinical characteristics were recorded. Respiratory muscle strength (maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP)) was measured using an electronic mouth pressure device, and respiratory muscle endurance was assessed using a constant workload protocol with linear workload device. Peak oxygen consumption (VO2peak) was measured using the cardiopulmonary exercise test (CPET) with modified Bruce protocol. Fatigue was assessed using the Brief Fatigue Inventory (BFI). The patients had similar demographic characteristics (p > 0.05). MEP (cmH2O and %predicted) were lower in the CRC group than in healthy controls (p < 0.05). MIP (cmH2O and %predicted) and test duration did not differ between the groups (p > 0.05). VO2peak (ml/min and %predicted) and VO2peak/kg (%predicted) were significantly lower in the CRC group (p < 0.05). BFI score differed significantly in the CRC and control groups (p < 0.05). Respiratory muscle strength, maximal exercise capacity, and fatigue are adversely affected in CRC survivors. Cancer treatment may cause loss of muscle strength and impair energy metabolism and oxygen transmission. These changes can result in decreased exercise capacity and respiratory muscle strength and increased fatigue. Studies examining the effects of different exercise training programs in CRC survivors are needed.