Changes In Cancer-related Fatigue Research Articles

A study on improving cancer-related fatigue and disease-related psychological variables in patients with cervical cancer based on online mindfulness-based stress reduction: a randomized controlled trial

BackgroundThe persistent destructive power of cancer-related fatigue (CRF) has been regarded as the biggest influencing factor affecting the postoperative physical and mental health of patients with cervical cancer. During this process, patients might also experience different feelings of disease-related psychological. Therefore, this study aimed to adopt mindfulness-based stress reduction (MBSR) to intervene in patients with cervical cancer, and conducted follow-up for 3 and 6 months to observe the effects of changes in CRF, uncertainty in illness, coping styles, sense of coherence (SOC), and perceived social support (PSS).MethodsA randomized controlled trial was conducted in ShengJing Hospital of China Medical University. A total of 102 patients were selected, and 78 patients completed the whole process, including 40 in the experimental group and 38 in the control group. Data were collected according to Cancer Fatigue Scale, Medical Coping Modes Questionnaire, Multidimensional Scale of Perceived Social Support, and Sense of Coherence-13. The change trend and difference of the two groups of research data were compared by repeated measurement analysis of variance. Bonferroni test was used for multiple tests between groups.ResultsThe CRF, SOC, and coping styles of the MBSR group showed a decreasing trend (P < 0.001) at after MBSR, 3 months follow-up, and 6 months follow-up compared to the before MBSR. However, the uncertainty in illness of the MBSR group showed a decreasing trend (P < 0.001) at after MBSR compared to the before MBSR, and it rose in 3 months follow-up and 6 months follow-up.ConclusionMBSR can effectively alleviate the fatigue of CRF after treatment, while improving their psychological environment. Medical workers can consider implementing online MBSR for patients with cervical cancer in their daily rehabilitation nursing, which is beneficial for their recovery.Trial registrationChina Clinical Trial Registration Center ChiCTR2000040122 (https//www.chictr.org.cn/). Registered on November 21, 2020.

Impact of Pilates Exercise on Quality of Life, Functional Capacity, Cancer-related Fatigue, Depression and Salivary Cortisol of Colorectal Cancer Survivors: A Quasi-Experimental Study.

This study aimed to investigate the effect of Pilates exercise on the quality of life, functional capacity, cancer-related fatigue, depression and salivary cortisol of colorectal cancer survivors. This is a quasi-experimental study which was conducted at Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia (UKM), and Hospital Al-Sultan Abdullah, Universiti Teknologi MARA (UiTM), Malaysia. The intervention group performed Pilates exercises with a certified Pilates instructor for eight weeks via online streaming from the participants' homes. Meanwhile, the control group participants received the usual care as stipulated by their oncologists. The primary outcome was the quality of life. The secondary outcomes were functional capacity, cancer-related fatigue, depression and salivary cortisol. Data was collected at baseline and eight weeks after the exercise intervention. The effects of the intervention were analyzed using Repeated Measures Analysis of Covariance (ANCOVA) statistical test. Thirty-six (36) colorectal cancer survivors were allocated into either a Pilates exercise intervention group (N= 18) or a control group (N= 18). Over eight weeks, the Pilates exercise group revealed significant group x time interactions in terms of quality of life (p = 0.003), role functioning (p = 0.012), functional capacity (p = 0.048), and stool frequency (p = 0.021). However, only the stool frequency symptom (p = 0.008) remained significant after controlling for the confounders of age, gender and stage of cancer. No significant changes in cancer-related fatigue, depression and salivary cortisol levels between the groups were observed after the intervention. Pilates exercise had positive impacts on role functioning, bowel function, and functional capacity among colorectal cancer survivors, ultimately contributing to an improvement in quality of life.

Acupuncture for fatigue in breast cancer survivors: a study protocol for a pragmatic, mixed method, randomised controlled trial

IntroductionFatigue is a common symptom observed in post-cancer treatment, yet its underlying mechanisms remain poorly understood. Acupuncture has been employed to alleviate cancer-related fatigue (CRF); however, its effectiveness in addressing...

The influence of yoga and cognitive behavioral therapy on mediational relationships between insomnia and cancer-related fatigue: A URCC NCORP RCT in 550 cancer survivors.

12015 Background: Cancer-related fatigue (CRF) often co-occurs with insomnia and both are incapacitating adverse toxicities of cancer and its treatment which may persist months and years after the completion of treatment. Yoga and Cognitive Behavioral Therapy for Insomnia (CBT-I) are promising behavioral approaches for improving CRF and insomnia among cancer survivors. However, the influence of changes in insomnia resulting from participating in yoga or CBT-I on the subsequent changes in CRF is not fully understood. Methods: We conducted mediation analyses on data collected from a multicenter phase III RCT among cancer survivors who were randomized to receive 1) Yoga for Cancer Survivors (YOCAS, 75-min./session, 2x/wk. for 4 wks.), 2) CBT-I (90-min./session, 1x/wk. for 8 wks.), or 3) a behavioral placebo (ASCO recommended Survivorship Education, 75-min/session, 2x/wk. for 4 wks.). Brief Fatigue Inventory and Insomnia Severity Index were used to assess CRF and insomnia, respectively, at pre-, mid-, and post-intervention. Causal mediation analyses were conducted to estimate the influence of changes in insomnia at mid-intervention resulting from participating in YOCAS, CBT-I, or behavioral placebo on subsequent changes in CRF at post-intervention. Results: 550 survivors (93% female; mean age 57 years; 75% were breast cancer survivors) completed baseline and post-intervention assessments. YOCAS, compared to placebo, significantly improved CRF and insomnia at mid-intervention (CRF: -0.38±0.16, p = 0.01; Insomnia: -1.15±0.35, p &lt; 0.01) and post-intervention (CRF: -0.35±0.17, p = 0.03; Insomnia: -1.43±0.41, p &lt; 0.01). Among YOCAS participants, improvement in insomnia at mid-intervention significantly influenced the subsequent reduction in CRF (-0.14±0.06, p = 0.01) and accounted for 37% (95% CI: 0% - 78%) of the total reduction in CRF at post-intervention. CBT-I, compared to placebo, also significantly improved CRF and insomnia at mid- (CRF: -0.32±0.18, p = 0.06; Insomnia: -2.64±0.40, p &lt; 0.01) and post-intervention (CRF: -0.59±0.18, p &lt; 0.01; Insomnia: -4.95±0.46, p &lt; 0.01). Among CBT-I participants, the improvement in insomnia at mid-intervention significantly influenced the subsequent reduction in CRF (-0.40±0.09, p &lt; 0.01) and accounted for 60% (95% CI: 21% - 99%) of the total reduction in CRF at post-intervention. Conclusions: Both YOCAS and CBT-I effectively improve CRF and insomnia among survivors. 37%-60% of the reduction in CRF resulting from participating in YOCAS or CBT-I is due to improvement in insomnia. Clinicians should consider prescribing YOCAS yoga or CBT-I for survivors who experience CRF and insomnia. Clinical trial information: NCT02613364 .

Cancer-related fatigue is associated with objective measures of physical function before and after a clinical exercise program: A retrospective analysis.

Background: Cancer-related fatigue (CRF) is a common symptom reported by survivors of cancer. CRF is associated with reduced self-reported physical function, but associations with objective measures of physical function are less robust. Exercise programs have been shown to improve both CRF and objective physical function, but the interaction of exercise, CRF, and function has not been explored. Methods: Retrospective data were collected from baseline (n = 420) and final assessments (n = 234) of survivors who participated in a 3-month clinical exercise program. Assessments included measures of CRF (Functional Assessment of Chronic Illness Therapy–Fatigue) and physical function (6-minute walk test, usual and fast gait speed, 30-second sit-to-stand test, and the Timed Up and Go test). Multiple regression analyses investigated associations between CRF and physical function before and after the program. CRF and functional changes following the program were calculated and associations investigated with multiple regressions. Results: All measures of CRF and physical function significantly improved following the program (P &lt; .01). CRF was associated with all functional measures at baseline (standardized β = −0.18 to 0.29, P &lt; .01) and final assessments (r = −0.27 to 0.26, P &lt; .01). Changes in CRF were associated with changes in function (standardized β = −0.12 to 0.23, P &lt; .05), except usual gait speed (P = .17). Conclusion: This investigation demonstrated associations between CRF and objective physical function before and after participation in an exercise program. The 3-way interaction between CRF, physical function, and exercise can be used clinically to personalize rehabilitation strategies. Future studies should investigate changes in CRF and function during an exercise program.

Physical Activity as a Treatment for Cancer-Related Fatigue in Children, Adolescents and Young Adults: A Systematic Review.

Cancer-related fatigue (CRF) is one of the most common and distressing symptoms in paediatric oncology. Based on previous studies, physical activity interventions are considered to be effective in reducing CRF in adult cancer patients. The aim of this systematic review is to investigate whether physical activity interventions can reduce CRF in paediatric patients undergoing cancer treatment. A systematic literature search was conducted in PubMed and Sport-Discus in October 2021 to identify intervention studies examining the effects of physical activity on CRF in cancer patients ≤ 21 years of age. Their methodological quality was assessed using the JBI Critical Appraisal Tool. A total of 20 studies (seven randomized-controlled, six quasi-experimental and seven single-arm intervention trials) were included in the review. Nine studies reported significant positive effects of physical activity interventions on CRF in group comparison or within groups. Eleven trials reported no significant changes in CRF. Physical activity as a therapeutic intervention in paediatric oncology may have the potential to reduce CRF in childhood cancer patients undergoing cancer treatment. Further high-quality studies with large samples are needed to verify these results and to assess the interdependence of dose and response of physical activity interventions.

Cancer-related fatigue mediates the relationships between physical fitness and attendance and quality of life after participation in a clinical exercise program for survivors of cancer.

Cancer-related fatigue (CRF) is a common and limiting symptom reported by survivors of cancer, negatively impacting health-related quality of life (HRQoL). Exercise improves CRF, HRQoL, and physical fitness in survivors. Prospective research trials have shown that exercise-associated fitness improvements effects on HRQoL are mediated by CRF; however, this has not been investigated in a pragmatic real-world setting. This study utilizes data from a large heterogenous population of survivors participating in a clinical exercise program to investigate this mediation effect, as well as effects of program attendance. Data were collected from 194 survivors completing the BfitBwell Cancer Exercise Program (July 2016-February 2020). Changes in HRQoL, CRF, and fitness were calculated and program attendance collected. Basic correlation analyses were performed. Linear regression analyses were performed to assess mediation by CRF. All measures of CRF, HRQoL, and physical fitness significantly improved following the exercise program. Improvements in physical fitness were significantly correlated with improvements in HRQoL (r = 0.15-0.18), as was program attendance (r = 0.26) and CRF (r = 0.59). The effects of physical fitness and program attendance on HRQoL were at least partially mediated by the effects of CRF. This study extends research findings on how exercise programs improve HRQoL in survivors of cancer to a real-world setting. Results indicate that clinical exercise programs should target reductions in CRF in survivors (during or after treatment) through improvements in physical fitness to improve HRQoL and that high attendance should be encouraged regardless of fitness changes.

Exploratory Analysis of Associations Between Whole Blood Mitochondrial Gene Expression and Cancer-Related Fatigue Among Breast Cancer Survivors.

Cancer-related fatigue is a prevalent, debilitating, and persistent condition. Mitochondrial dysfunction is a putative contributor to cancer-related fatigue, but relationships between mitochondrial function and cancer-related fatigue are not well understood. We investigated the relationships between mitochondrial DNA (mtDNA) gene expression and cancer-related fatigue, as well as the effects of fish and soybean oil supplementation on these relationships. A secondary analysis was performed on data from a randomized controlled trial of breast cancer survivors 4-36 months posttreatment with moderate-severe cancer-related fatigue. Participants were randomized to take 6 g fish oil, 6 g soybean oil, or 3 g each daily for 6 weeks. At pre- and postintervention, participants completed the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire and provided whole blood for assessment of mtDNA gene expression. The expression of 12 protein-encoding genes was reduced to a single dimension using principal component analysis for use in regression analysis. Relationships between mtDNA expression and cancer-related fatigue were assessed using linear regression. Among 68 participants, cancer-related fatigue improved and expression of all mtDNA genes decreased over 6 weeks with no effect of treatment group on either outcome. Participants with lower baseline mtDNA gene expression had greater improvements in cancer-related fatigue. No significant associations were observed between mtDNA gene expression and cancer-related fatigue at baseline or changes in mtDNA gene expression and changes in cancer-related fatigue. Data from this exploratory study add to the growing literature that mitochondrial dysfunction may contribute to the etiology and pathophysiology of cancer-related fatigue.

Predictors of cancer-related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy.

Breast cancer is the most common diagnosis and the leading cause of cancer death among women worldwide and ranks first among Asian and Taiwanese women. Cancer-related fatigue (CRF) affects patients' functioning significantly. The aim of this study was to examine changes in cancer-related fatigue (CRF) and related factors among women with breast cancer undergoing a single chemotherapy, and to identify predictors of CRF's change over the course of the chemotherapy cycle. Four self-report questionnaires were administered to assess CRF, sleep quality, depression and anxiety, and symptom distress. Heart rate variability (HRV) was assessed to evaluate autonomic nervous system activation related to CRF. Data were collected four times: (1) before initiation of the single chemotherapy cycle (T0), (2) after completion of the single cycle (T1), (3) 1week post-chemo (T2), and (4) 3weeks post-chemo (T3). Repeated measurement of variance and generalized estimating equations (GEE) were conducted to estimate the trajectories and predictors. One-hundred women with breast cancer (mean age 50.4 ± 9.42) participated. CRF (F=7.46), sleep quality (F=2.74), symptom distress (F=9.99), anxiety (F=5.72), and depression (F=4.14) varied significantly over the single cycle of chemotherapy (p < .001), which the trajectories showed exacerbating at T2. HRV indicated a higher variation only on the day of injection (T0, T1). Results of the GEE revealed that anxiety, depression, and symptom distress were predictors of CRF's change over the single cycle of chemotherapy. CRF worsens at 1week after a chemotherapy injection among Taiwanese women with breast cancer. Based on the risk predictors in CRF that included anxiety, depression, and symptom distress, multistrategy CRF-alleviating interventions should be provided prior to chemotherapy and targeted at the most disturbed period, that is, 1week after injection.

Commonalities in the Features of Cancer and Chronic Fatigue Syndrome (CFS): Evidence for Stress-Induced Phenotype Instability?

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) and Cancer-Related Fatigue (CRF) are syndromes with considerable overlap with respect to symptoms. There have been many studies that have compared the two conditions, and some of this research suggests that the etiologies of the conditions are linked in some cases. In this narrative review, CFS/ME and cancer are introduced, along with their known and putative mechanistic connections to multiple stressors including ionizing radiation. Next, we summarize findings from the literature that suggest the involvement of HPA-axis dysfunction, the serotonergic system, cytokines and inflammation, metabolic insufficiency and mitochondrial dysfunction, and genetic changes in CRF and CFS/ME. We further suspect that the manifestation of fatigue in both diseases and its causes could indicate that CRF and CFS/ME lie on a continuum of potential biological effects which occur in response to stress. The response to this stress likely varies depending on predisposing factors such as genetic background. Finally, future research ideas are suggested with a focus on determining if common biomarkers exist in CFS/ME patients and those afflicted with CRF. Both CFS/ME and CRF are relatively heterogenous syndromes, however, it is our hope that this review assists in future research attempting to elucidate the commonalities between CRF and CFS/ME.

Cancer related fatigue—light therapy: updated meta-analysis of randomised controlled trials

BackgroundModerate-to-severe cancer related fatigue occurs in 45% of patients with cancer and interferes with many aspects of quality of life. Although physical exercise has level 1 evidence for improvement of...

Novel Biomarkers Of Treatment-Induced Muscle Damage, Exercise And Fatigue: An RCT In Breast Cancer Patients

Radiation and hormone therapy may damage skeletal muscle and lead to cancer-related fatigue (CRF). Developmental myosin light chain 5 (MYL5) and myosin heavy chain 8 (MYH8) are required for normal muscle regeneration. Up-regulated serum levels of MYL5 and MYH8 resulting from radiation and hormone therapy may increase muscle degradation and lead to CRF, especially physical CRF—one of the multidimensional subcomponents of overall CRF. PURPOSE: To investigate the effect of a 6-week aerobic and anaerobic exercise intervention, called Exercise for Cancer Patients (EXCAP), on (1) CRF (overall and physical), (2) serum protein levels of MYL5 and MYH8, and (3) the association of CRF (overall and physical) with these novel biomarkers. METHODS: Ninety sedentary breast cancer patients (55.5±9.6 years, 79% white, 52% receiving radiation therapy, 48% receiving hormone therapy) were consented and participated in this phase II RCT. Patients were randomized into two arms: (1) standard cancer treatment (Control) or (2) standard cancer treatment plus EXCAP. Serum levels of MYL5 and MYH8 by ELISA assays and CRF (total and physical) by patient-report via the Multidimensional Fatigue Symptom Inventory were assessed pre- and post-intervention. RESULTS: T-tests showed significant reductions in overall CRF and physical CRF among exercisers (overall CRF: -4.9±2.6, p=0.07, physical CRF: -1.0±0.5, p=0.05) but not in controls, with significant group differences (overall CRF: -7.9±3.4, p=0.02; physical CRF: -1.9±0.7, p<0.01). T-tests also revealed statistical trends for down-regulation of MYL5 (-0.5±0.3, p=0.17) and MYH8 (-0.4±0.3, p=0.17) serum protein levels from pre- to post-intervention in exercisers, but not in controls. Spearman correlations also reveal statistical trends, in exercisers, where decreases in MYL5 and MYH8 serum protein levels are directly associated with decreases in total CRF (MYL5 r=0.23, p=0.17; MYH8 r=0.30, p=0.07) and physical CRF (MYL5 r=0.29, p=0.08; MYH8 r=0.39, p=0.02). CONCLUSIONS: EXCAP improves overall and physical CRF. EXCAP may also protect against cancer treatment-induced skeletal muscle damage via its effects on MYL5 and MYH8. Changes in these novel biomarkers may mediate changes in overall and physical CRF. Further phase III RCTs are needed to confirm these findings.

Analysis of Changes in Cancer-Related Fatigue of Breast Cancer Patients Receiving an Integrative Medicine Program.

Introduction:Cancer-related fatigue (CRF) occurs frequently in breast cancer patients. The aim of this real-world study was to analyze the longitudinal changes of CRF in breast cancer patients receiving an integrative medicine program, which includes the application of non-pharmacological interventions (NPIs) and Viscum album L. (VA) extracts.Methods:All data were collected from the clinical register of the Network Oncology of a German certified breast cancer center of the Gemeinschaftskrankenhaus Havelhöhe (GKH). Primary breast cancer patients, treated upon initial diagnosis with integrated NPIs, comprising art and exercise therapy, nursing interventions, and educational components, during their hospital stay, and who had answered the German Cancer-Fatigue Scale (CFS-D) questionnaire at first diagnosis and 12 months later, were included. The associations between NPIs and CFS-D changes were analyzed with adjusted multivariable regression analyses, considering received treatment regimens and demographic variables, using the software R.Results:231 female breast cancer patients of all tumor stages were evaluated. While chemotherapy exhibited significant severe deterioration, add-on VA applications seem to partially mitigate this impairment on CRF. 36 separate multivariable regression analyses for all NPIs showed that in particular significant associations between CFS-D improvements and the interventions nursing compresses (6 point change; P = .0002; R² = 28%) or elaborate consultations and life review (ECLR) (4 point change; P = .0002; R² = 25%) were observed.Conclusions:Breast cancer patients benefit from a hospital-based integrative medicine program. To alleviate fatigue symptoms during oncological therapy, an expansion of this concept should be developed in the future.

Instruments for determining clinically relevant fatigue in breast cancer patients during radiotherapy.

This study aimed to determine radiotherapy (RT)-related changes in cancer-related fatigue (CRF), using Multidimensional Fatigue Inventory-20 (MFI-20), and fatigue-intensity rating (FIR) instruments at three different timepoints and to identify the optimal thresholds of MFI-20 scores which would correlate with moderate-to-severe fatigue warranting an intervention in breast cancer patients treated with RT. Eighty-eight breast cancer patients treated with surgery followed by RT were included in the study. CRF was assessed with both FIR and MFI-20 tools at three different timepoints: within the week prior to RT (pre-RT), last week of RT, and 6weeks after RT completion (post-RT). Changes in measurements, correlations between measurements and optimal cutpoints of MFI-20 scores were analyzed. While FIR scores significantly changed over time (η2: 0.179), changes in MFI-20 scores were relatively small (η2: 0.076). Comparisons of the last week of RT versus post-RT scores showed small-to-moderate decrease for MFI-20 and FIR. FIR and MFI-20 scores were correlated at all timepoints and most correlated during and after RT (r = 0.525 95%CI 0.346-0.667, r = 0.791 95%CI 0.692-0.860 and r = 0.716 95%CI 0.589-0.808, respectively). Furthermore, the most correlated MFI-20 subscale with FIR was general fatigue (r = 0.603 95%CI 0.442-0.725, r = 0.821 95%CI 0.734-0.881 and r = 0.754 95%CI 0.641-0.835, respectively). Optimal cutpoints of the MFI-20 total scores corresponding to FIR scores ≥ 4 was 43.5 for all timepoints and the MFI total scores corresponding to FIR score ≥ 7 were 53.5, 52.5 and 60.5, respectively. MFI-20 and FIR scores are highly correlated measures of CRF among breast cancer patients treated with RT. An MFI-20 score of ≥ 43.5 is suggested as a clinically significant score indicating moderate-to-severe fatigue, while an MFI score of ≥ 52.5 is indicative of severe fatigue.

Instruments for Determining Clinically Relevant Fatigue in Breast Cancer Patients during Radiotherapy

This study aimed to determine radiotherapy (RT)-related changes in cancer-related fatigue (CRF), using Multidimensional Fatigue Inventory-20 (MFI-20), and fatigue-intensity rating (FIR) instruments at three different timepoints and to identify the optimal thresholds of MFI-20 scores which would correlate with moderate-to-severe fatigue warranting an intervention in breast cancer patients treated with RT. Eighty-eight breast cancer patients treated with surgery followed by RT were included in the study. CRF was assessed with both FIR and MFI-20 tools at three different timepoints: within the week prior to RT (pre-RT), last week of RT, and 6 weeks after RT completion (post-RT). Changes in measurements, correlations between measurements and optimal cutpoints of MFI-20 scores were analyzed. While FIR scores significantly changed over time (η2: 0.179), changes in MFI-20 scores were relatively small (η2: 0.076). Comparisons of the last week of RT versus post-RT scores showed small-to-moderate decrease for MFI-20 and FIR. FIR and MFI-20 scores were correlated at all timepoints and most correlated during and after RT (r = 0.525 95%CI 0.346–0.667, r = 0.791 95%CI 0.692–0.860 and r = 0.716 95%CI 0.589–0.808, respectively). Furthermore, the most correlated MFI-20 subscale with FIR was general fatigue (r = 0.603 95%CI 0.442–0.725, r = 0.821 95%CI 0.734–0.881 and r = 0.754 95%CI 0.641–0.835, respectively). Optimal cutpoints of the MFI-20 total scores corresponding to FIR scores ≥ 4 was 43.5 for all timepoints and the MFI total scores corresponding to FIR score ≥ 7 were 53.5, 52.5 and 60.5, respectively. MFI-20 and FIR scores are highly correlated measures of CRF among breast cancer patients treated with RT. An MFI-20 score of ≥ 43.5 is suggested as a clinically significant score indicating moderate-to-severe fatigue, while an MFI score of ≥ 52.5 is indicative of severe fatigue.

Effects of Exergaming in Cancer Related Fatigue in the Quality of Life and Electromyography of the Middle Deltoid of People with Cancer in Treatment: A Controlled Trial

Objective:In the present study, we aimed to evaluate the effects an exergaming protocol for cancer patients who undergo or have already undergone cancer treatment. We sought to evaluate changes in cancer-related fatigue, function, and ability to perform daily activities, in addition to changes in the electromyographic pattern of the middle deltoid muscle.Methods:We conducted a controlled trial. Nineteen volunteers in the cancer group (aged 61 ± 9 years; body mass index28 ± 5) and 19 in the control group (aged 58 ± 8 years); body mass index 28 ± 4) participated in the study. They were evaluated by means of a sociodemographic and clinical questionnaire, the Functional Assessment of Chronic Therapy-Fatigue (FACIT-F) questionnaire, and surface electromyography in the deltoid muscle at three moments: before the beginning of the exergaming protocol, after 10 training sessions, and after 20 sessions. The protocol consisted of practicing exergaming using Xbox 360® (Microsoft, Redmond, USA) with Kinect®. The game “Your Shape Fitness Evolved” (Ubisoft, Rennes, France) was used.Results:Total FACIT-F scores, fatigue subscale scores, and median frequency values observed in the cancer group were lower than those in the control group. These values improved in relation to the initial evaluation in the cancer group after the practice of the exergaming protocol.Conclusion:The exergaming protocol used in this study was effective for reducing reported symptoms of fatigue, increasing perceived quality of life, and improving the pattern of deltoid muscle contraction in cancer patients.

The influence of yoga on mediational relationships between sleep and cancer-related fatigue: A URCC NCORP RCT in 321 cancer patients.

10007 Background: Cancer-related fatigue (CRF) is one of the most incapacitating adverse effects of cancer and its treatments. CRF co-occurs with impaired sleep quality in cancer survivors, increasing morbidity and mortality. We have previously shown that yoga significantly lowers CRF and improves sleep quality in survivors. However, it is not clear if the effect of yoga on CRF is mediated by improvements in sleep quality. This study assessed the mediating effects of changes in sleep quality stemming from YOCAS yoga on improvements in CRF. Methods: We conducted a secondary analysis on data collected from a multicenter phase III randomized controlled clinical trial with 2 arms (standard care and standard care + a 4-week YOCAS yoga intervention). 321 cancer patients (96% female; mean age, 54 years; 77% had breast cancer) reported both sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), and CRF, evaluated by Multidimensional Fatigue Scale Inventory (MFSI). Causal mediation analyses were used to estimate effects of the changes in global PSQI scores and in each PSQI subscale on the relationship between yoga and CRF. Results: Yoga significantly improved both CRF (p &lt; 0.01) and sleep quality (p &lt; 0.01), compared to standard care, with total reduction in CRF by 6.5 points. Sleep quality significantly mediated the changes in CRF by 1.4 points (p &lt; 0.01) in addition to the direct effect of yoga on CRF reduction (by 5.1 points; p &lt; 0.01), suggesting that 22% (95% CI: 7%-54%) of the reduction in CRF was mediated through improving sleep quality. Among the PSQI subscales, daytime dysfunction had the most mediating effect of yoga on CRF. In this model, yoga directly improved CRF by 4.1 points (p = 0.01) and the mediating effect of yoga on CRF via daytime dysfunction was 2.4 points (p &lt; 0.01), suggesting that 37% (95% CI: 23%-81%) of the improvements in CRF was mediated through decreasing daytime dysfunction. Conclusions: Between 22 and 37% of the improvements in CRF from yoga are due to improvements in sleep quality and reductions in daytime dysfunction. Clinicians should consider prescribing yoga for survivors experiencing CRF in combination with sleep disorders. Funding: NCI UGCA189961, R25 CA102618. Clinical trial information: NCT00397930.

Effects of exercise on dyspnea and cancer-related fatigue in patients with prostate cancer.

e16580 Background: Dyspnea and fatigue are two of the most common symptoms reported by patients with advanced cancer. Patients with dyspnea report an inability to complete activities of daily living (ADL) and impaired quality of life (QOL). Exercise has been shown to reduce cancer-related fatigue (CRF); however the relationships between dyspnea, CRF, ADL and QOL are unclear. The purpose of this study is to examine the effect of exercise on dyspnea, CRF, ADL and QOL. Methods: A secondary data analysis was performed on a two-arm randomized controlled trial investigating the influence of exercise on prostate cancer patients treated with hormone (androgen deprivation therapy) and/or radiation therapy. Exercise for Cancer Patients (EXCAP©) is a 6 week home-based program that includes progressive aerobic and resistance band training. Participants were randomly assigned to usual care with EXCAP© or usual care only (UC). Dyspnea, CRF, ADL and QOL were measured using the Multidimensional Fatigue Symptom Inventory (MFSI) and a Clinical Symptom Inventory (SI) at pre- and post-intervention. Results: Participants included 57 sedentary prostate cancer patients, average age 67 ± 8 years. Mean changes in dyspnea showed a positive, association with mean changes in CRF (SI r = .525; p &lt; .01, MFSI r = .327; p = .08) in the EXCAP group but not in the UC group. Dyspnea changes were also positively associated with changes in exercise behavior (r = .590; p &lt; .01), ADL (r = .684; p &lt; .01), and QOL (r = .532; p &lt; .01) in the EXCAP group, no association was found in the UC group. Furthermore, exercisers who reported the greatest improvements in dyspnea also reported greater improvements in CRF = 2.2 (p &lt; .05), ADL = 1.8 (p &lt; .01), and QOL = 2.4 (p = .01). Conclusions: Exercise-induced improvements in dyspnea are associated with improvements in CRF, ADL and QOL in prostate cancer patients. Additional research is needed to further understand these results. NCORP UG1 CA189961, R25 CA102618, DOD PC061518 Clinical trial information: NCT00815672.

Effect of exercise on novel biomarkers of muscle damage and cancer-related fatigue: A nationwide URCC NCORP RCT in 350 patients with cancer.

10020 Background: Chemotherapy may lead to systemic muscle damage. Up-regulation of developmental myosin light chain 5 (MYL5) and myosin heavy chain 8 (MYH8) genes is required for normal muscle regeneration in response to damage. However, secretion of MYL5 and MYH8 proteins into the serum suggest degradation of muscle, which, in turn, may lead to cancer-related-fatigue (CRF). In this study, we investigated (1) the effect of an exercise intervention, Exercise for Cancer Patients (EXCAP) on mRNA gene expression and serum protein levels of MYL5 and MYH8 and (2) the association of these novel biomarkers with CRF. Methods: Chemotherapy naïve cancer patients (N = 350; mean age = 55.7) from 39 community oncology practices throughout the U.S. affiliated with the URCC NCORP Research Base participated in this nationwide, multicenter, phase III RCT. Patients were randomized into 2 groups: (1) chemotherapy and (2) chemotherapy plus a 6-week aerobic and resistance exercise prescription-EXCAP. Gene expression and protein levels of MYL5 and MYH8, as well as CRF were assessed pre- and post-intervention from whole blood by qPCR, from serum by Luminex assays, and from patient-report by the Multidimensional Fatigue Symptom Inventory, respectively. Results: T-tests show MYL5, but not MYH8, mRNA levels were significantly up-regulated from pre- to post-intervention in exercisers and controls (all p &lt; 0.01) with no significant group difference. Additionally, MYL5 and MYH8 serum protein levels significantly increased from pre to post in controls (all p &lt; 0.05), but remained stable in exercisers. Significant group differences in these serum proteins (p &lt; 0.01) suggest greater muscle degradation in non-exercisers. Pearson correlations revealed trends suggesting increases in MYL5 and MYH8 serum proteins are associated with increases in CRF (r = 0.09 and r = 0.11, respectively, all p &lt; 0.10). Conclusions: Results suggest EXCAP exercise is protective from chemotherapy-induced muscle damage via its effects on MYL5 and MYH8, and changes in these novel biomarkers may mediate changes in CRF. Further research is needed to confirm these findings. NCI UGCA189961, R25 CA102618. Clinical trial information: NCT00924651.

Nausea and disturbed sleep as predictors of cancer-related fatigue in breast cancer patients: a multicenter NCORP study.

Cancer-related fatigue (CRF) is a prevalent and distressing side effect of cancer and its treatment that remains inadequately understood and poorly managed. A better understanding of the factors contributing to CRF could result in more effective strategies for the prevention and treatment of CRF. The objectives of this study were to examine the prevalence, severity, and potential predictors for the early onset of CRF after chemotherapy cycle 1 in breast cancer patients. We report on a secondary data analysis of 548 female breast cancer patients from a phase III multi-center randomized controlled trial examining antiemetic efficacy. CRF was assessed by the Brief Fatigue Inventory at pre- and post-chemotherapy cycle 1 as well as by the four-day diary. The prevalence of clinically relevant post-CRF was 75%. Linear regression showed that pre-treatment CRF, greater nausea, disturbed sleep, and younger age were significant risk factors for post-CRF (adjusted R2=0.39; P<0.0001). Path modeling showed that nausea severity influenced post-CRF both directly and indirectly by influencing disturbed sleep. Similarly, pre-treatment CRF influenced post-CRF directly as well as indirectly through both nausea severity and disturbed sleep. Pearson correlations showed that changes in CRF over time were significantly correlated with concurrent changes in nausea severity (r=0.41; P<0.0001) and in disturbed sleep (r=0.20; P<0.0001). This study showed a high prevalence (75%) of clinically relevant CRF in breast cancer patients following their initial chemotherapy, and that nausea severity, disturbed sleep, pre-treatment CRF, and age were significant predictors of symptom.