Radiotherapy-induced Fatigue Research Articles

Changes in fatigue among cancer patients before, during, and after radiation therapy: A meta-analysis.

Fatigue is a common symptom in cancer patients receiving radiotherapy. However, previous studies report inconsistent patterns of fatigue change. The aim of this study was to estimate changes in fatigue among patients with cancer before, during, and after radiotherapy. Five databases (PubMed, SDOL, CINAHL Plus with Full Text, Medline [ProQuest], and ProQuest Dissertations) were searched for studies published from January 2006 to May 2021. Three effect sizes of fatigue change (immediate, short-term, and long-term) were calculated for each primary study using standardized mean difference. A random-effect model was used to combine effect sizes across studies. Subgroup analyses and meta-regression were performed to identify potential categorical and continuous moderators, respectively. Sixty-five studies were included in this meta-analysis. The weighted mean effect size for immediate, short-term, and long-term effects was 0.409 (p < .001; 95% CI [0.280, 0.537]), 0.303 (p < .001; 95% CI [0.189, 0.417]), and 0.201 (p = .05; 95% CI [-0.001, 0.404]), respectively. Studies with prostate cancer patients had a significantly higher short-term (0.588) and long-term weight mean effect size (0.531) than studies with breast (0.128, -0.072) or other cancers (0.287, 0.215). Higher radiotherapy dosage was significantly associated with a higher effect size for both immediate (β = .0002, p < .05) and short-term (β = .0002, p < .05) effect. Findings from this meta-analysis indicated that radiotherapy-induced fatigue (RIF) exist for more than 3 months after the completion of treatment. Assessment of radiation-induced fatigue in cancer patients should extend long after treatment completion, especially for patients with prostate cancer and patients receiving a higher radiation dose. Interventions to reduce fatigue tailored for different treatment phases may be developed.

From fatigued to fit: an investigation of the impact of physical exercise in the management of radiotherapy-induced fatigue in prostate cancer patients

AbstractAim:The aim of this paper is to investigate the effectiveness of physical exercise in managing fatigue during radiotherapy for prostate cancer patients. It explores the impact of various physical exercise regimes and their role in the prevention and management of fatigue to help inform best practice.Method:A literature search was conducted on OVID Medline database with a follow-up search on google scholar to include relevant references found during the initial search. Relevant systematic reviews and randomised controlled trials (RCTs) arising from this search were reviewed.Findings:There is evidence to support the notion that physical exercise in all its forms is an effective and safe intervention for fatigue management for prostate cancer patients undergoing radiotherapy. Although widely studied, there is limited evidence of fatigue management strategies being clearly implemented into current radiotherapy practice for patients with prostate cancer. This information is essential to enable therapeutic radiographers to educate prostate cancer patients regarding effective exercise strategies and ensure that fatigue is managed optimally.Conclusion:Further research is required into the optimum physical exercise prescription to reduce radiation-induced fatigue, and standardised best practice guidelines should be developed nationally. A future move toward patient education into physical exercise and wellbeing should be a central component of the therapeutic radiographer role with specialist advice offered by review radiographers, empowering patients to become more physically active during treatment. Therapeutic radiographers have a unique opportunity to educate and promote physical exercise through a holistic wellbeing approach that aims to mitigate fatigue and improve quality of life.

The Effect of Aromatherapy by Inhalation and Massage on Radiotherapy-induced Fatigue in Patients With Cancer

Background: Fatigue is one of the most prevalent and debilitating complications of cancer and its treatments. Patients undergoing radiotherapy experience some degrees of fatigue. Complementary medicine methods have reduced the complications of treatments in many disorders. Accordingly, the present study was conducted to compare the effect of aromatherapy by inhalation and massage on radiotherapy-induced fatigue in patients with cancer. Methods: In this randomized clinical trial, 105 patients with cancer undergoing radiotherapy in the oncology ward of Firouzgar Hospital in Tehran, Iran were selected conveniently based on the inclusion criteria and were randomly assigned into three groups of inhalation aromatherapy, massage aromatherapy, and control groups. In the first group, viola and almond oil were inhaled, in the second group, the Swedish massage was performed using aromatic oil, and the control group received routine care. Fatigue was measured by the Multidimensional Fatigue Inventory (MFI) before, and at the end of the intervention. The data were analyzed by descriptive and inferential statistics (ANOVA, Paired T-tests, Fischer’s exact, and Chi-square tests) using SPSS software V. 16. The significance level was considered as P≤0.05. Results: The findings showed that the three studied groups had no significant statistical difference in terms of demographic characteristics before the intervention. Fatigue score was significantly different in all three groups after both interventions (P&lt;0/001), which indicated a decrease in fatigue in the two test groups. However, according to Scheffe post hoc test, massage aromatherapy was more effective in reducing fatigue resulting from radiotherapy. Conclusion: The results of this study showed that massage aromatherapy was more effective in reducing radiotherapy-induced fatigue in patients with cancer. It is recommended that future studies recruit another group that receives the only massage.

The Effect of Aromatic Oil-based Effleurage Massage on Radiotherapy-Induced Fatigue in Patients with Cancer

The Effect of Aromatic Oil-based Effleurage Massage on Radiotherapy-Induced Fatigue in Patients with Cancer

Music Therapy Reduces Radiotherapy-Induced Fatigue in Patients With Breast or Gynecological Cancer: A Randomized Trial.

Purpose: To investigate the influence of music therapy on the reduction of fatigue in women with breast or gynecological malignant neoplasia during radiotherapy, since it is one of the most frequent side effects of this type of treatment, and may interfere with self-esteem, social activities, and quality of life. Experimental Design: Randomized controlled trial (control group [CG] and music therapy group [MTG]) to assess fatigue, quality of life, and symptoms of depression in women undergoing radiotherapy using the Functional Assessment of Cancer Therapy: Fatigue (FACT-F) version 4, Functional Assessment of Cancer Therapy–General (FACT-G) version 4, and Beck Depression Inventory in 3 separate times, namely, during the first week of radiotherapy, on the week of the intermediary phase, and during the last week of radiotherapy. Individual 30- to 40-minute sessions of music therapy with the presence of a trained music therapist were offered to participants. Results: In this study, 164 women were randomized and 116 (63 CG and 53 MTG) were included in the analyses, with mean age of 52.90 years (CG) and 51.85 years (MTG). Participants in the MTG had an average of 10 music therapy sessions, totaling 509 sessions throughout the study. FACT-F results were significant regarding Trial Outcome Index (P = .011), FACT-G (P = .005), and FACT-F (P = .001) for the MTG compared with the CG. Conclusions: Individual music therapy sessions may be effective to reduce fatigue related to cancer and symptoms of depression, as well as to improve quality of life for women with breast or gynecological cancer undergoing radiotherapy. Further well-designed research studies are needed to adequately determine the effects of music therapy on fatigue.

Exploring Genetic Attributions Underlying Radiotherapy-Induced Fatigue in Prostate Cancer Patients

ContextDespite numerous proposed mechanisms, no definitive pathophysiology underlying radiotherapy-induced fatigue (RIF) has been established. However, the dysregulation of a set of 35 genes was recently validated to predict development of fatigue in prostate cancer patients receiving radiotherapy. ObjectivesTo hypothesize novel pathways, and provide genetic targets for currently proposed pathways implicated in RIF development through analysis of the previously validated gene set. MethodsThe gene set was analyzed for all phenotypic attributions implicated in the phenotype of fatigue. Initially, a “directed” approach was used by querying specific fatigue-related sub-phenotypes against all known phenotypic attributions of the gene set. Then, an “undirected” approach, reviewing the entirety of the literature referencing the 35 genes, was used to increase analysis sensitivity. ResultsThe dysregulated genes attribute to neural, immunological, mitochondrial, muscular, and metabolic pathways. In addition, certain genes suggest phenotypes not previously emphasized in the context of RIF, such as ionizing radiation sensitivity, DNA damage, and altered DNA repair frequency. Several genes also associated with prostate cancer depression, possibly emphasizing variable radiosensitivity by RIF-prone patients, which may have palliative care implications. Despite the relevant findings, many of the 35 RIF-predictive genes are poorly characterized, warranting their investigation. ConclusionThe implications of herein presented RIF pathways are purely theoretical until specific end-point driven experiments are conducted in more congruent contexts. Nevertheless, the presented attributions are informative, directing future investigation to definitively elucidate RIF's pathoetiology. This study demonstrates an arguably comprehensive method of approaching known differential expression underlying a complex phenotype, to correlate feasible pathophysiology.

The Etiology and management of radiotherapy-induced fatigue.

Fatigue is one of the most common side-effects accompanying radiotherapy, but arguably the least understood. Radiotherapy-induced fatigue (RIF) is a clinical subtype of cancer treatment-related fatigue. It is described as a pervasive, subjective sense of tiredness persisting over time, interferes with activities of daily living, and is not relieved by adequate rest or sleep. RIF is one of the early side-effects and long-lasting for cancer patients treated with localized radiation. Although the underlying mechanisms of fatigue have been studied in several disease conditions, the etiology, mechanisms, and risk factors of RIF remain elusive, and this symptom remains poorly managed. The purpose of this paper is to review and discuss recent articles that defined, proposed biologic underpinnings and mechanisms to explain the pathobiology of RIF, as well as articles that proposed interventions to manage RIF. Understanding the mechanisms of RIF can describe promising pathways to identify at-risk individuals and identify potential therapeutic targets to alleviate and prevent RIF using a multimodal, multidisciplinary approach.

Abstract P2-12-04: Music Therapy Reduces Radiotherapy-Induced Fatigue in Patients with Breast or Gynecological Cancer: A Randomized Trial

Abstract BACKGROUND: Fatigue is a frequent side effect of radiotherapy, and may interfere with self-esteem, social activities, and quality of life. The authors investigated the influence of music therapy (MT) on the reduction of fatigue in women with breast or gynecological malignant neoplasia during radiotherapy. METHODS: Randomized controlled trial (control group-CG and music therapy group-MTG) to assess fatigue, quality of life using the Functional Assessment of Cancer Therapy (FACT-F and FACT-G) version 4 and symptoms of depression using Beck Depression Inventory (BDI) in women undergoing radiotherapy in three distinct moments (during the first and the last week of radiotherapy, and on the week of the intermediary phase). Individual 30–40 minute sessions of music therapy were offered to participants of the MTG. RESULTS: In this study, 164 women were randomized and 116 (63 CG and 53 MTG) were included in the analyses, with mean age of 52.9 years (CG) and 51.85 years (MTG). Participants in the MTG had an average of 10 MT sessions, during the study. FACT-F results were significant regarding Trial Outcome Index (TOI), synthesis of the Physical and functional well-being areas of FACT-F (p = 0.011), FACT-G (p = 0.005), FACT-F (p = 0.001) for MTG compared with CG. The depressive symptons were reduced to the minimum levels in the MTG (p = 0,005) with risk reduction of 74% (RR = 0,26; CI 0,10–0,70). CONCLUSIONS: Individual MT sessions are effective to reduce fatigue related to cancer and symptoms of depression, as well as to improve quality of life for women with breast or gynecological cancer undergoing radiotherapy. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-04.

Home-based Exercise, Health-related Fitness, Fatigue, Sleep, And HRQL Among Cancer Patients Undergoing Radiation

Cancer treatments, such as radiation, often result in side effects that impair a patient's health-related quality of life (HRQL). Radiotherapy-induced fatigue is reported in 78–80% of irradiated patients, is associated with sleep disruptions, and has been shown to improve with exercise participation. However, relationships between fatigue, sleep, HRQL and health-related physical fitness (e.g., cardiorespiratory fitness [CF], muscular strength [MS], muscle mass [MM], and body fat [BF]) have not been fully elucidated among cancer patients currently undergoing radiotherapy. PURPOSE To conduct a pilot study comparing the influence of a low to moderate home-based walking and resistance training intervention (HBEX) to standard care (SC) on health-related fitness (CF, MS, MM, and BF), fatigue, sleep, and HRQL in a sample of breast (BC) and prostate cancer (PC) patients undergoing radiotherapy. METHODS BC and PC patients (N=14, mean age=58, 64% female) were randomized to a 4wk HBEX or SC condition, with 6-minute walk, handgrip dynamometry, bioelectrical impedance, fatigue, sleep, and HRQL assessments pre and post-intervention. RESULTS Raw change scores indicated improvements in the HBEX group on all of the following outcomes: CF (mean=85.88, SE=58.27), MS (mean=.29, SE=1.57), MM (mean=1.07, SE=.67), BF (mean=−1.27, SE=.68), fatigue (mean=−1.86, SE=2.04), sleep (mean=.33, SE=.56), and HRQL (mean=1.29, SE=4.80), while the SC group demonstrated declines in all of these outcomes: CF (mean=−149.68, SE=54.47), MS (mean=−.33, SE=1.49), MM (mean=−.34, SE=.26), BF (mean=.11, SE=.33), fatigue (mean=2.86, SE=1.51), sleep (mean=−3.00, SE=1.05), and HRQL (mean=−.94, SE=2.85). Paired sample t-tests indicated that HBEX participants (N=7) demonstrated a trend toward significant improvements in sleep (T13=1.91, p=.08), while SC participants declined, from baseline to wk 6. Additionally, fatigue was significantly correlated with HRQL (r=−.85, p<.05) in both conditions, and CF with MS (r=−.90, p<.05) and fatigue (r=−.92, p<.001) in the SC condition. CONCLUSIONS Despite a lack of statistical significance due to a small sample, these results suggest that participation in a low to moderate home-based exercise program is associated with improvements in CF, MS, MM, BF, fatigue, sleep, and HRQL, while SC is associated with declines in all of these areas among BC and PC patients during radiotherapy. Future randomized controlled trials are needed with larger samples to fully investigate the influence of HBEX on CF, MS, MM, BF, fatigue, sleep, and HRQL, with foci on elucidating the relationships among these clinical outcomes.

Home-based Exercise, Health-related Fitness, Fatigue, Sleep, And HRQL Among Cancer Patients Undergoing Radiation

Cancer treatments, such as radiation, often result in side effects that impair a patient's health-related quality of life (HRQL). Radiotherapy-induced fatigue is reported in 78–80% of irradiated patients, is associated with sleep disruptions, and has been shown to improve with exercise participation. However, relationships between fatigue, sleep, HRQL and health-related physical fitness (e.g., cardiorespiratory fitness [CF], muscular strength [MS], muscle mass [MM], and body fat [BF]) have not been fully elucidated among cancer patients currently undergoing radiotherapy. PURPOSE To conduct a pilot study comparing the influence of a low to moderate home-based walking and resistance training intervention (HBEX) to standard care (SC) on health-related fitness (CF, MS, MM, and BF), fatigue, sleep, and HRQL in a sample of breast (BC) and prostate cancer (PC) patients undergoing radiotherapy. METHODS BC and PC patients (N=14, mean age=58, 64% female) were randomized to a 4wk HBEX or SC condition, with 6-minute walk, handgrip dynamometry, bioelectrical impedance, fatigue, sleep, and HRQL assessments pre and post-intervention. RESULTS Raw change scores indicated improvements in the HBEX group on all of the following outcomes: CF (mean=85.88, SE=58.27), MS (mean=.29, SE=1.57), MM (mean=1.07, SE=.67), BF (mean=−1.27, SE=.68), fatigue (mean=−1.86, SE=2.04), sleep (mean=.33, SE=.56), and HRQL (mean=1.29, SE=4.80), while the SC group demonstrated declines in all of these outcomes: CF (mean=−149.68, SE=54.47), MS (mean=−.33, SE=1.49), MM (mean=−.34, SE=.26), BF (mean=.11, SE=.33), fatigue (mean=2.86, SE=1.51), sleep (mean=−3.00, SE=1.05), and HRQL (mean=−.94, SE=2.85). Paired sample t-tests indicated that HBEX participants (N=7) demonstrated a trend toward significant improvements in sleep (T13=1.91, p=.08), while SC participants declined, from baseline to wk 6. Additionally, fatigue was significantly correlated with HRQL (r=−.85, p<.05) in both conditions, and CF with MS (r=−.90, p<.05) and fatigue (r=−.92, p<.001) in the SC condition. CONCLUSIONS Despite a lack of statistical significance due to a small sample, these results suggest that participation in a low to moderate home-based exercise program is associated with improvements in CF, MS, MM, BF, fatigue, sleep, and HRQL, while SC is associated with declines in all of these areas among BC and PC patients during radiotherapy. Future randomized controlled trials are needed with larger samples to fully investigate the influence of HBEX on CF, MS, MM, BF, fatigue, sleep, and HRQL, with foci on elucidating the relationships among these clinical outcomes.

Treatment of Radiotherapy-Induced Fatigue Through a Nonpharmacological Approach

Cancer-related fatigue (CRF) is a frequently occurring, burdensome side effect of radiation therapy that can result in detrimental effects to health-related quality of life (HRQL). The findings from a pilot study examining the efficacy of the complementary and alternative practice of Polarity Therapy (PT) in reducing CRF and improving HRQL are reported. Fifteen women undergoing radiation therapy for breast cancer and experiencing fatigue were randomized to receive 1, 2, or no PT treatments. Treatments were given 1 week apart to the patients receiving 2 treatments. Fatigue and HRQL were assessed at baseline prior to PT, 3 days following the first PT treatment (week 1), and 3 days following the second PT treatment (week 2). There was a statistically significant improvement in both CRF and HRQL in the 10 patients who received a PT treatment compared to the 5 control patients at the week 1 assessment. In addition, there was a statistically significant difference among the 3 treatment groups in improvement in CRF at the week 2 assessment. This finding, coupled with a visual inspection of the means, supports the plausibility of a dose response concerning PT. Results from this pilot investigation suggest that PT may have a positive influence on CRF and HRQL in women undergoing radiation treatment for breast cancer. Randomized, controlled clinical trials with larger sample sizes are needed.

Radiotherapy-related fatigue: how to assess and how to treat the symptom. A commentary.

Acute and chronic radiotherapy-related fatigue occurs in up to 80% and 30%, respectively, of patients undergoing irradiation for cancer. Frequently, the symptom is not expected by the patients and is underestimated by medical and nursing staff. Fatigue can affect global quality of life more than pain, sexual dysfunction and other cancer- or treatment-related symptoms. Its etiology and correlates are not clear. Published reports are mainly descriptive, and in many of them numerous methodological biases are present. One of the limitations is lack of a standard method of assessment that could simplify the comparison between different series. In the last decade, modern instruments have been designed to measure fatigue. They include uni- and multidimensional tools. Use of these specific instruments is highly recommended for research on radiation-related fatigue. In daily practice when time is limited, simple assessment is necessary. For example, systemic use of plain and easily understandable questions about fatigue, its level and impact on daily life could be sufficient and reliable. Therapeutic strategies for radiotherapy-induced fatigue have not yet been clearly defined, but a few randomized studies have been recently published. Physical exercise, group psychotherapy and relaxation therapy have been demonstrated to be effective. Moreover, pharmacological treatment of concomitant disturbances (anemia, pain, insomnia, depression, dehydration, infection, malnutrition) and other radiotherapy side effects (diarrhea, hormonal insufficiency etc.) should be considered. Further methodologically correct studies are warranted to better define the causes, optimal prevention, assessment and management of this symptom.