Reduction In Cancer-related Fatigue Research Articles

Impact of rehabilitation unit-based physical activity therapy versus symptomatic supportive treatment on older patients with advanced cancer: a non-randomized controlled study

ObjectivesRelatively few studies have investigated the effects of rehabilitation-based physical activity therapy as a treatment for older patients with advanced cancer. This study evaluated the effects of individualized precise and structured exercise interventions, prescribed by a rehabilitation physician, on fatigue, quality of life (QOL), and physical activity in older patients with advanced cancer.MethodsAfter admission to the rehabilitation department, older cancer patients were divided into groups receiving conventional symptomatic supportive therapy (SST) or physical activity therapy plus conventional symptomatic supportive therapy (PAT). The SST group was given symptomatic supportive treatment, exercised on their own, and were observed at home after their symptoms improved. The PAT group was required to implement physical exercise along with SST, involving 30 min of moderate-intensity exercise per day and 5 days per week, and were discharged after 4 weeks and instructed to continue to exercise outside the hospital. Cancer-related fatigue (CRF) at 4 and 8 weeks was the primary endpoint of the study, while the secondary endpoints included patients’ QOL, physical activity, and exercise adherence rate.ResultsSixty-five patients were included; 37 (56.92%) chose to enter the PAT group, and 28 (43.08%) chose to enter the SST group. After 4 and 8 weeks of treatment, CRF relief and QOL improvement were significantly better in the PAT group than in the SST group (p < 0.05), whereas global health status did not differ between the two treatment groups (T1: p = 0.84; T2: p = 0.92). Mild physical activity significantly increased for the PAT group at T1 and T2 (T1: p = 0.03; T2: p = 0.005). At the T2 time point, the PAT group exhibited a higher level of participation in moderate-intensity physical activities as well as a higher total leisure activity score (p < 0.05). Thirty-three patients (94.29%) completed the PAT exercise program during hospitalization. Only four (12.12%) patients achieved moderate-intensity exercise, while the other 29 (87.88%) patients were able to continue exercising after their exercise intensity was decreased.ConclusionsImplementation of precise and individualized exercise interventions, prescribed by the rehabilitation team, can lead to the reduction of CRF and improvement of QOL, and change in behavior related to physical activity.

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 .

The Mechanisms Underlying the Beneficial Impact of Aerobic Training on Cancer-Related Fatigue: A Conceptual Review.

Cancer-related fatigue (CRF) is a prevalent and persistent issue affecting cancer patients, with a broad impact on their quality of life even years after treatment completion. The precise mechanisms underlying CRF remain elusive, yet its multifaceted nature involves emotional, physical, and cognitive dimensions. The absence of effective medical treatments has prompted researchers to explore integrative models for potential insights. Notably, physical exercise emerges as a promising strategy for managing CRF and related symptoms, as studies showed a reduction in CRF ranging from 19% to 40%. Current recommendations highlight aerobic training at moderate intensity as beneficial, although questions about a dose-response relationship and the importance of exercise intensity persist. Despite the positive impact of exercise on CRF, the underlying mechanisms remain elusive. This review aims to provide a theoretical model explaining how aerobic exercise may alleviate CRF. Focusing on acute exercise effects, this review delves into the potential influence on peripheral and neural inflammation, immune function dysregulation, and neuroendocrine system disruptions. The objective is to enhance our understanding of the intricate relationship between exercise and CRF, ultimately paving the way for tailored interventions and potential pharmacological treatments for individuals unable to engage in physical exercise.

Effectiveness of exergaming in reducing cancer-related fatigue among children with acute lymphoblastic leukemia: a randomized controlled trial

Background Little is known about the effectiveness of the newly emerging technology of exergaming in reducing Cancer Related Fatigue (CRF). Objectives The study’s primary aim was to examine the effectiveness of exergaming in reducing CRF; the secondary aims were to improve functional capacity/endurance and promote physical activity (PA) among children with acute lymphoblastic leukemia (ALL). Methods In this Randomized Controlled Trial (RCT), 45 children aged 6–14 years were randomly assigned into group-I, n = 22, and group II, n = 23. Group-I played exergaming of moderate intensity for 60 min, twice a week for three weeks. Group II was given an instructional session regarding the benefits of PA with advice to practice PA for 60 min twice a week. CRF, functional capacity/endurance, and PA were measured using the pediatric quality of life multidimensional fatigue scale (Ped-QLMFS), six-minute walk test (6-MWT), and Godin-Shepard Leisure Time Physical Activity Questionnaire (QSLTPAQ) respectively. All measurements were taken thrice; in the first, third, and fifth weeks of intervention. Results Group-I demonstrated a significant reduction of CRF, and a significant increase of functional capacity/endurance compared to group-II over the five weeks study period. The effect of time × intervention interaction was significant. Based on Cohen’s guidelines, CRF and functional capacity/endurance had large effect sizes (η 2 = 0.41, p = .00) and (η 2 = 0.27, p = .00) respectively. Conclusion The protocol of exergaming used in this RCT effectively reduces CRF and promotes functional capacity/endurance and PA in children with ALL undergoing chemotherapy. It may provide an alternative treatment modality to decrease the healthcare load. Key messages Cancer-related fatigue (CRF) is described as physical exhaustion, sleep disturbance, emotional distress, and cognitive dysfunction. Exergaming reduces CRF and promotes functional capacity/endurance and physical activity in children with acute lymphoblastic leukemia undergoing chemotherapy. Exergaming may provide an alternative treatment modality to decrease the healthcare load.

Physical rehabilitation for the management of cancer-related fatigue during cytotoxic treatment: a systematic review with meta-analysis.

To assess the effect of physical therapy on cancer-related fatigue (CRF) during cytotoxic anticancer treatment. Systematic review with meta-analysis of randomized clinical trials published from 2010 to 2021 (EMBASE, MEDLINE, PEDro; SciELO, and LILACS). Studies assessing the effect of supervised physical therapy (IG) for the management of CRF on adults undergoing anticancer treatment compared with a control group (CG) covering usual care or any uncontrolled practice, such as recommendations about exercise and health education, were included in this review. A total of 22 studies were included in the SR and 21 in the meta-analysis, resulting in 1.992 individuals (CG = 973 and IG = 1.019). There was a reduction in general fatigue [SMD = - 0.69; 95%CI (- 1.15, - 0.22) p < 0.01; I2 = 87%; NNT = 3], with greater weight attributed to combined exercise (44%). Physical fatigue also reduced [SMD = - 0.76; 95%CI (- 1.13, - 0.39) p < 0.01; I2 = 90%; NNT = 2], with greater weight for resistance exercise (50%) and greater effect with combined exercise [SMD = - 1.90; 95%CI (- 3.04, - 0.76) p < 0.01; I 2 = 96%]. There was reduction in general fatigue with moderate intensity (74%) [SMD = - 0.89; 95%CI (- 1.61, - 0.17) p < 0.02; I2 = 90%] and physical fatigue [SMD = - 1.00; 95%CI (- 1.54, - 0.46) p < 0.01; I2 = 92%], while high intensity reduced only general fatigue [SMD = - 0.35; 95%CI (- 0.51, - 0.20) p < 0.01; I2 = 0%]. The number of overall and weekly sessions has been shown to contribute to the reduction of CRF. Physical rehabilitation with moderate intensity promoted greater relief of general and physical fatigue. Even after controlling for high heterogeneity, the quality of evidence, summarized in GRADE, was considered moderate for general fatigue and low for physical fatigue.

The effect of 5A nursing combined with psychological nursing on the immune function, cancer-related fatigue and complications of patients undergoing radical resection of colorectal cancer.

This study aimed to analyze the effects of 5A nursing (including Ask, Assess, Advise, Assist, and Access) combined with psychological nursing on the immune function, cancer-related fatigue, and complications of patients undergoing radical resection of colorectal cancer. For this purpose, 64 patients undergoing radical resection of colorectal cancer were treated with nursing intervention during the perioperative period from March 2019 to March 2021. They were randomly divided into a control group and a study group according to admission order. Each group had 32 cases. The control group performed routine nursing, and 5A nursing combined with psychological nursing was performed on the research group. Then the immune function, cancer-related fatigue, complications, self-efficacy, and nursing satisfaction were compared between the two groups. Results showed that the levels of CD3+ and CD4+ in the two groups were lower than before nursing, and the levels of CD8+, IgA, IgM, and IgG were higher than before nursing (P<0.05). The reduction of CD3+ and CD4+ in the study group was less than the control group, and the increase of CD8+, IgA, IgM, and IgG in the study group was higher than the control group (P<0.05). The scores of cancer-related fatigue after nursing were lower than before nursing (P<0.05), and the reduction of cancer-related fatigue in the study group was higher than the control group (P<0.05). The incidence of postoperative complications in the study group (12.50%) was lower than the control group (25.00%) after nursing (p<0.05). The scores of all dimensions of self-efficacy of the two groups after nursing were higher than before nursing (P<0.05). The improvement of self-efficacy of the study group was better than the control group (P<0.05). The overall nursing satisfaction of the observation group after nursing (96.88%) was higher than the control group (84.38%)(P<0.05). According to the results, the use of 5A nursing combined with psychological nursing can effectively relieve the perioperative psychological pressure of the patients, improve the immune function of the body, relieve cancer-related fatigue, prevent and control the incidence of complications, and improve the quality of clinical life of the patients for patients undergoing radical resection of colorectal cancer.

Feasibility and patient perception of a web-based exercise program during COVID pandemic in breast and ovarian cancer patients.

e13623 Background: Current literature shows us that therapeutic exercise has multiple benefits in oncology patients, such as improvement in quality of life or a reduction in cancer-related fatigue. Furthermore, given the risk of obesity, both exercise and diet play a key role in recovery from cancer. As a consequence of the COVID-19 pandemic, oncology patients present more difficulties to attend programs as they are considered a risk population, so new online exercise programs should be developed to ensure that patients take advantage of them in the post-COVID era. The main objective was to study patient´s perspectives and the feasibility of a web-based tailored and supervised therapeutic exercise program during COVID pandemic. Methods: A prospective study was performance on patients recruited from the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. Participants were between 18 and 65 years old and diagnosed of early resected breast cancer after finishing chemotherapy (CT) or metastatic ovarian (MOC) or breast cancer (MBC) with or without active treatment. Patients had had a good performance status (PS) with no prior cardiovascular history, and they were excluded if they were not used to online technologies. The duration of the program was 3 months, twice a week, delivered by a physiotherapist and a nutritionist. At the end of the program, women were asked 9 questions about their perspectives on the program. All of them signed informed consent. Results: 17 breast cancer survivor (BCS), 10 MBC and 3 MOC patients were initially recruited. From 30 patients recruited, 5 BCS did not started the program because of clinical contraindication and 5 patients left due to personal issues. 15 out of the remaining 20 completed the survey. All of patients reported that the program had contributed to improve their mood during the pandemic due to issues such functional ability, feeling better or less asthenia, and serving as improvement and encouragement in their lives. 86,7% reported having met their objectives and 100% reported going to continue doing some type of exercise or physical activity on a regular basis after the program is finished. Regarding advantages of online format compared to the face-to-face one, they reported avoiding displacement and lower risk of contagion. Lately, if they could participate again, 50% reported they would prefer online, while the remining 50% would prefer traditional modality. Conclusions: At the light of these results, the tele-exercise program contributed to improve the mood and fatigue of patients during the pandemic. The web-based program seems to be feasible and allow patients to meet their objectives after program completion and encourage them to keep doing some type of physical activity.

Association Between Music Therapy Techniques and Patient-Reported Moderate to Severe Fatigue in Hospitalized Adults With Cancer.

Cancer-related fatigue is a prevalent, debilitating symptom that contributes to increased health care utilization among hospitalized patients. Music therapy is a nonpharmacological intervention that uses active (eg, singing, selecting songs) and passive (eg, listening) techniques. Preliminary evidence from small trials suggests a potential benefit for cancer-related fatigue in the inpatient setting; however, it remains unclear which techniques are most effective. A cross-sectional mixed-methods study was performed to compare cancer-related fatigue before and after active or passive music therapy. Cancer-related fatigue was captured via the Edmonton Symptom Assessment Scale fatigue item. Patients were asked to provide postsession free-text comments. A total of 436 patients (mean [standard deviation] age, 62.2 [13.4] years; n = 284 [65.1%] women; n = 294 [67.4%] white; active music therapy n = 360 [82.6%]; passive music therapy n = 76 [17.4%]) with a range of primary malignancies participated. Active music therapy was associated with a 0.88-point greater reduction in cancer-related fatigue (95% CI, 0.26 to 1.51; P = .006; Cohen's D, 0.52) at postsession as compared with passive music therapy when restricting the analysis to patients who rated their baseline cancer-related fatigue as moderate to severe (ie, ≥ 4; n = 236 [54.1%]). Free-text responses confirmed higher frequencies of words describing positive affect/emotion among active music therapy participants. In a large sample of inpatient adults with diverse cancer disease types, active music therapy was associated with greater reduction in cancer-related fatigue and increased reporting of positive affect/emotions compared with passive music therapy. Additional research is warranted to determine the specific efficacy and underlying mechanisms of music therapy on cancer-related fatigue.

Effect of the Walking Exercise Program on Cancer-Related Fatigue in Patients with Acute Myeloid Leukemia Undergoing Chemotherapy.

Background:Cancer-related Fatigue (CRF) is one of the most common complications of acute myeloid leukemia (AML) and its related therapies. It can influence all physical and psychological aspects of the patient’s life. Also, it is believed that exercise can improve CRF in patients with cancer. Objective:This study aimed to investigate the effect of the walking exercise program on CRF in patients with AML undergoing chemotherapy. Methods:In this quasi-experimental study with a pre- and post-test design, 50 patients with AML undergoing chemotherapy were selected using a convenience sampling method at a teaching hospital in an urban area of Iran. The intervention included daily 30 minutes of planned walking for ten days. Data was collected using a demographic data form and the Brief Fatigue Inventory, which were filled out before the intervention, and on the fifth and tenth days of the intervention. Findings:Statistically significant differences were reported in the reduction of CRF on the fifth day and tenth day of the intervention (p <0.001). Conclusions:The planned walking intervention can be used as an easy and low-cost method for reducing CRF in patients with leukemia.

The effects of participation in an individualized exercise program under the supervision of health care professionals on cancer-related fatigue.

208 Background: A majority of (80–100%) of patients with cancer report cancer-related fatigue. Physical activity has shown to be an effective intervention for cancer-related fatigue. The cancer rehabilitation team at Aurora Health Care’s Aurora Medical Center Grafton initiated the Exercise for Cancer Recovery Program (ECRP) in order to have a greater impact on the quality of life of their patients. ECRP was an individualized exercise program taking place in a group setting with other cancer survivors under the supervision of healthcare professionals. The program was open to patients with all types and stages of cancer, including patients in active treatment as well as those who completed treatment. The aim of the study was to determine if participation in ECRP reduces cancer-related fatigue. Methods: Upon referral and/or clearance from the patient’s oncologist/advanced practitioner, the patient was evaluated by a physical therapist and placed on an individualized exercise program. ECRP ran twice per week for an hour. Patients followed and filled out an exercise log. During each session, the supervising health care professionals circulated throughout the class, providing individual guidance as appropriate to ensure safe participation and motivation. Baseline data on fatigue was obtained for each patient upon the initial session and monthly thereafter using the Brief Fatigue Inventory Outcome Measurement tool (BFI) over a 12-month period dating from January to December 2017. Twenty-seven patients participated in ECRP. Not all patients attended all exercise sessions or completed BFI every month. The minimum fatigue score was determined and compared with the initial score utilizing a paired t-test and signed rank test. Results: Data was obtained and analyzed utilizing a paired t-test and a signed rank test to evaluate the significance of BFI scores obtained between the initial and minimum score. There was a significant reduction in the Total Brief Fatigue score (P-value &lt; 0.001). Conclusions: An exercise program resulted in a significant reduction in cancer-related fatigue with improved patient outcomes and patient satisfaction.

Methylphenidate for Cancer-Related Fatigue in Children Receiving Pediatric Palliative Care (S752)

•Describe patterns of methylphenidate administration in children with cancer related fatigue.•Delineate patterns of side effects among children who received methylphenidate for cancer related fatigue. Methylphenidate (MPH) is a common symptomatic treatment of cancer-related fatigue (CRF). However, little evidence guiding its use for CRF in children exists. To describe characteristics, efficacy and side effects of MPH in children with CRF. A retrospective chart review was conducted for children who received cancer related care at a large academic center (January, 2000-June, 2015), were followed by the pediatric palliative care team and prescribed MPH for CRF. Child demographic and clinical characteristics were abstracted as were data related to concomitant opioid use. Clinician descriptions of fatigue prompting MPH treatment were collected, along with data regarding MPH efficacy and side effects. Results were summarized with descriptive statistics including frequencies and measures of central tendency. A total of 63 patients, 49% female, median (IQR) age 16 (13-19) were identified. About half (54%) had solid tumors; fewer had a brain tumor (22%), hematologic malignancy (19%) or hematopoietic stem cell transplant (5%). Over half (59%) received chemotherapy and 14% received radiation 2 weeks prior to initiating MPH. Many (68%) were on opioids at the time of MPH initiation. Patients started MPH a median (IQR) of 23 (8.4-36.5) months after cancer diagnosis and a median (IQR) of 3 (1-7) months before death. The mean (SD) starting dose of MPH was 0.22 mg/kg (0.17). The majority h90%) had a documented reduction in CRF. Among those who reported improvement, over half (51%) did not require any subsequent dose adjustment. Fourteen children reported a total of 18 side effects. The most common side effects were mood disturbance (6 reports); headache, sleep disturbance, anorexia and increased focus (2 reports each). Five children discontinued MPH due to intolerable side effects. Methylphenidate was effective and well tolerated by children with CRF.

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.

Aerobic Exercise And Cancer-Related Fatigue In Adults

BACKGROUND: Using the traditional random-effects model, a recent meta-analysis of randomized controlled trials reported a statistically significant standardized mean difference (SMD) reduction in cancer-related fatigue (CRF) as a result of aerobic exercise (SMD, -0.22, 95% CI, -0.39 to -0.04, p = 0.01). However, a recently developed inverse heterogeneity (IVhet) model has been shown to be more valid than the traditional random-effects model. PURPOSE: The purpose of this study was to compare these previous meta-analytic results with those using the IVhet model. METHODS: Using data from a previous meta-analysis that included 36 SMD effect sizes (ES’s) representing 2,830 adults (1,426 exercise, 1,404 control), results were pooled using the IVhet model. In addition, absolute and relative differences between the IVhet and random-effects results for CRF were calculated as well as influence analysis with each SMD ES deleted from the IVhet model once. Non-overlapping 95% confidence intervals were considered statistically significant. RESULTS: A statistically non-significant reduction in CRF fatigue was found as a result of aerobic exercise using the IVhet model (SMD, -0.08, 95% CI, -0.31 to 0.14, p = 0.46). The IVhet model yielded a SMD ES that was 0.14 (63.6%) smaller than the random-effects model. With each study deleted from the IVhet model once, results remained statistically non-significant with SMD ES’s ranging from -0.11 (95% CI, -0.33 to 0.11) to -0.06 (95% CI, -0.28 to 0.16). CONCLUSIONS: The results of the current study suggest that there is currently insufficient evidence to support the use of aerobic exercise for reducing CRF in adults. Future studies should consider use of the IVhet versus traditional random-effects model when conducting aggregate data meta-analyses. Supported by NIH Grant U54GM104942

Single Institute Experience With Methylphenidate and American Ginseng in Cancer-Related Fatigue.

Single therapy with methylphenidate or American ginseng contributes to the reduction in cancer-related fatigue (CRF) with different pharmacologic mechanisms and is relatively safe. However, the safety and efficacy of treating CRF with methylphenidate and AG combination therapy is unknown. The primary objective was to assess the clinical safety and the change in fatigue with numerical rating scale (NRS) on the Edmonton Symptom Assessment Scale (ESAS) after intervention with methylphenidate and AG combination therapy. We reviewed the electronic medical records of 857 patients seen in our Palliative Medicine outpatient clinic between February 1, 2015, and December 31, 2015. Fatigue was assessed by NRS on ESAS. Toxicity was reviewed on clinician's documents. We identified 28 patients who were prescribed a combination of methylphenidate (10-40 mg/d) and AG (2000 mg/d). Ten patients did not comply with the combination therapy. Three patients had stage 2 adverse effects. Fifteen patients completed prescribed combination therapy per instructions. The mean time interval between pre- and postintervention follow-up was 30.5 days (standard deviation [SD]: 7.78). There was a significant reduction in the fatigue score (mean score 6.93-4.13) from the pre- to postscore records (mean: -2.8; SD: 1.61; P < .0002* [*refers to statistically significant]). Sixty percent of patients reported significant reduction in fatigue (cutoff value: ≥3; reduction in fatigue score from baseline: 80% ≥2, 60% ≥3, and 46.7% ≥4). In our retrospective medical record review, the combination treatment of methylphenidate and AG had no discernible associated toxicities and showed potential clinical benefit in CRF.

Aerobic Exercise and Cancer-Related Fatigue in Adults: A Reexamination Using the IVhet Model for Meta-analysis.

Although the results of a recent meta-analysis using the traditional random effects model yielded a statistically significant standardized mean difference (SMD) reduction in cancer-related fatigue (CRF) as a result of aerobic exercise, a recently developed inverse heterogeneity (IVhet) model has been shown to be more valid than the traditional random effects model. The purpose of this study was to compare these previous meta-analytic results using the IVhet model. Using data from a previous meta-analysis that included 36 SMD effect sizes (ES) representing 2,830 adults (1,426 exercise, 1,404 control), results were pooled using the IVhet model. Absolute and relative differences between the IVhet and random effects results for CRF were also calculated as well as influence analysis with each SMD ES deleted from the IVhet model. Nonoverlapping 95% confidence intervals (CI) were considered statistically significant. A statistically nonsignificant reduction in CRF fatigue was found as a result of aerobic exercise using the IVhet model (SMD, -0.08; 95% CI, -0.31-0.14; P = 0.46). The IVhet model yielded a SMD ES that was 0.14 (63.6%) smaller than the random effects model. With each study deleted from the IVhet model once, results remained statistically nonsignificant with SMD ESs ranging from -0.11 (95% CI, -0.33-0.11) to -0.06 (95% CI, -0.28-0.16). Insufficient evidence currently exists to support the use of aerobic exercise for reducing CRF in adults. Additional studies are needed to determine the certainty of aerobic exercise on CRF in adults. Cancer Epidemiol Biomarkers Prev; 26(2); 281-3. ©2016 AACR.

Exercise Therapy for Children with Cancer Related Fatigue

Cancer Related Fatigue (CRF) is known as one of the strongest and incriminating side effects of cancer for adults and children. By now there is a lack of valid assessments and sufficient therapy in pediatric oncology. For children it is a tough challenge to accept this overwhelming tiredness and lower activity level in their daily life routines. First positive effects in CFR therapy were found by adults, but this specific scientific field is very young and therefore mostly unexplored. 4 databases for medical and therapeutic journals were systematically searched for RCTs, CCTs and CTs. Systematic reviews were analyzed as well. All studies were carried out in pediatric oncology and deal with exercise therapy. The enclosed studies were valued by PEDro-Scale. Only a handful papers about a potential reduction of CRF in pediatrics could be found, one RCT, 2 CCTs and one CT. No additional results could be found. To summarize the 4 papers, it can be stated that the duration of intervention depends between 2 days and 12 weeks. Also there are differences between the option inpatient and outpatient programs, as well as with or without supervising. The exercise therapy mostly consists of strength and endurance training in combination with warm-up and cool-down programs. This review underlines the importance of developing new assessments. Especially bigger groups of participants should be analyzed with the scope on individualized, supervised program. So far, CRF is underestimated in pediatric oncology and it is very crucial to identify the symptoms. This could lead to an improvement in quality of life.

Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer-Related Fatigue

Fatigue is a distressing and pervasive problem for people with cancer. In recent years, acupuncture has gained increasing attention among researchers as an alternative management strategy for cancer-related fatigue (CRF). This review aimed to evaluate the effectiveness of acupuncture for CRF. Five databases (Medline, CINAHL, Scopus, the Cochrane Library, and CAJ Full-text Database) were searched up to May 2013. Randomized controlled trials (RCTs) of acupuncture for the treatment of CRF were considered for inclusion. Seven RCTs were included for meta-analysis, involving a total of 689 subjects. Three studies compared acupuncture with sham acupuncture for CRF with follow-up at 10 weeks; the standardized mean difference (SMD) for general CRF change values was -0.82 (95% confidence interval [CI] = -1.90 to 0.26). When acupuncture plus education intervention was compared with usual care, there was a statistically significant difference for the change score of general CRF (SMD = -2.12; 95% CI = -3.21 to -1.03). The SMD for general CRF change scores between acupuncture with no treatment or wait-list control was -1.46 (95% CI = -3.56 to 0.63). Finally, the SMD for general CRF change scores between acupuncture with acupressure or self-acupuncture was -1.12 (95% CI = -3.03 to 0.78). Three trials reported data for general quality of life and functioning status, reporting enough data for statistical pooling but showing no statistically significant difference (Zscore = 1.15,P= .25, SMD = 0.99, 95% CI = -0.70 to 2.68 andZscore = 1.13,P= .26, SMD = 1.38, 95% CI = -1.02 to 3.79, respectively). TheI(2)statistics of all statistically pooled data were higher than 50%, indicating heterogeneity between the trials. There were 4 sets of comparison for the effectiveness of acupuncture for CRF; statistical pooling of the reduction in CRF from baseline to follow-up showed in favor of acupuncture. However, 3 sets of comparison for the pooled estimates of effect sizes had no statistical significance. Although one set of comparison (acupuncture plus education interventions vs usual care) had statistically significant differences, it is unclear whether this pooled positive outcome is attributable to the effects of acupuncture or to the education intervention. In addition, the duration of follow-up in these included trials was up to 10 weeks, and some RCTs had methodological flaws. Further rigorously designed RCTs adhering to acceptable standards of trial methodology are required to determine the effectiveness of acupuncture and its long-term effects on CRF.

Reduction of Cancer-Related Fatigue With Dexamethasone: A Double-Blind, Randomized, Placebo-Controlled Trial in Patients With Advanced Cancer

Cancer-related fatigue (CRF) is the most common symptom in patients with advanced cancer. The primary objective of this prospective, randomized, double-blind, placebo-controlled study was to compare the effect of dexamethasone and placebo on CRF. Patients with advanced cancer with ≥ three CRF-related symptoms (ie, fatigue, pain, nausea, loss of appetite, depression, anxiety, or sleep disturbance) ≥ 4 of 10 on the Edmonton Symptom Assessment Scale (ESAS) were eligible. Patients were randomly assigned to either dexamethasone 4 mg or placebo orally twice per day for 14 days. The primary end point was change in the Functional Assessment of Chronic Illness-Fatigue (FACIT-F) subscale from baseline to day 15. Secondary outcomes included anorexia, anxiety, depression, and symptom distress scores. A total of 84 patients were evaluable (dexamethasone, 43; placebo, 41). Mean (± standard deviation) improvement in the FACIT-F subscale at day 15 was significantly higher in the dexamethasone than in the placebo group (9 [± 10.3] v 3.1 [± 9.59]; P = .008). The improvement in FACIT-F total quality-of-life scores was also significantly better for the dexamethasone group at day 15 (P = .03). The mean differences in the ESAS physical distress scores at day 15 were significantly better for the dexamethasone group (P = .013, respectively). No differences were observed for ESAS overall symptom distress (P = .22) or psychological distress score (P = .76). Frequency of adverse effects was not significantly different between groups (41 of 62 v 44 of 58; P = .14). Dexamethasone is more effective than placebo in improving CRF and quality of life in patients with advanced cancer.

Research roundup

International Journal of Palliative NursingVol. 19, No. 9 Research roundupResearch roundupCraig NicholsonCraig NicholsonSearch for more papers by this authorCraig NicholsonPublished Online:30 Sep 2013https://doi.org/10.12968/ijpn.2013.19.9.463AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Wu FM, Newman JM, Lasher A, Brody AA (2013) Effects of initiating palliative care consultation in the emergency department on inpatient length of stay. J Palliat Med [epub ahead of print] DOI:10.1089/jpm.2012.0352 Crossref, Google ScholarYennurajalingam S, Frisbee-Hume S, Palmer JL (2013) Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. J Clin Oncol [epub ahead of print] DOI:10.1200/JCO.2012.44.4661 Crossref, Google ScholarMarc-Aurele KM, Nelesen R (2013) A five-year review of referrals for perinatal palliative care. J Palliat Med [epub ahead of print] DOI:10.1089/jpm.2013.0098 Google ScholarZeppetella G, Davies A, Eijgelshoven I, Jansen JP (2013) A network meta-analysis of the efficacy of opioid analgesics for the management of breakthrough cancer pain episodes. J Pain Symptom Manage [epub ahead of print] DOI:10.1016/j.jpainsymman.2013.05.020 Google ScholarFritz Z, Malyon A, Frankau JM et al. (2013) The Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: a mixed methods evaluation of the effects on clinical practice and patient care. PLoS One 8(9): e70977 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 1 September 2013Volume 19Issue 9ISSN (print): 1357-6321ISSN (online): 2052-286X Metrics History Published online 30 September 2013 Published in print 1 September 2013 Information© MA Healthcare LtdPDF download

A patient education program is effective in reducing cancer-related fatigue: A multi-centre randomised two-group waiting-list controlled intervention trial

ObjectiveTo evaluate a patient education program that aims at reducing perceived fatigue in cancer survivors. MethodsIn ten German centres, 261 patients with cancer-related fatigue were randomly assigned to a patient education program consisting of 6 sessions à 90 min or standard care. The primary outcome measure was cancer-related fatigue. Data were analysed using analysis of variance (ANOVA) with repeated measures. ResultsPatients in the intervention group showed statistically significant reduction in cancer-related fatigue (F = 76.510, p < 0.001, η2 = 0.248). Secondary outcomes also showed significant improvements in all measures, including quality of life (F = 29.607, p < 0.001, η2 = 0.113), general self-efficacy (F = 27.680, p < 0.001, η2 = 0.107), exercise self-efficacy (F = 49.230, p < 0.001, η2 = 0.175), physical activity (F = 8.036, p < 0.001, η2 = 0.033), anxiety (F = 33.194, p < 0.001, η2 = 0.125), depression (F = 24.604, p < 0.001, η2 = 0.096), and fatigue knowledge (F = 55.157, p < 0.001, η2 = 0.192). ConclusionThe program was effective in reducing perceived fatigue as well as further outcomes. Practice implicationsThis newly developed education program has the potential to fill a gap in the care of cancer survivors. The program needs further evaluation in other countries employing a control group of patients receiving equal time and attention as the intervention group.