Fatigue Symptoms Research Articles

Analysis of the Status Quo and Influencing Factors of Advanced Lung Cancer Patients’ Quality of Life

Objective: To investigate the quality of life and related influencing factors of patients with advanced lung cancer. Methods: A cross-sectional survey was conducted on 51 patients with advanced lung cancer who were hospitalized in the Department of Oncology from January 2023 to December 2023, and the influencing factors of patients’ quality of life were analyzed. Results: Among the five functional scales (physical, role, cognitive, emotional, and social functioning) of the QLQ-C30 scale, the social and emotional function scores were the lowest, respectively 16.7 (IQR: 0, 33.3) points, and 16.7 (IQR: 8.3, 25), and among the three symptom scales (fatigue, pain, nausea and vomiting), the fatigue symptom score was the highest: 77.7 (IQR: 66.7, 88.9) points. The results of Spearman correlation analysis showed that the anxiety score of patients with advanced lung cancer was positively correlated with depression score (P < 0.01), while the quality of life of patients with advanced lung cancer was not correlated with anxiety and depression score (P > 0.1). The self-care ability, the nature of the disease, and whether the patient was treated for chemotherapy were the independent influencing factors of the patient’s quality of life, and the difference was statistically significant (P < 0.001). Conclusion: Patients with advanced lung cancer have different degrees of anxiety and depression, and their quality of life is affected by many factors, which are mainly related to the patient’s self-care ability, the nature of the disease, and whether they received chemotherapy.

The Effect of Seated Baduanjin Exercise on Psychological State, Fatigue Symptoms, and Quality of Life in Maintenance Hemodialysis Patients

Objective: To evaluate the intervention effects of seated Baduanjin exercise on patients undergoing maintenance hemodialysis (MHD). Methods: A total of 108 MHD patients admitted between July 2022 and July 2023 were selected. They were randomly assigned into two groups: the experimental group, with 55 patients, who received seated Baduanjin exercise combined with leg exercises during dialysis; and the control group, with 53 patients, who only performed leg exercises during dialysis. The psychological state, fatigue symptoms, quality of life, and sleep quality scores were compared between the two groups, and exercise endurance was recorded. Results: After the intervention, the psychological state scores in the experimental group were lower than those in the control group, the fatigue symptom scores were lower, the quality of life scores were higher, the sleep quality scores were lower, and the exercise endurance was higher (P < 0.05). Conclusion: Seated Baduanjin exercise can improve the negative psychological state and fatigue symptoms of MHD patients, enhance their quality of life and sleep quality, and effectively increase their exercise endurance.

The effects of Tai Chi and Baduanjin on breast cancer patients: systematic review and meta-analysis of randomized controlled trials

BackgroundTai Chi and Baduanjin are nonpharmacological interventions that are widely applied among cancer patients.ObjectiveThis meta-analysis aimed to assess the effect of Tai Chi and Baduanjin on breast cancer patients by summarizing and pooling the results of previous studies.MethodsThe PubMed, Embase, Web of Science, Scopus and Cochrane Library and several databases were searched up to December 1, 2023, to identify high-quality RCTs. Relevant terms such as Tai Chi and Baduanjin were used as keywords. Stata 15.0 software and Review Manager (version 5.3; Cochrane Training) were used to screen the studies, extract the data, code the data, and perform the meta-analysis. The mean differences (MDs) and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias. The PICOS framework was used to develop the following eligibility criteria: (i) population - breast cancer patients; (ii) intervention - Tai Chi and Baduanjin intervention; (iii) comparison - Tai Chi and Baduanjin group and different intervention (e.g., regular intervention, routine rehabilitation training, waiting list, sham Qigong, usual care, no intervention); (iv) outcomes - cognitive ability, shoulder joint function, anxiety, depression, fatigue, sleep quality, quality of life; and (v) study design - randomized controlled trial.ResultsFrom January 2013 to December 2023, we included a total of 16 RCTs involving 1247 patients. A total of 647 patients were in the experimental group and were treated with Tai Chi and Baduanjin, while 600 patients were in the control group and were treated with traditional methods. The results of our meta-analysis indicate that Tai Chi and Baduanjin yield outcomes that are comparable to those of traditional treatment methods. Specifically, Tai Chi and Baduanjin significantly increased cognitive function, increased shoulder joint function, improved sleep quality indicators and improved quality of life indicators. Furthermore, Tai Chi and Baduanjin significantly reduced anxiety symptoms, depression symptoms, and fatigue symptoms among breast cancer patients. Sensitivity analysis was performed, a funnel plot was constructed. No publication bias was indicated by Egger’s or Begg’s test.ConclusionOverall, Tai Chi and Baduanjin are viable and effective nonpharmacological approaches for treating breast cancer patients, as they yield better results than traditional treatment methods. However, these findings should be interpreted with caution due to the limited number of controlled trials, small sample sizes, and low quality of the evidence.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023469301.

Effects of Traditional Chinese Martial Arts and Stretching Exercises on Symptoms of Fibromyalgia: A Systematic Review and Meta-Analysis.

Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread musculoskeletal pain and various associated symptoms. Non-pharmacological interventions have gained attention for managing FMS and improving patient outcomes. We reviewed past research to investigate the effects of traditional Chinese martial arts (TCMA) and stretching training (ST) on symptoms of patients with FMS. We searched Web of Science, Medline via PubMed, the Cochrane Library, and EMBASE from their inceptions to June 1, 2023. Across selected studies, we evaluated TCMA and ST using Fibromyalgia Impact Questionnaire (FIQ) scores, pain symptoms, fatigue levels, and sleep quality as outcome measures. Compared with control groups, participants receiving TCMA and ST interventions showed significantly lower FIQ scores (Standard Mean Difference (SMD) = -3.01, 95% Confidence Interval (CI) [-4.83,-1.19]), improved pain symptoms (SMD = -0.77, 95% CI [-1.07,-0.47]), less fatigue (SMD = 1.31, 95% CI [0.50,2.11]), and enhanced sleep quality (SMD = -0.55, 95% CI [-0.97,-0.12]). Subgroup analyses revealed that, irrespective of intervention duration, both TCMA and ST interventions were effective in relieving pain symptoms in these patients. ST interventions showed significant improvement in fatigue symptoms, while TCMA interventions positively influenced sleep quality. These findings highlight potential non-pharmalogical benefits of TCMA and ST interventions in managing FMS. However, future research should explore the optimal duration, frequency, intensity, and types of interventions for TCMA and ST and design targeted exercise intervention programs to study the effects of these interventions on different characteristics of FMS patients. Attention should be given to the effects of short-term interventions on improving fatigue symptoms, sleep quality, and pain relief, to provide more personalized and effective FMS treatment plans.

Sleep is altered during menstruation but not inflammatory parameters: Results from polysomnography of EPISONO database.

Menstruation is an inflammatory process that involves changes in women's physiology leading to mental and physical complaints. Sleep is essential for optimal hormonal release, immune response, and wellbeing, becoming an important factor to be evaluated. We compared sleep, inflammatory mediators, fatigue, anxiety and depression symptoms, and quality of life in menstruating and non-menstruating women. We used the polysomnographic data of 232 women from EPISONO 2007, an epidemiological study from São Paulo city, Brazil. Women were distributed into menstruating (N = 61) and non-menstruating groups (N = 171). We applied questionnaires related to sleep quality, sleepiness, insomnia, fatigue, anxiety and depression symptoms, and quality of life. The serum levels of interleukin 6, tumour necrosis factor-alpha, and C-reactive protein were analysed. For statistical analysis the significance level adopted was p < 0.05. Sleep efficiency was statistically lower in menstruating women (81% ± 13) compared with the non-menstruating group (84.2% ± 13.3, p < 0.023). No statistical differences between the two groups were found in respect to the other parameters analysed. Both groups scored for fatigue symptoms, but no statistical significance was observed between the groups. Our findings indicate that menstruation was associated with lower objective sleep efficiency, suggesting that menstruation may be a physiological factor impairing sleep. Further studies evaluating menstrual variables, and each phase of the menstrual cycle, should be undertaken to detect the main factors associated with sleep complaints, fatigue, and objective parameters of sleep.

Atypical presentation of PJP: hypercalcemia and kidney injury in an allogeneic stem cell transplant recipient

BackgroundPneumocystis jirovecii pneumonia (PJP) is an opportunistic infection that primarily affects immunocompromised individuals. Typical symptoms of PJP include the subacute onset of dyspnea, nonproductive cough, and low-grade fever. In hematology patients, particularly those who are allogeneic stem cell transplant recipients, the disease often presents with a more aggressive clinical course. While hypercalcemia has been documented as a manifestation of PJP in some solid organ transplant recipients, it has not been reported in hematology or stem cell transplant patients.Case presentationHere, we present a case of PJP in a 56-year-old male allogeneic stem cell transplant recipient, who developed hypercalcemia and renal failure during the late post-transplant period. The patient had a history of allogeneic stem cell transplantation due to acute myeloid leukemia. He presented with symptoms of fatigue and weakness. Laboratory tests revealed hypercalcemia (13.8 mg/dL) and elevated serum creatinine levels (2.3 mg/dL). The patient was hospitalized, and despite initial treatment with hydration and furosemide, the hypercalcemia persisted, leading to the administration of denosumab. During follow-up, hypoxia was detected, and a chest CT scan revealed mosaic attenuation and ground-glass opacities. Bronchoscopy was performed, and PCR testing confirmed the presence of Pneumocystis jirovecii. Other causes of hypercalcemia were ruled out, with PTH measured at 13.8 pg/mL (normal range 15–65 pg/mL), albumin at 3.71 g/dL, 1.25-dihydroxy vitamin D3 at 96 ng/dL (normal range 26–95 ng/dL), and 25-hydroxy vitamin D at 32.5 ng/mL (normal range 20–40 ng/mL). A PET-CT scan demonstrated no pathological FDG uptake, with the exception of findings suggestive of a pulmonary infection. Following treatment with trimethoprim-sulfamethoxazole and denosumab, the patient’s hypercalcemia and infection resolved.Conclusions Although rare, PJP can present with hypercalcemia and kidney injury in allogeneic stem cell transplant recipients. Early diagnosis and treatment can improve both PJP and hypercalcemia.

Functional Capacity, Functional Performance, and Symptoms in People With Heart Failure: An Integrative Review.

Heart failure (HF) is a clinical syndrome that has a negative effect on functional status, a multidimensional concept characterizing one's ability to provide for the necessities of life. Symptoms might be associated with different aspects of functional status in HF. However, the terms functional capacity and performance have been misused interchangeably, and no previous review has focused on the extent to which symptoms contribute to functional capacity and performance among people with HF. The aim of this study was to comprehensively review and synthesize the existing literature on the relationship between symptoms, functional capacity, and functional performance in people with HF. We conducted an integrated review of observational studies in which authors examined the relationship between at least 1 symptom and at least 1 aspect of functional capacity or performance in people with HF 18 years or older. The Joanna Briggs Institute's critical appraisal tools were used to analyze the quality of studies. We included 23 studies with 7219 participants and an age range of 40 to 86 years. Fifteen symptom measures were used to measure dyspnea, fatigue, pain, insomnia symptoms, depressive symptoms, and anxiety symptoms. Three functional capacity measures were assessed in 9 studies, and 7 functional performance measures were assessed in 17 studies. As often measured with the Six-Minute Walk Test, functional capacity was inversely associated with pain/discomfort, insomnia symptoms, and psychological symptoms. Functional performance, often measured by the New York Heart Association functional class and Medical Outcome Scale Short Form 36, was associated with sleep difficulties, fatigue, depressive symptoms, and anxiety. Four studies combined functional capacity and performance measures to elicit functional status. Depressive symptoms, fatigue, pain, and insomnia symptoms are associated with decreased functional performance and capacity. Commonly, symptoms experienced in HF are associated with declining functional status. However, this finding depends on the measures or metrics used to assess symptoms, functional capacity, and performance. The observed dissimilarities in the relationship between symptoms and functional capacity and performance highlight the conceptual distinctions, suggesting that authors of future studies should judiciously select appropriate dimensions and measures of functional status based on the study's purposes, design, and available resource.

Genetic variants associated with chronic fatigue syndrome predict population-level fatigue severity and actigraphic measurements.

The diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (CFS) is based on a constellation of symptoms which center around fatigue. However, fatigue is commonly reported in the general population by people without CFS. Does the biology underlying fatigue in patients with CFS also drive fatigue experienced by individuals without CFS? We used UK Biobank actigraphy data to characterize differences in physical activity patterns and daily temperature rhythms between participants diagnosed with CFS compared to controls. We then tested if single nucleotide variants (SNVs) previously associated with CFS are also associated with the variation of these actigraphic CFS correlates and/or subjective fatigue symptoms in the general population. Participants diagnosed with CFS (n = 295) had significantly decreased overall movement (Cohen's d = 0.220, 95% CI of -0.335 to -0.106, p-value = 2.42x10-15), lower activity amplitudes (Cohen's d = -0.377, 95% CI of -0.492 to -0.262, p-value = 1.74x10-6), and lower wrist temperature amplitudes (Cohen's d = -0.173, 95% CI of -0.288 -0.059, p-value = 0.002) compared to controls (n = 63,133). Of 30 tested SNVs associated in the literature with CFS, one was associated in the control population with subjective fatigue and one with actigraphic measurements (FDR < 0.05). The genetic overlap of CFS risk with actigraphy and subjective fatigue phenotypes suggests that some biological mechanisms underlying pathologic fatigue in CFS patients also underlie fatigue symptoms at a broader population level. Therefore, understanding the biology of fatigue in general may inform our understanding of CFS pathophysiology.

EFEITOS DOS EXERCÍCIOS NA MELHORA DA DOR PACIENTES COM FIBROMIALGIA: REVISÃO INTEGRATIVA

FM is a complex rheumatic condition characterized by chronic pain without evident inflammation. It primarily affects women between the ages of 55 and 74, impairing quality of life due to pain, fatigue, sleep disturbances, and emotional symptoms. Objective: To identify and report the effects of physical exercise on pain improvement in patients with FM. Methodology: An integrative literature review was conducted using the PICo strategy, covering primary studies from randomized clinical trials published between 2019 and 2024. The search was carried out in the LILACS, PubMed, SciELO, and PEDro databases, focusing on the benefits of exercise in pain management. The inclusion criteria were limited to full-text articles in Portuguese and English. Results: A total of 642 studies were analyzed, of which 9 were included in the final sample. These studies showed that aerobic, resistance, aquatic, and stretching exercises significantly contributed to the reduction of pain and fatigue. Additionally, there was an improvement in sleep quality, functional capacity, and emotional well-being, with a decrease in symptoms such as anxiety and depression. However, some studies did not show statistically significant results. Conclusion: It is concluded that physical exercise, when supervised and adjusted to individual needs, is an effective intervention in the management of fibromyalgia, providing pain relief and improving quality of life. Further studies are needed to investigate the interaction of exercises with other treatments, such as pharmacotherapy, and to evaluate long-term effects.

Post-dengue fatigue syndrome: A comprehensive review of an emerging clinical entity

Post-dengue fatigue syndrome (PDFS) is an emerging clinical entity characterised by persistent, debilitating fatigue and other symptoms following acute dengue infection. This review synthesises current evidence on the epidemiology, clinical features, pathophysiology and management of PDFS. Studies suggest that 20–25% of hospitalised dengue patients may develop PDFS, though population-based incidence is likely lower. Risk factors include older age, female sex and possibly host genetic factors. The hallmark symptom is profound fatigue, often accompanied by musculoskeletal pain, cognitive difficulties, sleep disturbances and mood changes. While some patients recover within weeks, others experience symptoms persisting for months or years. The pathophysiology of PDFS remains unclear but may involve persistent immune activation, hypothalamic-pituitary-adrenal axis dysfunction and autonomic nervous system disturbances. Diagnosis is based on the clinical history and exclusion of alternative causes. Management typically involves a multidisciplinary approach, including patient education, graded exercise therapy, cognitive behavioural therapy and symptomatic treatment. However, evidence for specific interventions is limited. Prognosis is variable, with some patients experiencing prolonged disability. Significant research gaps remain, including the need for standardised diagnostic criteria, biomarkers and controlled trials of potential therapies. As dengue’s global burden increases, further investigation of PDFS is crucial to improve recognition and develop evidence-based treatments for this impactful sequela of dengue infection.

Understanding psychological flexibility in long COVID: associations with stress, fatigue, and somatic symptom burden

Understanding psychological flexibility in long COVID: associations with stress, fatigue, and somatic symptom burden

A keep-it-simple embolisation approach to treat pelvic congestion syndrome without compromising clinical effectiveness.

There are two approaches to treating pelvic congestion syndrome (PCS): (i) the keep-it-simple (KIS) approach, which involves embolising only the refluxing vein(s), typically the left ovarian vein (LOV) unless the right ovarian vein (ROV) or left/right internal iliac vein (IIV) tributaries are also refluxing; and (ii) the extensive (EXT) approach, which empirically embolises almost all of the LOV, ROV, and left and right IIV tributaries. The aim of this study is to determine whether the KIS approach can effectively treat PCS while minimising the number of treated veins and coils used, without the need for injecting sclerosing agents into pelvic veins or the use of occlusion balloons. This is a single-institution retrospective cohort study. Our records identified 154 women who underwent venograms for possible PCS, with the intent to proceed with embolisation. Refluxing veins were treated using the KIS approach, deploying minimal number of coils, 'sandwiching' sclerosing foam. Short-term follow-up was conducted at 6 weeks; long-term follow-ups (between 12 and 60 months) were conducted via an electronic survey consisting of 19 questions assessing pelvic pain/pressure, leg and back pain, fatigue, and bladder and menstrual symptoms. Fifteen women had negative venogram; 139 women had one or more refluxing veins on venogram. Most women (73%) required unilateral ovarian vein (OV) embolisation, 14% required bilateral OV embolisation, and 12% underwent pelvic vein embolisation. Most cases required only four pushable coils. Clinical success was 89% at 6 weeks and 84% at 1-5 years. A visual analogue scale reduction of 5.2 points (from 7.8 to 2.7) was achieved. There were no instances of coil dislodgement or other complications. The keep-it-simple approach, embolising only the refluxing ovarian and/or iliac veins, can achieve a successful clinical outcome for pelvic congestion syndrome. The extensive approach of empirically embolising all ovarian veins and internal iliac veins may not be necessary. This carries implications for potential savings in procedure time, cost and radiation dose.

One-year trajectories of physical and mental health-related quality of life, fatigue and dyspnoea in COVID-19 survivors.

A substantial number of people experience a persisting impact on health-related quality of life (HRQoL) after COVID-19. The current study aims to identify different trajectories of physical and mental HRQoL, fatigue severity, and dyspnoea severity following hospitalisation with COVID-19, and associated factors of these trajectories. 500 patients with COVID-19 were followed for one year in a longitudinal cohort study. Self-reported outcomes were measured at 3, 6, 9, and 12 months after hospitalisation. Distinct trajectories were characterised using Growth Mixture Modelling. Sociodemographic and clinical correlates of trajectories were investigated using multivariable (multinomial) logistic regression analyses. Three trajectories ('stable high' (16%), 'improving' (40%), and 'stable low' (44%)) were found for physical HRQoL, and four ('stable high' (43%), 'improving' (14%), 'middle declining' (17%), and 'low' (26%)) for mental HRQoL. Older age, overweight and obesity, lower education, and comorbidities were associated with 'low' physical HRQoL. Younger age was associated with 'low' mental HRQoL. Four fatigue trajectories ('no fatigue' (15%), 'improving' (40%), 'low-severe' (27%), and 'high-severe' (18%)) were found. Participants either experienced almost never ('no dyspnoea', 75%) or almost always ('severe', 25%) dyspnoea. High co-occurrences between low HRQoL and severe fatigue and dyspnoea symptom trajectories were found. A substantial number of COVID-19 survivors continue to struggle with reduced HRQoL over time. However, large variations in these physical and mental HRQoL trajectories exist, and trajectories are associated with persisting COVID-19-related symptoms or pre-hospitalised health status. Regular measurement of HRQoL and post-COVID symptoms may help identify those that may benefit from timely interventions.

Online and Face-to-Face Mat Pilates Training for Long COVID-19 Patients: A Randomized Controlled Trial on Health Outcomes

This study investigated the impacts of online and face-to-face Mat Pilates training in adults with persistent symptoms of long COVID on health outcomes. Forty-nine patients (52 ± 5.85 yr.) diagnosed with long COVID related to fatigue symptoms were randomly included in three groups: online Mat Pilates training (n = 16), face-to-face Mat Pilates training (n = 15), and a control group (n = 18) without training. Mat Pilates training was conducted three times a week for 12 weeks. Fatigue, functional capacity, anthropometrics, body composition, and cardiometabolic markers were assessed before and after the interventions. Two-factor Generalized Estimating Equation analyses identified significant differences with Bonferroni post hoc testing (p &lt; 0.05). After the intervention, only the face-to-face Mat Pilates training group had an improved total, physical and mental fatigue, trunk isometric strength, upper limb muscle endurance strength, and aerobic capacity (p &lt; 0.05). No changes were found in fat mass, muscle mass, free fat mass, % of fat, body mass, body mass index, or waist and hip circumferences. No significant changes were observed in blood glucose, glycated hemoglobin, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, or blood pressure (p &gt; 0.05). Our results highlight the potential of face-to-face Mat Pilates training as an effective intervention to mitigate persistent symptoms of long COVID related to fatigue and functional capacities.

Clinical features and predictive nomogram for fatigue sequelae in non-severe patients infected with SARS-CoV-2 Omicron variant in Shanghai, China

BackgroundPatients with coronavirus disease 2019(COVID-2019) infections may still experience long-term effects, with fatigue being one of the most frequent ones. Clinical research on the long COVID in the Chinese population after infection is comparatively lacking. ObjectiveTo collect and analyze the long-term effects of non-severe COVID-19 infection patients and to develop a model for the prediction of fatigue symptoms. Methods223 non-severe COVID-19 patients admitted to one designated hospital were enrolled after finish all the self-designed clinical information registration form and nine-month follow-up. We explored the frequency and symptom types of long COVID. Correlation analysis was done on the neuropsychological scale results. After cluster analysis, lasoo regression and logistic regressions, a nomogram prediction model was produced as a result of investigating the risk factors for fatigue. ResultsA total of 108 (48.4%) of the 223 non-severe COVID-19 patients reported sequelae for more than 4 weeks, and of these, 35 (15.7%) had fatigue sequelae that were scale-confirmed. Other sequelae of more than 10% were brain fog (n = 37,16.6%), cough (n = 26,11.7%) and insomnia (n = 23,10.3%). A correlation between depression and fatigue was discovered following the completion of neuropsychological scale. The duration of hospitalization, the non-use of antiviral medications in treatment, IL-6 and CD16+CD56+ cell levels in blood are the main independent risk factors and predictors of fatigue sequelae in long COVID. Additionally, the neurology diseases and vaccination status may also influence the fatigue sequelae. ConclusionNearly half of the patients infected with COVID-19 Omicron variant complained of sequelae, and fatigue was the most common symptom, which was correlated with depression. Significant predictors of fatigue sequelae included length of hospitalization, non-use of antiviral drug, and immune-related serum markers of IL-6 and CD16+CD56+ NK cell levels. The presence of neurology diseases and a lack of vaccination could also predict the occurrence of fatigue sequelae.

Acute and long-term SARS-CoV-2 infection and neurodegeneration processes—circulus vitiosus

The global pandemic of COVID-19 caused by SARS-CoV-2 has had a devastating impact. Although many survived the acute effects of the pandemic, a significant number of survivors, including those with only mild symptoms, are now experiencing a prolonged and debilitating post-viral syndrome known as LC/PASC (long COVID/post-acute sequelae of SARS-CoV-2). Typical symptoms of LC/PASC include fatigue, breathlessness, chest pain, impaired cognition, difficulty sleeping, fever and gastrointestinal symptoms. Anxiety and depression can also last for weeks to months and range from mild to disabling. The association between neuropsychiatric symptoms and SARS-CoV-2 infection raises questions about the possible routes of SARS-CoV-2 entry to the central nervous system (CNS) and long-term effects of the virus on the CNS, their molecular basis, and the potential risk of neuronal damage associated with the subsequent development of neurodegenerative diseases.

Chemotherapy-induced cognitive impairment and its long-term development in patients with breast cancer: results from the observational CICARO study.

Chemotherapy-induced cognitive impairment (CICI) is a well-recognized side effect of breast cancer treatment. However, prospective long-term evaluations of CICI using standardized neuropsychological tests are scarce. This prospective longitudinal cohort study investigated cognitive dysfunction and its impact on quality of life and everyday functioning in patients with breast cancer receiving first-line chemotherapy compared to patients with breast cancer without chemotherapy. Assessment occurred prior to chemotherapy, postchemotherapy (median 6 months), and 2-3 years later. We used standardized neuropsychological tests, questionnaires, and scales to assess patients' quality of life and functioning. Additionally, serum analysis for neurodegenerative markers and autoantibodies was conducted. We included n = 53 patients. Overall cognitive function declined statistically significantly (P = .046) postchemotherapy compared to control patients, mostly driven by a reduced figural memory (P = .011). Patients who received chemotherapy showed a greater reduction in quality of life (increased fatigue symptoms, P = .023; reduced Karnofsky index, P<.001); however, without a statistically significant effect on cognitive decline. The neurodegenerative markers Neurofilament light chain (NfL) and phosphorylated Neurofilament heavy chain (pNfH) increased statistically significantly (P<.001) postchemotherapy and pNfH correlated with overall cognitive function. After 2-3 years, both cognitive performance and quality of life were comparable between chemotherapy-treated and control patients. Our findings suggest that chemotherapy statistically significantly contributes to overall cognitive dysfunction in patients with breast cancer, which disappears after 2-3 years, indicating a recovery in both objectively measurable cognitive function and subjective quality of life. Future research should examine larger sample sizes and explore screening indicators, particularly pNfH.

Patient-reported outcomes in patients with relapsed or refractory follicular lymphoma treated with zanubrutinib plus obinutuzumab versus obinutuzumab monotherapy: results from the ROSEWOOD trial

Objective We report patient-reported outcomes (PROs) measuring health-related quality of life (HRQoL) from the ROSEWOOD trial (NCT03332017), which demonstrated superior efficacy and a manageable safety profile with zanubrutinib plus obinutuzumab (ZO) versus obinutuzumab (O) in patients with heavily pretreated relapsed/refractory follicular lymphoma (R/R FL). Methods PROs were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30) and EQ-5D-5L questionnaires at baseline and subsequently every 12 weeks. All QLQ-C30 domains and EQ-5D-5L visual analog scale (VAS) scores were analyzed descriptively. At the key clinical timepoints (weeks 12 and 24), a mixed model for repeated measures (MMRM) analysis was used to evaluate the key PRO endpoints, including global health status, physical and role functioning, and symptoms of fatigue, pain, diarrhea, and nausea/vomiting. Clinically meaningful change was defined as a ≥ 5-point mean difference from baseline and between the ZO and O arms. Results Patients were randomized to ZO (n = 145) or O (n = 72). By week 48, descriptive analysis results indicated that patients in the ZO arm demonstrated improved outcomes in role functioning and fatigue and nausea/vomiting symptoms, compared with those in the O arm. Both groups experienced improvements in pain symptoms. EQ-5D-5L VAS scores showed no observable differences between treatment arms through week 48. MMRM analysis revealed that the global health status/quality of life of patients treated with ZO improved, as did fatigue, at week 12. At week 24, patients in the ZO arm experienced a clinically meaningful improvement in role functioning, pain, and fatigue. Conclusions In patients with R/R FL, ZO was associated with improved PROs compared with O. These findings suggest that zanubrutinib contributed clinically meaningful benefits to patient HRQoL when added to obinutuzumab. Trial registration The ROSEWOOD trial is registered on ClinicalTrials.gov (BGB-3111-212; ClinicalTrials.gov identifier: NCT03332017).

The spectrum of behavioral disorders in amyotrophic lateral sclerosis: current view.

Behavioral disorders, with an average prevalence of 30-60% are important non-motor symptoms in amyotrophic lateral sclerosis (ALS) that have a negative impact on prognosis, management and quality of life, yet the underlying neurobiology is poorly understood. Among people with ALS, apathy, fatigue, anxiety, irritability and other behavioral symptoms are the most prominent, although less frequent than cognitive impairment. The present review explores the current understanding of behavioral changes in ALS with particular emphasis on our current knowledge about their structural and functional brain correlates, substantiating a multisystem degeneration with particular dysfunction of frontal-subcortical circuits and dysfunction of fronto-striatal, frontotemporal and other essential brain systems. The natural history of behavioral dysfunctions in ALS and their relationship to frontotemporal lobe degeneration (FTLD) are not fully understood, although they form a clinical continuum, suggesting a differential vulnerability of non-motor brain networks, ALS being considered a brain network disorder. An assessment of risks or the early detection of brain connectivity signatures before structural changes may be helpful in investigating the pathophysiological mechanisms of behavioral impairment in ALS. Treatment of both ALS and co-morbid behavioral disorders is a multidisciplinary task, but whereas no causal or disease-modifying therapies for ALS are available, symptomatic treatment of a variety of behavioral symptoms plays a pivotal role in patient care, although the management of behavioral symptoms in clinical care still remains limited.

Characterizing Fatigue by Multiple Sclerosis Subtype and Determining Validity of a Fatigue Scale Specific to Persons With Progressive Multiple Sclerosis.

Fatigue is a common and debilitating symptom of multiple sclerosis (MS). Prior work suggests that the prevalence of fatigue is higher in progressive MS (PMS) than relapsing MS (RRMS). No patient-reported outcomes of fatigue have been validated specifically for individuals with PMS, despite evidence that they characterize fatigue differently than individuals with RRMS. Therefore, the objective of this study was to characterize fatigue in both the RRMS and PMS subtypes and determine the convergent validity of the Fatigue Symptoms and Impacts Questionnaire (FSIQ) for individuals with PMS. A nationwide survey yielded 806 (637 RRMS, 169 PMS) complete responses. The survey collected demographic information and self-reported disease severity, as well as measures of fatigue, health-related quality of life, and self-reported functioning. People with PMS reported significantly more severe fatigue than those with RRMS (P < .001). The FSIQ subdomains of physical, cognitive/emotional, and coping demonstrated moderate (r = 0.5-0.75) to excellent (r > 0.75) validity (P < .001) with other measures of fatigue. More severe fatigue in people with PMS as compared to those with RRMS underscores the importance of using validated tools to capture fatigue in persons with PMS. The FSIQ is a valid and freely available tool to capture the physical, mental, and emotional fatigue of individuals with PMS.