Possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion in advanced cancer

Effectiveness of Web Applications on Improving Nutritional Status of Patients with Colorectal Cancer

The most common cancer in Thailand is colorectal cancer (CRC). A lack of knowledge and misleading information from social media have contributed to cancer deaths from malnutrition. A web application is a tool that provides easy access to scientific nutritional information via an online platform. In this study, our goal was to compare the nutritional status of CRC patients using different nutrition-based educational tools with nutrition counseling, namely the Nutrition Educational Prototype based on Smartphone Web Applications (NEPSA) and standard hospital leaflets. Anthropometric and biochemical analyses and a dietary assessment, especially calories and protein, were measured during three visits. This study finally included 28 CRC patients who were undergoing chemotherapy and malnutrition with a body mass index (BMI) of <20 kg/m2. Thirteen participants received NEPSA while the remaining fifteen participants received a standard hospital leaflet. The results showed that NEPSAs improved nutritional outcomes by encouraging weight gain, increasing BMI, hemoglobin, hematocrit, and albumin levels, and consuming more calories and protein. NEPSA should be implemented to enhance the nutrition outcomes from anthropometric, biochemical, and dietary perspectives from nutrition advice among CRC patients. There could be positive impacts at the national level regarding equal accessibility to Thailand's nutrition information.

'Life became slow down': A descriptive qualitative study of the experiences of cancer-related fatigue amongst people with advanced lung cancer

BACKGROUND

Cancer-related fatigue is a complex multidimensional concept. However, little is known about the experience of cancer-related fatigue in people with advanced lung cancer. How they emotionally react to and cope with the experience of cancer-related fatigue according to cultural influences has not been extensively explored.

AIM

To explore the experience of cancer-related fatigue, its impacts and emotional reactions to and coping strategies for cancer-related fatigue amongst people with advanced lung cancer in China.

DESIGN

This was a cross-sectional, descriptive qualitative study with face-to-face semi-structured interviews. Data were analysed using content analysis.

SETTING/PARTICIPANTS

Twenty-one people with advanced lung cancer who experienced cancer-related fatigue were recruited in a hospital setting.

RESULTS

Four themes were identified: multifaceted experiences of cancer-related fatigue, impacts of cancer-related fatigue, negative perceptions of cancer-related fatigue and avoiding cancer-related fatigue. The multifaceted experience of cancer-related fatigue had physical, psychological and social impacts along the cancer trajectory. Informants regarded it as a sign of a 'bad ending', searched for root causes and had negative attitudes towards role changes. Avoiding coping strategies included not discussing cancer-related fatigue, refusing encouragement and support, hiding feelings, withdrawing from social life and attempting to control cancer-related fatigue.

CONCLUSION

The findings provide insights into the lack of flexibility of people with advanced lung cancer to adapt to the multidimensional experience of cancer-related fatigue. The reactions and coping towards cancer-related fatigue are profoundly influenced by Chinese culture. Developing psychological interventions based on the cultural background are highly recommended to cultivate the ability to cope flexibly with stressful events and live a meaningful cancer life.

Using different types of visual reaction time measurements for assessing cognitive difficulties in depression

There is a need for objective, easy and relatively short methods to diagnose cognition in depression. We have constructed a set of simple visual tasks using three different ways of speed measuring: paper-pencil-based, computer-based, and eye-tracking based. We used a single case design with 22 participants. A clinical group counted 11 patients with major depression examined two times (first examination without medication and second after three months of medical treatment) together with a group of 11 matched healthy controls. Cognitive difficulties were observable in all the checked levels of performance. The weakest in all tasks were patients before medication, some improvement was observed after medical treatment, but not matching the level of healthy controls. Cognitive difficulties were not eliminated by medical treatment as quickly as emotional disturbances were. The observed difficulties could be interpreted in terms of psychomotor retardation, a typical symptom in depression, which proved to be mainly cognitive as the analysis of differences in reaction times and the first saccade latencies concluded. The analysis of simple visual reaction times on several stages turned out to be a promising method to measure the cognitive state in persons with mood disorders and cognitive convalescence during major depressive disorder treatment.

Core body temperatures of rats subjected to treadmill exercise to fatigue or exhaustion: The journal Temperature toolbox

This study systematically reviewed the literature reporting the changes in rats' core body temperature (TCORE) induced by either incremental- or constant-speed running to fatigue or exhaustion. In addition, multiple linear regression analyses were used to determine the factors contributing to the TCORE values attained when exercise was interrupted. Four databases (EMBASE, PubMed, SPORTDiscus, and Web of Science) were searched in October 2021, and this search was updated in August 2022. Seventy-two studies (n = 1,538 rats) were included in the systematic review. These studies described heterogeneous experimental conditions; for example, the ambient temperature ranged from 5 to 40°C. The rats quit exercising with TCORE values varying more than 8°C among studies, with the lowest and highest values corresponding to 34.9°C and 43.4°C, respectively. Multiple linear regression analyses indicated that the ambient temperature (p < 0.001), initial TCORE (p < 0.001), distance traveled (p < 0.001; only incremental exercises), and running speed and duration (p < 0.001; only constant exercises) contributed significantly to explaining the variance in the TCORE at the end of the exercise. In conclusion, rats subjected to treadmill running exhibit heterogeneous TCORE when fatigued or exhausted. Moreover, it is not possible to determine a narrow range of TCORE associated with exercise cessation in hyperthermic rats. Ambient temperature, initial TCORE, and physical performance-related variables are the best predictors of TCORE at fatigue or exhaustion. From a broader perspective, this systematic review provides relevant information for selecting appropriate methods in future studies designed to investigate exercise thermoregulation in rats.

The temporal relation between pain and fatigue in individuals receiving treatment for chronic musculoskeletal pain

Background

Numerous investigations have revealed significant relations between pain and fatigue in individuals with persistent pain conditions. However, the direction of influence between pain and fatigue remains unclear. Shortcomings of design and analytic approaches used in previous research limit the nature of conclusions that can be drawn about possible causal or directional relations between pain and fatigue. The present study investigated the temporal relation between changes in pain and changes in fatigue in individuals with musculoskeletal pain enrolled in a 10-week behavioral activation intervention. On the basis of previous findings, it was hypothesized that analyses would support a bi-directional relation between pain and fatigue.

Methods

The study sample consisted of 104 individuals with chronic musculoskeletal pain participating in a 10-week standardized rehabilitation intervention. Measures of pain intensity and fatigue were completed pre-, mid-, and post-treatment. The three-wave data panel permitted examination of the direction of influence between pain and fatigue through the course of the intervention. A random-intercept cross-lagged panel model (RI-CLPM) was used to examine the temporal relation between pain and fatigue.

Results

Consistent with previous research, cross-sectional analyses of pre-treatment data revealed significant correlations between measures of pain and fatigue. Significant reductions in pain and fatigue were observed through the course of treatment (d = 0.33 and d = 0.66, p < .001, respectively). RI-CLPM revealed that pain severity predicted later fatigue (pre to mid-treatment standardized path coefficient (β) = 0.55, p = 0.02; mid to post-treatment β = 0.36, p = 0.001); however, fatigue did not predict later pain severity.

Conclusions

Discussion addresses the processes that might underlie the temporal relation between pain and fatigue. Clinical implications of the findings are also discussed.

The Experience of Fatigue in Breast Cancer Patients 1-12 Month Post-Chemotherapy: A Qualitative Study

The study explored the experience of fatigue, its effects and ways of coping with fatigue and the role of family and social support among breast cancer patients. In-depth, semi-structured interviews were conducted with 13 breast cancer patients stages I-III, aged 34-67, who were up to one year after the termination of chemotherapy. Two main themes emerged: "Being imprisoned in the body of an 80-year-old," focuses the fatigue experienced by younger and older women, during and post treatment, including the different patterns of fatigue and the various means of coping with fatigue; The "Family's bear-hug" exemplifies the role of the environment in coping with the experience of fatigue and the complexities entailed in receiving support from family and friends. The study provides a comprehensive picture of fatigue in its various contexts during and post-treatment and its impact on family relations and quality of life among younger and older breast cancer patients.

Tiredness, Fatigue, and Exhaustion as Perceived by Recreational Marathon Runners

In this article, we report the results of a study that was part of a five-study concept development project. Our goal was to learn about the nature of illness by exploring variations in the manifestations of fatigue, a symptom that is prevalent in both ill (cancer, depression, chronic fatigue syndrome) and selected nonill (recreational marathon runners, shift workers) populations. In this article, we report results of our study of recreational marathon runners, obtained from unstructured interviews with 13 runners between the ages 19 and 49 years using ethnoscience as the design. Key findings with implications for practice are the importance of planning recovery periods following large energy expenditures, the value of using dissociative strategies to manage tiredness, and the usefulness of associative strategies and support systems to manage fatigue. Future studies could explore whether these strategies would be useful for management of tiredness and fatigue in other populations.

Automatic analysis of treadmill running to estimate times to fatigue and exhaustion in rodents

Introduction

The determination of fatigue and exhaustion in experimental animals is complicated by the subjective nature of the measurement. Typically, it requires an observer to watch exercising animals, e.g. rats running on the treadmill, and to identify the time of the event. In this study, we hypothesized that automatic analysis of the time-averaged position of a rat on a treadmill could be an objective way for estimating times to fatigue and exhaustion. To test this hypothesis, we compared these times measured by a human observer to the results of an automated video tracking system.

Methods

Rats, previously familiarized to running on the treadmill, ran at a fixed speed with zero incline, until exhaustion. The experiments were performed at either room temperature (24 °C) or in a hot environment (32 °C). Each experiment was video recorded. A trained observer estimated the times to fatigue and exhaustion. Then, video tracking software was used to determine the position of the animals on the treadmill belt. The times to fatigue and exhaustion were determined, based on the position on the treadmill using predefined criteria.

Results

Manual scores and the average position on the treadmill had significant correlation. Both the observer and the automated video tracking determined that exercise in a hot environment, compared with the exercise at room temperature, results in shorter times to exhaustion and fatigue. Also, estimates of times made by the observer and the automated video tracking were not statistically different from each other.

Discussion

A similarity between the estimates of times to fatigue and exhaustion made by the observer and the automated technique suggests that video tracking of rodents running on a treadmill can be used to determine both parameters in experimental studies. Video tracking technique allows for a more objective measure and would allow for an increased performance in experimentation. The Supplemental information to this manuscript contains an Excel file, which includes the code in Virtual Basic with freeware license, to process and visualize running data and automatically estimate the times to fatigue and exhaustion. Instructions for the software are also included.

Problems and needs in patients with incurable esophageal and pancreaticobiliary cancer: a descriptive study

Patients with incurable esophageal cancer (EC) or pancreaticobiliary cancer (PBC) often have multiple symptoms and their quality of life is poor. We investigated which problems these patients experience and how often care is expected for these problems to provide optimal professional care. Fifty-seven patients with incurable EC (N = 24) or PBC (N = 33) from our outpatient clinic completed the validated "Problems and Needs for Palliative Care" (PNPC) questionnaire and two disease-specific quality of life questionnaires, European Organization for Research and Treatment in Cancer (EORTC). Although patients in general had several problems, physical, emotional, and loss of autonomy (LOA) problems were most common. For these physical and emotional problems, patients also expected professional care, although to a lesser extent for LOA problems. Inadequate care was received for fatigue, fear, frustration, and uncertainty. We conclude that an individualized approach based on problems related to physical, emotional, and LOA issues and anticipated problems with healthcare providers has priority in the follow-up policy of patients with incurable upper gastrointestinal cancer. Caregivers should be alert to discuss needs for fatigue, feelings of fear, frustration, and uncertainty.

Fatigue in children and adolescents with cancer from the perspective of health professionals

Objective:

to investigate health professionals' knowledge about the concept, assessment and intervention in fatigue in children and adolescents with cancer.

Method:

exploratory study with qualitative approach, with 53 health professionals (10 nurses, 33 assistant nurses, 3 physicians, 3 nutritionists, 2 psychologists and 2 physical therapists). Semi structured interviews were held, which were recorded and analyzed by means of inductive thematic content analysis.

Results:

the data were organized around three themes: knowledge of health professionals about fatigue; identification of fatigue and interventions to relieve fatigue.

Conclusion:

the results indicate the health professionals' limited knowledge about fatigue, as well as the lack of investment in their training and continuing education. Most of all, the lack of research on the theme in the Brazilian context remains a barrier to support improvements in care for this symptom in children and adolescents with cancer.

The Nature of Fatigue in Chronic Fatigue Syndrome

In this article, we report the findings of our study on the nature of fatigue in patients diagnosed with chronic fatigue syndrome. Using ethnoscience as a design, we conducted a series of unstructured interviews and card sorts to learn more about how people with chronic fatigue syndrome describe fatigue. Participants (N = 14) described three distinct domains: tiredness, fatigue, and exhaustion. Most participants experienced tiredness prior to diagnosis, fatigue during daily life, and exhaustion after overexertion. We also discuss participants' ability to adapt to a variety of stressors and prevent shifts to exhaustion, and relate our findings to stress theory and other current research. Primary strategies that promoted adaptation to stressors included pacing and extended rest periods. These findings can aid health care professionals in detecting impending shifts between tiredness, fatigue, and exhaustion and in improving adaptive strategies, thereby improving quality of life.

Non-pharmacological interventions to manage fatigue and psychological stress in children and adolescents with cancer: an integrative review

Cancer-related fatigue (CRF) is the most stressful and prevalent symptom in paediatric oncology patients. This integrative review aimed to identify, analyse and synthesise the evidence of non-pharmacological intervention studies to manage fatigue and psychological stress in a paediatric population with cancer. Eight electronic databases were used for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and the Cochrane Library. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts and the full articles, a final sample of nine articles was obtained. The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises. It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRF and psychological stress.

Family caregivers of cancer patients: perceived burden and symptoms during the early phases of cancer treatment

This study investigated levels of symptoms, caregiver burden, and changes over time in 278 family caregivers (FC) of cancer patients. FCs experienced high levels of depressive symptoms and sleep disturbance, low levels of fatigue, and low to moderate levels of caregiver burden, yet these symptoms remained relatively stable over time. Being female and not being employed were factors associated with an increased risk of symptoms and caregiver burden. The understanding evolving from this study can enhance social- and health care professionals' awareness of FCs' challenging situation and the potential impact this has on the FCs' ability to provide care to the patient.

Cancer-related fatigue in breast cancer patients after surgery: a multicomponent model using partial least squares-path modeling

OBJECTIVE

The aim of this study is to examine factors contributing to cancer-related fatigue (CRF) in breast cancer patients who have undergone surgery.

METHODS

Sixty women (mean age: 50.0) completed self-rated questionnaires assessing components of CRF, muscular and cognitive functions. Also, physiological and subjective data were gathered. Data were analyzed using partial least squares variance-based structural equation modeling in order to examine factors contributing to CRF after breast surgery.

RESULTS

The tested model was robust in terms of its measurement quality (reliability and validity). According to the structural model results, emotional distress (β = 0.59; p < 0.001), pain (β = 0.23; p < 0.05), and altered vigilance (β = 0.30; p < 0.05) were associated with CRF, accounting for 61% of the explained variance. Also, emotional distress (β = 0.41; p < 0.05) and pain (β = 0.40; p < 0.05) were related to low physical function and accounted for 41% of the explained variance. However, the relationship between low physical function and CRF was weak and nonsignificant (β = 0.01; p > 0.05).

CONCLUSION

Emotional distress, altered vigilance capacity, and pain are associated with CRF in postsurgical breast cancer. In addition, emotional distress and pain are related to diminished physical function, which, in turn, has no significant impact on CRF. The current model should be examined in subsequent phases of the treatment (chemotherapy and/or radiotherapy) when side effects are more pronounced and may lead to increased intensity of CRF and low physical function.

Review article: Description and management of fatigue in inflammatory bowel disease

BACKGROUND

Fatigue is a common and leading concern for patients with inflammatory bowel disease (IBD). It is managed inadequately in IBD, and there is little evidence to support interventions.

AIM

To examine patients' experience of and factors contributing to IBD-fatigue, and to appraise its management by patients and healthcare professionals.

METHODS

Seven electronic databases were searched. Subject headings and free-text searching were used, with no time limit set. Reference lists of retrieved papers were searched manually.

RESULTS

Twenty-eight papers were reviewed. Researchers used terms including 'fatigue', 'low energy', 'tiredness', 'decline in vitality and vigour' and 'reduced energy and vitality'. Different definitions were used to conceptualise fatigue. None of the reviewed studies asked patients to describe the experience of fatigue in their own words. Numerous physical, psychological and situational factors associated with fatigue were identified. Three small randomised control trials reported a favourable effect of infliximab and adalimumab on fatigue. One intervention study reported benefit from a stress management programme and one from solution-focused therapy.

CONCLUSIONS

Inconsistent use of terminology, lack of data from patients' perspective on inflammatory bowel disease-fatigue and lack of evidence to support its management contribute to fatigue being largely ignored or overlooked by healthcare professionals. Future research should explore the experience of IBD-fatigue from the individual patient perspective. Further studies are required to fully explore the factors associated with fatigue and to develop patient-centred interventions to reduce fatigue.

Development and psychometric testing of the Adaptive Capacity Index, an instrument to measure adaptive capacity in individuals with advanced cancer

BACKGROUND

We have proposed that declines in adaptive capacity, defined as the ability to adapt to multiple stressors, may serve as an indicator of risk for fatigue. A comprehensive measure of adaptive capacity does not exist.

OBJECTIVES

In this paper we describe construction of an instrument to measure adaptive capacity, the Adaptive Capacity Index (ACI).

DESIGN

Descriptive and psychometric.

SETTING

Six sites providing palliative care in Western Canada.

PARTICIPANTS

INCLUSION CRITERIA

≥18 years old, diagnosed with advanced cancer, able to read and write English, Mini-Mental Status Exam score ≥22. Pilot study n=48; Main study n=225 stratified using the Edmonton Symptom Assessment Scale (ESAS) tiredness score (≥0 to ≤2 n=60; ≥3 to ≤6 n=108; ≥7 and ≤10 n=57).

METHODS

Following ethics approval, 17 experts in symptom management assisted with content validation and consenting individuals completed the Functional Assessment of Cancer Therapy-Fatigue (FACT-F), the Profile of Mood States-Vigor short form (POMS-Vsf), and the ACI. A research assistant collected demographic information and assigned an Eastern Cooperative Oncology Group (ECOG) score. Data were analyzed using descriptive and inferential statistics (i.e., exploratory factor analyses, correlation, multivariate analyses of variance, and multiple regression).

RESULTS

Five 6-item ACI factors/subscales (Cognitive Function, Stamina/Muscle Endurance, Sleep Quality, Emotional Reactivity, and Social Interaction) were identified. The ACI-total scale and its subscales were internally consistent (Cronbach's alpha 0.76-0.89), and were significantly correlated with each other, and with each fatigue measure (Pearson's r ranging from -0.724 to 0.634). The ACI total score was sensitive to changes in the ESAS tiredness score. Stamina/Muscle Endurance, Cognitive Function, and Sleep Quality predicted 60.8% of the variance in FACT-F. Stamina/Muscle Endurance and Social Interaction predicted 36.8% of the variance in POMS-Vsf. Stamina/Muscle Endurance and Sleep Quality predicted 8% of the variance in ECOG.

CONCLUSIONS

The ACI is reliable and has beginning evidence of validity. In future studies we will examine relationships between ACI subscale scores and subsequent increases in fatigue and explore linkages to physiological processes. We will also establish ACI norms for early and late stage cancers and explore variations in ACI subscale scores base on age or gender.

Cancer-related fatigue: the impact of skeletal muscle mass and strength in patients with advanced cancer

BACKGROUND: Although exertional fatigue is directly and negatively related to skeletal muscle mass and strength, it is currently unknown if these variables are associated with cancer-related fatigue (CRF). Therefore, the purpose of this study was to determine if CRF is associated with measures of appendicular lean muscle mass and strength in advanced cancer patients (ACP). METHODS AND RESULTS: Eighty-four patients (48 men, 36 women aged 61.6 ± 13.2 year) newly diagnosed (≤6 months) with inoperable (Stages III-IV) gastrointestinal or non-small cell lung cancer participated in this study. All patients completed the Brief Fatigue Inventory (BFI). Handgrip (HGS) and quadriceps (QS) strength were assessed using isometric and isokinetic dynamometry, respectively. Skeletal muscle mass index (SMMI) was calculated from the appendicular lean mass measured via dual-energy X-ray absorptiometry divided by body height squared. Univariate analysis showed BFI to be significantly associated with body mass index, weight loss, anemia, hypoalbuminemia, activity level, pain, depression, and sarcopenia along with SMMI, HGS, and QS. HGS (r = -0.34; p = 0.018), QS (r = -0.39; p = 0.024), and SMMI (r = -0.60; p < 0.001) were negatively correlated with BFI total scores in men but not in women. When adjusted for sex, age, diagnosis, survival, along with the above characteristics, multivariate analyses showed that BFI scores were negatively associated with HGS (B = -0.90; 95% CI -1.5:-0.3), QS (-0.2; -0.3:-0.01), and SMMI (-7.5; -13.0:-2.0). There was a significant sex × SMMI interaction (10.8; 1.2:20.5), where BFI decreased with increasing SMMI in men, but did not change with SMMI in women. CONCLUSION: These results suggest that in ACP, CRF is related to muscle mass and strength, which may provide targets for future interventions.

Tiredness, fatigue, and exhaustion in the context of a major depressive disorder

Framed in a multimethod design using ethnoscience and grounded theory, the purpose of this study was to characterize the attributes of tiredness, fatigue, and exhaustion, and to explore their influences on illness experiences in individuals with major depressive disorder. Two domains, mind (attributes: cognitive function, sleep quality, emotional reactivity, social interaction) and body (attributes: stamina and control over body processes), were identified. These attributes changed qualitatively with participants' progression from tiredness to fatigue and from fatigue to exhaustion, and determined whether participants "faced outward" to engage with others or "faced inward" to protect energy reserves--a decision largely influenced by the capacity "to hold up a mask" to conceal symptoms. The mask was energy depleting, and if participants could not hold up their mask, they withdrew to preserve energy. Findings regarding the role of the mask could contribute to the development of patient self-care strategies and caregiver interventions.

The fatigue experiences of older Taiwanese women with breast cancer

AIMS AND OBJECTIVES

This study explored the fatigue experiences in older Taiwanese women with breast cancer.

BACKGROUND

Cancer is a common disease for older people, and breast cancer ranks second in occurrence among all cancers. Fatigue is the most frequently seen symptom, with more than 90% of cancer patients having such experiences. Fatigue may lead to functional dependence, affecting the care and quality of life for this older population.

DESIGN

A qualitative design was used in this study.

METHODS

In-depth interviews were conducted with participants being treated at the oncology outpatient department in a teaching hospital in northern Taiwan. Data were collected from November 2006-March 2007.

RESULTS

The study included 15 women, aged 65-82, with breast cancer. Analysis of the interviews revealed three themes: factors related to fatigue, interpretation of fatigue and ways to deal with fatigue. The factors related to fatigue arose from treatment, symptom distress and the impact of their emotions. Participants interpreted the fatigue as an inevitable normal reaction, and they were embarrassed to share its occurrence with others. Although fatigue made participants suffer, they found the ways to decrease the feeling of fatigue using psychological adjustments, practical changes and support systems.

CONCLUSIONS

Facing the multilayered influences from treatments and ageing, older women with breast cancer considered fatigue as a physical and psychological expression. By raising the awareness of fatigue, nurses can help this older population manage or relieve fatigue by controlling symptoms, providing emotional support and making related resources available.

RELEVANCE TO CLINICAL PRACTICE

The results of this study can enhance the sensitivity and evaluation abilities of nurses in dealing with the cancer-related fatigue in older women with breast cancer.

Fatigue, sleepiness, and physical activity in patients with multiple sclerosis

Fatigue is a frequent and disabling symptom in patients with multiple sclerosis (MS). The objective of the study was to compare fatigue and sleepiness in MS, and their relationship to physical activity. Eighty patients with MS rated the extent of experienced fatigue (Fatigue Severity Scale, FSS) and sleepiness (Epworth Sleepiness Scale, ESS). The relationship between the scales was analysed for the scales as a whole and for single items. The clinical status of the patients was measured with the Extended Disability Status Scale (EDSS). In addition, physical activity was recorded continuously for 1 week by wrist actigraphy. The mean scores of fatigue and sleepiness were significantly correlated (FSS vs. ESS r=0.42). Single item analysis suggests that fatigue and sleepiness converge for situations that demand self-paced activation, while they differ for situations in which external cues contribute to the level of activation. While fatigue correlated significantly with age (r=0.40), disease severity (EDSS, r=0.38), and disease duration (r=0.25), this was not the case for sleepiness. Single patient analysis showed a larger scatter of sleepiness scores in fatigued patients (FSS>4) than in non-fatigued patients. Probably, there is a subgroup of MS patients with sleep disturbances that rate high on ESS and FSS. The amount of physical activity, which was measured actigraphically, decreased with disease severity (EDSS) while it did not correlate with fatigue or sleepiness.

Cancer-related fatigue: a review of nursing interventions

Fatigue is a common and distressing symptom that is a concern for cancer patients, their families, carers and health professionals. Cancer-related fatigue is a multidimensional phenomenon that is self-perceived and includes physical, emotional, cognitive and behavioural components. It can be unrelenting, disrupts daily life, fosters helplessness and may culminate in despair. The many causes of cancer-related fatigue stem from the disease itself, the cancer treatments and their side effects. The conclusion from a recent critical review of research evidence is that physical exercise and the treatment of underlying problems, such as anaemia or clinical depression, are effective interventions. However, a wide range of practical interventions and complementary therapies are likely to be helpful such as: acupressure and acupuncture, stress management and relaxation, energy conservation measures, anticipatory guidance and preparatory information, and attention-restoring activities. This article will provide a comprehensive review of current knowledge surrounding cancer-related fatigue and the nursing interventions that can be implemented in community practice.

A rehabilitation program for patients with gastroesophageal cancer--a pilot study

PURPOSE

Gastroesophageal carcinoma has a 5-year survival rate of 20%. Esophagogastrectomy is a significant life-altering operation which interferes with a patient's ability to eat food as a normal social interaction. Dumping syndrome, delayed gastric emptying, and reflux are encountered after surgery. In addition, loss of appetite and body weight occurs. Fatigue is universally encountered. We conducted this study to evaluate whether a structured cancer nutrition and rehabilitation program has an effect on the symptoms and quality of life of patients with gastroesophageal cancer.

MATERIALS AND METHODS

Fifty-three patients with histologically documented gastroesophageal carcinoma were evaluated before and after an 8-week multidisciplinary program consisting of physicians, oncology nurse, dietitian, physical and occupational therapists, social worker, and psychologist. Twenty-two patients completed all the following questionnaires pre- and post-program: The Edmonton Symptom Assessment Scale (ESAS), Patient-Generated Subjective Global Assessment (PG-SGA), Brief Fatigue Inventory (BFI), and the Distress Thermometer.

RESULT

There were 42 male and 11 female patients. The median age was 63 years (22-80 years). Thirty patients had gastric cancer and 23 had esophageal cancer. On the ESAS, appetite, strength, shortness of breath, and constipation all improved (p = 0.01). The PG-SGA score decreased significantly (p = 0.05). Fatigue and general activity as measured on the BFI improved significantly. The 6-min walk increased from 384 to 435 m (p = 0.01).

CONCLUSION

The Cancer Nutrition and Rehabilitation program offers a multidimensional, holistic treatment approach emphasizing the patient as an individual. Participation in a cancer rehabilitation program ameliorates symptoms, improves nutrition, decreases global distress, and increases physical activities.

Using Evidence-Based Instruments to Document Eligibility and Improve Quality of Life of Hospice Patients

Hospices have been implementing various approaches to cope with the increased regulatory scrutiny in the past 3 years, prompted by concern about costs and outcomes. Medicare, through its fiscal intermediaries, has issued increasingly more restrictive local coverage determination guidelines for initial and ongoing qualifying criteria. The article examines how one hospice, United Hospice of Rockland, Inc. (UHR, New City, NY), designed multifaceted program to simultaneously improve regulatory compliance and improve quality of life. This article presents how the six scales (i.e., pain-verbal and non-verbal, breathing, functional decline-PPS and Fast, and anxiety) were developed and implemented, and also presents the preliminary evaluation of successful results.

Diagnostic criteria of cachexia and their assessment: decreased muscle strength and fatigue

PURPOSE OF REVIEW

The classification of cachexia or wasting disease is currently being revised to improve clinical trial design and clinical care. Decreased muscle strength and fatigue are proposed as diagnostic criteria for cachexia or wasting disease including, but not limited to, cancer. This review discusses their expected value in cancer cachexia.

RECENT FINDINGS

Fatigue is frequent and multifactorial in cancer patients with limited value to predict cachexia, however, most cachectic patients have fatigue. Its assessment requires multimodal subjective instruments, for outcome monitoring many other fatigue cofactors need to be controlled. Cachexia seems a dominant cause for decreased muscle strength. Most cachectic patients lose muscle strength, usually together with reduced muscle mass. High-individual variability of muscle strength limits its use to longitudinal monitoring. Physical activity monitoring, applying also body-worn sensors, offers additional monitoring tools.

SUMMARY

To diagnose and monitor cachexia, muscle strength should be measured directly, whereas fatigue is seen as a global outcome.

The changing causal foundations of cancer-related symptom clustering during the final month of palliative care: a longitudinal study

BACKGROUND

Symptoms tend to occur in what have been called symptom clusters. Early symptom cluster research was imprecise regarding the causal foundations of the coordinations between specific symptoms, and was silent on whether the relationships between symptoms remained stable over time. This study develops a causal model of the relationships between symptoms in cancer palliative care patients as they approach death, and investigates the changing associations among the symptoms and between those symptoms and well-being.

METHODS

Complete symptom assessment scores were obtained for 82 individuals from an existing palliative care database. The data included assessments of pain, anxiety, nausea, shortness of breath, drowsiness, loss of appetite, tiredness, depression and well-being, all collected using the Edmonton Symptom Assessment System (ESAS). Relationships between the symptoms and well-being were investigated using a structural equation model.

RESULTS

The model fit acceptably and explained between 26% and 83% of the variation in appetite, tiredness, depression, and well-being. Drowsiness displayed consistent effects on appetite, tiredness and well-being. In contrast, anxiety's effect on well-being shifted importantly, with a direct effect and an indirect effect through tiredness at one month, being replaced by an effect working exclusively through depression at one week.

CONCLUSION

Some of the causal forces explaining the variations in, and relationships among, palliative care patients' symptoms changed over the final month of life. This illustrates how investigating the causal foundations of symptom correlation or clustering can provide more detailed understandings that may contribute to improved control of patient comfort, quality of life, and quality of death.