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Chartogne M, Rahmani A, Landry S, Morel B. Comparison of neuromuscular fatigability amplitude and etiologies between fatigued and non-fatigued cancer patients. Eur J Appl Physiol 2024; 124:1175-1184. [PMID: 37952231 DOI: 10.1007/s00421-023-05347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) is the most reported side effect of cancer and its treatments. Mechanisms of CRF are multidimensional, including neuromuscular alterations leading to decreased muscle strength and endurance (i.e., fatigability). Recently, exercise fatigability and CRF have been related, while fatigability mechanisms remain unclear. Traditionally, fatigability is assessed from maximal voluntary contractions (MVC) decrease, but some authors hypothesized that the rate of force development (RFD) determined during a rapid contraction could also be an interesting indicator of functional alterations. However, to our knowledge, no study investigated RFD in cancer patients. The purpose of this study was to determine whether RFD, fatigability amplitude, and etiology are different between fatigued and non-fatigued cancer patients. METHODS Eighteen participants with cancer, divided in fatigued or non-fatigued groups according their CRF level, completed a 5-min all-out exercise in ankle plantar flexor muscles composed of 62 isometric MVC of 4 s with 1 s rest, to assess fatigability amplitude as the force-time relationship asymptote (FA). Before and after exercise, fatigability etiologies (i.e., voluntary activation (VA) and evoked forces by electrical stimulation (Db100)) were assessed as well as RFD in 50 and 100 ms (RFD50 and RFD100, respectively) during rapid contractions. RESULTS FA is significantly lower in fatigued group. Significant differences were found between pre- and post-exercise VA, Db100, RFD50, and RFD100 for both groups, with no statistical difference between groups. CONCLUSION During treatments, fatigability is higher in fatigued patients; however, the mechanisms of fatigability and RFD alterations are similar in both groups. TRIAL REGISTRATION ClinicalTrials.gov, NCT04391543, May 2020.
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Affiliation(s)
- M Chartogne
- Le Mans University, Movement-Interactions-Performance, MIP, UR 4334, 72000, Le Mans, France.
- Nantes University, Movement-Interactions-Performance, MIP, UR 4334, 44322, Nantes Cedex 3, France.
| | - A Rahmani
- Le Mans University, Movement-Interactions-Performance, MIP, UR 4334, 72000, Le Mans, France
| | - S Landry
- Centre de Cancérologie de la Sarthe, 72000, Le Mans, France
| | - B Morel
- Le Mans University, Movement-Interactions-Performance, MIP, UR 4334, 72000, Le Mans, France
- Univ Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, 73000, Chambéry, France
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Maulet T, Bonnyaud C, Laforêt P, Cattagni T. Characterization of neuromuscular performances in adults with late-onset Pompe disease: A control case cross-sectional study. Neuromuscul Disord 2023; 33:923-935. [PMID: 37989689 DOI: 10.1016/j.nmd.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023]
Abstract
Adults with late-onset Pompe disease (aLOPD) are characterized by muscular contractile tissue deterioration. However, their neuromuscular performances are poorly known. We aimed to compare maximal muscle strength, activation, explosive strength and neuromuscular fatigue between aLOPD and controls. We studied 20 aLOPD and 20 matched controls. Isometric maximum voluntary contraction (MVC) torque was obtained for the hip, knee and ankle muscles. The voluntary activation level (VAL) during knee extensor MVC was assessed using interpolated twitch technique. Explosive strength was evaluated for knee and ankle muscles through the rate of torque development (RTD) during fast contractions. Neuromuscular fatigue was measured during a 30-second contraction of knee flexors and extensors. All muscle MVC torques were significantly lower in aLOPD than controls (p <0.05). The weakest muscles were the hip extensors followed by hip abductors and abductors. Raw value of RTD was lower in aLOPD for the majority of muscles (p <0.05). No intergroup differences were reported for normalized RTD, VAL and neuromuscular fatigue (p-values> 0.05). Our study shows that maximal strength was the only neuromuscular characteristic affected in aLOPD with a proximal-distal intensity gradient. This suggests that the surviving muscle tissue of aLOPD is as functionally efficient as that of control individuals.
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Affiliation(s)
- Théo Maulet
- Laboratory End: icap, Inserm Unit 1179, UVSQ, 2 Av. de la Source de la Bièvre, 78180 Montigny-le-Bretonneux France; Paris-Saclay University, Research Unit ERPHAN, UVSQ, 2 Av. de la Source de la Bièvre, 78180 Montigny-le-Bretonneux France; Movement analysis laboratory, Functional exploration unit, APHP, Raymond Poincaré hospital, 104 Bd Raymond Poincaré, 92380 Garches, France
| | - Céline Bonnyaud
- Paris-Saclay University, Research Unit ERPHAN, UVSQ, 2 Av. de la Source de la Bièvre, 78180 Montigny-le-Bretonneux France; Movement analysis laboratory, Functional exploration unit, APHP, Raymond Poincaré hospital, 104 Bd Raymond Poincaré, 92380 Garches, France
| | - Pascal Laforêt
- Laboratory End: icap, Inserm Unit 1179, UVSQ, 2 Av. de la Source de la Bièvre, 78180 Montigny-le-Bretonneux France; Neurology unit, APHP, Raymond Poincaré hospital, 104 Bd Raymond Poincaré, 92380 Garches, France
| | - Thomas Cattagni
- Nantes University, Mouvement - Interactions - Performance, MIP, UR 4334, F-44000, 25 bis, boulevard Guy Mollet, BP 72206 44322 Nantes Cedex 3, France.
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da Silva Alves R, de Carvalho JM, Borges JBC, Nogueira DA, Iunes DH, Carvalho LC. Effect of Exergaming on Quality of Life, Fatigue, and Strength and Endurance Muscle in Cancer Patients: A Randomized Crossover Trial. Games Health J 2023; 12:358-365. [PMID: 37155685 PMCID: PMC10541921 DOI: 10.1089/g4h.2022.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Objective: To analyze the influence of exergaming (EXE) quality of life, cancer-related fatigue (CRF), electromyography, and strength and endurance muscle in a randomized crossover trial. Methods: We conducted a single-blinded, randomized, and crossover trial, which included 38 cancer volunteers undergoing chemotherapy (Age = 60.07 ± 12.10 years; body mass index = 26.79 ± 5.33 kg/m2). All volunteers were randomized into two intervention moments: EXE and without intervention (WI) and after 1-month washout period of crossing of the evaluated moments. The intervention was performed on an EXE protocol using Xbox 360 Kinect®, with the game "Your Shape Fitness Evolved 2012" two to three times per week for 20 sessions. All volunteers were assessed the CRF and quality-of-life levels through the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire, the median frequency (MDF) by surface electromyography, maximal voluntary isometric contraction (MVIC), and the muscle endurance time at 80% MVIC of the dorsiflexors and plantar flexors using dynamometer. Results: In the comparison between EXE and WI moments, were observed increase in the scores for quality of life (P < 0.001), subscale fatigue (P < 0.001), in the MDF values of right lateral gastrocnemius muscles: P = 0.017, muscle endurance time (left dorsiflexion [LDF]: P < 0.001; right dorsiflexion [RDF]: P < 0.001; left plantar flexion [LPF]: P < 0.001; RPF: P = 0.039), and muscle strength (LDF: P < 0.001; RDF: P < 0.001; LPF: P = 0.002). Conclusion: The crossover study, the EXE protocol promoted improvement in cancer-related fatigue (CRF) and quality of life, increased MVIC, endurance time, and MDF values of the dorsiflexor and plantar flexor muscles of cancer volunteers undergoing chemotherapy.
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Affiliation(s)
- Ricardo da Silva Alves
- Bioscience Applied to Health Program, Federal University of Alfenas, Alfenas, Brazil
- Physiotherapy Course, Sapucaí Valley University, Pouso Alegre, Brazil
| | - Jovana Maria de Carvalho
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
- Science Rehabilitation Program, and Federal University of Alfenas, Alfenas, Brazil
| | - Juliana Bassalobre Carvalho Borges
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
- Science Rehabilitation Program, and Federal University of Alfenas, Alfenas, Brazil
| | | | - Denise Hollanda Iunes
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
- Science Rehabilitation Program, and Federal University of Alfenas, Alfenas, Brazil
| | - Leonardo Cesar Carvalho
- Bioscience Applied to Health Program, Federal University of Alfenas, Alfenas, Brazil
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
- Science Rehabilitation Program, and Federal University of Alfenas, Alfenas, Brazil
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Chatrenet A, Piccoli G, Audebrand JM, Torreggiani M, Barbieux J, Vaillant C, Morel B, Durand S, Beaune B. Analysis of the rate of force development reveals high neuromuscular fatigability in elderly patients with chronic kidney disease. J Cachexia Sarcopenia Muscle 2023; 14:2016-2028. [PMID: 37439126 PMCID: PMC10570076 DOI: 10.1002/jcsm.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) induces muscle wasting and a reduction in the maximum voluntary force (MVF). Little is known about the neuromuscular fatigability in CKD patients, defined as the reduction of muscle force capacities during exercise. Neuromuscular fatigability is a crucial physical parameter of the daily living. The quantification of explosive force has been shown to be a sensitive means to assess neuromuscular fatigability. Thus, our study used explosive force estimates to assess neuromuscular fatigability in elderly CKD patients. METHODS Inclusion criteria for CKD patients were age ≥ 60 years old and glomerular filtration rate (GFR) < 45 mL/min/1.73 m2 not on dialysis, and those for controls were GFR > 60 mL/min/1.73 m2 , age and diabetes matched. The fatigability protocol focused on a handgrip task coupled with surface electromyography (sEMG). Scalars were extracted from the rate of force development (RFD): absolute and normalized time periods (50, 75, 100, 150 and 200 ms, RFD50 , RFD75 , RFD100 , RFD150 and RFD200 , respectively), peak RFD (RFDpeak in absolute; NRFDpeak normalized), time-to-peak RFD (t-RFDpeak ) and the relative force at RFDpeak (MVF-RFDpeak ). A statistical parametric mapping approach was performed on the force, impulse and RFD-time curves. The integrated sEMG with time at 0-30, 0-50, 0-100 and 0-200 ms time intervals relative to onset of sEMG activity was extracted and groups were compared separately for each sex. RESULTS The cohort of 159 individuals had a median age of 69 (9IQR ) years and body mass index was 27.6 (6.2IQR ) kg/m2 . Propensity-score-matched groups balanced CKD patients and controls by gender with 66 males and 34 females. In scalar analysis, CKD patients manifested a higher decrement than controls in the early phase of contraction, regarding the NRFDpeak (P = 0.009; η2 p = 0.034) and RFD75 and RFD100 (for both P < 0.001; η2 p = 0.068 and 0.064). The one-dimensional analysis confirmed that CKD males manifest higher and delayed neuromuscular fatigability, especially before 100 ms from onset of contraction. sEMG was lower in CKD patients than controls in the 0-100 ms (at rest: P = 0.049, Cohen's d = 0.458) and 0-200 ms (at rest: P = 0.016, Cohen's d = 0.496; during exercise: P = 0.006, Cohen's d = 0.421) time windows. Controls showed greater decrease of sEMG than CKD patients in the 0-30 ms (P = 0.020, Cohen's d = 0.533) and 0-50 ms (P = 0.010, Cohen's d = 0.640) time windows. As opposite to females, males showed almost the same differences between groups. CONCLUSIONS Our study is the first to show that CKD patients have higher fatigability than controls, which may be associated with an impaired motor-unit recruitment, highlighting a neural drive disturbance with CKD. Further studies are needed to confirm these findings.
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Affiliation(s)
- Antoine Chatrenet
- Le Mans Université, Movement – Interactions – Performance, MIP, UR4334Le MansFrance
- Department of NephrologyCentre Hospitalier Le MansLe MansFrance
| | | | | | | | - Julien Barbieux
- Department of Digestive SurgeryCentre Hospitalier Le MansLe MansFrance
| | - Charly Vaillant
- Department of EndocrinologyCentre Hospitalier Le MansLe MansFrance
| | - Baptiste Morel
- Inter‐University Laboratory of Human Movement Biology (EA 7424)Université Savoie Mont BlancChambéryFrance
| | - Sylvain Durand
- Le Mans Université, Movement – Interactions – Performance, MIP, UR4334Le MansFrance
| | - Bruno Beaune
- Le Mans Université, Movement – Interactions – Performance, MIP, UR4334Le MansFrance
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Hucteau E, Mallard J, Pivot X, Schott R, Pflumio C, Trensz P, Favret F, Pagano AF, Hureau TJ. Exacerbated central fatigue and reduced exercise capacity in early-stage breast cancer patients treated with chemotherapy. Eur J Appl Physiol 2023:10.1007/s00421-023-05177-5. [PMID: 36939876 DOI: 10.1007/s00421-023-05177-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The present study aimed to characterize the etiology of exercise-induced neuromuscular fatigue and its consequences on the force-duration relationship to provide mechanistic insights into the reduced exercise capacity characterizing early-stage breast cancer patients. METHODS Fifteen early-stage breast cancer patients and fifteen healthy women performed 60 maximal voluntary isometric quadriceps contractions (MVCs, 3 s of contraction, 2 s of relaxation). The critical force was determined as the mean force of the last six contractions, while W' was calculated as the force impulse generated above the critical force. Quadriceps muscle activation during exercise was estimated from vastus lateralis, vastus medialis and rectus femoris EMG. Central and peripheral fatigue were quantified via changes in pre- to postexercise quadriceps voluntary activation (ΔVA) and quadriceps twitch force (ΔQTw) evoked by supramaximal electrical stimulation, respectively. RESULTS Early-stage breast cancer patients demonstrated lower MVC than controls preexercise (- 15%, P = 0.022), and this reduction persisted throughout the 60-MVC exercise (- 21%, P = 0.002). The absolute critical force was lower in patients than in controls (144 ± 29N vs. 201 ± 47N, respectively, P < 0.001), while W' was similar (P = 0.546), resulting in lower total work done (- 23%, P = 0.001). This was associated with lower muscle activation in the vastus lateralis (P < 0.001), vastus medialis (P = 0.003) and rectus femoris (P = 0.003) in patients. Immediately following exercise, ΔVA showed a greater reduction in patients compared to controls (- 21.6 ± 13.3% vs. - 12.6 ± 7.7%, P = 0.040), while ΔQTw was similar (- 60.2 ± 13.2% vs. - 52.8 ± 19.4%, P = 0.196). CONCLUSION These findings support central fatigue as a primary cause of the reduction in exercise capacity characterizing early-stage breast cancer patients treated with chemotherapy. CLINICAL TRIALS REGISTRATION No. NCT04639609-November 20, 2020.
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Affiliation(s)
- Elyse Hucteau
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Joris Mallard
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Xavier Pivot
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Roland Schott
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Carole Pflumio
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Trensz
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Fabrice Favret
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
| | - Allan F Pagano
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
| | - Thomas J Hureau
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France.
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France.
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Millet GY, Bertrand MF, Lapole T, Féasson L, Rozand V, Hupin D. Measuring objective fatigability and autonomic dysfunction in clinical populations: How and why? Front Sports Act Living 2023; 5:1140833. [PMID: 37065809 PMCID: PMC10101442 DOI: 10.3389/fspor.2023.1140833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
Fatigue is a major symptom in many diseases, often among the most common and severe ones and may last for an extremely long period. Chronic fatigue impacts quality of life, reduces the capacity to perform activities of daily living, and has socioeconomical consequences such as impairing return to work. Despite the high prevalence and deleterious consequences of fatigue, little is known about its etiology. Numerous causes have been proposed to explain chronic fatigue. They encompass psychosocial and behavioral aspects (e.g., sleep disorders) and biological (e.g., inflammation), hematological (e.g., anemia) as well as physiological origins. Among the potential causes of chronic fatigue is the role of altered acute fatigue resistance, i.e. an increased fatigability for a given exercise, that is related to physical deconditioning. For instance, we and others have recently evidenced that relationships between chronic fatigue and increased objective fatigability, defined as an abnormal deterioration of functional capacity (maximal force or power), provided objective fatigability is appropriately measured. Indeed, in most studies in the field of chronic diseases, objective fatigability is measured during single-joint, isometric exercises. While those studies are valuable from a fundamental science point of view, they do not allow to test the patients in ecological situations when the purpose is to search for a link with chronic fatigue. As a complementary measure to the evaluation of neuromuscular function (i.e., fatigability), studying the dysfunction of the autonomic nervous system (ANS) is also of great interest in the context of fatigue. The challenge of evaluating objective fatigability and ANS dysfunction appropriately (i.e.,. how?) will be discussed in the first part of the present article. New tools recently developed to measure objective fatigability and muscle function will be presented. In the second part of the paper, we will discuss the interest of measuring objective fatigability and ANS (i.e. why?). Despite the beneficial effects of physical activity in attenuating chronic fatigue have been demonstrated, a better evaluation of fatigue etiology will allow to personalize the training intervention. We believe this is key in order to account for the complex, multifactorial nature of chronic fatigue.
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Affiliation(s)
- Guillaume Y. Millet
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
- Institut Universitaire de France (IUF), Paris, France
- Correspondence: Guillaume Y. Millet
| | - Mathilde F. Bertrand
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
| | - Thomas Lapole
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
| | - Léonard Féasson
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
- Service de physiologie clinique et de l'exercice, CHU de Saint-Étienne, Saint-Étienne, France
- Centre Référent Maladies Neuromusculaires rares - Euro-NmD, CHU de Saint-Étienne, Saint-Étienne, France
| | - Vianney Rozand
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
| | - David Hupin
- Service de physiologie clinique et de l'exercice, CHU de Saint-Étienne, Saint-Étienne, France
- Jean Monnet University Saint-Etienne, Mines Saint-Etienne, University hospital of Saint-Etienne, INSERM, SAINBIOSE, U1059, DVH team, Saint-Etienne, France
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Fisher MI, Cohn JC, Harrington SE, Lee JQ, Malone D. Screening and Assessment of Cancer-Related Fatigue: A Clinical Practice Guideline for Health Care Providers. Phys Ther 2022; 102:pzac120. [PMID: 36179114 PMCID: PMC9525018 DOI: 10.1093/ptj/pzac120] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/23/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. Regular surveillance is recommended, but few clinical practice guidelines transparently assess study bias, quality, and clinical utility in deriving recommendations of screening and assessment methods. The purpose of this clinical practice guideline (CPG) is to provide recommendations for the screening and assessment of CRF for health care professions treating individuals with cancer. Following best practices for development of a CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) Statement and Emergency Care Research Institute (ECRI) Guidelines Trust Scorecard, this CPG included a systematic search of the literature, quality assessment of included evidence, and stakeholder input from diverse health care fields to derive the final CPG. Ten screening and 15 assessment tools supported by 114 articles were reviewed. One screen (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-30 Core Questionnaire) and 3 assessments (Piper Fatigue Scale-Revised, Functional Assessment of Chronic Illness Therapy-Fatigue, and Patient Reported Outcome Measurement Information System [PROMIS] Fatigue-SF) received an A recommendation ("should be used in clinical practice"), and 1 screen and 5 assessments received a B recommendation ("may be used in clinical practice"). Health care providers have choice in determining appropriate screening and assessment tools to be used across the survivorship care continuum. The large number of tools available to screen for or assess CRF may result in a lack of comprehensive research evidence, leaving gaps in the body of evidence for measurement tools. More research into the responsiveness of these tools is needed in order to adopt their use as outcome measures. IMPACT Health care providers should screen for and assess CRF using one of the tools recommended by this CPG.
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Affiliation(s)
| | - Joy C Cohn
- Good Shepherd Penn Partners, Philadelphia, Pennsylvania, USA
| | - Shana E Harrington
- Exercise Science Department, University of South Carolina, Columbia, South Carolina, USA
| | - Jeanette Q Lee
- Department of Physical Therapy and Rehabilitation Science, University of California at San Francisco/San Francisco State University, San Francisco, California, USA
| | - Daniel Malone
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
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Increased Fatigability in Women With Persistent Cancer-Related Fatigue After Breast Cancer Treatment: A Pilot Study. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chartogne M, Leclercq A, Beaune B, Boyas S, Forestier C, Martin T, Thomas-Ollivier V, Landry S, Bourgeois H, Cojocarasu O, Pialoux V, Zanna O, Messonnier LA, Rahmani A, Morel B. Building a biopsychosocial model of cancer-related fatigue: the BIOCARE FActory cohort study protocol. BMC Cancer 2021; 21:1140. [PMID: 34688272 PMCID: PMC8542307 DOI: 10.1186/s12885-021-08831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Cancer-related fatigue (CRF) is the most common side effect of cancer and cancer treatment. CRF prevalence is up to 50% in breast cancer patients and can continue several years after cancer remission. This persistent subjective sense of exhaustion is multifactorial. Numerous parameters have been evidenced to be related to CRF across biological, physical, psychological, social and/or behavioral dimensions. Although CRF has been studied for many years, the majority of previous studies focused on only one dimension, i.e., physical function. Moreover, few studies investigated CRF longitudinally with repeated measures. These are the two main obstacles that limit the understanding of CRF mechanisms. The purpose of this study is to create a biopsychosocial model of CRF with simultaneous and longitudinal anthropometric, clinical, biological, physical, psychological and sociological parameters. Methods BIOCARE FActory is a multicentric prospective study that will consist of an 18-month follow-up of 200 women diagnosed with breast cancer. Four visits will be scheduled at diagnosis, after treatments, and 12 and 18 months after diagnosis. The same procedure will be followed for each visit. Each session will be composed of anthropometric data collection, a semi-structured interview, cognitive tests, postural control tests, neuromuscular fatigability tests and a cardiorespiratory fitness test. Clinical and biological data will be collected during medical follow-ups. Participants will also complete questionnaires to assess psychological aspects and quality of life and wear an actigraphy device. Using a structural equation modeling analysis (SEM), collected data will build a biopsychosocial model of CRF, including the physiological, biological, psychological, behavioral and social dimensions of CRF. Discussion This study aims to highlight the dynamics of CRF and its correlates from diagnosis to post treatment. SEM analysis could examine some relations between potential mechanisms and CRF. Thus, the biopsychosocial model will contribute to a better understanding of CRF and its underlying mechanisms from diagnosis to the aftermaths of cancer and its treatments. Trial registration This study is registered at ClinicalTrials.gov (NCT04391543), May 2020.
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Affiliation(s)
- M Chartogne
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France.
| | - A Leclercq
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - B Beaune
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - S Boyas
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - C Forestier
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - T Martin
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - V Thomas-Ollivier
- Nantes Université, Movement - Interactions - Performance, MIP, 4334, Nantes, EA, France
| | - S Landry
- Elsan-Clinique Victor Hugo, Centre Jean Bernard, Le Mans, France
| | - H Bourgeois
- Elsan-Clinique Victor Hugo, Centre Jean Bernard, Le Mans, France
| | - O Cojocarasu
- Centre Hospitalier Le Mans (CHM), Le Mans, France
| | - V Pialoux
- Univ Lyon, University Claude Bernard Lyon 1, Inter-University Laboratory of Human Movement Biology, Team Atherosclerosis Thrombosis & Physical Activity, EA7424, Lyon, France
| | - O Zanna
- Le Mans Université, VIPS2, EA4636, Le Mans, France
| | - L A Messonnier
- Laboratoire Interuniversitaire de Biologie de la Motricité, Univ. Savoie Mont Blanc, 7424, F-73000, Chambéry, EA, France
| | - A Rahmani
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - B Morel
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France.,Laboratoire Interuniversitaire de Biologie de la Motricité, Univ. Savoie Mont Blanc, 7424, F-73000, Chambéry, EA, France
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10
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Physiological and psychosocial correlates of cancer-related fatigue. J Cancer Surviv 2021; 16:1339-1354. [PMID: 34609702 DOI: 10.1007/s11764-021-01115-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/15/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a common and distressing symptom of cancer that may persist for years following treatment completion. However, little is known about the pathophysiology of CRF. Using a comprehensive group of gold-standard physiological and psychosocial assessments, this study aimed to identify correlates of CRF in a heterogenous group of cancer survivors. METHODS Using a cross-sectional design to determine the physiological and psychosocial correlates of CRF, ninety-three cancer survivors (51 fatigued, 42 non-fatigued) completed assessments of performance fatigability (i.e. the decline in muscle strength during cycling), cardiopulmonary exercise testing, venous blood samples for whole blood cell count and inflammatory markers and body composition. Participants also completed questionnaires measuring demographic, treatment-related, and psychosocial variables. RESULTS Performance fatigability, time-to-task-failure, peak oxygen uptake (V̇O2peak), tumor necrosis factor-α (TNF-α), body fat percentage, and lean mass index were associated with CRF severity. Performance fatigability, V̇O2peak, TNF-α, and age explained 35% of the variance in CRF severity. Those with clinically-relevant CRF reported more pain, more depressive symptoms, less perceived social support, and were less physically active than non-fatigued cancer survivors. CONCLUSIONS The present study utilised a comprehensive group of gold-standard physiological and psychosocial assessments and the results give potential insight into the mechanisms underpinning the association between physical inactivity, physical deconditioning and CRF. IMPLICATIONS FOR CANCER SURVIVORS Given the associations between CRF and both physiological and psychosocial measures, this study identifies targets that can be measured by rehabilitation professionals and used to guide tailored interventions to reduce fatigue.
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11
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Abstract
A diagnosis of cancer is a major life stressor that can affect the physiological, psychological and physical state of the person concerned. Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness. The aim of this review is to provide background information on cancer-related fatigue. This review discusses cancer-related fatigue (CRF) in terms of the definition, prevalence, risk factors, aetiology, and the measurement scales used. The differences between definitions of symptoms and relevant theories will be explored and discussed to help explain the variety of instruments used in its measurement. The prevalence of fatigue will be assessed by looking critically at the evidence of fatigue and the factors that affect it. Potential treatment and management strategies for CRF will also be discussed. Finally, there will be an overview of the instruments used to measure fatigue. This review also provides important evidence for measuring and managing CRF that can help nurses to understand fatigue among patients with cancer. Assessing CRF should be routinely undertaken in clinical settings to help identify the proper interventions, treatments and management to reduce fatigue among cancer patients.
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Affiliation(s)
- Mohammed Al Maqbali
- Research Assistant, School of Applied Social and Policy Sciences, Ulster University, Magee Campus, Derry-Londonderry
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12
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de Carvalho MS, Carvalho LC, Alves RDS, Menezes FDS, Gomes EDC, Frazin A, Iunes DH. Analysis of the Muscular Activity, Peak Torque in the Lower Limbs, and Static Balance after Virtual Rehabilitation in Women with Fibromyalgia: A Randomized Controlled Study. Games Health J 2021; 10:190-197. [PMID: 34143668 DOI: 10.1089/g4h.2020.0206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To analyze the effect of the exergaming on muscular activity at rest and on maximum voluntary isometric contraction by electromyography (EMG) at peak torque, widespread pressure hyperalgesia identified using a tender point count, and static balance in fibromyalgia. Materials and Methods: Thirty-five women were divided into two groups: Wii™ (virtual rehabilitation, n = 16) and control (stretching exercises, n = 19), through simple randomization. The volunteers were evaluated by means of EMG, dynamometry by load cell, baropodometry, and algometry before interventions and reevaluated after the 10th and 20th sessions. The subjects participated fully in three 1-hour treatment sessions per week of 20 sessions. Results: The Wii group showed significant benefits for the peak torque of dorsiflexion movement after 20 sessions and for movement plantarflexion after 10 sessions. The control group showed bilateral improvement in muscular activity in the tibialis anterior muscle after 20 sessions. Both groups showed a significant decrease in tender point count, suggesting improved hyperalgesia after 10 sessions and 20 sessions. No significant improvement was found in static baropodometry in the two evaluated groups. Conclusion: Exergaming have the potential to increase the peak torque for dorsiflexion and plantarflexion movement in women with fibromyalgia. It also produces a decrease in tender point count equal to that with flexibility exercises and does not produce changes in the static balance.
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Affiliation(s)
| | - Leonardo Cesar Carvalho
- Bioscience Applied to Health Program, Federal University of Alfenas, Alfenas, Brazil.,Science Rehabilitation Program, Federal University of Alfenas, Alfenas, Alfenas, Brazil
| | | | - Flavia da Silva Menezes
- Science Rehabilitation Program, Federal University of Alfenas, Alfenas, Alfenas, Brazil.,Graduate of Physical Therapy Faculty, Federal University of Alfenas, Alfenas, Brazil
| | | | - Andressa Frazin
- Graduate of Physical Therapy Faculty, Federal University of Alfenas, Alfenas, Brazil
| | - Denise Hollanda Iunes
- Science Rehabilitation Program, Federal University of Alfenas, Alfenas, Alfenas, Brazil
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13
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EEG Correlates of Central Origin of Cancer-Related Fatigue. Neural Plast 2021; 2020:8812984. [PMID: 33488692 PMCID: PMC7787808 DOI: 10.1155/2020/8812984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022] Open
Abstract
The neurophysiological mechanism of cancer-related fatigue (CRF) remains poorly understood. EEG was examined during a sustained submaximal contraction (SC) task to further understand our prior research findings of greater central contribution to early fatigue during SC in CRF. Advanced cancer patients and matched healthy controls performed an elbow flexor SC until task failure while undergoing neuromuscular testing and EEG recording. EEG power changes over left and right sensorimotor cortices were analyzed and correlated with brief fatigue inventory (BFI) score and evoked muscle force, a measure of central fatigue. Brain electrical activity changes during the SC differed in CRF from healthy subjects mainly in the theta (4-8 Hz) and beta (12-30 Hz) bands in the contralateral (to the fatigued limb) hemisphere; changes were correlated with the evoked force. Also, the gamma band (30-50 Hz) power decrease during the SC did not return to baseline after 2 min of rest in CRF, an effect correlated with BFI score. In conclusion, altered brain electrical activity during a fatigue task in patients is associated with central fatigue during SC or fatigue symptoms, suggesting its potential contribution to CRF during motor performance. This information should guide the development and use of rehabilitative interventions that target the central nervous system to maximize function recovery.
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14
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Chartogne M, Rahmani A, Landry S, Bourgeois H, Peyrot N, Morel B. Neuromuscular, Psychological, and Sleep Predictors of Cancer-Related Fatigue in Cancer Patients. Clin Breast Cancer 2021; 21:425-432. [PMID: 33422432 DOI: 10.1016/j.clbc.2020.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/03/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is the most reported side effect of cancer and its treatments. This distressing sense of exhaustion critically impairs quality of life and can persist for years after treatment completion. Mechanisms of CRF are multidimensional (eg, physical, psychological, or behavioral), suggesting the need for a complex assessment. Nevertheless, CRF remains assessed mainly with 1-dimensional questionnaires. The purpose of this study was to test whether neuromuscular parameters enhance a model including well-known predictors of CRF. PATIENTS AND METHODS Forty-five participants with cancer history completed self-assessment questionnaires about quality of life, CRF, sleep disturbances, and emotional symptoms. They also completed a 5-minute handgrip fatiguing test composed of 60 maximal voluntary contractions to assess neuromuscular fatigability. Hierarchical linear regression analyses were performed to determine whether the neuromuscular fatigability threshold improved the FA12 score prediction beyond that provided by anxiety/depression and sleep disturbances. RESULTS The hierarchical linear regression analysis evidenced that a model including anxiety/depression, sleep disturbances, and neuromuscular fatigability explained 56% of CRF variance. In addition, the results suggest that the mechanisms leading to CRF may be different from one person to another. CONCLUSION Results revealed that sleep disturbances, emotional symptoms, and neuromuscular fatigability were the most important CRF predictors in cancer patients. This information could be useful for healthcare professionals offering tailored, individual support to patients with CRF.
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Affiliation(s)
- Martin Chartogne
- Le Mans Université, Nantes Université, Movement-Interactions-Performance, MIP, EA 4334, Le Mans, France.
| | - Abderrahmane Rahmani
- Le Mans Université, Nantes Université, Movement-Interactions-Performance, MIP, EA 4334, Le Mans, France
| | - Sébastien Landry
- Elsan, Clinique Victor Hugo, Centre Jean Bernard, Le Mans, France
| | - Hugues Bourgeois
- Elsan, Clinique Victor Hugo, Centre Jean Bernard, Le Mans, France
| | - Nicolas Peyrot
- Le Mans Université, Nantes Université, Movement-Interactions-Performance, MIP, EA 4334, Le Mans, France
| | - Baptiste Morel
- Université Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Chambéry, France
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15
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Buffart LM, Sweegers MG, de Ruijter CJ, Konings IR, Verheul HMW, van Zweeden AA, Grootscholten C, Chinapaw MJ, Altenburg TM. Muscle contractile properties of cancer patients receiving chemotherapy: Assessment of feasibility and exercise effects. Scand J Med Sci Sports 2020; 30:1918-1929. [PMID: 32599670 PMCID: PMC7540386 DOI: 10.1111/sms.13758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
Background This pilot trial explores the feasibility of measuring muscle contractile properties in patients with cancer, effects of exercise during chemotherapy on muscle contractile properties and the association between changes in contractile muscle properties and perceived fatigue. Method Patients who received (neo)adjuvant chemotherapy for breast or colon cancer were randomized to a 9‐12 week exercise intervention or a waitlist‐control group. At baseline and follow‐up, we measured knee extensor strength using maximal voluntary contraction (MVC), contractile muscle properties of the quadriceps muscle using electrical stimulation, and perceived fatigue using the Multidimensional Fatigue Inventory. Feasibility was assessed by the proportion of patients who successfully completed measurements of contractile muscle properties. Exercise effects on muscle contractile properties were explored using linear regression analyses. Between‐group differences >10% were considered potentially relevant. Pearson correlation (rp) of changes in contractile muscle properties and changes in perceived fatigue was calculated. Results Twenty two of 30 patients completed baseline and follow‐up assessments. Measurements of contractile properties were feasible except for muscle fatigability. We found a potentially relevant between‐group difference in the rate of force development favoring the intervention group (1192 N/s, 95% CI = −335; 2739). Change in rate of force development was negatively correlated with change in perceived general (rp = −0.54, P = .04) and physical (rp = −0.59, P = .02) fatigue. Conclusion Chemotherapy induces a decrease in the rate of force development, which may reflect a larger loss in type II muscle fibers. This may be attenuated with (resistance) exercise. The increase in the rate of force development was related to a decrease in perceived fatigue.
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Affiliation(s)
- Laurien M Buffart
- Department of Physiology, Radboudumc, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Maike G Sweegers
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J de Ruijter
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Inge R Konings
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Annette A van Zweeden
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands.,Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands
| | - Cecile Grootscholten
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mai J Chinapaw
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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16
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Thong MSY, van Noorden CJF, Steindorf K, Arndt V. Cancer-Related Fatigue: Causes and Current Treatment Options. Curr Treat Options Oncol 2020; 21:17. [PMID: 32025928 PMCID: PMC8660748 DOI: 10.1007/s11864-020-0707-5] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer-related fatigue (CRF) is a problem for a significant proportion of cancer survivors during and after active cancer treatment. However, CRF is underdiagnosed and undertreated. Interventions are available for CRF although there is no gold standard. Based on current level of evidence, exercise seems to be most effective in preventing or ameliorating CRF during the active- and posttreatment phases.
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Affiliation(s)
- Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), P.O. Box 101949, 69009, Heidelberg, Germany.
| | - Cornelis J F van Noorden
- Department of Medical Biology, Amsterdam University Medical Centers, AMC, Amsterdam, Netherlands.,Department of Genetic Toxicology and Tumor Biology, National Institute of Biology, Ljubljana, Slovenia
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), P.O. Box 101949, 69009, Heidelberg, Germany
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17
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Cruz-Fernández M, Achalandabaso-Ochoa A, Gallart-Aragón T, Artacho-Cordón F, Cabrerizo-Fernández MJ, Pacce-Bedetti N, Cantarero-Villanueva I. Quantity and quality of muscle in patients recently diagnosed with colorectal cancer: a comparison with cancer-free controls. Support Care Cancer 2020; 28:4745-4752. [PMID: 31970516 DOI: 10.1007/s00520-020-05314-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/16/2020] [Indexed: 12/27/2022]
Abstract
This cross-sectional study compares the muscle mass, core strength and physical fragility of patients recently diagnosed with colorectal cancer (pRD-CRC) with those of healthy subjects and identifies variables to be considered when designing pre-treatment physical interventions for such patients. Body composition, anthropometric variables, the muscle architecture of the lumbopelvic region, physical fitness and frailty were assessed in 32 pRD-CRC and 29 healthy control subjects. The patients showed a reduction in muscle mass (F = 10.059; P = 0.003), in the width of the lumbar multifidus (F = 21.869; P < 0.001), in the transverse abdominal muscle (U = 323.00; P = 0.042) and in the abdominal strength resistance (F = 12.264; P = 0.001). They were also frailer (P = 0.002) than the controls. These results suggest that pRD-CRC are affected by reduced strength and myopenia, leading to frailty. The early incorporation of these patients into strength-enhancing programs may be advisable.
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Affiliation(s)
- Mayra Cruz-Fernández
- "Cuídate" Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS, University of Granada, Granada, Spain
- Department of Physiotherapy, University of Granada, Granada, Spain
| | | | - Tania Gallart-Aragón
- Unit of Mammary Pathology, General Surgery Services, "Campus de la Salud" Hospital, Granada, Spain
| | - Francisco Artacho-Cordón
- "Cuídate" Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS, University of Granada, Granada, Spain
- Department of Physiotherapy, University of Granada, Granada, Spain
- Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain
| | | | | | - Irene Cantarero-Villanueva
- "Cuídate" Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS, University of Granada, Granada, Spain.
- Department of Physiotherapy, University of Granada, Granada, Spain.
- Biohealth Research Institute in Granada (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.
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18
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Functional Corticomuscular Signal Coupling Is Weakened during Voluntary Motor Action in Cancer-Related Fatigue. Neural Plast 2019; 2019:2490750. [PMID: 31346330 PMCID: PMC6617923 DOI: 10.1155/2019/2490750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/08/2019] [Accepted: 04/30/2019] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Cancer-related fatigue (CRF) is widely recognized as one of the most common symptoms and side effects of cancer and/or its treatment. However, neuropathological mechanisms contributing to CRF are largely unknown, and the lack of knowledge makes CRF difficult to treat. Recent research has shown dissociation between changes in the brain and muscle signals during voluntary motor performance in cancer survivors with CRF, and this dissociation may be caused by an interruption in functional coupling (FC) of the two signals. The goal of this study was to assess the FC between EEG (cortical signal) and EMG (muscular signal) in individuals with CRF and compare the FC with that of healthy controls during a motor task that led to progressive muscle fatigue. Method Eight cancer survivors with CRF and nine healthy participants sustained an isometric elbow flexion contraction (at 30% maximal level) until self-perceived exhaustion. The entire duration of the EEG and EMG recordings was divided into the first-half (less-fatigue stage) and second-half (more-fatigue stage) artifact-free epochs without overlapping. The EEG-EMG coupling (measured by coherence of the two signals) in each group and stage was computed. Coherence values at different frequencies were statistically analyzed using a repeated-measure general linear model. Results The results demonstrated that compared to healthy controls, CRF participants sustained the contraction for a significantly shorter time and exhibited robust and significantly lower EEG-EMG coherence at the alpha (8~14 Hz) and beta (15~35 Hz) frequency bands. Both the CRF and healthy control groups exhibited significantly decreased EEG-EMG coherence from the less-fatigue to more-fatigue stages at the alpha and beta frequency bands, indicating fatigue-induced weakening of functional corticomuscular coupling. Conclusion Impaired functional coupling between the brain and muscle signals could be a consequence of cancer and/or its treatment, and it may be one of the contributing factors to the abnormal feeling of fatigue that caused the early failure of sustaining a prolonged motor task.
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19
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Cancer-related fatigue and biochemical parameters among cancer patients with different stages of sarcopenia. Support Care Cancer 2019; 28:581-588. [DOI: 10.1007/s00520-019-04717-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
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20
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Cancer-related fatigue stratification system based on patient-reported outcomes and objective outcomes: A cancer-related fatigue ambulatory index. PLoS One 2019; 14:e0215662. [PMID: 31009501 PMCID: PMC6476532 DOI: 10.1371/journal.pone.0215662] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/05/2019] [Indexed: 12/16/2022] Open
Abstract
Although breast cancer mortality is decreasing, morbidity following treatment remains a significant issue, as patients face symptoms such as cancer-related fatigue (CRF). The aim of the present study is to develop a classification system that monitors fatigue via integration of an objective clinical assessment with patient self-report. Forty-three women participated in this research. Participants were post-treatment breast cancer survivors who had been surgically treated for their primary tumour with no evidence of neoplastic disease at the time of recruitment. Self-perceived fatigue was assessed with the Spanish version of the Piper Fatigue Scale-Revised (R-PFS). Objective fatigue was assessed by the 30 second Sit-to-Stand (30-STS) test. Confirmatory factor analysis was done with Maximum Likelihood Extraction (MLE). Internal consistency was obtained by Cronbach's α coefficients. Bivariate correlation showed that 30-STS performance was negatively-inversely associated with R-PFS. The MANOVA model explained 54.3% of 30-STS performance variance. Using normalized scores from the MLE, a classification system was developed based on the quartiles. This study integrated objective and subjective measures of fatigue to better allow classification of patient CRF experience. Results allowed development of a classification index to classify CRF severity in breast cancer survivors using the relationship between 30-STS and R-PFS scores. Future research must consider the patient-perceived and clinically measurable components of CRF to better understand this multidimensional issue.
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21
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Davis MP, Behm B. Ginseng: A Qualitative Review of Benefits for Palliative Clinicians. Am J Hosp Palliat Care 2019; 36:630-659. [PMID: 30686023 DOI: 10.1177/1049909118822704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ginseng has been used for centuries to treat various diseases and has been commercially developed and cultivated in the past 300 years. Ginseng products may be fresh, dried (white), or dried and steamed (red). Extracts may be made using water or alcohol. There are over 50 different ginsenosides identified by chromatography. We did an informal systematic qualitative review that centered on fatigue, cancer, dementia, respiratory diseases, and heart failure, and we review 113 studies in 6 tables. There are multiple potential benefits to ginseng in cancer. Ginseng, in certain circumstances, has been shown to improve dementia, chronic obstructive pulmonary disease, and heart failure through randomized trials. Most trials had biases or unknown biases and so most evidence is of low quality. We review the gaps in the evidence and make some recommendations regarding future studies.
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Affiliation(s)
- Mellar P Davis
- 1 Palliative Care Department, Knapper Cancer Center, Geisinger Medical Center, Danville, PA, USA
| | - Bertrand Behm
- 1 Palliative Care Department, Knapper Cancer Center, Geisinger Medical Center, Danville, PA, USA
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22
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Clinical utility of portable electrophysiology to measure fatigue in treatment-naïve non-small cell lung cancer. Support Care Cancer 2018; 27:2617-2623. [PMID: 30467793 DOI: 10.1007/s00520-018-4542-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) biology remains poorly understood. Responsible mechanisms may be central or peripheral and originate anywhere from the brain to muscle fiber. Objective measurement is complex and previously limited to specialized laboratories. Portable electroencephalography (EEG) and electromyography (EMG) may enhance objective measurement. This study evaluated the feasibility and acceptability of portable EMG-EEG in CRF assessment. METHODS A prospective observational feasibility study compared ten outpatients with inoperable, treatment-naïve non-small cell lung cancer and CRF to ten healthy volunteers. All completed a sustained isometric hand-grip contraction at 30% maximal level until self-perceived exhaustion. 128-channel EEG and 2-channel EMG signals of forearm muscles were recorded. Device acceptability was evaluated by questionnaire. RESULTS The task was evaluated in two stages; first and last 20 s. CRF cohort perceived exhaustion earlier than volunteers (mean 137 ± 76 s vs 208 ± 51 s). As fatigue progressed, EMG amplitude increased significantly (CRF p = 0.02; volunteers: p = 0.04) in both groups as did EMG beta band power (CRF p = 0.008; volunteers: p = 0.006). The increase was significantly less in CRF (amplitude p = 0.032; beta power: p = 0.014). EEG beta band power in the contralateral motor cortex increased significantly (CRF p = 0.03; volunteers: p = 0.019) in both cohorts but to greater extent (p = 0.024) in CRF. One hundred percent device acceptability was reported. CONCLUSIONS A laboratory-based evaluation was successfully adapted to the outpatient setting during routine visits. High acceptability supports clinical utility. In CRF, a higher degree of cortical activation was required to drive a much lower level of muscle performance. This suggests impairment of both central and peripheral mechanisms in CRF.
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23
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Winters-Stone KM, Medysky ME, Savin MA. Patient-reported and objectively measured physical function in older breast cancer survivors and cancer-free controls. J Geriatr Oncol 2018; 10:311-316. [PMID: 30344000 DOI: 10.1016/j.jgo.2018.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/28/2018] [Accepted: 10/10/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Older breast cancer survivors (BCS) consistently report more functional limitations than women without cancer, but whether or not these differences remain when using objective measures of physical functioning and the correlates of these measures is unknown. METHODS Cross-sectional study comparing older (≥60 years old) BCS (n = 84) to similarly aged women without cancer (n = 40). Patient-reported physical function was assessed by the SF-36 physical function (SF-36PF) subscale and the Late Life Function & Disability Instrument (LLFDI). Objective measures included the short Physical Performance Battery (sPPB), usual walk speed (m/s), chair stand time (sec) and, grip strength (kg). Potential predictors included age, comorbidities, symptom severity, fatigue and skeletal muscle index (SMI; kg/m2). RESULTS Patient-reported physical function was significantly lower in BCS than controls using SF-36PF (47.3 ± 0.1 vs. 52.9 ± 4.0, p < 0.001) and LLFDI (68.2 ± 10.5 vs. 75.0 ± 8.9, p = 0.001). BCS had significantly lower sPPB scores (10.7 ± 0.1 vs. 11.7 ± 0.5, p < 0.001), longer chair stand times (12.6 ± 3.7 vs. 10.1 ± 1.4 s, p < 0.001), and lower handgrip strength (22.3 ± 5.0 vs. 24.3 ± 4.4 kg, p = 0.03) than controls, but similar walk speed (1.1+0.2 vs. 1.1+0.1 m/s, p = 0.75). Within BCS, age, comorbidities, SMI, symptom severity and fatigue explained 17.3%-33.1% of the variance across physical function measures. Fatigue was the variable most consistently associated with patient-reported physical functioning and age and comorbidities were the variables most consistently associated with objectively measured physical functioning. CONCLUSION Older BCS should be screened for functional limitations using simple standardized objective tests and interventions that focus on improving strength and reducing fatigue should be tested.
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Affiliation(s)
- Kerri M Winters-Stone
- Knight Cancer Institute, Oregon Health and Science University, 2720 SW Moody Ave, Mailcode KCRB-CPC, Portland, OR 97201, USA; School of Nursing, Oregon Health and Science University, 3455 SW, US Veterans Rd, Portland, OR, USA.
| | - Mary E Medysky
- School of Nursing, Oregon Health and Science University, 3455 SW, US Veterans Rd, Portland, OR, USA
| | - Michael A Savin
- Knight Cancer Institute, Oregon Health and Science University, 2720 SW Moody Ave, Mailcode KCRB-CPC, Portland, OR 97201, USA
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Abstract
PURPOSE OF REVIEW This review provides an up-to-date overview of the evidence relating to how physical inactivity ameliorates cancer-related fatigue. A summary of the postulated biological mechanisms underpinning the relationship is presented. RECENT FINDINGS Systematic reviews and meta-analyses synthesising the results of randomised controlled trials of physical activity interventions to reduce fatigue broadly conclude that aerobic and combination exercise may be the most helpful, while resistance training alone is less efficacious. Further, light- and moderate-intensity physical activity interventions appeared to reduce fatigue, whereas vigorous-intensity activity may exacerbate the condition. Physical activity interventions result in greater reductions in cancer-related fatigue when delivered post-treatment. Biological mechanisms that may explain how physical activity can improve different elements of cancer-related fatigue include inflammation; the hypothalamic-pituitary-adrenal (HPA) axis and circadian rhythm dysregulation; serotonin dysregulation; and alterations in ATP and muscle metabolism. Physical activity is well tolerated by cancer survivors and results in modest improvements in cancer-related fatigue. Much of the research in this field has been from small-scale feasibility trials. In order to help clinicians and allied health professionals tailor exercise prescriptions to individual needs, further research is required. New trials in this field should implement rigorous inclusion criteria, be fully powered to detect effects in sub-group analyses, incorporate multiple sites, and have well-defined control conditions. There is also a need to better understand how physical activity affects different subtypes of cancer-related fatigue.
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Twomey R, Martin T, Temesi J, Culos-Reed SN, Millet GY. Tailored exercise interventions to reduce fatigue in cancer survivors: study protocol of a randomized controlled trial. BMC Cancer 2018; 18:757. [PMID: 30041626 PMCID: PMC6057053 DOI: 10.1186/s12885-018-4668-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/11/2018] [Indexed: 12/29/2022] Open
Abstract
Background Cancer-related fatigue (CRF) is a common and distressing symptom of cancer and/or cancer treatment that persists for years after treatment completion in approximately one third of cancer survivors. Exercise is beneficial for the management of CRF, and general exercise guidelines for cancer survivors are available. There are multiple potential pathways by which exercise improves CRF, and cancer survivors with CRF are diverse with respect to cancer type, treatments and experienced side effects. While the general exercise guidelines are likely sufficient for most cancer survivors, tailoring of exercise interventions may be more effective in those with persistent fatigue. The primary aim of this research is to investigate the effect of a traditional vs. tailored exercise intervention on CRF severity in cancer survivors with persistent CRF. Methods/design Cancer survivors (≥ 3 months and ≤ 5 years since primary treatment) who score ≤ 34 on the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) will be randomly allocated to one of two parallel treatment arms: traditional (active control) and tailored exercise. Participants in the traditional exercise group will engage in aerobic and resistance exercise that is consistent with exercise guidelines for cancer survivors. The tailored exercise group will be prescribed an intervention designed to address individual deficits identified at baseline, such as loss of muscular strength, cardiorespiratory deconditioning or sleep disturbance. Participants will be assessed before and after the intervention for CRF severity and other patient-reported outcomes, neuromuscular function and fatigue in response to whole-body exercise, sleep quantity and quality, physical activity levels, cardiorespiratory fitness and blood biomarkers. Discussion To our knowledge, this will be the first study to compare the effects of a traditional vs. tailored exercise intervention on CRF severity in cancer survivors with persistent CRF. Using physiological, behavioural and patient-reported outcomes, this study will add to the current knowledge about both the factors contributing to CRF, and the potential reduction in CRF severity with an exercise intervention. Trial registration The study is registered at ClinicalTrials.gov (NCT03049384), February, 2017. Electronic supplementary material The online version of this article (10.1186/s12885-018-4668-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosie Twomey
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Tristan Martin
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - John Temesi
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Guillaume Y Millet
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.
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O'Higgins CM, Brady B, O'Connor B, Walsh D, Reilly RB. The pathophysiology of cancer-related fatigue: current controversies. Support Care Cancer 2018; 26:3353-3364. [PMID: 29961146 DOI: 10.1007/s00520-018-4318-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/12/2018] [Indexed: 12/21/2022]
Abstract
Fatigue is one of the most common and debilitating cancer symptoms, and is associated with impaired quality of life. The exact pathophysiology of cancer-related fatigue (CRF) is poorly understood, but in any individual, it is likely multifactorial and involves inter-related cytokine, muscular, neurotransmitter, and neuroendocrine changes. Underlying CRF mechanisms proposed include central and peripheral hypotheses. Central mechanisms include hypotheses about cytokine dysregulation, hypothalamic-pituitary-adrenal-axis disruption, circadian rhythm disruption, serotonin, and vagal afferent nerve function while peripheral mechanisms include hypotheses about adenosine triphosphate and muscle contractile properties. Currently, these hypotheses are largely based on evidence from other conditions in which fatigue is characteristic. The purpose of this article is to provide a narrative review of the literature and present the current controversies in the pathophysiology of CRF, particularly in relation to central and peripheral hypotheses for CRF. An understanding of pathophysiology may facilitate direct and simple therapeutic interventions for those with cancer.
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Affiliation(s)
- C M O'Higgins
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland.,Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland
| | - B Brady
- Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - B O'Connor
- Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Declan Walsh
- School of Medicine, Trinity College Dublin, Dublin, Ireland. .,Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland. .,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland. .,Department of Supportive Oncology, Levine Cancer Institute, Carolinas HealthCare System, School of Medicine, University of North Carolina at Chapel Hill, Charlotte, NC, USA.
| | - R B Reilly
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland.,School of Engineering, Trinity College Dublin, Dublin, Ireland
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27
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Handgrip fatiguing exercise can provide objective assessment of cancer-related fatigue: a pilot study. Support Care Cancer 2018; 27:229-238. [PMID: 29936623 DOI: 10.1007/s00520-018-4320-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 06/13/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE As a subjective symptom, cancer-related fatigue is assessed via patient-reported outcomes. Due to the inherent bias of such evaluation, screening and treatment for cancer-related fatigue remains suboptimal. The purpose is to evaluate whether objective cancer patients' hand muscle mechanical parameters (maximal force, critical force, force variability) extracted from a fatiguing handgrip exercise may be correlated to the different dimensions (physical, emotional, and cognitive) of cancer-related fatigue. METHODS Fourteen women with advanced breast cancer, still under or having previously received chemotherapy within the preceding 3 months, and 11 healthy women participated to the present study. Cancer-related fatigue was first assessed through the EORTC QLQ-30 and its fatigue module. Fatigability was then measured during 60 maximal repeated handgrip contractions. The maximum force, critical force (asymptote of the force-time evolution), and force variability (root mean square of the successive differences) were extracted. Multiple regression models were performed to investigate the influence of the force parameters on cancer-related fatigue's dimensions. RESULTS The multiple linear regression analysis evidenced that physical fatigue was best explained by maximum force and critical force (r = 0.81; p = 0.029). The emotional fatigue was best explained by maximum force, critical force, and force variability (r = 0.83; p = 0.008). The cognitive fatigue was best explained by critical force and force variability (r = 0.62; p = 0.035). CONCLUSION The handgrip maximal force, critical force, and force variability may offer objective measures of the different dimensions of cancer-related fatigue and could provide a complementary approach to the patient reported outcomes.
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28
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da Silva Alves R, Iunes DH, Pereira IC, Borges JBC, Nogueira DA, Silva AM, Lobato DFM, Carvalho LC. Influence of Exergaming on the Perception of Cancer-Related Fatigue. Games Health J 2018; 6:119-126. [PMID: 28418751 DOI: 10.1089/g4h.2016.0051] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Exercise is recommended for cancer patients to reduce fatigue and improve quality of life. This study's aim is to evaluate the influence of an exergaming protocol on cancer-related fatigue, muscle fatigue, and muscle strength in cancer patients. MATERIALS AND METHODS We conducted a quasi-experimental control study using exergaming in all groups through an Xbox360 Kinect™ console, two to three times per week, for 20 sessions. Three groups were created: cancer patients in chemotherapy and/or radiotherapy group (CRG; n:15), cancer patients after chemotherapy and/or radiotherapy (CAG; n:15), and a control group (CG; n:15). They were assessed for cancer-related fatigue using the fatigue subscale of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. To assess dorsiflexor and plantar flexor muscle functioning, we used median frequency (MDF) of the surface electromyography and muscle strength using a dynamometer. The assessments were performed preintervention (EV0), after 10 sessions (EV1), and after 20 sessions (EV2). RESULTS With an exergaming protocol, CRG and CAG showed a reduction in related fatigue compared with CG (P < 0.01). The CRG group saw an increase in maximal voluntary isometric contraction in right plantar flexor muscles and dorsiflexor muscles, as well as an increase in the MDF of both medial gastrocnemius muscles and the left tibialis anterior muscle of the CAG. For other analyses done, the differences were observed during exergaming. CONCLUSIONS Exergaming demonstrated efficacy in reducing cancer patients' fatigue, including muscle fatigue, and increasing muscle strength in patients' legs.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Ferreira Moreira Lobato
- 1 Bioscience Program, Federal University of Alfenas , Alfenas, Brazil .,2 Physical Therapy Course, Federal University of Alfenas , Alfenas, Brazil
| | - Leonardo Cesar Carvalho
- 1 Bioscience Program, Federal University of Alfenas , Alfenas, Brazil .,2 Physical Therapy Course, Federal University of Alfenas , Alfenas, Brazil
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29
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Mijwel S, Backman M, Bolam KA, Olofsson E, Norrbom J, Bergh J, Sundberg CJ, Wengström Y, Rundqvist H. Highly favorable physiological responses to concurrent resistance and high-intensity interval training during chemotherapy: the OptiTrain breast cancer trial. Breast Cancer Res Treat 2018; 169:93-103. [PMID: 29349712 PMCID: PMC5882634 DOI: 10.1007/s10549-018-4663-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 12/19/2022]
Abstract
Background Advanced therapeutic strategies are often accompanied by significant adverse effects, which warrant equally progressive countermeasures. Physical exercise has proven an effective intervention to improve physical function and reduce fatigue in patients undergoing chemotherapy. Effects of high-intensity interval training (HIIT) in this population are not well established although HIIT has proven effective in other clinical populations. The aim of the OptiTrain trial was to examine the effects of concurrent resistance and high-intensity interval training (RT-HIIT) or concurrent moderate-intensity aerobic and high-intensity interval training (AT-HIIT), to usual care (UC) on pain sensitivity and physiological outcomes in patients with breast cancer during chemotherapy. Methods Two hundred and forty women were randomized to 16 weeks of RT-HIIT, AT-HIIT, or UC. Outcomes: cardiorespiratory fitness, muscle strength, body mass, hemoglobin levels, and pressure-pain threshold. Results Pre- to post-intervention, RT-HIIT (ES = 0.41) and AT-HIIT (ES = 0.42) prevented the reduced cardiorespiratory fitness found with UC. Handgrip strength (surgery side: RT-HIIT vs. UC: ES = 0.41, RT-HIIT vs. AT-HIIT: ES = 0.28; non-surgery side: RT-HIIT vs. UC: ES = 0.35, RT-HIIT vs. AT-HIIT: ES = 0.22) and lower-limb muscle strength (RT-HIIT vs. UC: ES = 0.66, RT-HIIT vs. AT-HIIT: ES = 0.23) were significantly improved in the RT-HIIT. Increases in body mass were smaller in RT-HIIT (ES = − 0.16) and AT-HIIT (ES = − 0.16) versus UC. RT-HIIT reported higher pressure-pain thresholds than UC (trapezius: ES = 0.46, gluteus: ES = 0.53) and AT-HIIT (trapezius: ES = 0.30). Conclusion Sixteen weeks of RT-HIIT significantly improved muscle strength and reduced pain sensitivity. Both exercise programs were well tolerated and were equally efficient in preventing increases in body mass and in preventing declines in cardiorespiratory fitness. These results highlight the importance of implementing a combination of resistance and high-intensity interval training during chemotherapy for women with breast cancer.
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Affiliation(s)
- Sara Mijwel
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. .,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Malin Backman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Division of Nursing, Karolinska University Hospital, Stockholm, Sweden
| | - Kate A Bolam
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Emil Olofsson
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Jessica Norrbom
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.,Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Carl Johan Sundberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Division of Nursing, Karolinska University Hospital, Stockholm, Sweden
| | - Helene Rundqvist
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
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30
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Neuromuscular fatigue during exercise: Methodological considerations, etiology and potential role in chronic fatigue. Neurophysiol Clin 2017; 47:95-110. [PMID: 28434551 DOI: 10.1016/j.neucli.2017.03.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The term fatigue is used to describe a distressing and persistent symptom of physical and/or mental tiredness in certain clinical populations, with distinct but ultimately complex, multifactorial and heterogenous pathophysiology. Chronic fatigue impacts on quality of life, reduces the capacity to perform activities of daily living, and is typically measured using subjective self-report tools. Fatigue also refers to an acute reduction in the ability to produce maximal force or power due to exercise. The classical measurement of exercise-induced fatigue involves neuromuscular assessments before and after a fatiguing task. The limitations and alternatives to this approach are reviewed in this paper in relation to the lower limb and whole-body exercise, given the functional relevance to locomotion, rehabilitation and activities of daily living. It is suggested that under some circumstances, alterations in the central and/or peripheral mechanisms of fatigue during exercise may be related to the sensations of chronic fatigue. As such, the neurophysiological correlates of exercise-induced fatigue are briefly examined in two clinical examples where chronic fatigue is common: cancer survivors and people with multiple sclerosis. This review highlights the relationship between objective measures of fatigability with whole-body exercise and perceptions of fatigue as a priority for future research, given the importance of exercise in relieving symptoms of chronic fatigue and/or overall disease management. As chronic fatigue is likely to be specific to the individual and unlikely to be due to a simple biological or psychosocial explanation, tailored exercise programmes are a potential target for therapeutic intervention.
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32
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Morgado PC, Giorlando A, Castro M, Navigante A. Relationship between weight loss and parameters of skeletal muscle function in patients with advanced cancer and fatigue. Support Care Cancer 2016; 24:3961-6. [DOI: 10.1007/s00520-016-3236-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/17/2016] [Indexed: 01/10/2023]
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33
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Cai B, Allexandre D, Rajagopalan V, Jiang Z, Siemionow V, Ranganathan VK, Davis MP, Walsh D, Dai K, Yue GH. Evidence of significant central fatigue in patients with cancer-related fatigue during repetitive elbow flexions till perceived exhaustion. PLoS One 2014; 9:e115370. [PMID: 25532032 PMCID: PMC4274034 DOI: 10.1371/journal.pone.0115370] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 11/21/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To investigate whether fatigue induced by an intermittent motor task in patients with cancer-related fatigue (CRF) is more central or peripheral. METHODS Ten patients with CRF who were off chemo and radiation therapies and 14 age-matched healthy controls were enrolled. Participants completed a Brief Fatigue Inventory (BFI) and performed a fatigue task consisting of intermittent elbow-flexion contractions at submaximal (40% maximal voluntary contraction) intensity till self-perceived exhaustion. Twitch force was elicited by an electrical stimulation applied to the biceps brachii muscle. The relative degree of peripheral (muscle) vs. central contribution to fatigue induced by the intermittent motor task (IMT) was assessed using twitch force ratio (TF ratio) defined as post IMT twitch force to pre IMT twitch force. The total number of trials (intermittent contractions) and total duration of all trials performed by each subject were also quantified. RESULTS BFI scores were higher (p < 0.001) in CRF than controls, indicating greater feeling of fatigue in CRF patients than controls. A significantly smaller number of trials and shorter total duration of the trials (p < 0.05) were observed in CRF than control participants. The TF ratio (0.81 ± 0.05) in CRF was higher (p < 0.05) compared with that of controls (0.62 ± 0.05), suggesting CRF patients experienced a significantly lower degree of muscle (peripheral) fatigue at the time of perceived exhaustion. CONCLUSION Consistent with prior findings for fatigue under submaximal sustained contraction, our results indicate that motor fatigue in CRF is more of central than peripheral origin during IMT. Significant central fatigue in CRF patients limits their ability to prolong motor performance.
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Affiliation(s)
- Bin Cai
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
- Institute of Rehabilitation Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China
| | - Didier Allexandre
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, United States of America
| | - Venkateswaran Rajagopalan
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, United States of America
| | - Zhiguo Jiang
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, United States of America
| | - Vlodek Siemionow
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
| | - Vinoth K. Ranganathan
- Department of Physical Medicine & Rehabilitation, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
| | - Mellar P. Davis
- The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
| | - Declan Walsh
- The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
| | - Kerong Dai
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, PRC, 1954 Huashan Road, Shanghai 200030, China
| | - Guang H. Yue
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, United States of America
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
- Department of Physical Medicine & Rehabilitation, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
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Abstract
There is an interdependent relationship between insomnia and fatigue in the medical literature, but both remain distinct entities. Insomnia entails problematic sleep initiation, maintenance, or restoration with an accompanying decrease in perceived daytime function. Lethargy is a symptom that has a wide differential diagnosis that heavily overlaps with cancer-related fatigue; however, insomnia may contribute to worsened fatigue and lethargy in cancer patients. Insomnia is a major risk factor for mood disturbances such as depression, which may also contribute to lethargy in this at-risk population. The pathophysiology of fatigue and insomnia is discussed in this review, including their differential diagnoses as well as the emerging understanding of the roles of neurotransmitters, branched-chain amino acids, and inflammatory cytokines. Treatment approaches for insomnia and fatigue are also discussed and reviewed, including the role of hypnotics, psychotropics, hormonal agents, and alternative therapies.
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35
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Electromyogram features during linear torque decrement and their changes with fatigue. Eur J Appl Physiol 2014; 114:2105-17. [DOI: 10.1007/s00421-014-2928-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
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36
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Muls AC. Acta Oncologica Lecture. Gastrointestinal consequences of cancer treatment and the wider context: a bad gut feeling. Acta Oncol 2014; 53:297-306. [PMID: 24460087 DOI: 10.3109/0284186x.2013.873140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The percentage of people living with a diagnosis of cancer is rising globally. Between 20% and 25% of people treated for cancer experience a consequence of cancer which has an adverse impact on the quality of their life. Gastrointestinal (GI) symptoms are the most common of all consequences of cancer treatment and have the greatest impact on daily activity. PATHOPHYSIOLOGY OF LONG-TERM BOWEL DAMAGE AFTER PELVIC RADIOTHERAPY: Long-term damage to the bowel after radiotherapy is mediated by ischaemic changes and fibrosis. Each fraction of radiotherapy causes a series of repetitive injuries to the intestinal tissue resulting in an altered healing process, which affects the integrity of the repair and changes the architecture of the bowel wall. THE NATURE OF GI SYMPTOMS THAT DEVELOP: Patient-reported outcome measures show that diarrhoea, urgency, increased bowel frequency, tenesmus and flatulence are the five most prevalent GI symptoms with a moderate or severe impact on patients' daily lives after treatment with pelvic radiotherapy. Many patients also experience fatigue, urinary problems and have sexual concerns. SYSTEMATIC ASSESSMENT AND MANAGEMENT: The complex nature of those symptoms warrants systematic assessment and management. The use of a tested algorithm can assist in achieving this. The most common contributing factors to ongoing bowel problems after pelvic radiotherapy are small intestinal bacterial overgrowth, bile acid malabsorption, pancreatic insufficiency, rectal bleeding and its impact on bone health. THE WIDER CONTEXT Symptom burden, socio-psychosocial impact, memory and cognitive function, fatigue, urinary problems and sexual concerns need to be taken into account when thinking about consequences of cancer treatment. CONCLUSION As our understanding of consequences of cancer treatments continues to emerge and encompass a wide variety of specialties, a holistic, multifaceted and multidisciplinary approach is required to manage those consequences long-term.
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Salhi B, Huysse W, Van Maele G, Surmont VF, Derom E, van Meerbeeck JP. The effect of radical treatment and rehabilitation on muscle mass and strength: a randomized trial in stages I-III lung cancer patients. Lung Cancer 2014; 84:56-61. [PMID: 24560331 DOI: 10.1016/j.lungcan.2014.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/08/2014] [Accepted: 01/14/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Little is known about the impact of an oncological treatment on muscle mass and strength in patients with lung cancer and the impact of a subsequent rehabilitation program. This study investigates the effect of radical treatment and post-treatment pulmonary rehabilitation on muscle mass and strength in patients with lung cancer and the relationship between muscle mass and strength. METHODS Lung cancer patients, candidate for radical treatment, were randomly (2:1) allocated after radical treatment to either standard follow up (CON) or a 12-week rehabilitation training program (RT). Muscle mass was estimated by bioelectric impedance and CT-scan. Muscle strength was estimated by measuring quadriceps force (QF) with a hand held dynamometer. All variables were measured before (M1) and after radical treatment (M2), and at the earliest 12 weeks after randomization (M3). Data are presented as means with standard deviation. RESULTS 45 lung cancer patients (age: 65 years (9)) participated in the study. At M2, both muscle cross sectional area (MCSA) and QF were significantly decreased (p<0.05). 28 patients were randomized. 13/18 RT and 9/10 CON patients ended the trial. At M3, RT-patients improved significantly their MCSA compared to CON-patients (ΔMCSA: 6 cm(2) (6) (p=0.003) vs. 1cm(2) (11) (p=0.8)). CONCLUSION Muscle mass and strength: (1) are decreased at presentation in a substantial part of lung cancer patients; (2) are significantly negatively affected by radical treatment and (3) completely recover after a 12 week structured rehabilitation program, whereas a further decline was observed in CON-patients.
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Affiliation(s)
- B Salhi
- Department of Respiratory Medicine, Ghent University Hospital, Belgium.
| | - W Huysse
- Department of Medical Imaging, Ghent University Hospital, Belgium
| | - G Van Maele
- Biostatistical Unit, Faculty of Medicine, Ghent University, Belgium
| | - V F Surmont
- Department of Respiratory Medicine, Ghent University Hospital, Belgium
| | - E Derom
- Department of Respiratory Medicine, Ghent University Hospital, Belgium
| | - J P van Meerbeeck
- Department of Respiratory Medicine, Ghent University Hospital, Belgium; Thoracic Oncology, MOCA, Antwerp University Hospital, Belgium
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Kisiel-Sajewicz K, Siemionow V, Seyidova-Khoshknabi D, Davis MP, Wyant A, Ranganathan VK, Walsh D, Yan JH, Hou J, Yue GH. Myoelectrical manifestation of fatigue less prominent in patients with cancer related fatigue. PLoS One 2013; 8:e83636. [PMID: 24391800 PMCID: PMC3877402 DOI: 10.1371/journal.pone.0083636] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/05/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE A lack of fatigue-related muscle contractile property changes at time of perceived physical exhaustion and greater central than peripheral fatigue detected by twitch interpolation technique have recently been reported in cancer survivors with fatigue symptoms. Based on these observations, it was hypothesized that compared to healthy people, myoelectrical manifestation of fatigue in the performing muscles would be less significant in these individuals while sustaining a prolonged motor task to self-perceived exhaustion (SPE) since their central fatigue was more prominent. The purpose of this study was to test this hypothesis by examining electromyographic (EMG) signal changes during fatiguing muscle performance. METHODS Twelve individuals who had advanced solid cancer and cancer-related fatigue (CRF), and 12 age- and gender-matched healthy controls performed a sustained elbow flexion at 30% maximal voluntary contraction till SPE. Amplitude and mean power frequency (MPF) of EMG signals of the biceps brachii, brachioradialis, and triceps brachii muscles were evaluated when the individuals experienced minimal, moderate, and severe fatigue. RESULTS CRF patients perceived physical "exhaustion" significantly sooner than the controls. The myoelectrical manifestation of muscular fatigue assessed by EMG amplitude and MPF was less significant in CRF than controls. The lower MPF even at minimal fatigue stage in CRF may indicate pathophysiologic condition of the muscle. CONCLUSIONS CRF patients experience less myoelectrical manifestation of muscle fatigue than healthy individuals near the time of SPE. The data suggest that central nervous system fatigue plays a more important role in limiting endurance-type of motor performance in patients with CRF.
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Affiliation(s)
- Katarzyna Kisiel-Sajewicz
- Department of Biomedical Engineering, the Lerner Research Institute, the Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Vlodek Siemionow
- Department of Biomedical Engineering, the Lerner Research Institute, the Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Physical Medicine and Rehabilitation, the Neurological Institute, the Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Dilara Seyidova-Khoshknabi
- The Harry R. Horvitz Center for Palliative Medicine, the Taussig Cancer Center, the Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Mellar P. Davis
- The Harry R. Horvitz Center for Palliative Medicine, the Taussig Cancer Center, the Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Alexandria Wyant
- Department of Biomedical Engineering, the Lerner Research Institute, the Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Vinoth K. Ranganathan
- Department of Biomedical Engineering, the Lerner Research Institute, the Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Physical Medicine and Rehabilitation, the Neurological Institute, the Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Declan Walsh
- The Harry R. Horvitz Center for Palliative Medicine, the Taussig Cancer Center, the Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Jin H. Yan
- Institute of Affective and Social Neuroscience, Shenzhen University, Shenzhen; Department of Psychology, Tsinghuan University, Beijing, China
- * E-mail: (GHY); (JHY)
| | - Juliet Hou
- Department of Physical Medicine and Rehabilitation, the Neurological Institute, the Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Guang H. Yue
- Department of Biomedical Engineering, the Lerner Research Institute, the Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Physical Medicine and Rehabilitation, the Neurological Institute, the Cleveland Clinic, Cleveland, Ohio, United States of America
- Kessler Foundation Research Center, West Orange, New Jersey, United States of America
- * E-mail: (GHY); (JHY)
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Neefjes ECW, van der Vorst MJDL, Blauwhoff-Buskermolen S, Verheul HMW. Aiming for a better understanding and management of cancer-related fatigue. Oncologist 2013; 18:1135-43. [PMID: 24037979 DOI: 10.1634/theoncologist.2013-0076] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cancer-related fatigue (CRF) is a serious symptom of patients with cancer and deteriorates their daily quality of life. Whereas fatigue is a common problem in the general population, with a prevalence of about 30%, up to 99% of patients with cancer have fatigue of more intense severity. CRF is directly related to the biology of cancer, but it can also be caused by anticancer treatment. We reviewed current evidence about the potential pathophysiological mechanisms causing CRF. Clinical methods to determine the presence and severity of CRF and potential treatment options to reduce CRF will be discussed. After reading this review, the reader will have knowledge of the current understanding of CRF and will be able to give evidence-based advice to patients with CRF.
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Kilgour RD, Vigano A, Trutschnigg B, Lucar E, Borod M, Morais JA. Handgrip strength predicts survival and is associated with markers of clinical and functional outcomes in advanced cancer patients. Support Care Cancer 2013; 21:3261-70. [DOI: 10.1007/s00520-013-1894-4] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 06/25/2013] [Indexed: 01/05/2023]
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Navigante A, Morgado PC, Casbarien O, Delgado NL, Giglio R, Perman M. Relationship between weakness and phase angle in advanced cancer patients with fatigue. Support Care Cancer 2013; 21:1685-90. [DOI: 10.1007/s00520-012-1714-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 12/28/2012] [Indexed: 12/21/2022]
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