Developing a community program on cancer pain and fatigue

Reduced Cancer-Related Fatigue after Tablet-Based Exercise Education for Patients

AIM

Exercise can be an effective treatment for cancer-related fatigue, but exercise is not prescribed for many cancer patients. Our specific aim was to compare usual care and a tablet-based fatigue education and prescription program for effects on level of fatigue (primary outcome) and satisfaction with fatigue and amount of exercise (secondary outcomes).

METHODS

In a four-week pretest/posttest randomized study, 279 patients with cancer completed a touch screen fatigue assessment and daily paper-based activity logs. The experimental group also had access to FatigueUCope, a tablet-based multimedia education intervention focused on exercise as therapy for fatigue.

RESULTS

In total, 94% of intervention group accessed FatigueUCope. Controlling for baseline fatigue, compared to the usual-care group, the experimental group reported lower fatigue scores (P = .02). Neither satisfaction with fatigue nor exercise level was significantly different between groups, but not all activity logs were returned. None of the patients reported adverse effects.

CONCLUSION

Objective indicators of exercise are warranted in future studies to examine whether exercise is indeed the mechanism of the FatigueUCope effect and determine the clinical utility of this intervention. This brief, engaging tablet-based multimedia education and prescription program has promise to help patients recognize the benefits of exercise to manage cancer-related fatigue.

Effectiveness of a clinical intervention to eliminate barriers to pain and fatigue management in oncology

BACKGROUND

Pain and fatigue are recognized as critical symptoms that impact quality of life (QOL) in cancer, particularly in palliative care settings. Barriers to pain and fatigue relief have been classified into three categories: patient, professional, and system barriers. The overall objective of this study was to test the effects of a clinical intervention on reducing barriers to pain and fatigue management in oncology.

METHODS

This longitudinal, three-group, quasi-experimental study was conducted in three phases: phase 1 (usual care), phase 2 (intervention), and phase 3 (dissemination). A sample of 280 patients with breast, lung, colon, or prostate cancers, stage III and IV disease (80%), and a pain and/or fatigue of 4 or more (moderate to severe) were recruited. The intervention group received four educational sessions on pain/fatigue assessment and management, whereas the control group received usual care. Pain and fatigue barriers and patient knowledge were measured at baseline, 1 month, and 3 months post-accrual for all phases. A 3 × 2 repeated measures statistical design was utilized to derive a priori tests of immediate effects (baseline to 1 month) and sustained effects (baseline or 1 month to 3 months) for each major outcome variable, subscale, and/or scale score.

RESULTS

There were significant immediate and sustained effects of the intervention on pain and fatigue barriers as well as knowledge. Measurable improvements in QOL were found in physical and psychological well-being only.

CONCLUSION

A clinical intervention was effective in reducing patient barriers to pain and fatigue management, increasing patient knowledge regarding pain and fatigue, and is feasible and acceptable to patients.

Development of an Educational Intervention for Cancer-Related Fatigue

Introduction:

Fatigue is one of the most common and disabling symptoms experienced during cancer treatment. Educational interventions are used by health professionals, such as occupational therapists, to manage cancer-related fatigue; however, there is a lack of information about the content, format and effectiveness of educational interventions in managing fatigue. This paper presents the development and structure of CAN-FIT, a theoretically driven cancer-related fatigue educational intervention, and a preliminary study of the intervention's feasibility and acceptability.

Preliminary evaluation:

The CAN-FIT programme was piloted with two groups with a total of nine radiotherapy patients. Patients completed a confidential evaluation form and were asked qualitative questions to provide feedback about the programme. The results of the preliminary study indicated that the intervention was acceptable to and feasible for participants. The participants reported that they received a high level of new information and skills from the education sessions and would recommend the sessions to others. Small modifications to programme components were made based on participant feedback.

Conclusion:

The CAN-FIT programme provided a feasible structured educational intervention for the management of cancer-related fatigue, which was acceptable to the participant sample. A randomised controlled trial is required to provide evidence of its effectiveness among the wider radiotherapy population.

Reducing patient barriers to pain and fatigue management

CONTEXT

Pain and fatigue are recognized as critical symptoms that impact the quality of life of cancer patients. The barriers to pain and fatigue relief have been classified into three categories: patient, professional, and system barriers.

OBJECTIVES

The overall objective of this trial as to test the effects of the "Passport to Comfort" intervention on reducing barriers to pain and fatigue management for ambulatory care cancer patients.

METHODS

This quasi-experimental, comparative study uses a Phase 1 control group of usual care followed sequentially by a Phase 2 intervention group in which educational and system-change efforts were directed toward improved pain and fatigue management. A sample of 187 cancer patients with breast, lung, colon, or prostate cancers, and a pain and/or fatigue rating of 4 or more (moderate to severe), were recruited. Patients in the intervention group received four educational sessions on pain/fatigue assessment and management, whereas patients in the control group received usual care. Pain and fatigue barriers and patient knowledge were measured at baseline, one month, and three months post-accrual.

RESULTS

Patients in the intervention group experienced significant improvements in pain and fatigue measures immediately postintervention, and these improvements were sustained over time.

CONCLUSION

The "Passport to Comfort" intervention was effective in reducing patient barriers to pain and fatigue management as well as in increasing patient knowledge regarding pain and fatigue. This intervention demonstrates innovation by translating the evidence-based guidelines for pain and fatigue as developed by the National Comprehensive Cancer Network into practice.

Patient-related barriers to fatigue communication in cancer patients receiving active treatment

OBJECTIVE

To explore barriers to reporting fatigue in cancer patients receiving active treatment and the significant factors associated with those barriers from fatigue characteristics (i.e., intensity, duration, and interference with daily life), to demographic characteristics and disease/treatment variables.

METHODS

Patients with various types of cancer (n = 288) were recruited from an outpatient chemotherapy center, and from seven oncology and hematology units in a teaching hospital in northern Taiwan. Data were collected using the Fatigue Management Barriers Questionnaire to explore barriers to fatigue communication.

RESULTS

Fear of distracting the doctor was rated as the highest barrier of reporting fatigue. The degree of fatigue interference with daily life by patients was associated with the willingness to report fatigue. Patients with gastrointestinal cancer experienced more barriers to reporting fatigue than those with hematological cancer. Patients without religion perceived the highest level of barriers to fatigue communication. Outpatients had higher levels of concern than inpatients.

CONCLUSIONS

Discussion with patients about their high level of perceived fatigue barriers before implementing patient education is recommended. Assessing fatigue interference with daily life and identifying factors associated with barriers to reporting fatigue (i.e., type of cancer, religion, and the setting for receiving treatment) are suggested in order to provide better fatigue management in clinical settings.

Self care and end of life care in advanced cancer: literature review

BACKGROUND

Self care is a key feature of health care policy in the UK. It has been suggested that self care by patients with cancer improves quality of life, symptom management, and patient satisfaction. However, little is known about self care and end of life care.

OBJECTIVES

This review sets out to find out what is known about how people experiencing end of life care manage their illness themselves, in the advanced stages of their disease.

METHODS

A systematic review was conducted; searching key databases; extracting relevant literature, using RefMan, NVIVO; grading, analysing, and appraising the literature.

RESULTS

Eighteen articles were included in the review. Themes identified were; interventions for end of life care; self care behaviours used by patients; factors that prevent patients to self care.

CONCLUSION

The nurses' role in supporting self care for people with advanced cancer is important. The review identifies various ways nurses can empower patients to self care related to oncology.

Implementing the Fatigue Guidelines at one NCCN member institution: process and outcomes

Fatigue, despite being the most common and distressing symptom in cancer, is often unrelieved because of numerous patient, provider, and system barriers. The overall purpose of this 5-year prospective clinical trial is to translate the NCCN Cancer-Related Fatigue Clinical Practice Guidelines in Oncology and NCCN Adult Cancer Pain Clinical Practice Guidelines in Oncology into practice and develop a translational interventional model that can be replicated across settings. This article focuses on one NCCN member institution's experience related to the first phase of the NCCN Cancer-Related Fatigue Guidelines implementation, describing usual care compared with evidence-based guidelines. Phase 1 of this 3-phased clinical trial compared the usual care of fatigue with that administered according to the NCCN guidelines. Eligibility criteria included age 18 years or older; English-speaking; diagnosed with breast, lung, colon, or prostate cancer; and fatigue and/or pain ratings of 4 or more on a 0 to 10 screening scale. Research nurses screened all available subjects in a cancer center medical oncology clinic to identify those meeting these criteria. Instruments included the Piper Fatigue Scale, a Fatigue Barriers Scale, a Fatigue Knowledge Scale, and a Fatigue Chart Audit Tool. Descriptive and inferential statistics were used in data analysis. At baseline, 45 patients had fatigue only (> or = 4) and 24 had both fatigue and pain (> or = 4). This combined sample (N = 69) was predominantly Caucasian (65%), female (63%), an average of 60 years old, diagnosed with stage 3 or 4 breast cancer, and undergoing treatment (82%). The most common barriers noted were patients' belief that physicians would introduce the subject of fatigue if it was important (patient barrier); lack of fatigue documentation (professional barrier); and lack of supportive care referrals (system barrier). Findings showed several patient, professional, and system barriers that distinguish usual care from that recommended by the NCCN Cancer-Related Fatigue Guidelines. Phase 2, the intervention model, is designed to decrease these barriers and improve patient outcomes over time, and is in progress.

Meeting information needs on cancer-related fatigue: an exploration of views held by Italian patients and nurses

BACKGROUND

Interest in cancer-related fatigue has been growing over the last two decades and efforts have been dedicated to investigate this topic. However, research addressing the adequacy of educational resources for patients with this distressing and common symptom is lacking. Only one study has been undertaken and this explored Swiss and British patients' views.

MATERIALS AND METHODS

The current study replicated and extended the study previously undertaken in the United Kingdom (UK) and Switzerland. It sought views on the adequacy of materials on cancer-related fatigue available to patients with cancer living in Italy, and to determine the educational preferences and needs of Italian patients with cancer-related fatigue. These were attained through conduct of two focus groups. One was undertaken with Italian patients and the other with a group of Italian nurses.

MAIN RESULTS

Findings from this study supported patients' desire for timely, accurate and individualised information. Barriers to effective fatigue education included the limited dialogue regarding fatigue initiated in clinical settings. It appeared that nurses and patients held different priorities in symptom management. Further, it was acknowledged that there was often insufficient time to inform patients adequately about fatigue. Participants considered written materials as helpful complements to oral information, thus supporting the provision of information in both forms. However, it was clear that fewer written resources concerning cancer-related fatigue were available in Italy compared to either in Switzerland or in the UK.

CONCLUSION

The study supported the view within the current literature that whilst cancer-related fatigue is recognised as a frequent and disruptive symptom, patient education about this symptom and its management still needs to be enhanced. The resources available to educate patients about cancer-related fatigue should be improved and made more accessible to patients who experience it.

A review of literature about involving people affected by cancer in research, policy and planning and practice

OBJECTIVE

To systematically review the literature on involving people affected by cancer in healthcare research, policy and planning and practice.

METHODS

Database searches, cited author, and grey literature searches were conducted.

RESULTS

131 documents were included. Rationales for the agenda of involvement represent two polar characteristics of modernity: individualism and collectivism. In research, people acted as advocates, strategists, advisors, reviewers and as participatory researchers. In policy and planning, people were involved in one-off involvement exercises and in longer-term partnerships. Men, those with rare cancers, children, and people who are socially deprived have been rarely involved. There is little research evidence about the impact of involvement. Training and information, resources and a change in attitudes and roles are required to implement an agenda of involvement.

CONCLUSION

The USA, the UK, followed by Canada and Australia have promoted an agenda of involvement.

PRACTICE IMPLICATIONS

A dissemination strategy to share good practice; involvement of all types of people; an individualised and flexible approach; training, resources and a shift in thinking from paternalism towards partnership working are required. More research is needed about the impact of involvement and relationships between rationales for involvement and implementation.

Supportive intervention for fatigue in patients undergoing chemotherapy: a randomized controlled trial

This study evaluated a supportive intervention for fatigue in patients undergoing chemotherapy. One hundred three chemotherapy-naïve patients were recruited, stratified by treatment regimen, and randomly allocated to intervention or usual care. The intervention was conducted over three months. Recipients were provided with an investigator-designed information pack and Fatigue Diary that they completed during the week following each treatment. Additionally, support nurses visited them monthly at home. They assessed fatigue, provided psychological support, and coached participants in self-care. The intervention group reported significantly less fatigue (P < 0.05), lower associated distress (P < 0.05), and less impact of fatigue on valued pastimes (P < 0.05) than the control group. Further, they reported significantly less anxiety (P < 0.05) and depression (P < 0.05) and displayed more adaptive coping (P < 0.05). The intervention enabled patients to adapt to living with fatigue and contributed to their psychological/emotional well-being and ability to cope with their illness and treatment.

Rehabilitation and the older cancer patient

Older persons with cancer can often benefit from rehabilitative care. Rehabilitation may be of benefit to the patient whether or not their malignancy is curable. Rehabilitative programs must be tailored to the patient's abilities, endurance, prognosis, and individual goals.

Managing cancer side effects to improve quality of life: a cancer psychoeducation program

This study aimed to develop and pilot test a community-based education program that addresses the prevention and management of the major side effects of cancer and its treatment according to a Patient Active Empowerment Model. This piloted program evaluated the health and quality of life outcomes for patients with cancer. The program was implemented through a half-day patient education conference. This conference included clinical information concerning disease and treatment-related side effects, an overview of treatment methods, information to help improve communication between the patient and healthcare team, education materials and experiences to empower patients and caregivers, and integration of specific mind-body techniques to strengthen key educational messages and reinforce the importance of side effect management. A total of 32 patients completed both the program and psychometric assessments on the day of the intervention and 30 days later. The participants were primarily white women with an average age of 57 years. Breast cancer was the most prevalent type of cancer experienced by the participants. The pilot results for this small sample showed that from baseline to follow-up evaluation, patients reported significant decreases in depressive symptoms and problems with work or other daily activities that resulted from emotional distress. Some improvements in health and well-being were greater for those who had not experienced fever or infection, those who had no children, and those who were working. Participants indicated that the program was useful in its ability to help them manage treatment side effects. Although the findings presented in this article are based only on a pilot program evaluation and a small sample, they do suggest that the program may be effective in educating patients about specific cancer side effects and empowering them to cope more effectively with their illness. Results showing that subgroups of individuals may have benefited more from the intervention provide important information about specific components of the program that may be particularly salient and potential changes that might be usefully implemented.