1
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Irestorm E, Schouten-van Meeteren AYN, van Gorp M, Twisk JWR, van Santen HM, Partanen M, Grootenhuis MA, van Litsenburg RRL. The development of fatigue after treatment for pediatric brain tumors does not differ between tumor locations. Pediatr Blood Cancer 2024; 71:e31028. [PMID: 38698502 DOI: 10.1002/pbc.31028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Children and adolescents treated for a brain tumor suffer from more fatigue than survivors of other types of childhood cancer. As tumor location might be predictive of fatigue, our aim was to investigate the longitudinal development of fatigue in children with brain tumors and risk factors for fatigue separately for different tumor locations. METHODS Fatigue was assessed 1235 times for 425 participants. Self-report versions of PedsQL Multidimensional Fatigue Scale were used to repeatedly assess fatigue from the end of treatment up to 8 years later. Mixed models were used to analyze fatigue over time and determinants separately for infratentorial (N = 205), supratentorial hemispheric (N = 91), and supratentorial midline tumors (N = 129). RESULTS Cognitive fatigue worsened with time, while sleep-rest and general fatigue first decreased and then increased. There was no difference in fatigue between the tumor locations, but the risk factors differed when stratified by location. Radiotherapy was associated with more fatigue for infratentorial tumors, and centralization of care was associated with less fatigue for the supratentorial midline tumors. For supratentorial hemispheric tumors, female sex was associated with more fatigue. Higher parental education was associated with less fatigue regardless of tumor location. CONCLUSIONS The development of fatigue seems to be more related to sociodemographic and treatment variables than to tumor location. Healthcare providers need to be aware that fatigue may develop in the years following end of treatment, and that patients with a low/middle educational family background might be more vulnerable and in need of targeted support.
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Affiliation(s)
- Elin Irestorm
- Faculty of Medicine, Department of Paediatrics, Lund University, Lund, Sweden
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Marloes van Gorp
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, Utrecht, The Netherlands
| | - Marita Partanen
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Raphaele R L van Litsenburg
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Holthuijsen DDB, van Roekel EH, Bours MJL, Ueland PM, Breukink SO, Janssen-Heijnen MLG, Keulen ETP, Brezina S, Gigic B, Peoples AR, Ulrich CM, Ulvik A, Weijenberg MP, Eussen SJPM. Longitudinal associations of plasma kynurenines and ratios with fatigue and quality of life in colorectal cancer survivors up to 12 months post-treatment. Int J Cancer 2024. [PMID: 38783597 DOI: 10.1002/ijc.34992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 05/25/2024]
Abstract
Fatigue is prevalent in colorectal cancer (CRC) survivors, impacting their health-related quality of life (HRQoL). Inflammation-induced activation of the kynurenine pathway may play a role in cancer-related fatigue and HRQoL, but evidence is scarce. Therefore, we aimed to investigate longitudinal associations of plasma tryptophan, kynurenines, and ratios with fatigue and HRQoL in CRC survivors up to 12 months post-treatment. Repeated measurements at 6 weeks, 6 months, and 12 months post-treatment were performed in 249 stage I-III CRC survivors. Plasma tryptophan and eight kynurenines were analyzed using liquid chromatography-tandem mass spectrometry (LC/MS-MS). Fatigue and HRQoL outcomes were evaluated using validated questionnaires. Confounder-adjusted linear mixed models were conducted to analyze longitudinal associations, with false discovery rate (FDR) correction. Higher tryptophan (Trp), kynurenic acid (KA), and xanthurenic acid (XA) concentrations, as well as a higher kynurenic acid-to-quinolinic acid ratio (KA/QA), were associated with less fatigue and better functioning, while a higher kynurenine-to-tryptophan ratio (KTR) and 3-hydroxykynurenine ratio (HKr) were associated with more fatigue and worse functioning. Finally, higher KA and XA concentrations and a higher KA/QA ratio were associated with a higher overall HRQoL summary score, while a higher HKr was associated with a lower overall HRQoL summary score. In conclusion, we observed that tryptophan and several kynurenines were longitudinally associated with fatigue and HRQoL in CRC survivors up to 12 months post-treatment. Future research is needed to validate our findings and explore the potential of the kynurenine pathway as intervention target for reducing fatigue and enhancing HRQoL after CRC treatment.
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Affiliation(s)
- Daniëlle D B Holthuijsen
- Department of Epidemiology, CARIM Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Eline H van Roekel
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | | | - Stéphanie O Breukink
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Eric T P Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre Sittard-Geleen, Geleen, The Netherlands
| | - Stefanie Brezina
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Matty P Weijenberg
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Simone J P M Eussen
- Department of Epidemiology, CARIM Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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3
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Okinaka Y, Kageyama S, Goto T, Sugimoto M, Tomita A, Aizawa Y, Kobayashi K, Wada A, Kawauchi A, Kataoka Y. Metabolomic profiling of cancer-related fatigue involved in cachexia and chemotherapy. Sci Rep 2024; 14:8329. [PMID: 38594321 PMCID: PMC11004174 DOI: 10.1038/s41598-024-57747-y] [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: 01/04/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Patients with advanced cancer are frequently burdened with a severe sensation of fatigue called cancer-related fatigue (CRF). CRF is induced at various stages and treatments, such as cachexia and chemotherapy, and reduces the overall survival of patients. Objective and quantitative assessment of CRF could contribute to the diagnosis and prediction of treatment efficacy. However, such studies have not been intensively performed, particularly regarding metabolic profiles. Here, we conducted plasma metabolomics of 15 patients with urological cancer. The patients with and without fatigue, including those with cachexia or chemotherapy-induced fatigue, were compared. Significantly lower concentrations of valine and tryptophan were observed in fatigued patients than in non-fatigued patients. In addition, significantly higher concentrations of polyamine pathway metabolites were observed in patients with fatigue and cachexia than in those without cachexia. Patients with exacerbated fatigue due to chemotherapy showed significantly decreased cysteine and methionine metabolism before chemotherapy compared with those without fatigue exacerbation. These findings suggest that plasma metabolic profiles could help improve the diagnosis and monitoring of CRF.
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Affiliation(s)
- Yuki Okinaka
- Department of Urology, Shiga University of Medical Science, Shiga, 520-2192, Japan
- RIKEN Center for Biosystems Dynamics Research, Hyogo, 650-0047, Japan
| | - Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Toshiyuki Goto
- RIKEN Center for Biosystems Dynamics Research, Hyogo, 650-0047, Japan
- Graduate School of Science, Technology and Innovation, Kobe University, Hyogo, 650-0047, Japan
| | - Masahiro Sugimoto
- Institute of Medical Science, Tokyo Medical University, Tokyo, 160-8402, Japan
- Institute for Advanced Biosciences, Keio University, Yamagata, 997-0052, Japan
| | - Atsumi Tomita
- Institute of Medical Science, Tokyo Medical University, Tokyo, 160-8402, Japan
| | - Yumi Aizawa
- Institute of Medical Science, Tokyo Medical University, Tokyo, 160-8402, Japan
| | - Kenichi Kobayashi
- Department of Urology, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Akinori Wada
- Department of Urology, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Yosky Kataoka
- RIKEN Center for Biosystems Dynamics Research, Hyogo, 650-0047, Japan.
- Graduate School of Science, Technology and Innovation, Kobe University, Hyogo, 650-0047, Japan.
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García-González D, Romero-Elías M, Álvarez-Bustos A, Rosado-García S, Sánchez-López AJ, Cantos B, Maximiano C, Méndez M, Méndez-Otero M, Cebolla H, García-Foncillas J, Ruiz-Casado A. Cancer-Related Fatigue and Circulating Biomarkers in Breast Cancer Survivors. Biol Res Nurs 2024; 26:270-278. [PMID: 37947791 DOI: 10.1177/10998004231215777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) is the most common and disruptive symptom experienced by cancer survivors and because of its frequency and severity is especially worrisome in breast cancer survivors (BCS). Despite a great deal of research, the mechanisms underlying CRF have not been determined. The present study aims to describe associations between CRF in BCS and different blood biomarkers. METHODS A descriptive and cross-sectional study was conducted. A set of biomarkers assessing inflammation were measured in BCS: C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), IL-1β, IL-6, IL-8, IL-10, tumor necrosis factor (TNF); HPA axis dysfunction (cortisol), autonomic dysfunction (noradrenaline); oxidative stress (8-OH deoxyguanosine); insulin resistance markers (insulin, IGF-I, IGFBP3) and sexual hormones (estrogens, progesterone, testosterone). RESULTS NLR (p = .00) and cortisol (p = .02) were positive and negatively associated with CRF, respectively. The rest of the blood markers were not associated with CRF. CONCLUSION Our results increase the evidence on pathophysiological mechanisms driving CRF in BCS. However, longitudinal studies are needed to explore the role of these factors as potential causal mechanisms.
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Affiliation(s)
| | - María Romero-Elías
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alejandro Álvarez-Bustos
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Silvia Rosado-García
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | | | - Blanca Cantos
- Department of Medical Oncology, IDIPHISA, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Constanza Maximiano
- Department of Medical Oncology, IDIPHISA, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Miriam Méndez
- Department of Medical Oncology, IDIPHISA, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Marta Méndez-Otero
- Department of Medical Oncology, IDIPHISA, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Jesús García-Foncillas
- School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
- Department of Medical Oncology, UAM, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Ruiz-Casado
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Department of Medical Oncology, IDIPHISA, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Phan TT, Scott KS, Chelette B, Phillip West A, Dantzer R. The fatigue-inducing effects of cancer and its therapy are characterized by decreased physical activity in the absence of any motivational deficit. Brain Behav Immun 2024; 117:205-214. [PMID: 38244945 DOI: 10.1016/j.bbi.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024] Open
Abstract
Although cancer and its therapy are well known to be associated with fatigue, the exact nature of cancer-related fatigue remains ill-defined. We previously reported that fatigue-like behavior induced independently by tumor growth and by the chemotherapeutic agent cisplatin is characterized by reduced voluntary wheel running and an intact motivation to expand effort for food rewards. The present set of experiments was initiated to characterize the functional consequences of fatigue induced by chemoradiotherapy in tumor-bearing mice and relate them to changes in the expression of genes coding for inflammation, mitochondria dynamics and metabolism. Two syngeneic murine models of cancer were selected for this purpose, a model of human papilloma virus-related head and neck cancer and a model of lung cancer. In both models, tumor-bearing mice were submitted to chemoradiotherapy to limit tumor progression. Two dimensions of fatigue were assessed, the physical dimension by changes in physical activity in mice trained to run in wheels and the motivational dimension by changes in the performance of mice trained to nose poke to obtain a food reward in a progressive ratio schedule of food reinforcement. Chemoradiotherapy reliably decreased wheel running activity but had no effect on performance in the progressive ratio in both murine models of cancer. These effects were the same for the two murine models of cancer and did not differ according to sex. Livers and brains were collected at the end of the experiments for qRT-PCR analysis of expression of genes coding for inflammation, mitochondria dynamics, and metabolism. The observed changes were mainly apparent in the liver and typical of activation of type I interferon and NF-κB-dependent signaling, with alterations in mitochondrial dynamics and a shift toward glycolysis. Although the importance of these alterations for the pathophysiology of cancer-related fatigue remains to be explored, the present findings indicate that fatigue brought on by cancer therapy in tumor-bearing mice is more physical than motivational.
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Affiliation(s)
- Thien T Phan
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Current address: Department of Medical Physiology, School of Medicine, Texas A&M University, Bryan, TX 77807, USA
| | - Kiersten S Scott
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Present address: Department of Neurology, McGovern School of Medicine, UT Health Houston, TX 77030, USA
| | - Brandon Chelette
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - A Phillip West
- Department of Microbial Pathogenesis and Immunology, School of Medicine, Texas A&M University, Bryan, TX 77087, USA; Present address: The Jackson Laboratory, Bar Harbor, ME 04609, USA
| | - Robert Dantzer
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Irestorm E, van Gorp M, Twisk J, Nijhof S, de Bont J, Grootenhuis M, van Litsenburg R. Longitudinal development of fatigue after treatment for childhood cancer: a national cohort study. Acta Oncol 2023; 62:1309-1321. [PMID: 37676687 DOI: 10.1080/0284186x.2023.2254477] [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: 05/24/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Fatigue is a distressing and prevalent long-term sequela of treatment for childhood cancer, and there is a need for longitudinal studies to investigate the development of fatigue over time. The objective of this study was to calculate growth-curves for the longitudinal development of fatigue after treatment for childhood cancer, and to investigate the effects of biopsychosocial predictors. MATERIALS AND METHODS Participants were recruited from a patient monitoring program and data extracted from medical records. Parent-proxy and self-report versions of PedsQLTM Multidimensional Fatigue Scale were used to repeatedly assess fatigue up to 5 years after the end of treatment for childhood cancer. Fatigue was assessed 2440 times for 761 participants (median:3) with proxy-reports (age 2-8 years) and 2657 times for 990 participants with self-reports (above 8 years) (median:2). Mixed models were used to establish growth-curves and to analyze the effect of predictors separately for participants with solid tumors (ST), hemato-oncological malignancies and central nervous system-tumors (CNS). RESULTS CNS-tumors were associated with more cognitive fatigue than ST at the end of treatment, for both proxy-reports (-11.30, p<.001) and self-reports (-6.78, p=.002), and for proxy-reports of general fatigue (-6.78, p=.002). The only significant difference in change over time was for self-reports of sleep-rest fatigue. The raw scores for the CNS-group decreased with -0.87 per year (95% CI -1.64; -0.81, p=.031) compared to the ST-group. Parental distress was overall the variable most associated with increased fatigue, while immunotherapy was the most frequent medical predictor. National centralization of childhood cancer care decreased fatigue for the CNS-group, but not for other diagnoses. DISCUSSION Children and adolescents treated for CNS-tumors reported more fatigue than other participants after the end of treatment, and this difference remained over time. Results from this study may help to facilitate the early recognition of children with insufficient recovery of fatigue symptoms.
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Affiliation(s)
- Elin Irestorm
- Department of Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marloes van Gorp
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Sanne Nijhof
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith de Bont
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Ortelli P, Versace V, Saltuari L, Randi A, Stolz J, Dezi S, Maestri R, Buechner S, Giladi N, Oliviero A, Sebastianelli L, Ferrazzoli D. Looking deeper: does a connection exist between fatigue and attentional deficits in Parkinson's disease? A conceptual framework. Front Neurol 2023; 14:1212876. [PMID: 37638176 PMCID: PMC10457007 DOI: 10.3389/fneur.2023.1212876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Paola Ortelli
- Psychology Service, Hospital of Bressanone (SABES-ASDAA) - Teaching Hospital of the Paracelsus Medical Private University (PMU), Bressanone-Brixen, Italy
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Anna Randi
- Psychology Service, Hospital of Bressanone (SABES-ASDAA) - Teaching Hospital of the Paracelsus Medical Private University (PMU), Bressanone-Brixen, Italy
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Jakob Stolz
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Sabrina Dezi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Roberto Maestri
- Istituti Clinici Scientifici Maugeri, IRCCS, Department of Biomedical Engineering of Montescano Institute, Pavia, Italy
| | - Susanne Buechner
- Department of Neurology, Hospital of Bolzano (SABES-ASDAA) - Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Nir Giladi
- Brain Institute, Tel Aviv Soursky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy - Teaching Hospital of the Paracelsus Medical Private University (PMU), Salzburg, Austria
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8
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Klepin HD, Tooze JA, Bitting RL, Davis B, Pleasant K, Melo AC, Cook K, Soto-Pantoja DR, Tallant EA, Gallagher PE. Study design and methods for the pilot study of muscadine grape extract supplement to improve fatigue among older adult cancer survivors (FOCUS) trial. J Geriatr Oncol 2023; 14:101478. [PMID: 36990930 PMCID: PMC10164712 DOI: 10.1016/j.jgo.2023.101478] [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: 11/18/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Fatigue is a prevalent symptom among both cancer survivors and older adults. Negative consequences of fatigue include increased sedentary behavior, decreased physical activity and function, and lower quality of life. Few pharmacologic interventions improve fatigue. Our preclinical and clinical data show promising effects of a muscadine grape extract supplement (MGES) on oxidative stress, mitochondrial bioenergetics, the microbiome, and the symptom of fatigue. This pilot study seeks to translate these observations to cancer survivorship by testing the preliminary effect of MGE supplementation on older adult cancer survivors with self-reported fatigue. MATERIALS AND METHODS We designed a double-blinded placebo-controlled pilot study to evaluate preliminary efficacy of MGE supplementation versus placebo on fatigue among older adult cancer survivors (aged ≥65 years) who report baseline fatigue. Sixty-four participants will be enrolled and randomized 1:1 to twice daily MGES (four tablets twice daily) versus placebo for 12 weeks. The primary outcome is change in Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue score from baseline to 12 weeks. Secondary outcomes are change in self-reported physical function, physical fitness (6-min walk test), self-reported physical activity, global quality of life (QOL), and the Fried frailty index. Correlative biomarker assays will assess changes in 8-hydroxy-2 deoxyguanosine, peripheral blood mitochondrial function, inflammatory markers, and the gut microbiome. DISCUSSION This pilot study builds on preclinical and clinical observations to estimate effects of MGE supplementation on fatigue, physical function, QOL, and biologic correlates in older adult cancer survivors. Trial registration #: CT.govNCT04495751; IND 152908.
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Affiliation(s)
- Heidi D Klepin
- Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston Salem, NC, United States of America.
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Rhonda L Bitting
- Division of Medical Oncology, Duke University, Durham, NC, United States of America
| | - Brittany Davis
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Katherine Pleasant
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Ana Clara Melo
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Katherine Cook
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - David R Soto-Pantoja
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - E Ann Tallant
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Patricia E Gallagher
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
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9
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Li S, Gao Y, Lin Y, Wu W, Fang Q, Ni X, Zhou Y, Hong M, Zhang R, Lou Y. Development and preliminary testing of the cancer-related fatigue comprehensive assessment scale in cancer survivors. J Clin Nurs 2023; 32:1186-1217. [PMID: 35285109 DOI: 10.1111/jocn.16272] [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: 09/07/2021] [Revised: 01/19/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tailored management of cancer-related fatigue (CRF) is important for effective coping; however, it has been hindered by the lack of a comprehensive tool that assesses both symptoms and treatable influencing factors. AIMS AND OBJECTIVES The aim was to develop a cancer-related fatigue comprehensive assessment scale (CRF-CAS) and assess its psychometric properties. DESIGN This was a mixed-method study. METHODS The study included two phases which were conducted in Zhejiang Province, China. In phase one, a literature search, brainstorming sessions, Delphi studies, cognitive interviews and a pilot study were conducted to construct and revise CRF-CAS indicators. In phase two, a questionnaire-based survey was conducted among cancer survivors. Item analysis was used to select and optimize indicators. Cronbach's α was calculated for reliability analysis. Validity analysis included concurrent validity and structural validity. RESULTS A 93-item tool was initially constructed. Phase one ended with revision and optimization. The preliminary scale included five dimensions (CRF symptoms, physical activity, cognitive-emotional status, sleep status, nutritional status) and 30 items. The mean item-content validity index (I-CVI) and scale-level CVI universal agreement (S-CVI/UA) were .98, and the adjusted mean values of Kappa for indicators ranged from .91-1, as evaluated by the expert group. The Pearson correlation coefficient between the CRF-CAS and criterion scales ranged from .337-.862. Cronbach's α coefficient ranged from .624-.728. Respondents agreed that the scale was acceptable for administration and that it contributed to decision-making in fatigue management. Confirmatory factor analysis (CFA) indicated that the CRF-CAS fit well. CONCLUSIONS The construction process of the CRF-CAS, involving panel discussion and expert and participant evaluations, was shown to be scientific and feasible. The CRF-CAS had relatively good validity and reliability in version 5 of its preliminary scale, which requires further improvement in future studies.
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Affiliation(s)
- Shuaini Li
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China.,The Children's Hospital Zhejiang University School of Medicine (National Clinical Research Center for Child Health), Hangzhou, Zhejiang Province, China
| | - Yating Gao
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Ying Lin
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Wanying Wu
- Zhejiang Cancer Hospital (Cancer Hospital of the University of Chinese Academy of Sciences), Hangzhou, Zhejiang Province, China
| | - Qunying Fang
- Zhejiang Cancer Hospital (Cancer Hospital of the University of Chinese Academy of Sciences), Hangzhou, Zhejiang Province, China
| | - Xiaosha Ni
- Hangzhou Ninth People's Hospital, Hangzhou, Zheijiang province, China
| | - Yao Zhou
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Meirong Hong
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Ruolin Zhang
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Yan Lou
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
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10
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Physical Activity as a Treatment for Cancer-Related Fatigue in Children, Adolescents and Young Adults: A Systematic Review. CHILDREN 2023; 10:children10030572. [PMID: 36980130 PMCID: PMC10047895 DOI: 10.3390/children10030572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
Background: Cancer-related fatigue (CRF) is one of the most common and distressing symptoms in paediatric oncology. Based on previous studies, physical activity interventions are considered to be effective in reducing CRF in adult cancer patients. Aim: The aim of this systematic review is to investigate whether physical activity interventions can reduce CRF in paediatric patients undergoing cancer treatment. Methodology: A systematic literature search was conducted in PubMed and Sport-Discus in October 2021 to identify intervention studies examining the effects of physical activity on CRF in cancer patients ≤ 21 years of age. Their methodological quality was assessed using the JBI Critical Appraisal Tool. Results: A total of 20 studies (seven randomized-controlled, six quasi-experimental and seven single-arm intervention trials) were included in the review. Nine studies reported significant positive effects of physical activity interventions on CRF in group comparison or within groups. Eleven trials reported no significant changes in CRF. Conclusion: Physical activity as a therapeutic intervention in paediatric oncology may have the potential to reduce CRF in childhood cancer patients undergoing cancer treatment. Further high-quality studies with large samples are needed to verify these results and to assess the interdependence of dose and response of physical activity interventions.
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11
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Andreas M, Ernst M, Kusch M, Ruffer JU, Csenar M, Cryns N, Bröckelmann PJ, Aldin A, Skoetz N. Pharmacological interventions to treat adults with cancer-related fatigue. Hippokratia 2023. [PMCID: PMC9922168 DOI: 10.1002/14651858.cd015118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- Marike Andreas
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Moritz Ernst
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Michael Kusch
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Cologne Germany
| | | | - Mario Csenar
- Cochrane Haematology, Department I of Internal Medicine; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Nora Cryns
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Paul J Bröckelmann
- Department I of Internal Medicine; Centre of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, University of Cologne; Cologne Germany
- Max-Planck Institute for the Biology of Ageing; Cologne Germany
| | - Angela Aldin
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
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12
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van Roekel EH, Bours MJL, Breukink SO, Aquarius M, Keulen ETP, Gicquiau A, Rinaldi S, Vineis P, Arts ICW, Gunter MJ, Leitzmann MF, Scalbert A, Weijenberg MP. Longitudinal associations of plasma metabolites with persistent fatigue among colorectal cancer survivors up to 2 years after treatment. Int J Cancer 2023; 152:214-226. [PMID: 36054767 PMCID: PMC9825888 DOI: 10.1002/ijc.34252] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/08/2022] [Accepted: 07/25/2022] [Indexed: 01/11/2023]
Abstract
The underlying biological mechanisms causing persistent fatigue complaints after colorectal cancer treatment need further investigation. We investigated longitudinal associations of circulating concentrations of 138 metabolites with total fatigue and subdomains of fatigue between 6 weeks and 2 years after colorectal cancer treatment. Among stage I-III colorectal cancer survivors (n = 252), blood samples were obtained at 6 weeks, and 6, 12 and 24 months posttreatment. Total fatigue and fatigue subdomains were measured using a validated questionnaire. Tandem mass spectrometry was applied to measure metabolite concentrations (BIOCRATES AbsoluteIDQp180 kit). Confounder-adjusted longitudinal associations were analyzed using linear mixed models, with false discovery rate (FDR) correction. We assessed interindividual (between-participant differences) and intraindividual longitudinal associations (within-participant changes over time). In the overall longitudinal analysis, statistically significant associations were observed for 12, 32, 17 and three metabolites with total fatigue and the subscales "fatigue severity," "reduced motivation" and "reduced activity," respectively. Specifically, higher concentrations of several amino acids, lysophosphatidylcholines, diacylphosphatidylcholines, acyl-alkylphosphatidylcholines and sphingomyelins were associated with less fatigue, while higher concentrations of acylcarnitines were associated with more fatigue. For "fatigue severity," associations appeared mainly driven by intraindividual associations, while for "reduced motivation" stronger interindividual associations were found. We observed longitudinal associations of several metabolites with total fatigue and fatigue subscales, and that intraindividual changes in metabolites over time were associated with fatigue severity. These findings point toward inflammation and an impaired energy metabolism due to mitochondrial dysfunction as underlying mechanisms. Mechanistic studies are necessary to determine whether these metabolites could be targets for intervention.
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Affiliation(s)
- Eline H. van Roekel
- Department of EpidemiologyGROW School for Oncology and Developmental Biology, Maastricht UniversityMaastrichtThe Netherlands
| | - Martijn J. L. Bours
- Department of EpidemiologyGROW School for Oncology and Developmental Biology, Maastricht UniversityMaastrichtThe Netherlands
| | - Stéphanie O. Breukink
- Department of Surgery, GROW School for Oncology and Developmental BiologySchool of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+MaastrichtThe Netherlands
| | - Michèl Aquarius
- Department of GastroenterologyVieCuri Medical CenterVenloThe Netherlands
| | - Eric T. P. Keulen
- Department of Internal Medicine and GastroenterologyZuyderland Medical CentreSittard‐GeleenThe Netherlands
| | - Audrey Gicquiau
- Nutrition and Metabolism BranchInternational Agency for Research on Cancer (IARC‐WHO)LyonFrance
| | - Sabina Rinaldi
- Nutrition and Metabolism BranchInternational Agency for Research on Cancer (IARC‐WHO)LyonFrance
| | - Paolo Vineis
- MRC Centre for Environment and HealthSchool of Public Health, Imperial CollegeLondonUK
- Italian Institute of TechnologyGenoaItaly
| | - Ilja C. W. Arts
- Maastricht Centre for Systems Biology (MaCSBio)Maastricht UniversityMaastrichtThe Netherlands
| | - Marc J. Gunter
- Nutrition and Metabolism BranchInternational Agency for Research on Cancer (IARC‐WHO)LyonFrance
| | - Michael F. Leitzmann
- Department of Epidemiology and Preventive MedicineUniversity of RegensburgRegensburgGermany
| | - Augustin Scalbert
- Nutrition and Metabolism BranchInternational Agency for Research on Cancer (IARC‐WHO)LyonFrance
| | - Matty P. Weijenberg
- Department of EpidemiologyGROW School for Oncology and Developmental Biology, Maastricht UniversityMaastrichtThe Netherlands
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13
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Fatigue trajectories during pediatric ALL therapy are associated with fatigue after treatment: a national longitudinal cohort study. Support Care Cancer 2023; 31:1. [PMID: 36512099 PMCID: PMC9747814 DOI: 10.1007/s00520-022-07456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Fatigue is one of the most prevalent and distressing symptoms reported by survivors of childhood cancer. There is currently a lack of longitudinal studies on cancer-related fatigue, and especially on the relationship between the course of fatigue during treatment and fatigue at follow-up. The purpose of the current study was therefore to investigate if the course of fatigue during treatment, treatment intensity, serious adverse events, sex, or age at diagnosis are associated with cancer-related fatigue after treatment. METHODS Participants were 92 children and adolescents diagnosed with acute lymphoblastic leukemia (mean age at diagnosis was 6.26 years). Fatigue was measured with PedsQL multidimensional fatigue scale proxy reports 5 months after diagnosis, 12 months after diagnosis, 24 months after diagnosis, and at follow-up 12 months after end of treatment. The effect of patient and treatment characteristics on fatigue reported at follow-up was tested through logistic regression analyses. RESULTS The course of fatigue during treatment significantly predicted fatigue reported at follow-up for general fatigue (p = .038, OR = 9.20), sleep/rest fatigue (p = .011, OR = 15.48), and cognitive fatigue (p < .001, OR = 10.78). None of the other variables were associated with fatigue at follow-up for any of the subscales. CONCLUSIONS The findings demonstrate that fatigue reported during treatment can predict fatigue at follow-up. These results stress the need for longitudinal assessments. Healthcare professionals need to be aware that pediatric patients who are fatigued during treatment need to receive additional attention and timely interventions since cancer-related fatigue will not resolve by itself in the first year after end of treatment.
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14
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Adame H, Wettersten K, Schwinghamer A, Friesen-Janochoski A. Cancer-related fatigue as a mediator between self-efficacy and quality of life for adolescents and young adults impacted by cancer. J Psychosoc Oncol 2022; 41:502-517. [PMID: 36541375 DOI: 10.1080/07347332.2022.2147120] [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: 12/24/2022]
Abstract
OBJECTIVE Adolescents and young adults are a unique subpopulation within oncology, with different and often unmet needs. The current study investigated the relationships between cancer-related self-efficacy, cancer-related fatigue, and quality of life, with the hypothesis that fatigue would mediate the negative relationship between self-efficacy and quality of life for adolescents and young adults impacted by cancer. METHODS Structural equation modeling was utilized to examine the pathways between these variables. RESULTS As predicted, results (n = 265, 92.8% female) demonstrated a strong positive relationship between self-efficacy and quality of life. Fatigue partially but significantly mediated the pathway between self-efficacy and quality of life. CONCLUSIONS It appears that cancer-related self-efficacy may work, at least in part, through the mediating variable of fatigue, to influence quality of life for adolescents and young adults.
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15
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Sarsam SM, Al-Samarraie H, Alzahrani AI, Shibghatullah AS. A non-invasive machine learning mechanism for early disease recognition on Twitter: The case of anemia. Artif Intell Med 2022; 134:102428. [PMID: 36462907 DOI: 10.1016/j.artmed.2022.102428] [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: 10/09/2021] [Revised: 09/10/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
Social media sites, such as Twitter, provide the means for users to share their stories, feelings, and health conditions during the disease course. Anemia, the most common type of blood disorder, is recognized as a major public health problem all over the world. Yet very few studies have explored the potential of recognizing anemia from online posts. This study proposed a novel mechanism for recognizing anemia based on the associations between disease symptoms and patients' emotions posted on the Twitter platform. We used k-means and Latent Dirichlet Allocation (LDA) algorithms to group similar tweets and to identify hidden disease topics. Both disease emotions and symptoms were mapped using the Apriori algorithm. The proposed approach was evaluated using a number of classifiers. A higher prediction accuracy of 98.96 % was achieved using Sequential Minimal Optimization (SMO). The results revealed that fear and sadness emotions are dominant among anemic patients. The proposed mechanism is the first of its kind to diagnose anemia using textual information posted on social media sites. It can advance the development of intelligent health monitoring systems and clinical decision-support systems.
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Affiliation(s)
| | - Hosam Al-Samarraie
- School of Design, University of Leeds, Leeds, UK; Centre for Instructional Technology & Multimedia, Universiti Sains Malaysia, Penang, Malaysia.
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16
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Thambiraj J, Kirshbaum MN, Liu XL, Waheed N, Valery PC. "You feel different in your body": Experiences of fatigue among children undergoing radiotherapy for cancer treatment. J Pediatr Nurs 2022; 67:7-14. [PMID: 35872502 DOI: 10.1016/j.pedn.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/27/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this research is to examine the experience and impact of radiotherapy related fatigue in children diagnosed with solid tumours. DESIGN AND METHODS Children (n = 25) and parents (n = 19) participated in a semi-structured interview on the last week of radiotherapy treatment. The study sample included children who were 6 to 14 years of age, diagnosed with brain or solid tumour, and received radiotherapy as part of their treatment protocol over the period of 6 weeks. Interpretation of data was undertaken through the adoption of thematic analysis approach. RESULTS Data revealed children's experience and response to fatigue while undergoing radiotherapy. Several recurring themes arose about their experience of fatigue/tiredness while undergoing radiotherapy. Two themes and eight sub themes, namely 'Experience of Fatigue' ("You feel Different in your body", Mood and Feeling, Activity and Occurrence) and 'Response to Fatigue' (Rest and Sleep, Activity, Mood and Concentration and Eating Habit) were identified. CONCLUSIONS The findings illustrated significant fatigue on activity sleep, rest and mood of children undergoing radiotherapy. PRACTICE IMPLICATIONS Monitoring and addressing fatigue and its consequences during radiotherapy treatment are essential to improve well-being of children with cancer.
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Affiliation(s)
- Jessy Thambiraj
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Charles Darwin University, Northern Territory, Australia.
| | | | - Xian-Liang Liu
- Charles Darwin University, Northern Territory, Australia
| | - Nasreena Waheed
- College of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Australia
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17
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Galiano A, Schiavon S, Nardi M, Guglieri I, Pambuku A, Martino R, Bolshinsky M, Murgioni S, Intini R, Soldà C, Marino D, Daniel F, De Toni C, Pittarello C, Chiusole B, Prete AA, Bimbatti D, Nappo F, Caccese M, Bergamo F, Brunello A, Lonardi S, Zagonel V. Simultaneous care in oncology: Assessment of benefit in relation to symptoms, sex, and age in 753 patients. Front Oncol 2022; 12:989713. [PMID: 36313660 PMCID: PMC9614371 DOI: 10.3389/fonc.2022.989713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/05/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Early activation of palliative care for patients with advanced cancer is central in the treatment trajectory. At the Veneto Institute of Oncology, a simultaneous-care outpatient clinic (SCOC) has been active since 2014, where patients are evaluated by an oncologist together with a palliative care team. Recently, we reported on consecutive patients admitted at SCOC from 2018 to 2021 in terms of appropriateness, process, and outcome indicators. Here, we report further analysis in the same group of 753 patients, evaluating other parameters and the correlation between symptom intensity, gender, age, and survival. METHODS SCOC data were retrieved from a prospectively maintained database. RESULTS Among the patients, 42.2% were women, and the median age was 68 years, with 46.7% of patients aged ≥70 years. The most prevalent disease type was gastrointestinal cancer (75.2%), and 90.9% of the patients had metastatic disease. The median score for the distress thermometer was 4; the vast majority of the patients (98.6%) reported physical problems, and 69.4% presented emotional issues. Younger women demonstrated a significantly greater median distress than other patients (p=0.0018). Almost all symptoms had a higher prevalence on the 0-3 Edmonton Symptom Assessment Scale (ESAS) score, except for fatigue. About 43.8% of the patients received systemic anticancer treatment (SAT) in the last 60 days of life, 15.0% of whom received SAT in the last month and 3.1% in the last 2 weeks. For some symptoms, women frequently had more ESAS >3. Pain and nausea were significantly less reported by older patients compared with younger adults. Men had a lower risk of having MUST score ≥ 2 (p=0.0311). Men and older patients showed a lower prognosis awareness (p=0.0011 and p=0.0049, respectively). Older patients received less SAT within the last 30 days of life (p=0.0006) and had death risk decreased by 20.0%. CONCLUSION Our study identified two subgroups of patients with advanced cancer who require special attention and support due to important symptoms' burden detected by Patient Reported Outcome Measures tests: women and younger adults. These categories of patients require special attention and should be provided early access at SCOC. The role of an oncologist remains crucial to intercept all patients in need of early palliative care and balancing trade-offs of anticancer treatment in advanced metastatic disease.
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Affiliation(s)
- Antonella Galiano
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Stefania Schiavon
- Pain Therapy and Palliative Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mariateresa Nardi
- Clinical Nutrition Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Ardi Pambuku
- Pain Therapy and Palliative Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Rosalba Martino
- Hospital Psychology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maital Bolshinsky
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Sabina Murgioni
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Rossana Intini
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Caterina Soldà
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Dario Marino
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Francesca Daniel
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Chiara De Toni
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Chiara Pittarello
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Benedetta Chiusole
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alessandra Anna Prete
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Davide Bimbatti
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Floriana Nappo
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mario Caccese
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Francesca Bergamo
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonella Brunello
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Sara Lonardi
- Department of Oncology, Oncology Unit 3, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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Levesque A, Caru M, Duval M, Laverdière C, Marjerrison S, Sultan S. Cancer-related fatigue in childhood cancer survivors: A systematic scoping review on contributors of fatigue and how they are targeted by non-pharmacological interventions. Crit Rev Oncol Hematol 2022; 179:103804. [PMID: 36087854 DOI: 10.1016/j.critrevonc.2022.103804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We aimed to identify contributors to cancer-related fatigue (CRF), explore non-pharmacological interventions addressing CRF, and highlight which contributors were targeted by these interventions in childhood cancer survivors. METHODS We performed a search in various databases and used the PRISMA-ScR checklist. Findings were synthesized in various different tables and figures in accordance with our objectives. RESULTS We included 49 articles in this systematic scoping review. We identified 59 significant contributors. Depression and physical activity level were some of the most studied significant contributors. Ten interventional studies were identified (e.g., yoga, physical activity intervention) that addressed 6 contributors (e.g., physical activity level). DISCUSSION This review is the first to describe and relate contributors and non-pharmacological interventions targeting CRF in childhood cancer survivors. Important clinical implications could be derived from the variety of factors explaining CRF and how it is currently addressed.
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Affiliation(s)
- Ariane Levesque
- Department of Psychology, Université de Montreal, Montreal, Canada; Research Center, Sainte-Justine University Health Center, Montreal, Canada.
| | - Maxime Caru
- Department of Pediatric Hematology and Oncology, and Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Michel Duval
- Research Center, Sainte-Justine University Health Center, Montreal, Canada; Charles-Bruneau Cancer Care Center, Sainte-Justine University Health Center, Montreal, Canada; Department of Pediatrics, Université de Montreal, Montreal, Canada
| | - Caroline Laverdière
- Research Center, Sainte-Justine University Health Center, Montreal, Canada; Charles-Bruneau Cancer Care Center, Sainte-Justine University Health Center, Montreal, Canada; Department of Pediatrics, Université de Montreal, Montreal, Canada
| | - Stacey Marjerrison
- Department of Pediatrics, McMaster University Children's Hospital, Hamilton, Ontario, Canada
| | - Serge Sultan
- Department of Psychology, Université de Montreal, Montreal, Canada; Research Center, Sainte-Justine University Health Center, Montreal, Canada; Charles-Bruneau Cancer Care Center, Sainte-Justine University Health Center, Montreal, Canada; Department of Pediatrics, Université de Montreal, Montreal, Canada
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Baussard L, Cousson-Gélie F, Jarlier M, Charbonnier E, Le Vigouroux S, Montalescot L, Janiszewski C, Fourchon M, Coutant L, Guerdoux E, Portales F. Hypnosis and cognitive behavioral therapy with online sessions to reduce fatigue in patients undergoing chemotherapy for a metastatic colorectal cancer: Rational and study protocol for a feasibility study. Front Psychol 2022; 13:953711. [PMID: 35967617 PMCID: PMC9363840 DOI: 10.3389/fpsyg.2022.953711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background In metastatic colorectal cancer (CRCm), fatigue is pervasive, reduces quality of life, and is negatively associated with survival. Its course is explained in part by psychosocial variables such as emotional distress, coping strategies, or perceived control. Thus, to reduce fatigue, psychosocial interventions appear to be relevant. In some cancers, Cognitive Behavioral Therapies (CBT) reduce fatigue. Hypnosis is also used as a complementary therapy to reduce the side effects of cancer. While CBT requires specific training often reserved for psychologists, hypnosis has the advantage of being increasingly practiced by caregivers and is therefore less expensive (Montgomery et al., 2007). On the other hand, CBT and hypnosis remain understudied in the CRC, do not focus on the symptom of fatigue and in Europe such programs have never been evaluated. Objectives Implementing an intervention in a healthcare setting is complex (e.g., economic and practical aspects) and recruiting participants can be challenging. The primary objective will therefore be to study the feasibility of two standardized interventions (hypnosis and CBT) that aim to reduce fatigue in patients with CRCm treated in a French cancer center. Methods and design A prospective, single-center, randomized interventional feasibility study, using mixed methods (both quantitative and qualitative). A total of 60 patients will be allocated to each intervention group [Hypnosis (n = 30) and CBT (n = 30)]. Participants will be randomized into two parallel groups (ratio 1:1). Both programs will consist of 6 weekly sessions focusing on the CRF management over a period of 6 weeks. Trained therapists will conduct the program combining 3 face-to-face sessions and 3 online sessions. The feasibility and experience of interventions will be evaluated by the outcome variables, including the adhesion rate, the reasons for acceptability, relevance or non-adherence, the satisfaction, the fatigue evolution (with ecological momentary assessments), and the quality of life. All questionnaires will be self-assessment using an online application from the cancer center. Discussion Results will highlight the barriers/facilitators to the implementation of the program and the relevance of the program to the patients, and will be used to generate hypotheses for a randomized control trial. Clinical trial registration ClinicalTrials.gov Identifier: NCT04999306; https://clinicaltrials.gov/ct2/show/NCT04999306.
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Affiliation(s)
- Louise Baussard
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
- *Correspondence: Louise Baussard
| | - Florence Cousson-Gélie
- Université Paul Valéry Montpellier 3, Laboratoire Epsylon EA4556, Languedoc-Roussillon, France
| | - Marta Jarlier
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
| | - Elodie Charbonnier
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
| | - Sarah Le Vigouroux
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
| | - Lucile Montalescot
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
| | - Chloé Janiszewski
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
| | - Michele Fourchon
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
| | - Louise Coutant
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
| | - Estelle Guerdoux
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
- Institut Desbrest d'Epidémiologie et de Santé Publique, INSERM, Université de Montpellier, Languedoc-Roussillon, France
| | - Fabienne Portales
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
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Delgado-Bustamante RI, Rodríguez-Santillán E. Evidencia del ejercicio en el tratamiento de la fatiga relacionada al cáncer infantil. Revisión temática. Rev Salud Publica (Bogota) 2022. [DOI: 10.15446/rsap.v24n3.99217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo Recopilar la evidencia más reciente que soporte el uso del ejercicio y la actividad física para disminuir la fatiga relacionada al cáncer infantil.
Métodos Se llevó a cabo una búsqueda electrónica de literatura no mayor a cinco años. Posteriormente, los artículos se agruparon en categorías por tipo de estudio y se analizaron sus resultados de acuerdo con el objetivo planteado.
Resultados Fueron incluidos 16 artículos de diferentes diseños, incluyendo estudios clínicos y revisiones sistemáticas. De manera general, se muestran diferencias significativas en favor del ejercicio para disminuir la fatiga; también se reportan efectos positivos en otros aspectos como la movilidad funcional y la calidad de vida.
Conclusión Se respalda la idea de continuar generando evidencias para conocer de manera más puntual la dosificación del ejercicio dependiendo de todas las variables que se pueden presentar en el pediátrico oncológico.
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21
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Sleight AG, Crowder SL, Skarbinski J, Coen P, Parker NH, Hoogland AI, Gonzalez BD, Playdon MC, Cole S, Ose J, Murayama Y, Siegel EM, Figueiredo JC, Jim HSL. A New Approach to Understanding Cancer-Related Fatigue: Leveraging the 3P Model to Facilitate Risk Prediction and Clinical Care. Cancers (Basel) 2022; 14:cancers14081982. [PMID: 35454890 PMCID: PMC9027717 DOI: 10.3390/cancers14081982] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 01/02/2023] Open
Abstract
Simple Summary For the growing number of cancer survivors worldwide, fatigue presents a major hurdle to function and quality of life. Treatment options for cancer-related fatigue are still emerging, and our current understanding of its etiology is limited. In this paper, we describe a new application of a comprehensive model for cancer-related fatigue: the predisposing, precipitating, and perpetuating (3P) factors model. We propose that the 3P model may be leveraged—particularly using metabolomics, the microbiome, and inflammation in conjunction with behavioral science—to better understand the pathophysiology of cancer-related fatigue. Abstract A major gap impeding development of new treatments for cancer-related fatigue is an inadequate understanding of the complex biological, clinical, demographic, and lifestyle mechanisms underlying fatigue. In this paper, we describe a new application of a comprehensive model for cancer-related fatigue: the predisposing, precipitating, and perpetuating (3P) factors model. This model framework outlined herein, which incorporates the emerging field of metabolomics, may help to frame a more in-depth analysis of the etiology of cancer-related fatigue as well as a broader and more personalized set of approaches to the clinical treatment of fatigue in oncology care. Included within this review paper is an in-depth description of the proposed biological mechanisms of cancer-related fatigue, as well as a presentation of the 3P model’s application to this phenomenon. We conclude that a clinical focus on organization risk stratification and treatment around the 3P model may be warranted, and future research may benefit from expanding the 3P model to understand fatigue not only in oncology, but also across a variety of chronic conditions.
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Affiliation(s)
- Alix G. Sleight
- Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sylvia L. Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94501, USA;
- Department of Infectious Diseases, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA 94501, USA
- Physician Researcher Program, Kaiser Permanente Northern California, Oakland, CA 94501, USA
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA 94501, USA
| | - Paul Coen
- AdventHealth Orlando, Translational Research Institute, Orlando, FL 32804, USA;
| | - Nathan H. Parker
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Mary C. Playdon
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84044, USA;
- Department of Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84044, USA
| | - Steven Cole
- Department of Psychiatry & Biobehavioral Sciences and Medicine, University of California, Los Angeles, CA 90001, USA;
| | - Jennifer Ose
- Department of Population Sciences, University of Utah, Salt Lake City, UT 84044, USA;
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84044, USA
| | - Yuichi Murayama
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Y.M.); (J.C.F.)
| | - Erin M. Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33601, USA;
| | - Jane C. Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Y.M.); (J.C.F.)
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
- Correspondence:
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22
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Crowder SL, Playdon MC, Gudenkauf LM, Ose J, Gigic B, Greathouse L, Peoples AR, Sleight AG, Jim HSL, Figueiredo JC. A Molecular Approach to Understanding the Role of Diet in Cancer-Related Fatigue: Challenges and Future Opportunities. Nutrients 2022; 14:nu14071496. [PMID: 35406105 PMCID: PMC9003400 DOI: 10.3390/nu14071496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Cancer-related fatigue (CRF) is considered one of the most frequent and distressing symptoms for cancer survivors. Despite its high prevalence, factors that predispose, precipitate, and perpetuate CRF are poorly understood. Emerging research focuses on cancer and treatment-related nutritional complications, changes in body composition, and nutritional deficiencies that can compound CRF. Nutritional metabolomics, the novel study of diet-related metabolites in cells, tissues, and biofluids, offers a promising tool to further address these research gaps. In this position paper, we examine CRF risk factors, summarize metabolomics studies of CRF, outline dietary recommendations for the prevention and management of CRF in cancer survivorship, and identify knowledge gaps and challenges in applying nutritional metabolomics to understand dietary contributions to CRF over the cancer survivorship trajectory.
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Affiliation(s)
- Sylvia L. Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33617, USA; (S.L.C.); (L.M.G.); (H.S.L.J.)
| | - Mary C. Playdon
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA;
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Lisa M. Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33617, USA; (S.L.C.); (L.M.G.); (H.S.L.J.)
| | - Jennifer Ose
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA; (J.O.); (A.R.P.)
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69047 Heidelberg, Germany;
| | - Leigh Greathouse
- Human Science and Design, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA;
| | - Anita R. Peoples
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA; (J.O.); (A.R.P.)
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
| | - Alix G. Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33617, USA; (S.L.C.); (L.M.G.); (H.S.L.J.)
| | - Jane C. Figueiredo
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Correspondence:
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23
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Machado P, Morgado M, Raposo J, Mendes M, Silva CG, Morais N. Effectiveness of exercise training on cancer-related fatigue in colorectal cancer survivors: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2022; 30:5601-5613. [PMID: 35107601 DOI: 10.1007/s00520-022-06856-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the effects of exercise training on cancer-related fatigue (CRF) in colorectal cancer survivors. METHODS Randomized controlled trials published between 1 January 2010 and 19 October 2020, selected through online search conducted in PubMed, Scopus, Web of Science, SPORTDiscus and PEDro databases, were included. Eligible trials compared the effect of exercise training interventions, versus non-exercise controls on CRF, in colorectal cancer survivors, during or after treatment. The methodological quality of individual studies was analysed using the Physiotherapy Evidence Database (PEDro) scale. Standardized mean differences (SMD) that were pooled using random-effects models were included as the effect size. In addition, 95% prediction intervals (PI) were calculated. RESULTS Six trials involving 330 colorectal cancer patients met the inclusion criteria and presented reasonable to good methodological quality. An overall small-to-moderate effect of exercise training on CRF was found (SMD = - 0.29: 95% CI: [- 0.53; - 0.06]; p = 0.01; PI: [- 0.63; 0.04]; low-quality evidence). Subgroup analysis revealed moderate effects of exercise interventions performed during chemotherapy (SMD = - 0.63; 95% CI: [- 1.06; - 0.21]; p = 0.003) and small, non-significant effects, when exercise training was performed after cancer treatment (SMD = - 0.14; 95% CI: [- 0.43; 0.14]; p = 0.32). Steady improvements were achieved when a combination of aerobic plus resistance exercise was used, in interventions lasting 12 to 24 weeks. CONCLUSION Exercise training could be regarded as a supportive therapy for the clinical management of CRF in colorectal cancer patients undergoing chemotherapy, but further studies are necessary to clarify the effects of exercise interventions on CRF after cancer treatment.
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Affiliation(s)
- Pedro Machado
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal. .,University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal. .,School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal.
| | - Miguel Morgado
- School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| | - João Raposo
- School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| | - Marco Mendes
- School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| | - Cândida G Silva
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal.,Coimbra Chemistry Centre, Institute of Molecular Sciences (CQC-IMS), Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | - Nuno Morais
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal.,School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal.,Centre for Rapid and Sustainable Product Development (CDRSP), Polytechnic of Leiria, Marinha Grande, Portugal
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24
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Wagoner CW, Lee JT, Hanson ED, Kerr ZY, Nyrop KA, Muss HB, Battaglini CL. Baseline fatigue in early breast cancer survivors: understanding its prevalence in community-based exercise. Support Care Cancer 2022; 30:4407-4416. [DOI: 10.1007/s00520-021-06776-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
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25
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Crabtree VM, LaRosa KN, MacArthur E, Russell K, Wang F, Zhang H, Pan H, Brigden J, Schwartz LE, Wilson M, Pappo A. Feasibility and Acceptability of Light Therapy to Reduce Fatigue in Adolescents and Young Adults Receiving Cancer-Directed Therapy. Behav Sleep Med 2021; 19:492-504. [PMID: 32746639 DOI: 10.1080/15402002.2020.1797744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE/BACKGROUND Fatigue is one of the most consistent and distressing symptoms reported by adolescent/young adult (AYA) oncology patients. Bright white light (BWL) is used to treat fatigue in adult oncology but has not been explored in AYA oncology patients. The purpose of the current study was to determine the feasibility and acceptability of BWL for AYA who were receiving cancer-directed therapy. PARTICIPANTS 51 AYA patients with newly diagnosed solid tumors, including lymphoma. METHODS Participants were randomized to dim red light (DRL, n = 25) or BWL (n = 26) from devices retrofitted with adherence monitors for 30 minutes upon awakening daily for 8 weeks. Side effects were assessed via modified Systematic Assessment for Treatment-Emergent Effects (SAFTEE). Participants completed the PedsQL Multidimensional Fatigue Scale. RESULTS Of patients approached, 73% consented and participated. Mean adherence was 57% of days on study with 30.68 average daily minutes of usage. BWL did not cause more extreme treatment-emergent effects over DRL. Patients in the BWL group demonstrated significant improvement on all fatigue outcomes by both self-report and parent proxy report, which was not observed in the DRL group. CONCLUSIONS This is the first study to evaluate the feasibility and acceptability of light therapy to reduce fatigue in AYA patients receiving cancer-directed therapy. These findings demonstrate the feasibility and acceptability of the intervention and provide preliminary evidence of the potential benefits of BWL, which warrants further study in a confirmatory efficacy trial.ClinicalTrials.gov Identifier Number: NCT02429063.
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Affiliation(s)
| | - Kayla N LaRosa
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erin MacArthur
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kathryn Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jane Brigden
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Laura E Schwartz
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew Wilson
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Alberto Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Steur LMH, Kaspers GJL, Van Someren EJW, Van Eijkelenburg NKA, Van der Sluis IM, Dors N, Van den Bos C, Tissing WJE, Grootenhuis MA, Van Litsenburg RRL. Sleep-wake rhythm disruption is associated with cancer-related fatigue in pediatric acute lymphoblastic leukemia. Sleep 2021; 43:5691200. [PMID: 31889198 PMCID: PMC7294409 DOI: 10.1093/sleep/zsz320] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/28/2019] [Indexed: 12/16/2022] Open
Abstract
Study Objectives To compare sleep–wake rhythms, melatonin, and cancer-related fatigue in pediatric patients with acute lymphoblastic leukemia (ALL) to healthy children and to assess the association between sleep–wake outcomes and cancer-related fatigue. Methods A national cohort of ALL patients (2–18 years) was included. Sleep–wake rhythms were measured using actigraphy and generated the following variables: Interdaily stability (IS): higher IS reflects higher stability; intradaily variability (IV): lower IV indicates less fragmentation; L5 and M10 counts: activity counts during the five least and 10 most active hours, respectively; and relative amplitude (RA): the ratio of L5 and M10 counts (higher RA reflects a more robust rhythm). The melatonin metabolite, 6-sulfatoxymelatonin (aMT6s), was assessed in urine. Cancer-related fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Using regression models sleep–wake rhythms, aMT6s, and cancer-related fatigue were compared to healthy children and associations between sleep–wake outcomes and cancer-related fatigue were assessed in ALL patients. Results In total, 126 patients participated (response rate: 67%). IS, RA, and M10 counts were lower in patients compared to healthy children (p < 0.001). aMT6s levels were comparable to healthy children (p = 0.425). Patients with ALL were more fatigued compared to healthy children (p < 0.001). Lower IS, RA and M10 counts and higher IV were significantly associated with more parent-reported cancer-related fatigue. Associations between sleep–wake rhythms and self-reported cancer-related fatigue were not statistically significant. Conclusions Sleep–wake rhythm impairment is associated with more cancer-related fatigue in pediatric ALL patients. Interventions aimed to improve sleep hygiene and encourage physical activity may reduce cancer-related fatigue.
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Affiliation(s)
- Lindsay M H Steur
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Dutch Childhood Oncology Group, Utrecht, the Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (An Institute of the Royal Netherlands Academy of Arts and Sciences), Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Amsterdam Neuroscience, Center for Neurogenomics and Cognitive Research (CNCR), VU University Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Inge M Van der Sluis
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cor Van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Raphaële R L Van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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HIENSCH ANOUKE, MIJWEL SARA, BARGIELA DAVID, WENGSTRÖM YVONNE, MAY ANNEM, RUNDQVIST HELENE. Inflammation Mediates Exercise Effects on Fatigue in Patients with Breast Cancer. Med Sci Sports Exerc 2021; 53:496-504. [PMID: 32910094 PMCID: PMC7886356 DOI: 10.1249/mss.0000000000002490] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The randomized controlled OptiTrain trial showed beneficial effects on fatigue after a 16-wk exercise intervention in patients with breast cancer undergoing adjuvant chemotherapy. We hypothesize that exercise alters systemic inflammation and that this partially mediates the beneficial effects of exercise on fatigue. METHODS Two hundred and forty women scheduled for chemotherapy were randomized to 16 wk of resistance and high-intensity interval training (RT-HIIT), moderate-intensity aerobic and high-intensity interval training (AT-HIIT), or usual care (UC). In the current mechanistic analyses, we included all participants with >60% attendance and a random selection of controls (RT-HIIT = 30, AT-HIIT = 27, UC = 29). Fatigue (Piper Fatigue Scale) and 92 markers (e.g., interleukin-6 [IL-6] and tumor necrosis factor α [TNF-α]) were assessed at baseline and postintervention. Mediation analyses were conducted to explore whether changes in inflammation markers mediated the effect of exercise on fatigue. RESULTS Overall, chemotherapy led to an increase in inflammation. The increases in IL-6 (pleiotropic cytokine) and CD8a (T-cell surface glycoprotein) were however significantly less pronounced after RT-HIIT compared with UC (-0.47, 95% confidence interval = -0.87 to -0.07, and -0.28, 95% confidence interval = -0.57 to 0.004, respectively). Changes in IL-6 and CD8a significantly mediated the exercise effects on both general and physical fatigue by 32.0% and 27.7%, and 31.2% and 26.4%, respectively. No significant between-group differences in inflammatory markers at 16 wk were found between AT-HIIT and UC. CONCLUSIONS This study is the first showing that supervised RT-HIIT partially counteracted the increase in inflammation during chemotherapy, i.e., IL-6 and soluble CD8a, which resulted in lower fatigue levels postintervention. Exercise, including both resistance and high-intensity aerobic training, might be put forward as an effective treatment to reduce chemotherapy-induced inflammation and subsequent fatigue.
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Affiliation(s)
- ANOUK E. HIENSCH
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, THE NETHERLANDS
| | - SARA MIJWEL
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, SWEDEN
| | - DAVID BARGIELA
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UNITED KINGDOM
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, SWEDEN
| | - YVONNE WENGSTRÖM
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, SWEDEN
- Theme Cancer, Karolinska University Hospital, Stockholm, SWEDEN
| | - ANNE M. MAY
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, THE NETHERLANDS
| | - HELENE RUNDQVIST
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, SWEDEN
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Feng LR, Barb JJ, Regan J, Saligan LN. Plasma metabolomic profile associated with fatigue in cancer patients. Cancer Med 2021; 10:1623-1633. [PMID: 33534943 PMCID: PMC7940245 DOI: 10.1002/cam4.3749] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Metabolomics is the newest -omics methodology and allows for a functional snapshot of the biochemical activity and cellular state. The goal of this study is to characterize metabolomic profiles associated with cancer-related fatigue, a debilitating symptom commonly reported by oncology patients. METHODS Untargeted ultrahigh performance liquid chromatography/mass spectrometry metabolomics approach was used to identify metabolites in plasma samples collected from a total of 197 participants with or without cancer. Partial least squares-discriminant analysis (PLS-DA) was used to identify discriminant metabolite features, and diagnostic performance of selected classifiers was quantified using area under the receiver operating characteristics (AUROC) curve analysis. Pathway enrichment analysis was performed using Fisher's exact test and the Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic pathway database. FINDINGS The global metabolomics approach yielded a total of 1120 compounds of known identity. Significant metabolic pathways unique to fatigued cancer versus control groups included sphingolipid metabolism, histidine metabolism, and cysteine and methionine metabolism. Significant pathways unique to non-fatigued cancer versus control groups included inositol phosphate metabolism, primary bile acid biosynthesis, ascorbate and aldarate metabolism, starch and sucrose metabolism, and pentose and glucuronate interconversions. Pathways shared between the two comparisons included caffeine metabolism, tyrosine metabolism, steroid hormone biosynthesis, sulfur metabolism, and phenylalanine metabolism. CONCLUSIONS We found significant metabolomic profile differences associated with cancer-related fatigue. By comparing metabolic signatures unique to fatigued cancer patients with metabolites associated with, but not unique to, fatigued cancer individuals (overlap pathways) and metabolites associated with cancer but not fatigue, we provided a broad view of the metabolic phenotype of cancer-related fatigue.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing ResearchNational Institutes of HealthBethesdaMDUSA
| | | | - Jeniece Regan
- The Pennsylvania State University College of MedicineHersheyPAUSA
| | - Leorey N. Saligan
- National Institute of Nursing ResearchNational Institutes of HealthBethesdaMDUSA
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Pearson EJ, Drosdowsky A, Edbrooke L, Denehy L. Exploring the Use of Two Brief Fatigue Screening Tools in Cancer Outpatient Clinics. Integr Cancer Ther 2021; 20:1534735420983443. [PMID: 33522317 PMCID: PMC7871054 DOI: 10.1177/1534735420983443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Cancer fatigue guidelines recommend routine fatigue screening, with further assessment for people reporting moderate to severe fatigue. There is neither a gold-standard, nor a broadly accepted screening method, and knowledge about the impact of screening on care processes is limited. This study aimed to explore the feasibility of 2 fatigue screening methods and current clinical practice in cancer outpatient clinics. METHODS Hospital outpatients attending cancer clinics during 1 week completed a five-item survey: a numeric scale for current tiredness, 2 categorical pictorial scales rating tiredness last week and the impact of fatigue (Fatigue Pictogram), screening tool preference and help needed for survey completion. Participant demographics and fatigue documentation by clinical staff for that appointment were extracted from medical records. Analyses used descriptive statistics. Groups were compared using appropriate statistical tests. RESULTS Over 75% of participants rated their fatigue consistently as mild or significant on both screening tools. Of 1709 eligible outpatients, 533 (31%) completed the survey. Records were audited for 430 (81%) identifiable participants. Over half of the participants reported moderate or severe tiredness either "now" (237, 57%) and/or "last week" (226, 53%). Clinician documentation of fatigue seldom matched self-reports. Fatigue was rated as severe by 103 participants (24%), yet was noted in only 21 (20%) of these individuals' clinical notes. Both screening tools were equally preferred. CONCLUSION The numeric rating scale and Fatigue Pictogram are equally applicable for screening fatigue in cancer outpatient care. There is a high prevalence of clinically significant fatigue in a hospital outpatient setting that is not documented. Adequate care pathways for further management should be established alongside fatigue screening.
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Affiliation(s)
- Elizabeth J Pearson
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Allison Drosdowsky
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lara Edbrooke
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Denehy
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Rostagno E, Bergadano A, Piredda M, De Marinis MG. Italian nurses knowledge and attitudes towards fatigue in pediatric onco-hematology: A cross-sectional nationwide survey. Int J Pediatr Adolesc Med 2020; 7:161-165. [PMID: 33319013 PMCID: PMC7729244 DOI: 10.1016/j.ijpam.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/28/2020] [Indexed: 12/17/2022]
Abstract
Background and Objective Fatigue is one of the most debilitating and prevalent symptoms in pediatric cancer patients and it is important to know if nurses are able to recognize and manage it. The aim of this study was to investigate the knowledge and attitudes towards fatigue of nurses working in Italian pediatric onco-hematology centers. Methods Cross-sectional online survey. An existing questionnaire was adapted to the Italian context, extended with a section on attitudes, and psychometrically tested. The questionnaire was sent to all nurses working in Italian pediatric onco-hematology centers. Results Respondents (n = 189), who were working in 37/53 (∼70%) centers, reported 42% of children and 68% of adolescents experiencing fatigue, with intensity increasing with age. Contributing factors were treatments and co-morbidities; frequent symptoms were mood changes and lack of energy. Among respondents who did not assess fatigue, 36.2% did not know an appropriate tool. Nurses recognized fatigue as an important problem and their knowledge and attitudes towards fatigue seemed satisfactory. Conclusion This study provides nurses with an instrument to investigate their knowledge and attitudes about fatigue. Nurses' awareness of the significance of fatigue is a fundamental step towards improving its management and offering strategies that can help both the child and their family.
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Affiliation(s)
- Elena Rostagno
- Pediatric Oncology and Hematology Unit, S.Orsola-Malpighi Hospital, Via Massarenti, 40138, Bologna, Italy
| | - Anna Bergadano
- Pediatric Onco-Hematology Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia, 94 - 10100, Torino, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
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Vichaya EG, Ford BG, Quave CB, Rishi MR, Grossberg AJ, Dantzer R. Toll-like receptor 4 mediates the development of fatigue in the murine Lewis Lung Carcinoma model independently of activation of macrophages and microglia. Psychoneuroendocrinology 2020; 122:104874. [PMID: 32979744 PMCID: PMC7686070 DOI: 10.1016/j.psyneuen.2020.104874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/23/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
Cancer-related fatigue at the time of tumor diagnosis is commonly attributed to inflammation associated with the disease process. However, we have previously demonstrated that running wheel deficits occur well before increased expression of proinflammatory cytokines in the liver and brain in a murine model of human papilloma virus-related head and neck cancer (mEER). Further, we have demonstrated that genetic deletion of type I interleukin-1 receptor and MyD88 has no effect. In the current investigation we sought to test the generality of this finding by assessing whether there is a role for toll-like receptor (TLR) 4-dependent inflammation in the fatigue-like behavior observed in mice with Lewis Lung Carcinoma (LLC) or mEER tumors. Genetic deletion of TLR4 attenuated tumor-induced elevations in liver pro-inflammatory cytokine expression in both models. However, it only abrogated wheel running deficits in LLC tumor bearing mice. To determine whether TLR4 signaling in the LLC model involves innate immune cells, mice were treated with the colony stimulating factor (CSF)-1 receptor antagonist PLX-5622 before and throughout tumor development to deplete microglia and peripheral macrophages. Administration of PLX-5622 had no protective effect on wheel running deficits in either mEER or LLC tumor models despite effective depletion of microglia and a down regulation of peripheral proinflammatory cytokine expression. These results indicate that the TLR4 signaling that mediates fatigue-like behavior in LLC mice is not dependent upon microglial or peripheral macrophage activation. Based on the literature and our data demonstrating attenuation of ubiquitin proteasome pathway activation in the gastrocnemius muscle of Tlr4-/- mice implanted with LLC cells, we interpret our current findings as indication that skeletal muscle TLR4 signaling may be involved. These results are important in that they add to the evidence that tumor-induced fatigue develops independently from classical neuroinflammation.
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Affiliation(s)
- Elisabeth G. Vichaya
- Department of Psychology & Neuroscience, Baylor University, Waco, TX 76798,Department of Symptom Research, Laboratory of Neuroimmunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Bianca G. Ford
- Department of Symptom Research, Laboratory of Neuroimmunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Cana B. Quave
- Department of Symptom Research, Laboratory of Neuroimmunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030,University of Texas Health Science Center at Houston, Graduate School of Biomedical Sciences, Houston, TX 77030
| | - M. Raafay Rishi
- Department of Symptom Research, Laboratory of Neuroimmunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Aaron J. Grossberg
- Department of Radiation Medicine, Brenden-Colson Center for Pancreatic Care, Cancer Early Detection Advanced Research Center, Oregon Health & Sciences University, Portland, OR, US
| | - Robert Dantzer
- Department of Symptom Research, Laboratory of Neuroimmunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030
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Schulte F, Forbes C, Wurz A, Patton M, Russell KB, Pluijm S, Krull KR. Childhood Cancer Survivorship: Daily Challenges. Pediatr Clin North Am 2020; 67:1083-1101. [PMID: 33131536 DOI: 10.1016/j.pcl.2020.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Survivors of childhood cancer are at risk of experiencing fatigue, pain, lower levels of physical activity, increased engagement in risky health behavior, and poor social adjustment, after finishing treatment. Risks are more pronounced for survivors of specific diagnoses or receiving specific treatment protocols. Interventions to address these outcomes are in their infancy. Future research should focus on exploring the antecedents and consequences of these outcomes. In the meantime, researchers and cancer centers should attempt to provide high-quality and accessible health information to survivors through various media outlets to encourage healthy behaviors.
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Affiliation(s)
- Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.
| | - Caitlin Forbes
- University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Amanda Wurz
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Saskia Pluijm
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, TN, USA
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Centeno C, Rojí R, Portela MA, De Santiago A, Cuervo MA, Ramos D, Gandara A, Salgado E, Gagnon B, Sanz A. Improved cancer-related fatigue in a randomised clinical trial: methylphenidate no better than placebo. BMJ Support Palliat Care 2020; 12:226-234. [PMID: 33168668 DOI: 10.1136/bmjspcare-2020-002454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/25/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Methylphenidate is a psychostimulant drug used to treat fatigue in patients with advanced cancer, for which there is no gold standard of treatment. OBJECTIVE To explore the efficacy of methylphenidate in the relief of fatigue in patients with advanced cancer. MATERIALS AND METHODS A randomised double-blind placebo-controlled multicentre clinical trial, stratified according to the intensity of fatigue. The treatment was considered effective if the improvement in mean fatigue intensity between baseline values and day 6 was significantly higher in the methylphenidate group than in the placebo group. The responses were measured using the Edmonton Symptoms Assessment System (ESAS) and the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scales. RESULTS 35 patients received placebo and 42 patients received methylphenidate. The populations of both groups were homogeneous. Patients receiving methylphenidate did not exhibit statistically significant improvement of fatigue in comparison to patients receiving placebo (p=0.52). The mean improvement of fatigue (ESAS) on day 6 was -1.9 (±2.5) in the placebo group, and -2.3 (±2.6) in the methylphenidate group (p=0.52). The results obtained with the FACT-F were congruent with those obtained by the ESAS. The responses in patients with severe fatigue were -2.4 (±2.9) in the placebo group and -3.4 (±2.5) in the methylphenidate group; the difference was not statistically significant (p=0.3). CONCLUSION Methylphenidate was not more efficient than placebo to treat cancer-related fatigue. Fatigue improved significantly after 3 days of treatment and was stabilised on day 6, both with placebo and methylphenidate. The side effects of methylphenidate were mild and infrequent. TRIAL REGISTRATION NUMBER EudraCT Registry (2008-002171-27).
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Affiliation(s)
- Carlos Centeno
- Palliative Medicine, University of Navarra Clinic, Pamplona, Spain.,Culture and Society Institute, ATLANTES Project, University of Navarra, Pamplona, Spain.,IdiSNA, Pamplona, Navarra, Spain
| | - Rocío Rojí
- Palliative Medicine, University of Navarra Clinic, Pamplona, Spain .,IdiSNA, Pamplona, Navarra, Spain
| | - Maria Angustias Portela
- Palliative Medicine, University of Navarra Clinic, Pamplona, Spain.,Palliative Care Unit, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Ana De Santiago
- Palliative Medicine, Foundation Vianorte-Laguna, Madrid, Spain
| | | | - Daniel Ramos
- Palliative Care Team, Rio Hortega University Hospital, Valladolid, Spain
| | - Alvaro Gandara
- Palliative Care Unit, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain.,Palliative Medicine, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | | | | | - Alvaro Sanz
- Medical Oncology, Rio Hortega University Hospital, Valladolid, Spain
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Ehlers DK, DuBois K, Salerno EA. The effects of exercise on cancer-related fatigue in breast cancer patients during primary treatment: a meta-analysis and systematic review. Expert Rev Anticancer Ther 2020; 20:865-877. [PMID: 32842816 DOI: 10.1080/14737140.2020.1813028] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Cancer-related fatigue is one of the most prevalent symptoms reported by breast cancer survivors. Despite a corpus of literature dedicated to understanding and identifying evidence-based treatments for cancer-related fatigue, gaps in the literature remain, particularly for breast cancer survivors during their primary treatment. Exercise training may represent an efficacious behavioral modality for mitigating fatigue symptoms in cancer survivors; yet, the effects of exercise during adjuvant therapy is an understudied area. AREAS COVERED In this review, we synthesize the most recent evidence of exercise's effects on cancer-related fatigue during active treatment for breast cancer. We summarize the overall effects of exercise, moderators of these effects, and areas requiring further research. EXPERT OPINION Strong evidence supports at least modest effects of exercise on cancer-related fatigue during breast cancer treatment. However, several knowledge gaps persist, including the need to: risk stratify patients to tailor exercise promotion strategies; implement higher-quality studies and translate this evidence to clinical practice; adopt biobehavioral models to better understand exercise's effects on cancer-related fatigue; evaluate the effects of exercise modes besides aerobic and combined training; and integrate technology to better understand and promote fatigue-reducing behaviors, such as exercise, across cancer care.
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Affiliation(s)
- Diane K Ehlers
- Department of Neurological Sciences, University of Nebraska Medical Center , Omaha, NE, USA
| | - Kelli DuBois
- Department of Health Promotion, Education, & Behavior, University of South Carolina Arnold School of Public Health , Columbia, SC, USA
| | - Elizabeth A Salerno
- Division of Cancer Epidemiology & Genetics, Metabolic Epidemiology Branch, National Cancer Institute , Rockville, MD, USA
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Recommendations for the surveillance of cancer-related fatigue in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. J Cancer Surviv 2020; 14:923-938. [PMID: 32839902 PMCID: PMC7572340 DOI: 10.1007/s11764-020-00904-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) negatively affects the lives of childhood, adolescent, and young adult (CAYA) cancer survivors. We aimed to provide an evidence-based clinical practice guideline (CPG) with internationally harmonized CRF surveillance recommendations for CAYA cancer survivors diagnosed < 30 years. METHODS This CPG was developed by a multidisciplinary panel under the umbrella of the International Late Effects of Childhood Cancer Guideline Harmonization Group. After evaluating concordances and discordances of four existing CPGs, we performed systematic literature searches. We screened articles for eligibility, assessed quality, extracted, and summarized the data from included articles. We formulated recommendations based on the evidence and clinical judgment. RESULTS Of 3647 articles identified, 70 articles from 14 countries were included. The prevalence of CRF in CAYA cancer survivors ranged from 10-85%. We recommend that healthcare providers are aware of the risk of CRF, implement regular screening with validated measures, and recommend effective interventions to fatigued survivors. CONCLUSIONS A considerable proportion of CAYA cancer survivors suffers from CRF even years after the end of treatment. IMPLICATIONS FOR CANCER SURVIVORS We recommend that healthcare providers adopt regular screening to detect and treat CRF early and positively influence survivors' health and quality of life.
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36
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Misra S, Lee G, Korzets Y, Wang L, Lau A, Koch CA, Croke J, Helou J. Patient-reported acute fatigue in elderly breast cancer patients treated with and without regional nodal radiation. Breast Cancer Res Treat 2020; 183:391-401. [PMID: 32651754 DOI: 10.1007/s10549-020-05781-5] [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: 02/05/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Although regional nodal irradiation (RNI) improves outcomes in breast cancer (BC) patients, it is associated with increased toxicity. Therefore, controversy still exists surrounding its indications. The purpose of this study was to evaluate and compare patient-reported acute fatigue in elderly BC patients with and without regional nodal radiation (RNI). METHODS Elderly breast cancer patients (≥ 65 years) treated with adjuvant radiotherapy (RT) between 2012 and 2017 were identified from a prospective database. The validated Edmonton Symptom Assessment System-revised (ESAS-r) questionnaire, which assesses fatigue, was completed prior to (baseline), during, at end of RT and first follow-up (3-6 months). Symptoms were rated on a 10-point Likert scale, with higher scores indicating higher fatigue. Patient's treatment characteristics were also recorded prospectively. This was a retrospective study which identified elderly breast cancer patients who had received adjuvant radiation, completed ESAS-r prospectively and provided research consent for using ESAS-r. Patients were divided into two cohorts: those who received RNI (cohort 1) and those who did not (cohort 2). A minimal clinically important difference (MID) was defined using an anchor of ≥ 1-point compared to baseline. The proportion of patients reporting a change in fatigue at the end of RT was evaluated. To test the robustness of the results, dynamic changes of fatigue scores over time were further compared between the cohorts using a general linear mixed model (GLMM) after assuming individual patient with random effect. Univariate and multivariable logistic regression were conducted to assess the association between RNI and MID after adjusting for potential confounders. In addition to longitudinal analysis, a multivariable mixed effect model was developed to determine the association of RNI with fatigue after adjusting for potential confounders. A two-tailed p value ≤ 0.05 was considered statistically significant. RESULTS Of the 1198 patients, 859 had provided research consent and completed the ESAS-r at baseline and any other time-point and were included in the longitudinal analysis (cohort 1 = 159, cohort 2 = 700), while 637 (cohort 1 = 135, cohort 2 = 502) patients completed the ESAS-r at baseline and end of radiotherapy and were included in the anchor-based analysis. Mean age at diagnosis was similar between the groups: cohort 1; 71.5 ± 5.7 vs. cohort; 2 72 ± 5.4 years (total 71.8 ± 5.5). Overall, cohort 1 had higher stage (Stage 3: 32.7% vs 3.6%, p < 0.001) and reception of chemotherapy (68.6% vs. 16.1%, p < 0.001). Mean baseline fatigue was higher for cohort 1 vs. 2 (2.7 ± 2.5 vs. 2.1 ± 2.3, p = 0.006). On univariate and multivariable analyses, RNI was not associated with an increased odd of MID for fatigue at the end of RT (44% vs. 47%; OR 0.89, 95% CI 0.61-1.30, p = 0.56). After adjusting for confounders (age, duration of RT, endocrine therapy), treatment with RNI was not associated with increased odds of worse fatigue at the end of RT (OR 1.33, 95% CI 0.85-2.10, p = 0.22). Higher baseline fatigue (OR 0.86, 95% CI 0.79-0.92, p < 0.001) and receipt of chemotherapy had decreased odds (OR 0.50, 95% CI 0.32-0.86, p = 0.001) and were the only factors associated with decreased odds of MID. Dynamic changes showed a significant worsening of fatigue scores over time (p < 0.001) towards the end of RT and recovery at first follow-up (p < 0.001) with no difference between the cohorts (p = 0.38); both experienced parallel worsening of fatigue levels over time (cohort*time p = 0.71 and cohort*time2p = 0.78). On multivariable analysis earlier stage, the absence of chemotherapy and higher baseline depression were independent predictors of worse fatigue scores over time (p = 0.01, p = 0.003, and p = 0.02, respectively). CONCLUSION The addition of RNI in elderly BC patients is not associated with a significant worsening of patient-reported fatigue. Predictors of acute fatigue will enable shared decision making between patients and clinicians.
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Affiliation(s)
- Shagun Misra
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,University Health Network - Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada.,Currently Working As Assistant Professor, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Grace Lee
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,University Health Network - Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Yasmin Korzets
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,University Health Network - Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Lisa Wang
- University Health Network - Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada.,Department of Biostatistics, University of Toronto, Toronto, ON, Canada
| | - Anthea Lau
- University Health Network - Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada.,Department of Biostatistics, University of Toronto, Toronto, ON, Canada
| | - Christine Anne Koch
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,University Health Network - Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Jennifer Croke
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,University Health Network - Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. .,University Health Network - Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
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Rau KM, Shun SC, Chiou TJ, Lu CH, Ko WH, Lee MY, Huang WT, Yeh KH, Chang CS, Hsieh RK. A nationwide survey of fatigue in cancer patients in Taiwan: an unmet need. Jpn J Clin Oncol 2020; 50:693-700. [PMID: 32303764 PMCID: PMC7284537 DOI: 10.1093/jjco/hyaa038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/15/2022] Open
Abstract
Background Cancer-related fatigue (CRF) is an emerging clinical issue, although its prevalence and impact on quality of life (QOL) in cancer patients in Taiwan remain unclear. The present nationwide cross-sectional study was conducted to provide a thorough overview of the prevalence, related factors and impact of CRF in Taiwan. Methods In this multi-center survey, data were collected using the International Classification of Diseases 10th Revision (ICD-10) Fatigue evaluation, Brief Fatigue Inventory–Taiwan (BFI-T), the Chinese version of the Symptom Distressed Scale and a fatigue experience survey. Logistic regression was used to determine the correlations between fatigue characteristics and the factors studied. Results A total of 1207 cancer patients were recruited from 23 hospitals in Taiwan. Fatigue was the most distressing symptom in Taiwanese cancer patients. The distress score was higher if CRF was diagnosed using ICD-10 compared with BFI-T. Rest and nutritional supplementation were the most common non-pharmacological treatments; blood transfusion was the most common pharmacological treatment. There were 45% of patients reported not receiving a timely intervention for fatigue. Conclusions Fatigue is the most bothersome symptom reported by Taiwanese cancer patients. Caregivers should be aware of the impact of CRF on QOL in cancer patients, constantly measure the severity of fatigue and provide appropriate interventions.
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Affiliation(s)
- Kun-Ming Rau
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan.,I-Shou University, Collage of Medicine, Kaohsiung, Taiwan
| | | | - Tzeon-Jye Chiou
- Cancer Center, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
| | - Chang-Hsien Lu
- Division of Hematology-Oncology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wei-Hsu Ko
- Anfa Clinic, Taipei, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ming-Yang Lee
- Department of Hematology and Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wen-Tsung Huang
- Department of Hematology and Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Shyong Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Division of Hematology-Oncology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ruey-Kuen Hsieh
- Department of Hematology and Oncology, MacKay Memorial Hospital, Taipei, Taiwan
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Buffart LM, Schreurs MAC, Abrahams HJG, Kalter J, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Armes J, Arving C, Braamse AM, Brandberg Y, Dekker J, Ferguson RJ, Gielissen MF, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Knoop H, Verdonck-de Leeuw IM. Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses. Clin Psychol Rev 2020; 80:101882. [PMID: 32640368 DOI: 10.1016/j.cpr.2020.101882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects. METHODS Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs. RESULTS CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (β = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = -0.16,95%CI = -0.25;-0.07) and anxiety (β = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05). CONCLUSIONS CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.
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Affiliation(s)
- L M Buffart
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - M A C Schreurs
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - H J G Abrahams
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - J Kalter
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, Florida, USA.
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - J Armes
- School of Health Science, University of Surrey, Surrey, UK.
| | - C Arving
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - A M Braamse
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
| | | | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - M M Goedendorp
- Department of Health Science, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA.
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK.
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada.
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Brug
- National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
| | - H Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - I M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, the Netherlands.
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Fabi A, Bhargava R, Fatigoni S, Guglielmo M, Horneber M, Roila F, Weis J, Jordan K, Ripamonti CI. Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Ann Oncol 2020; 31:713-723. [PMID: 32173483 DOI: 10.1016/j.annonc.2020.02.016] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- A Fabi
- Division of Medical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - R Bhargava
- William Osler Health System, Corporate Department of Research, Department of Oncology and Division of Palliative Care, Brampton, Canada
| | - S Fatigoni
- Division of Medical Oncology, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - M Guglielmo
- Oncology-Supportive Care Unit, Department Onco-Haematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - M Horneber
- Department of Internal Medicine, Division of Oncology and Hematology & Division of Pneumology, Paracelsus Medical University, Klinikum, Nuremberg, Germany
| | - F Roila
- Division of Medical Oncology, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - J Weis
- Department of Self Help Research in Oncology, Comprehensive Cancer Center, University Medical Center, Freiburg, Germany
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - C I Ripamonti
- Oncology-Supportive Care Unit, Department Onco-Haematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Steur LMH, Kaspers GJL, van Someren EJW, van Eijkelenburg NKA, van der Sluis IM, Dors N, van den Bos C, Tissing WJE, Grootenhuis MA, van Litsenburg RRL. The impact of maintenance therapy on sleep-wake rhythms and cancer-related fatigue in pediatric acute lymphoblastic leukemia. Support Care Cancer 2020; 28:5983-5993. [PMID: 32285260 PMCID: PMC7686190 DOI: 10.1007/s00520-020-05444-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
Abstract
Purpose To assess the impact of maintenance therapy and the additional impact of dexamethasone treatment on cancer-related fatigue and sleep-wake rhythms in pediatric acute lymphoblastic leukemia (ALL) patients and to determine the association between these outcomes. Methods A national cohort of pediatric ALL patients (≥ 2 years) was included (± 1 year post-diagnosis). Patients receiving dexamethasone were assessed twice (assessment with and without dexamethasone). Actigraphy assessments were used to calculate sleep-wake outcomes with nonparametric methods. Cancer-related fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Sleep-wake rhythms and cancer-related fatigue were compared between patients participating in the assessment without dexamethasone and healthy children (linear regression) and between assessments with and without dexamethasone (mixed models). Using linear regression, associations between sleep-wake outcomes and cancer-related fatigue were determined during assessments with and without dexamethasone. Results Responses were collected for 125 patients (113 assessments with and 81 without dexamethasone). The sleep-wake rhythm was less stable (p = 0.03) and less robust (p = 0.01), with lower physical activity levels (p < 0.001) and higher cancer-related fatigue levels (p < 0.001) in ALL patients compared to healthy children. Physical activity was lower (p = 0.001) and cancer-related fatigue more severe (p ≤ 0.001) during assessments with dexamethasone compared to without dexamethasone. Sleep-wake outcomes were significantly associated with cancer-related fatigue during periods without dexamethasone, but not during periods with dexamethasone. Conclusion Sleep-wake rhythms are disturbed, physical activity levels lower, and cancer-related fatigue levels higher during maintenance therapy. Interventions aimed to enhance sleep-wake rhythms during maintenance therapy could improve cancer-related fatigue. Families should be supported in coping with the additional burden of dexamethasone treatment to improve well-being of ALL patients. Electronic supplementary material The online version of this article (10.1007/s00520-020-05444-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L M H Steur
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - G J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Dutch Childhood Oncology Group, Utrecht, The Netherlands
| | - E J W van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (an institute of the Royal Netherlands Academy of Arts and Sciences), Amsterdam, The Netherlands
- Department of Integrative Neurophysiology, Amsterdam Neuroscience, Center for Neurogenomics and Cognitive Research (CNCR), VU University Amsterdam, Amsterdam, The Netherlands
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - N K A van Eijkelenburg
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - I M van der Sluis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N Dors
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Oncology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C van den Bos
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of pediatric oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - R R L van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
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Jim HSL, Hoogland AI, Han HS, Culakova E, Heckler C, Janelsins M, Williams GC, Bower J, Cole S, Desta Z, Babilonia MB, Morrow G, Peppone L. A randomized placebo-controlled trial of bupropion for Cancer-related fatigue: Study design and procedures. Contemp Clin Trials 2020; 91:105976. [PMID: 32147571 PMCID: PMC7263969 DOI: 10.1016/j.cct.2020.105976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cancer-related fatigue is a significant problem and is associated with poor quality of life. Behavioral interventions include exercise and cognitive-behavioral therapy, which survivors may be unwilling or unable to adopt. Pharmacologic interventions (e.g., selective serotonin reuptake inhibitors) have been disappointing. One potential therapy is the antidepressant bupropion, a norepinephrine-dopamine reuptake inhibitor that targets both inflammation and the hypothalamic-pituitary-adrenal axis. The current study is intended to provide a rigorous test of the efficacy and tolerability of bupropion for cancer-related fatigue. METHODS A randomized, double-blind, placebo-controlled trial will examine the effects of bupropion on cancer-related fatigue. The trial will be conducted nationwide through the University of Rochester Medical Center (URMC) National Cancer Institute Community Oncology Research Program (NCORP). Disease-free breast cancer survivors (n = 422) who completed chemotherapy and/or radiotherapy 12-60 months previously and report significant fatigue will be randomized 1:1 to receive bupropion (300 mg/day) or placebo. Outcomes will be assessed at baseline and the 12-week follow-up. The primary outcome, fatigue, will be measured with the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F). Secondary outcomes include quality of life, depression, and drug tolerability. Exploratory outcomes include cognition and symptomatology. Potential biological mechanisms and genetic moderators of cancer-related fatigue will also be explored. DISCUSSION This study is the first placebo-controlled trial to our knowledge to evaluate bupropion for cancer-related fatigue. Positive results could revolutionize the treatment of cancer-related fatigue, as bupropion is safe, inexpensive, widely-available, and may be more tolerable and acceptable for many patients than current, limited treatment options.
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Affiliation(s)
| | | | | | - Eva Culakova
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | - Julienne Bower
- University of California Los Angeles, Los Angeles, CA, USA
| | - Stephen Cole
- University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Gary Morrow
- University of Rochester Medical Center, Rochester, NY, USA
| | - Luke Peppone
- University of Rochester Medical Center, Rochester, NY, USA
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Age-related cytokine effects on cancer-related fatigue and quality of life in acute myeloid leukemia. J Geriatr Oncol 2020; 11:402-409. [DOI: 10.1016/j.jgo.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/20/2019] [Accepted: 04/09/2019] [Indexed: 12/22/2022]
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Salehifar E, Azimi S, Janbabai G, Zaboli E, Hendouei N, Saghafi F, Borhani S. Efficacy and safety of bupropion in cancer-related fatigue, a randomized double blind placebo controlled clinical trial. BMC Cancer 2020; 20:158. [PMID: 32106832 PMCID: PMC7045731 DOI: 10.1186/s12885-020-6618-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/11/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cancer-related fatigue (CRF) is one of the most prevalent complications experienced by cancer patients during and after the process of treatment. Despite conducting a lot of studies, there is no approved therapy to help manage CRF. This study aims to investigate the efficacy of bupropion on CRF. MATERIALS AND METHODS In this double-blind randomized placebo-controlled clinical trial, a total of 30 eligible cancer patients suffering from fatigue were randomly divided into two groups (15 patients in each group). Bupropion was administered 75 mg/day for the first three days and 150 mg/day (divided in two doses) till the end of the study at week 6. Fatigue as the primary outcome was measured by BFI (Brief Fatigue Inventory) and FACIT-Fatigue (Functional Assessment of Chronic Illness Therapy) scales. Secondary outcomes included HADS (Hospital Anxiety and Depression Scale) and performance status (PS) measured by Karnofsky and ECOG (Eastern Cooperative Oncology Group) scales. Assessments were done at baseline, end of the second and sixth week. RESULTS There was no significant difference between placebo and bupropion at baseline and the end of second week. Significant difference was seen between two groups at the end of week six (P = 0.006 based on BFI) in favor of bupropion. In-group assessment showed improvement in fatigue levels in both groups during study time (P = 0.000 based on BFI for both bupropion and placebo). Secondary outcomes (e.g., HADS and PS) were not different at baseline and the end of second week. However, at the end of week six, the difference was significant in favor of bupropion. CONCLUSION A six-week trial of bupropion reduces the CRF and improves the PS of cancer patients. TRIAL REGISTRATION Current Controlled Trials IRCT20090613002027N12, registration date: 2018-06-01.
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Affiliation(s)
- Ebrahim Salehifar
- Pharmaceutical Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Saeid Azimi
- Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghasem Janbabai
- Gastrointestinal Cancer Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ehsan Zaboli
- Gastrointestinal Cancer Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Narjes Hendouei
- Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Saghafi
- Faculty of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Samaneh Borhani
- Emam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
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Lanser L, Kink P, Egger EM, Willenbacher W, Fuchs D, Weiss G, Kurz K. Inflammation-Induced Tryptophan Breakdown is Related With Anemia, Fatigue, and Depression in Cancer. Front Immunol 2020; 11:249. [PMID: 32153576 PMCID: PMC7047328 DOI: 10.3389/fimmu.2020.00249] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/30/2020] [Indexed: 12/13/2022] Open
Abstract
Many patients with cancer suffer from anemia, depression, and an impaired quality of life (QoL). These patients often also show decreased plasma tryptophan levels and increased kynurenine concentrations in parallel with elevated concentrations of Th1 type immune activation marker neopterin. In the course of anti-tumor immune response, the pro-inflammatory cytokine interferon gamma (IFN-γ) induces both, the enzyme indoleamine 2,3-dioxygenase (IDO) to degrade tryptophan and the enzyme GTP-cyclohydrolase I to form neopterin. High neopterin concentrations as well as an increased kynurenine to tryptophan ratio (Kyn/Trp) in the blood of cancer patients are predictive for a worse outcome. Inflammation-mediated tryptophan catabolism along the kynurenine pathway is related to fatigue and anemia as well as to depression and a decreased QoL in patients with solid tumors. In fact, enhanced tryptophan breakdown might greatly contribute to the development of anemia, fatigue, and depression in cancer patients. IDO activation and stimulation of the kynurenine pathway exert immune regulatory mechanisms, which may impair anti-tumor immune responses. In addition, tumor cells can degrade tryptophan to weaken immune responses directed against them. High IDO expression in the tumor tissue is associated with a poor prognosis of patients. The efficiency of IDO-inhibitors to inhibit cancer progression is currently tested in combination with established chemotherapies and with immune checkpoint inhibitors. Inflammation-mediated tryptophan catabolism and its possible influence on the development and persistence of anemia, fatigue, and depression in cancer patients are discussed.
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Affiliation(s)
- Lukas Lanser
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Patricia Kink
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Maria Egger
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
- Oncotyrol Centre for Personalized Cancer Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Guenter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Kurz
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
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Abu-Taha OM, Al Qadire MI, Maharmeh M, Alyami MS. Assessment of cancer-related fatigue among Jordanian patients: a cross-sectional survey. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:111-117. [PMID: 31972112 DOI: 10.12968/bjon.2020.29.2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is considered to be one of the most common symptoms reported by cancer patients. However, little information is available regarding the variables associated with CRF among Jordanian patients. AIMS To assess the prevalence of CRF and explore its predictors among Jordanian patients. METHODS A cross-sectional survey design was used. FINDINGS Of the 240 patients surveyed, 210 (87.5%) had fatigue at the time of the survey. The total mean fatigue score was 6.2 (SD=1.7) out of a maximum possible score of 10. The results also showed that being unemployed, with longer hospitalisation, low haemoglobin, and having lung cancer seem to predict higher levels of CRF. CONCLUSION Several variables and factors associated with CRF were identified. In response to these results, healthcare providers should pay more attention to CRF, which needs to be assessed on a regular basis and to be managed with the available pharmacological and non-pharmacological interventions.
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Affiliation(s)
| | | | - Mahmoud Maharmeh
- Associate Professor, Faculty of Nursing, Head of Clinical Nursing Department, University of Jordan, Amman, Jordan
| | - Mansour Saleh Alyami
- General Director, General Directorate of Academic Affairs and Training, Ministry of Health, Saudi Arabia
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Lin PJ, Kleckner IR, Loh KP, Inglis JE, Peppone LJ, Janelsins MC, Kamen CS, Heckler CE, Culakova E, Pigeon WR, Reddy PS, Messino MJ, Gaur R, Mustian KM. Influence of Yoga on Cancer-Related Fatigue and on Mediational Relationships Between Changes in Sleep and Cancer-Related Fatigue: A Nationwide, Multicenter Randomized Controlled Trial of Yoga in Cancer Survivors. Integr Cancer Ther 2019; 18:1534735419855134. [PMID: 31165647 PMCID: PMC6552348 DOI: 10.1177/1534735419855134] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) often co-occurs with sleep disturbance and is one of the most pervasive toxicities resulting from cancer and its treatment. We and other investigators have previously reported that yoga therapy can improve sleep quality in cancer patients and survivors. No nationwide multicenter phase III randomized controlled trial (RCT) has investigated whether yoga therapy improves CRF or whether improvements in sleep mediate the effect of yoga on CRF. We examined the effect of a standardized, 4-week, yoga therapy program (Yoga for Cancer Survivors [YOCAS]) on CRF and whether YOCAS-induced changes in sleep mediated changes in CRF among survivors. STUDY DESIGN AND METHODS Four hundred ten cancer survivors were recruited to a nationwide multicenter phase III RCT comparing the effect of YOCAS to standard survivorship care on CRF and examining the mediating effects of changes in sleep, stemming from yoga, on changes in CRF. CRF was assessed by the Multidimensional Fatigue Symptom Inventory. Sleep was assessed via the Pittsburgh Sleep Quality Index. Between- and within-group intervention effects on CRF were assessed by analysis of covariance and 2-tailed t test, respectively. Path analysis was used to evaluate mediation. RESULTS YOCAS participants demonstrated significantly greater improvements in CRF compared with participants in standard survivorship care at post-intervention ( P < .01). Improvements in overall sleep quality and reductions in daytime dysfunction (eg, excessive napping) resulting from yoga significantly mediated the effect of yoga on CRF (22% and 37%, respectively, both P < .01). CONCLUSIONS YOCAS is effective for treating CRF among cancer survivors; 22% to 37% of the improvements in CRF from yoga therapy result from improvements in sleep quality and daytime dysfunction. Oncologists should consider prescribing yoga to cancer survivors for treating CRF and sleep disturbance.
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Affiliation(s)
- Po-Ju Lin
- 1 University of Rochester Medical Center, Rochester, NY, USA
| | - Ian R Kleckner
- 1 University of Rochester Medical Center, Rochester, NY, USA
| | - Kah Poh Loh
- 1 University of Rochester Medical Center, Rochester, NY, USA
| | - Julia E Inglis
- 1 University of Rochester Medical Center, Rochester, NY, USA
| | - Luke J Peppone
- 1 University of Rochester Medical Center, Rochester, NY, USA
| | | | - Charles S Kamen
- 1 University of Rochester Medical Center, Rochester, NY, USA
| | | | - Eva Culakova
- 1 University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Michael J Messino
- 3 Southeast Clinical Oncology Research Consortium, Winston-Salem, NC, USA
| | - Rakesh Gaur
- 4 Kansas City NCORP, Prairie Village, KS, USA
| | - Karen M Mustian
- 1 University of Rochester Medical Center, Rochester, NY, USA
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Kudubes AA, Bektas M, Mutafoğlu K. The Effect of Fatigue-Related Education on Pediatric Oncology Patients' Fatigue and Quality of Life. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:1130-1141. [PMID: 30132265 DOI: 10.1007/s13187-018-1419-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The identification of cancer-related fatigue as a clinical problem in pediatric oncology is an important phenomenon, and there are limited number of studies about raising the awareness of pediatric oncology patients and their parents. Fatigue-related education for patients and their parents before and during cancer treatment reduces the fatigue levels of patients. This study aims to analyze the effect of fatigue-related education for pediatric oncology patients aged 7-12 and their parents on their fatigue and quality of life. This study was conducted with 80 children with cancer and their parents who were assigned to either the control group (n = 40) or the experimental group (n = 40). The experimental group received a fatigue-related educational program. The data were collected three times: prior to the program, 3 months later, and 6 months afterwards. Multidimensional variance analysis, the Bonferroni adjusted t test and regression analysis were used to analyze the data. A significant difference was found among the experimental and the control group for total mean scores and the mean scores of subdimensions of the Scale for the Assessment of Fatigue-Child Form in terms of the interactions of group, time, and group*time (p < 0.05). Significant differences were found among the experimental and control groups' mean scores on the Scale for the Quality of Life-Child and Parents Form in terms of the interactions of group, time, and group*time (p < 0.05). Fatigue-related education is an effective education model as a way to reduce fatigue and increase the quality of life of children with cancer. The use of fatigue-related education by nurses in pediatric oncology clinics will have positive effects on children and their parents.
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Affiliation(s)
- Aslı Akdeniz Kudubes
- Department of Pediatric Nursing, Dokuz Eylul University Faculty of Nursing, Inciralti, 35340, Izmir, Turkey.
| | - Murat Bektas
- Department of Pediatric Nursing, Dokuz Eylul University Faculty of Nursing, Inciralti, 35340, Izmir, Turkey
| | - Kamer Mutafoğlu
- Department of Pediatrics, Izmir University of Economics Faculty of Medicine, Izmir, Turkey
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Van Dijk-Lokkart EM, Steur LMH, Braam KI, Veening MA, Huisman J, Takken T, Bierings M, Merks JH, Van den Heuvel-Eibrink MM, Kaspers GJL, Van Dulmen-den Broeder E, Van Litsenburg RRL. Longitudinal development of cancer-related fatigue and physical activity in childhood cancer patients. Pediatr Blood Cancer 2019; 66:e27949. [PMID: 31436372 DOI: 10.1002/pbc.27949] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/27/2019] [Accepted: 07/14/2019] [Indexed: 11/05/2022]
Abstract
PURPOSE Cancer-related fatigue is one of the most distressing side effects of childhood cancer treatment. Physical activity can decrease fatigue and has positive effects on other health outcomes. Most research on physical activity pertains to adults, and the few studies that focus on children have limited follow-up time. This study evaluates cancer-related fatigue in children and its association with physical activity over a one-year time period. METHODS Sixty-eight children with cancer (7-18 years) were recruited during or within the first year after treatment. Physical activity (Actical activity monitor) and cancer-related fatigue (Pediatric Quality-of-Life Questionnaire Multidimensional Fatigue Scale (PedsQL-MFS), self- and parent- reports) were assessed at baseline, 4 months, and 12 months. PedsQL-MFS scores were compared with Dutch norms. Longitudinal association of cancer-related fatigue with physical activity was evaluated (No. NTR 1531). RESULTS Generally, PedsQL-MFS scores were worse than norms at baseline and 4 months, and recovered by 12 months except for the parent-proxy scores in adolescents. Younger children (≤12 years) self-reported comparable or better scores than norms. Physical activity generally improved over time, but patients mostly remained sedentary. During follow-up, increased physical activity was associated with less cancer-related fatigue. CONCLUSION Cancer-related fatigue in children improves over time, and increased physical activity is associated with less cancer-related fatigue. Given the sedentary lifestyle of this population, the positive effect of physical activity on cancer-related fatigue, and the many other health benefits of an active lifestyle, it is important to stimulate physical activity in childhood cancer patients and survivors.
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Affiliation(s)
- Elisabeth M Van Dijk-Lokkart
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Lindsay M H Steur
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Katja I Braam
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Faculty of Health, University of Applied Science, Amsterdam, the Netherlands
| | - Margreet A Veening
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jaap Huisman
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Tim Takken
- Child Development and Exercise Center, Wilhelmina's Children's Hospital, UMC Utrecht, the Netherlands
| | - Marc Bierings
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Wilhelmina Children's Hospital, UMC Utrecht, the Netherlands
| | - Johannes H Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Department of Pediatric Oncology, Amsterdam, The Netherlands
| | - Marry M Van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Eline Van Dulmen-den Broeder
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Raphaële R L Van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Kenzik KM, Demark-Wahnefried W, Ganz PA, Colditz G, Rock CL, Rogers LQ. Changes in Body Mass Index and Physical Activity Predict Changes in Vitality During a Weight Loss Trial in Breast Cancer Survivors. Ann Behav Med 2019; 52:999-1009. [PMID: 29617707 PMCID: PMC7189976 DOI: 10.1093/abm/kay004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Breast cancer survivors rank fatigue (e.g., decreased vitality) as their number one concern affecting quality of life. Excess adiposity is associated with decreased vitality in breast cancer survivors, yet weight loss intervention trials report inconsistent effects on this parameter. Methods This is a secondary analysis of the Exercise and Nutrition to Enhance Recovery and Good Health for You trial, in which 692 overweight or obese breast cancer survivors ≤5 years from diagnosis, initiated weight loss interventions, and completed assessments semi-annually for 2 years. Assessments included the Godin Leisure-Time Exercise Questionnaire and the SF-36 MOS vitality subscale as an inverse measure of fatigue. Multilevel structural equation models estimated the direct effects of physical activity on vitality and indirect effects through body mass index (BMI) changes. Results Within-person findings show that at assessments with greater physical activity, BMI was significantly lower (B = -0.07, p < 0.001) and vitality was higher (B = 0.22, p < 0.001). However, there was no direct relationship between lower BMI and higher vitality (B = -0.11, p = 0.262) after controlling for the relationship of physical activity with BMI and physical activity with vitality. The between-person indirect effect of physical activity change through BMI change to vitality was significant (B = 0.03, p < 0.001). Participants whose physical activity was above the mean (B = 0.37, p < 0.001) and whose BMI was below the mean (B = -1.05, p < 0.001) were more likely to report greater vitality. Conclusion Improvements in vitality are primarily associated with increases in physical activity rather than BMI changes in this trial. Vitality was lower among survivors with higher BMI, although within-individual changes in BMI had no effect on vitality. Physical activity and weight loss share mechanistic links to vitality with physical activity potentially increasing (e.g., in an additive or synergistic manner) the effect of BMI reduction on vitality.
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Affiliation(s)
- Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, South Birmingham, AL, USA
- University of Alabama at Birmingham, UAB Comprehensive Cancer Center, Birmingham, AL, USA
- Kelly Kenzik
| | - Wendy Demark-Wahnefried
- University of Alabama at Birmingham, UAB Comprehensive Cancer Center, Birmingham, AL, USA
- Department of Nutrition Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patricia A Ganz
- Departments of Health Care Organization and Policy and Medicine, Schools of Public Health and Medicine, University of California, Los Angeles (UCLA), Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Graham Colditz
- Division of Public Health Sciences, School of Medicine, Washington University, St. Louis, MO, USA
| | - Cheryl L Rock
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, San Diego, CA, USA
| | - Laura Q Rogers
- University of Alabama at Birmingham, UAB Comprehensive Cancer Center, Birmingham, AL, USA
- Department of Nutrition Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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50
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The Evolving Design of NIH-Funded Cardio-Oncology Studies to Address Cancer Treatment-Related Cardiovascular Toxicity. JACC: CARDIOONCOLOGY 2019; 1:105-113. [PMID: 32529192 PMCID: PMC7288847 DOI: 10.1016/j.jaccao.2019.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiovascular (CV) toxicity from cancer therapy is a significant and growing concern. Conventional oncology clinical trial designs focused solely on cancer treatment efficacy have not provided sufficient information on both CV risk factors and outcomes. Similarly, traditional CV trials evaluating standard interventions typically exclude cancer patients, particularly those actively receiving cancer therapy. Neither trial type simultaneously evaluates the balance between CV toxicity and cancer outcomes; however, there is increasing collaboration among oncologists and cardiologists to design new cardio-oncology trials that address this important need. In this review, we detail 5 ongoing, oncology-based trials with integrated CV endpoints. Key design features include: 1) a careful assessment of CV risk factors and disease before, during, and after cancer therapy with standardized collection of clinical imaging, functional, and biomarker data; 2) an introduction of cardioprotective interventions at various timepoints in cancer therapy; 3) a balance of the risk of subclinical CV injury with the need for ongoing cancer treatment; and 4) an understanding of the time profile for development of clinically apparent CV toxicity. Additional critical priorities in cardio-oncology clinical research include harmonization of data collection and definitions for all physician- and patient-reported exposures and outcomes. Prospective assessment of CV risk factors before, during, and after cancer treatment. Longitudinal monitoring of CV function with standardized review of CV imaging and functional and biomarker endpoints for evidence of subclinical cardiotoxicity. Consideration for the timing of the introduction of the cardioprotective strategy. Need to balance the delivery of cancer treatment with the risk of CV injury. Long-term follow-up beyond cancer treatment intervention to determine clinical cardiotoxicity outcomes. Rigorous collection of cancer and CV endpoints to answer questions about the impact of CV events on the delivery of cancer treatment and the long-term patient outcomes.
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