Cancer-related fatigue-pharmacological interventions: systematic review and network meta-analysis

Lifestyle and integrative oncology interventions for cancer-related fatigue and sleep disturbances

Fatigue, insomnia and sleep disturbances are common after cancer diagnosis, and have a negative impact on quality of life and function. This narrative review synthesised evidence on lifestyle and integrative oncology interventions for cancer-related fatigue, insomnia and sleep disturbances in cancer survivors. There is strong evidence in support of aerobic and strength exercise for the relief of cancer-related fatigue. Yoga, massage therapy, acupuncture, Tai Chi and qigong can also be recommended for cancer-related fatigue. The evidence on yoga, acupuncture and massage therapy for sleep disturbances in cancer is mixed, while exercise appears to have a modest favourable effect. There is insufficient evidence on nutrient supplements or dietary interventions for cancer-related fatigue or insomnia and other sleep disturbances after cancer. Beyond alleviating cancer-related fatigue and insomnia-related symptoms, integrative oncology and lifestyle interventions have potential to effect multiple other benefits, such as improvement in symptoms such as pain and menopausal symptoms. There is a need for well-designed randomised controlled trials of interventions, particularly in the areas of diet and nutrient supplements, and for implementation studies of interventions already supported by evidence.

Top Ten Tips Palliative Care Clinicians Should Know About Diagnosing, Categorizing, and Addressing Fatigue

Fatigue is a multifactorial symptom that is commonly faced by patients with cancer, chronic disease, and other serious illnesses. Fatigue causes suffering across biopsychosocial domains and affects patients and their loved ones. In this article, a consortium of professionals across cancer care, physical therapy, exercise, pharmacy, psychiatry, and palliative medicine offers tips and insights on evaluating, categorizing, and addressing fatigue in the setting of serious illness. The comprehensive approach to managing fatigue underscores the importance of collaborative efforts characteristic of interdisciplinary palliative care. Prioritizing screening, diagnosing, and treating fatigue is crucial for enhancing patients' and families' overall quality of life.

Putting Methylphenidate for Cancer-Related Fatigue to Rest?

In the article that accompanies this editorial, Stone et al. present a randomized, double-blind, placebo-controlled trial of individually dose-titrated methylphenidate for treatment of fatigue in patients with advanced cancer, finding that methylphenidate, while safe and well-tolerated, was no more effective than placebo at relieving fatigue after 6 (±2) weeks. Future studies should consider the multifaceted nature of cancer-related fatigue, as well as the substantial placebo effects of psychostimulants, and may benefit from focusing on methylphenidate in combination with non-pharmacological interventions, or for fatigue with a predominant emotional or cognitive component.

Cancer-Related Fatigue in Head and Neck Cancer Survivors: Longitudinal Findings from the Head and Neck 5000 Prospective Clinical Cohort

Cancer-related fatigue (CRF) is a common side-effect of cancer and its treatments. For head and neck cancer (HNC), CRF may exacerbate the symptom burden and poor quality-of-life. Using data from the Head and Neck 5000 prospective clinical cohort, we investigated clinically important CRF over a year post-diagnosis, assessing temporal trends, CRF by HNC site and treatment received, and subgroups at higher risk of CRF. Recruitment was undertaken in 2011-2014. Socio-demographic and clinical data, and patient-reported CRF (EORTC QLQ-C30 fatigue subscale score ≥39 of a possible 100) were collected at baseline (pre-treatment) and 4- and 12- months post-baseline. Mixed-effects logistic multivariable regression was used to investigate time trends, compare cancer sites and treatment groups, and identify associations between clinical, socio-demographic and lifestyle variables and CRF. At baseline, 27.8% of 2847 patients scored in the range for clinically important CRF. This was 44.7% at 4 months and 29.6% at 12 months. In the multivariable model, after adjusting for time-point, the odds of having CRF over 12 months were significantly increased in females and current smokers; those with stage 3/4 disease, comorbidities and multimodal treatment; and those who had depression at baseline. The high prevalence of clinically important CRF indicates the need for additional interventions and supports for affected HNC patients. These findings also identified patient subgroups towards whom such interventions could be targeted.

Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship

Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.

Meta-Analysis of Pharmacological, Nutraceutical and Phytopharmaceutical Interventions for the Treatment of Cancer Related Fatigue

Purpose: In this study we aimed to estimate the effectiveness of pharmacological, nutraceutical, and phytopharmaceutical treatments on CRF. Methods: Ovid MEDLINE, Ovid Embase, Ovid Psych info, CINHAHL and Cochrane Library databases were searched up to 30 September 2021. Randomized controlled trials of pharmacological, nutraceutical and phytopharmaceutical interventions for treatment of CRF for at least one week duration and have used valid tool to assess severity of CRF as a primary or secondary outcome were considered. Results: 32 eligible studies (4896 patients) were reviewed. For the overall meta-analysis, the random effect models yielded the treatment effect (95% CI) of −0.29 (−0.48,−0.09), p < 0.001. The meta-analysis did not show significant reduction of CRF with treatment with ginseng (n = 6), guarana (n = 3), megestrol (n = 2), mistletoe (n = 3), psychostimulants (n = 14), SSRI/antidepressants (n = 2). Corticosteroids (n = 2) showed significant reduction in CRF with treatment effects of 0.94 (−1.21, −0.67), p <0.0001, respectively. Conclusions: In this study, overall meta-analysis of all studies demonstrates significant reduction of CRF using Pharmacological, Nutraceutical and Phytopharmaceutical interventions with a pooled standardized treatment effect of −0.29. Metanalysis of Corticosteroids studies showed significant reduction in CRF. Further studies are needed.

Fatigue During Cancer-Related Radiotherapy and Associations with Activities, Work Ability and Quality of Life: Paying Attention to Subgroups more Likely to Experience Fatigue

BACKGROUND

Having knowledge of which patients are more likely to experience fatigue during radiotherapy and the relationship between fatigue and health-related quality of life (HRQL) is important to improve identification and care of patients experiencing burdensome fatigue.

OBJECTIVE

To identify subgroups of patients, varying in situational, physiological, and psychological factors, who are more likely to experience fatigue an ordinary week of radiotherapy, and to compare patients experiencing and not experiencing fatigue regarding perceived HRQL and functional performance, that is, daily and physical activity and work ability.

METHODS

Cross-sectional study of 457 patients (52% women) undergoing radiotherapy (38% breast, 32% prostate cancer), using self-reported questionnaire data on fatigue, HRQL and functional performance analyzed using multivariable regression models.

RESULTS

Of the 448 patients who answered the fatigue question, 321 (72%) experienced fatigue. Patients reporting any comorbidity or depressed mood were more likely to experience fatigue, relative risk (RR) 1.56 ([95% confidence interval (CI)] 1.13-2.16) and RR 2.57 (CI 1.73-3.83), respectively. Patients with fatigue reported worse HRQL and performed less physical activity, including daily (P = .003), vigorous (P = .003) and moderate (P = .002) activity. Patients with and without fatigue reported 60% versus 40% sickness absence.

CONCLUSION

Patients with depressed mood or comorbidity were more likely to experience fatigue an ordinary week of radiotherapy than other patients were. Patients experiencing fatigue perceived worse HRQL and performed less daily and physical activity compared to patients not experiencing fatigue. Cancer care practitioners may consider paying extra attention to these subgroups of patients.

[Post-COVID syndrome-Focus fatigue]

Die Weltgesundheitsorganisation (WHO) definiert Post-COVID-19(„coronavirus disease 2019“) als Zustand, der bei Personen mit einer anamnestisch wahrscheinlichen oder bestätigten SARS-CoV-2(„severe acute respiratory syndrome coronavirus type 2“)-Infektion 3 Monate nach Beginn der COVID-19-Symptome und mindestens 2 Monate andauernd vorhanden ist und durch eine alternative Diagnose nicht erklärbar ist. Kernsymptome des Post-COVID-Syndroms umfassen Atemnot, Fatigue und kognitive Dysfunktion, welche das alltägliche Funktionsniveau beeinflussen. Neuropsychiatrische Spätfolgen sind bei COVID-19-Patienten mit Inzidenzraten von über 30 % häufig. Neben den genannten Kernsymptomen zeigen Schlafstörungen, Depression und Angsterkrankungen erhöhte Inzidenzen. Nach gegenwärtiger Meinung werden assoziierte neuropsychiatrische Symptome sowohl unter dem Begriff Post-COVID-Syndrom subsumiert, aber auch als Komorbiditäten interpretiert, welche die Manifestation eines Post-COVID-Syndroms begünstigen können. So zeigt das Kernsymptom Fatigue Symptomüberlappung und Komorbidität mit psychischen Erkrankungen. Bildgebungsstudien deuten auf ein organisches Korrelat der Fatigue bei Post-COVID-Patienten hin, darüber hinaus wurden psychosoziale Aspekte und psychiatrische Komorbiditäten wie Depression und Angsterkrankungen als modulierende und damit potenziell behandelbare Faktoren identifiziert. Die Therapie der Fatigue umfasst neben dem pharmakologischen Management mit u. a. Stimulanzien und Antidepressiva auch nichtpharmakologische Strategien, hier vor allem die kognitive Verhaltenstherapie sowie körper- und bewegungsfokussierte Interventionen. Die Evidenz hierfür erwächst aus Metaanalysen bei tumorassoziierter oder postviraler Fatigue.